Advertisement

Trans Fatty Acids: Are Its Cardiovascular Risks Fully Appreciated?

  • Paul Nestel
    Correspondence
    Address correspondence to: Paul Nestel, Baker Heart and Diabetes Institute, PO Box 6492, St. Kilda Road Central, Melbourne 8008, Australia
    Affiliations
    Baker Heart IDI, and Diabetes Institute, Melbourne, Australia
    Search for articles by this author

      Abstract

      Objective

      The goal of this article was to review the causal link between trans fatty acids (TFA) produced from partially hydrogenated vegetable oil (PHVO) and cardiovascular disease (CVD) risk and its likely mechanisms. The potential risk of TFA from ruminant dairy and meats, which are currently the major sources of dietary TFA, is also discussed.

      Methods

      Evidence was derived from observational studies of large cohorts followed up prospectively; from randomized controlled trials of clinical interventions; and from specific case-control studies that investigated biomarkers in tissues. Searches included PubMed and Medline from 1990 to 2013.

      Results

      Despite TFA from PHVO being associated more strongly with CVD risk than even saturated fats, it may prove difficult to totally eliminate PHVO from all foods. This raises the issue of the lower limit of TFA consumption below which CVD risk is not increased. Limits of <1% of total energy have been suggested. The major mechanism underlying the increased CVD risk from TFA is an increase in LDL-C and Lp(a) lipoproteins and a decrease in HDL-C; increased inflammation and adverse effects on vascular function have also been shown. Both PHVO and ruminant TFA comprise a range of isomers, some specific to each source but including a substantial commonality that supports findings of similar adverse effects at equivalent intakes of TFA. However, the amount of TFA in ruminant fat is relatively small; this limits the CVD risk from eating ruminant products, an inference supported by analysis of prospective cohort studies.

      Conclusions

      Two key challenges to the health industry arise from this evidence. They must first determine whether a small intake of TFA from PHVO is safe and what constitutes a safe amount. They must also determine whether TFA from ruminant fat in currently consumed amounts represent limited cardiovascular risk that is balanced by the nutritional benefits of dairy products.

