1. Trans fats in food Why they should be eliminated Alan Maryon-Davis FRCP FFPH

2. What exactly are trans fats? Short for trans fatty acids (TFAs) – ‘trans’ refers to their molecular structure Non-essential. No known benefits to human health Small amounts occur naturally in milk and milk products Vast majority are man-made by partially hydrogenating plant oils – industrially produced TFAs Commercial advantages: increased bulk, improved texture; longer shelf-life, semi-solid consistency, rancid-resistant, cheaper

3. Industrially produced trans fats  Clear vegetable oils Solid or semi-solid fats by hydrogenation

4. Trans fats made in cooking  Clear cooking oil Low TFAs Cloudy cooking oil High TFAs Repeated re-heating

5. Trans fats are mainly consumed in fried fast-food, biscuits, pastries, cakes, pies and cooking fats

6. Impact of trans fats on the body Push up the level of LDL (‘bad’) cholesterol Decrease the level of HDL (’good’) cholesterol Increase the level of triglycerides Increase vascular endothelial dysfunction May increase insulin resistance

7. Risks to health of higher trans fat intakes Clear evidence of an increased risk of coronary heart disease (CHD) – angina, heart attack, etc Some evidence suggesting an increased risk of type 2 diabetes Possible increased risk of prostate cancer Possible increased risk of breast cancer

8. Impact on population health Meta-analysis of five large-scale prospective population studies* found a 24% increase in CHD risk associated with higher TFA intakes Gram for gram, TFAs carry five times the risk associated with saturated fats * Mozaffarian D, Katan MB, Ascherio A, Stampfer MJ, Willett WC. Trans 2 fatty acids and cardiovascular disease. N Engl J Med 2006;354: 1601-13.

9. Impact on population health Every gram increase in the average intake increases CHD deaths by 5% According to a recent review by NICE* the current UK consumption of TFAs causes 5000-15000 deaths every year. These deaths are totally avoidable * NICE 2009

10. COMA 1994 Recommended that TFAs should contribute no more than 2% of food energy (ie. calorie) intake across the whole population * *Expressed as the maximum recommended contribution these nutrients should make to the population average diet.

11. Policy history 1994 – COMA (later SACN) recommends population maximum for TFAs of 2% of food energy intake 2003 – WHO recommends a population intake of less than 1% of total energy 2007 – FSA endorses the COMA/SACN population maximum and recommends no change 2009 – a WHO review emphasised the need ‘to significantly reduce or virtually eliminate industrially produced TFAs from the food supply’

12. SACN review of trans fats 2007 recommendations Improved monitoring of specific groups, particularly young adults, at risk of low nutritional status is required. These population groups …and people (especially adults with children) in lower socio-economic groups could benefit from focused health initiatives.

13. Progress SACN recommendation (adults) < 2% of food energy 1986/872.2% 2000/011.2% 20100.8%

14. Limitations of the NDNS Small sample (<1000 households in the first year) 43% non-response or inadequate response A common reason for non-response was ‘language difficulties’ Around 20% of food intake is not reported

15. FSA review 2007 Reviewed the latest evidence Only considered population average intakes Concerned that further reductions in TFAs would lead to compensatory increases in sat fats Sat fat reduction programme considered to be a higher priority Recommended no change in COMA/SACN population-wide limit of 2% Recommended continuing the existing voluntary approach rather than mandatory regulation

16. TFA consumption and health inequalities There is concern that children and young people, and those on low incomes, are consuming worryingly high levels of TFAs in deep-fried takeaway foods A recent study in Tower Hamlets suggests that some individuals are consuming 6-12% of food energy as TFAs The high intakes among young people and deprived populations was a key consideration in the Denmark legislation

17. CHD mortality in Scotland, 35-64

18. TFAs in fast foods One in six meals is eaten outside the home The number of takeaway outlet is rising by about 8% a year Main customers are children and young people, and those on lower incomes Cooking practices vary greatly Very high TFA levels can result from re-heating cooking oil, even when initial levels are low Deep-fat fryer in small takeaways of particular concern Relatively little UK data on this (ad hoc studies, eg. Tower Hamlets trading standards study)

19. Scope for action in UK Reduce recommended maximum TFA intake (DRV) to <0.5% of food energy across the population (Denmark has achieved this) Shift from voluntary to mandatory regulation Ban IPTFAs in all manufactured foods Mandatory TFA labelling for specific groups of foods Improved guidance and tougher regulation for providers of foods eaten outside the home Improved monitoring of TFA intake in specific subgroups, eg. children, low income groups, ethnic minorities Regular mini-surveys of TFA content of fast-foods