Tians-fatty acius anu

Caiuiovasculai uisease

Joanna Helm

%7,38-fatty acids and cardiovascuIar disease

n the early 20
th
century the development of hydrogenation changed the food
processing and manufacturing industries, and ultimately the health of the world. n
1901 German chemist Wilhelm Normann experimented with hydrogenation catalysts
and successfully hydrogenated liquid fat, producing semisolid fat, which is now known
as 97,38fat. The use of 97,38fats experienced exponential growth during the late 1970's
and throughout the 1980's. As information and studies were published surrounding the
need to decrease saturated fat and cholesterol, 97,38fats became the easily substituted
alternative by the 1990's.
t was not until 1993 that the findings from the historical Nurses' Health Study in
Boston, MA brought 97,38fat to the limelight. The findings in this study supported the
relationship between 97,38fats and coronary heart disease (1). This study showed that
coronary heart disease risk was the highest for those who consumed 1.5 times more
97,38fats than their counterparts who consumed nearly no 97,38fats.
Cardiovascular disease remains the leading cause of death in the United States
as other risk factors such as obesity, diabetes, and hypertension have continued to
increase. Diet is clearly an important point in creating a healthy population. Denmark
has monitored the amount of 97,38fatty acids contained the food supply for the past 30
years (2). The Danes have continued to regulate and effectively remove nearly all
synthetic 97,38fatty acids from their foods. For example, in the 1970's it was recorded
that, on average, margarine contained 10g of 97,38fats for every 100g of margarine. n
contrast, by 2005 all 97,38fats were removed. The ban on 97,38fatty acids applies to
only the synthetic sources. t does not apply to oils and fats of animal origin. Figure 1
shows the dramatic difference in 97,38fats between the same foods among different
countries. Note the drastic difference between the United States content at the top
versus Denmark in 2005 at the very bottom of the graph. The epidemiological
consequence has been a 60% decline in cardiovascular disease (2). This drastic
decline is not exclusive to the passage of legislation banning 97,38fats. Advances in
medicine, consumer awareness, and treatment options have also increased over the
past 30 years.
n June of 2006, the Food and Drug Administration (FDA) enacted the mandatory
labeling of 97,38fats on all nutrition labels (3). New York, California, and Canada all
have some type of legislation limiting or banning the use of 97,38fats. t is too soon to
determine if these actions have been effective.
Fatty acids are long, unbranched chains of carboxylic acids ranging in
length from 1220 carbons. Fatty acids are derived from the hydrolysis of animal fats,
vegetable oils and the phospholipids of biological membranes (3). Animal fats are rich
in saturated fatty acids and plants tend to consist of unsaturated fatty acids.
Hydrogenation is the process of using nickel as a catalyst and hydrogen to reduce the
double bonds (4). By reducing the double bonds, the chain of acids can be more tightly
packed, thus creating a solidified product. The hardened product that is now partially
hydrogenated is desired by food manufacturers and consumers for use in processed
foods as it makes the fat more stable and less likely to spoil. The hydrogenation
process gives vegetable oils a longer shelf life and higher frying temperatures, which
are highly desirable in the cooking and manufacturing industries (5).
The oils usually used for frying in the typical fastfood restaurant are partially
hydrogenated plant oils and contain 97,38fatty acids that are transferred to the foods
that are cooked in them (4). Other sources of synthetically produced trans fats include:
stick margarine, commercial bakery products, crmefilled cookies, potato and corn
chips, commercial pizza, candies, snack foods, microwave popcorn, fried foods,
processed foods, frozen breakfast foods and cake mixes (2,5). %7,38fats are also
contained in anything listing partially hydrogenated vegetable oils, hydrogenated
vegetable oils or shortening in the ingredient list.
Fats are added in processed foods to add texture, taste and consistency. Some
97,38fats are found in small amounts in meats and dairy products. Currently, most
transfatty acids are produced artificially by hydrogenating monounsaturated or
polyunsaturated fats (5). There are several types of 97,38fats produced during partial
hydrogenation of vegetable oils. One is the97,38isomer of oleic acid, trans18:1 and
the other is a 97,38isomer of linoleic acid, trans18:2. The bacteria found in cattle
produce 97,38isomers of palmitoleic acid, 97,3816:1 (6). The 97,38fats in animals have