      Key words

      To read this article in full you will need to make a payment
      Subscribe to Clinical Therapeutics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Mensink R.P.
        • Nestel P.J.
        Trans fatty acids and cardiovascular risk markers: does the source matter?.
        Curr Opin Lipidol. 2009; 20: 1
        • Aro A.
        • Antoine J.M.
        Pizzoferrato, et al. Trans fatty acids in dairy and meat products from 14 European countries.
        J Food Composition Analysis. 1998; 11: 150-160
        • Bhattacharya A.
        • Banu J.
        • Rahman M.
        • et al.
        Biological effects of conjugated linoleic acids in health and disease.
        J Nutr Biochem. 2009; 17: 789-810
        • Oh K.
        • Manson J.E.
        • Stampfer M.J.
        • Willett W.C.
        Dietary fat intake and risk of coronary heart disease in women: 20 years of follow-up of the Nurses’ Health Study.
        Am J Epidemiol. 2005; 161: 672-679
        • Ascherio A.
        • Rimm E.B.
        • Giovannucci E.L.
        • et al.
        Dietary fat and risk of coronary heart disease in men: cohort follow-up study in the United States.
        BMJ. 2006; 313: 84-90
        • Mozaffarian D.
        • Aro A.
        • Willett W.C.
        Health effects of trans fatty acids: experimental and observational studies.
        Eur J Clin Nutr. 2009; 63: S5-S21
        • Sun Q.
        • Ma J.
        • Campos H.
        • et al.
        A prospective study of trans fatty acids in erythrocytes and risk of coronary heart disease.
        Circulation. 2007; 115: 1858-1865
        • Oomen C.M.
        • Ocke M.C.
        • Feskens E.J.
        • et al.
        Association between trans fatty acid intake and 10-year risk of coronary heart disease in the Zutphen Elderly Study: a prospective population-based study.
        Lancet. 2001; 357: 745-751
        • Mozaffarian D.
        • Clarke R.
        Quantitative effects on coronary heart disease risk factors and coronary heart disease of replacing partially hydrogenated vegetable oils with other fats and oils.
        Eur J Clin Nutr. 2009; 63: S22-S33
        • Clifton P.M.
        • Keogh J.B.
        • Noakes M.
        Trans fatty acids in adipose tissue and the food supply are associated with myocardial infarction.
        J Nutr. 2004; 134: 874-879
        • Aro A.
        • Kardinaal A.F.
        • Salminen I.
        • et al.
        Adipose tissue isomeric trans fatty acids and risk of myocardial infarction in 9 countries: the EURAMIC study.
        Lancet. 1995; 345: 273-278
        • Lemaitre R.N.
        • King J.B.
        • Raghunathan T.E.
        • et al.
        Cell membrane trans fatty acids and the risk of primary cardiac arrest.
        Circulation. 2002; 105: 697-701
        • Katan M.B.
        • Zock P.L.
        • Mensink R.P.
        Trans fatty acids and their effects on lipoproteins in humans.
        Annu Rev Nutr. 1995; 15: 473-493
        • Nestel P.
        • Noakes M.
        • Belling B.
        Plasma lipid and Lp(a) changes with substitution of elaidic acid for oleic acid.
        J Lipid Res. 1992; 33: 1029-1036
        • Mensink R.P.
        • Zock P.L.
        • Katan M.B.
        • Hornstra G.
        Effects of dietary cos and trans fatty acids on serum lipoprotein(a) levels in humans.
        J Lipid Res. 1992; 33: 1493-1501
        • Kamstrup P.R.
        • Tybjaerg-Hansen A.
        • Nordestgaard BG
        Extreme lipoprotein (a) levels and risk of myocardial infarction in the general population: the Copenhagen Heart Study.
        Circulation. 2008; 117: 164-176
        • De Roos N.M.
        • Schouten E.G.
        • Katan M.B.
        Trans fatty acids, HDL cholesterol and cardiovascular disease. Effects of dietary change on vascular reactivity.
        Eur J Med Res. 2003; 8: 355-357
        • Bendsen N.T.
        • Stender S.
        • Szechi P.B.
        • et al.
        Effect of industrially produced trans fatty acids on markers of systemic inflammation. Evidence from a randomized trial in women.
        J Lipid Res. 2011; 52: 1821-1828
        • Lopez-Garcia E.
        • Schultze M.B.
        • Meigs J.B.
        • et al.
        Consumption of trans fatty acids is related to plasma biomarkers of inflammation and endothelial dysfunction.
        J Nutr. 2005; 135: 562-566
        • Aronis K.N.
        • Khan S.M.
        • Mantzoros C.S.
        Effect of trans fatty acids on glucose homeostasis: a meta-analysis of randomized, placebo-controlled clinical trials.
        Am J Clin Nutr. 2012; 96: 1093-1099
        • Allison D.B.
        • Egan S.K.
        • Barraj I.M.
        • et al.
        Estimated intakes of trans fatty acids in the US population.
        J Am Diet Assoc. 1999; 99: 166-174
        • Mansour M.B.
        • Sinclair A.J.
        The trans fatty acid and positional (sn-2) fatty acid composition of some Australian margarines, dairy blends and animal fats.
        Asia Pacific J Clin Nutr. 1993; 3: 155-163
        • Lock A.L.
        • Bauman D.E.
        Modifying milk fat composition of dairy cows to enhance fatty acid benefits for human health.
        Lipids. 2004; 39: 1197-1206
        • Vermont S.H.
        • Beaufrere B.
        • Riemersma R.A.
        • et al.
        Dietary trans alpha-linolenic acid from deodorised rapeseed oil and plasma lipids and lipoproteins in healthy men.
        Br J Nutr. 2001; 85: 387-392
        • Almendingen K.
        • Jordal O.
        • Kierulf P.
        • et al.
        Effects of partially hydrogenated fish oil, partially hydrogenated soybean oil, and butter on serum lipoproteins and Lp(a) in men.
        J Lipid Res. 1995; 36: 1370-1484
        • Lichtenstein A.H.
        • Appel L.J.
        • Brands M.
        • et al.
        Diet and lifestyle recommendations revision 2006: A scientific statement from the American Heart Association nutrition committee.
        Circulation. 2006; 114: 82-96
        • Baylin A.
        • Kabagambe E.K.
        • Ascherio A.
        • et al.
        Adipose trans alpha-linolenic acid and nonfatal acute myocardial infarction in Costa Rica.
        Circulation. 2003; 107: 1586-1591
        • Piettinen P.
        • Ascherio A.
        • Korhonen P.
        • et al.
        Intakes of fatty acids and risk of coronary heart disease in a cohort of Finnish men. The Alpha-Tocopherol, Beta-Carotene, Cancer Prevention Study.
        Am J Epidemiol. 1997; 145: 876-887
        • Bendsen N.T.
        • Christensen R.
        • Bartels E.M.
        • Astrup A.
        Consumption of industrial and ruminant trans fatty acids and risk of coronary heart disease: a systematic review and meta-analysis of cohort studies.
        Eur J Clin Nutr. 2011; 65: 773-783
        • Mozaffarian D.
        • Cao H.
        • King B.
        • et al.
        Trans-palmitoleic acid, metabolic risk factors, and new-onset diabetes in US adults.
        Ann Intern Med. 2010; 153: 790-799
        • Chardigny J.M.
        • Destaillats F.
        • Malpuech-Brugere C.
        • et al.
        Do industrially produced and natural trans fatty acid sources have the same impact on cardiovascular disease risk factors in healthy subjects? Results of the TRANSFACT Study.
        Am J Clin Nutr. 2008; 87: 558-566
        • Motard-Belanger A.
        • Charnest A.
        • Grenier G.
        • et al.
        Study of the effects of trans fatty acid from ruminants on blood lipids and other risk factors for cardiovascular disease.
        Am J Clin Nutr Clin. 2008; 87: 593-599
        • Astrup A.
        • Dyerberg J.
        • Elwood P.
        • et al.
        The role of reducing intakes of saturated fat in the prevention of cardiovascular disease: where does the evidence stand in 2010.
        Am J Clin Nutr. 2011; 93: 684-688
        • Brouwer I.A.
        • Wanders A.J.
        • Katan M.B.
        Effect of animal and industrial trans fatty acids on HDL and LDL cholesterol levels in humans—a quantitative review.
        PLoS One. 2010; 5: e9434
        • Mozaffarian D.
        • Pischon T.
        • Hankinson S.E.
        • et al.
        Dietary intake of trans fatty acids and systemic inflammation in women.
        Am J Clin Nutr. 2004; 79: 606-612