Trans fats and CHD
Trans fat ban in Denmark prevented one in nine deaths from coronary heart disease
Oleg Lischuk, N+1
Danish and British researchers concluded that after the ban on industrially produced trans fats in food, introduced in In Denmark in 2003, the number of deaths from coronary heart disease (CHD) in the country decreased by about 11 percent. The results of the work are published in the journal PLOS ONE (Bjoernsbo et al., Quantifying benefits of the Danish transfat ban for coronary heart disease mortality 1991-2007: Socio-Economic analysis using the IMPACTsec model).
Trans isomers of unsaturated fatty acids are present in small amounts in meat and milk (vegetable fats contain cis isomers). The bulk of trans fats in food are by-products of hydrogenation of fatty acids (in the production of margarine and partially hydrogenated oils), deodorization of vegetable oils and the use of commercial fryers. In the body, they increase the level of low—density lipoprotein cholesterol and decrease it - high, increase the content of triglycerides in the blood, provoke a systemic inflammatory response and disrupt the function of the vascular endothelium, which dramatically increases the risk of cardiovascular diseases, primarily various forms of coronary heart disease (including myocardial infarction and sudden cardiac death). It is estimated that each additional percentage of daily calories gained from trans fats increases mortality from these diseases by about 12 percent.
Because of this, many countries have introduced legislative restrictions or complete bans on industrial trans fats in products (Denmark was the first in this). In 2018, the World Health Organization presented a six-step plan for their exclusion from global food supplies and included this issue in the overall work program for 2019-2023.
To quantify the effects of the ban on trans fats, the staff of several Danish clinical centers, the Danish University of Technology and the University of Liverpool, led by Kirsten Schroll Bjoernsbo, used the general population data of the Danish Central Office of Civil Registration from 1991 to 2007. The population was divided into 60 layers based on gender, six age groups (25-34, 35-44, 45-54, 55-64, 65-74 and 75-84 years) and five socio-economic quintiles (according to the state statistical service on income and taxation).
To assess the dynamics of trans fat consumption during the study period, data from 663 participants in the population study Dan-MONICA III in 1991 and 2792 - DANSDA in 2005-2008 were included in the work. All of them reported in detail on the food consumed and kept seven-day food diaries.
The information prepared in this way was processed by an extended version created in The UK and the IMPACTsec model validated in several countries. This deterministic cellular model allows us to determine with high sensitivity how individual effects on risk factors and therapeutic interventions affect the dynamics of mortality from coronary heart disease in different socio-economic groups.
The average contribution of trans fats to the total energy consumption of Danes in 2007 compared to 1991 decreased approximately tenfold — from 1.1 to 0.1 percent for men and from 1.0 to 0.1 percent for women. According to the model, this is directly related to a decrease in the number of deaths from coronary heart disease by 1,191 cases (95% confidence interval 989-1409).
In total, in 2007, 11110 fewer deaths from coronary heart disease occurred in the country than expected at the level of 1991. Thus, the legislative ban on trans fats has reduced the number of deaths from this disease by about 11 percent.
The greatest effect was observed in the least affluent segments of the population (27 percent of the total number of deaths prevented in the lower quintile compared with 12 percent in the upper quintile). Such a difference is quite logical, since trans fats are contained in large quantities in inexpensive factory—made products with a long shelf life (especially pastries and snacks) - hydrogenated oils go rancid more slowly.
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