a different structure than the synthetically produced fats. There were several studies
done to assess if there is any difference between the two types of fats. The first study
showed that both natural and synthetic 97,38fats had similar effects on HDL and LDL
counts (7). The TRANSFACT study showed both levels of cholesterol increased from
synthetic 97,38fat in women and there was no significant difference in natural 97,38fats.
There were no changes seen in the males (8). The most significant difference between
these fats is the amount consumed, not the source.
The average daily intake of 97,38fatty acids is between 8g10g in the American
diet (9). This equates to between 24 percent of daily energy intake. As an example,
one small serving of French fries weighs 4.7g. t contains 28% fatty acids and is 2.1%
of daily energy intake for a 2000 kcal diet. The current recommendation is to keep
consumption below 1 percent of total energy intake, or as low as possible (3).
n the followup study done on the historic Nurses Association study, there was
strong evidence showing that a high intake of 97,38fat increases the risk of coronary
heart disease and it also shows support for consuming polyunsaturated fat as a
potential to help prevent coronary heart disease (CHD) (1). This study suggested by
replacing just 2% of food energy from 97,38fats to natural vegetable oils could prevent
between 30,000 and 100,000 premature coronary deaths per year (1).
The physiological effect of 97,38fats has been identified in four major systems in
the body. The 97,38fatty acids have been shown to affect: hepatocytes, endothelial
cells, adipocytes, and monocytes/macrophages (10). n regards to hepatocytes, the
97,38fat interrupts the transfer of cholesteryl esters that convert verylow density
lipoproteins (VLDL) to highdensity lipoproteins (HDL). n endothelial cells, the 97,38
fats impair nitric oxidedependent dilation of arteries, potentially causing atherosclerosis.
%7,38fats may also directly bind to nuclear receptors in adipose tissue that regulate
gene transcription. They also cause a stress response in the endoplasmic reticulum.
The combination of these effects causes an increase in free fatty acid levels and
inflammation and a decrease in triglyceride uptake and cholesterol esterification. n
macrophages, the 97,38fatty acids cause an increase in production of inflammatory
responses produce by TNFalpha and interleukin6 (10).
n order to more completely understand the full impact that 97,38fats have on the
cardiovascular system, Stampfer et al. developed a study that compared saturated fat to
97,38fatty acid calorie consumption. t was determined that when consumed in equal
amounts, the trans fatty acids raised the lowdensity lipoprotein (LDL) cholesterol levels,
lowered the HDL cholesterol levels, and increased the ratio of total cholesterol to HDL
cholesterol (11). %7,38fats have also been shown to increase the blood levels of
triglycerides, increase the level of Lp(a) lipoprotein and create smaller LDL particles (12)
(13). Lipoprotein(a), also known as Lp(a), consists of LDL cholesterol bound to the
protein apolipoprotein(a) (14).
A second physiological effect is systemic inflammation. nflammation has been
determined to be in independent risk factor for atherosclerosis, diabetes, and heart
failure (10). The inflammatory effects of a diet high in 97,38fats may exacerbate the
inflammation already present in the body. Creactive protein is one type of inflammatory
marker in the body. When studied in response to dietary intake of 97,38fat, it was
shown that an intake of just 2.1% of total dietary intake would increase risk of
cardiovascular disease by 30% (15). %7,38fats have also been linked to increasing
levels of tumor necrosis factor and interleukin6, which are produced in adipocytes.
%7,38fats affect lipid metabolism by altering secretion, composition, and the size
of apolipoprotein B100 (16). By consuming 97,38fats, the activity of the enzyme
responsible for the transfer of cholesterol esters from HDL to LDL and then to VLDL is
increased. This is potentially an explanation for the decreased levels of HDL and
increased levels of LDL and VLDL that have been seen in previously noted studies. A
low level of consumption of 97,38fats, just 13 percent of daily caloric intake, has been
shown to increase the risk of CHD more than any other macronutrient (12).
Consuming significant amounts of 97,38fatty acids can lead to serious health
concerns related to serum cholesterol levels. Overall, low serum cholesterol and a
decreased ratio of low density lipoprotein (LDL) to high density lipoprotein (HDL) are
associated with good cardiovascular health (1). Consuming a diet high in 97,38fatty
acids substantially increases the risk of cardiovascular disease by elevating the ratio of
LDL to HDL cholesterol, thus increasing the risk of developing atherosclerosis.
Numerous studies have been conducted on the impact of fatty acids, and 97,38
fatty acids on serum cholesterol levels. n one study done by Mensink, Katan et al. in
1990 addressed the differences between consuming saturated fat versus 97,38fat. t
was concluded that the subjects tested on 97,38fat diets had a higher level of LDL
cholesterol, and lower level of HDL and the ratio of LDL to HDL cholesterol was higher
on the transfatty acid diet than on the saturated fat diet (9). This combined effect
makes transfats twice has unhealthy as saturated fats. The previous thinking to this
point was that saturated fats were equally as detrimental to health as97,38fats. %7,38
fatty acids have also been linked to an increase in plasma triglyceride levels and are
associated with systemic inflammation, endothelial dysfunction and increased risk of
Type Diabetes (5).
Based upon the evidence surrounding the adverse effects on 97,38fatty
acids on serum cholesterol levels, inflammation responses, diabetes, cardiac arrest,
and other risk factors, the harm outweighs the good surrounding transfatty acid
consumption. The most powerful piece of evidence found was in the study completed
by Mozaffarian and colleagues. This study shows just a 2 percent increase in 97,38
fatty acids leads to a 23 percent increase in cardiovascular risk factors. This fact leaves
no doubt in my mind about the detrimental effects 97,38fats have on health. There
have been no studies that have shown that synthetic 97,38fats are necessary in the
diet, or that they provide any health benefits.
feel as though the FDA labeling regulations are a good first step to increasing
awareness about 97,38fats. do not agree with the ability to label a product with equal
to or less than 0.5g of 97,38fat as 0g of 97,38fat. This is misleading to someone who
thinks they are consuming a 97,38fat free diet when in reality they could be exceeding
the 1% total energy consumption recommendation.
The Denmark study has substantial research surrounding the elimination
of 97,38fats and the decrease in cardiovascular disease but little information was
presented regarding the changes made to the health system, educational resources
available to the public, and the financial impact the change in manufacturing has had on
the economy. n regards to the current bans in the United States, personally recognize
the data the shows that 97,38fats are a contributor to cardiovascular disease and need
to be managed in a way to reduce the potential harm they can cause. also recognize
that Americans tend to not want to be told what they can and cannot do, have or
consume. feel some people may question where we stop with banning those things
that are bad for us and allow people to make their own decisions. The correlation
between banning soft drinks and 97,38fat could be made. f you can ban 97,38fat
because it is bad for you, then why stop there? We should ban all soft drinks due to
their negative health consequences. The list could go on and on. My response to this
would be to "vote with your dollars. We hold more power in the items we chose to buy
versus any other means of change. By setting the example and not purchasing the
products containing 97,38fat we can make a difference. We can also offer incentives to
manufacturers to eliminate 97,38fats, and offer other socioeconomic alternatives to
those who tend to consume a high 97,38fat diet due to their socioeconomic situation. t
is a tough line "to draw in the sand as to what should be regulated and what is allowed
to be in our food chain. At the end of the day, feel as though Denmark has been very
progressive and proactive in their proceedings surrounding 97,38fats.
believe that in the end, those of us in the health and medical fields hold the key
to education, creating healthy habits in our clients and patients, and changing impact
97,38fats has in our lives. We can have an effect by spending some extra time
counseling, participating in the legislative actions presented by our Congress, and
setting the example in the young of our world.



















Figure 1. Comparison of 97,38fatty acids between nations


Fig. 1. Grams of industrially produced trans fatty acids in a `high trans fat menu. A large serving of fast
food consists of 160 g of nuggets and 171 g of French fries. In each country, the products with the highest
amount of trans fatty acids per 100 g product in each category are shown. Values in brackets are percent
trans fatty acids of total fat in French fries, biscuits/cakes/wafers and microwave oven popcorn, respectively.
The foods were bought between 2005 and 2008.













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