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Last year the ESC released a position paper on the use of industrial trans fatty acids (TFAs) in foods. The paper, which described the detrimental effects of TFAs on heart health and mortality as ‘now beyond dispute’, was issued in advance of a report from the European Commission, which was then expected in December 2014. That report has been delayed and delayed, and is not now expected until later this year. The ESC’s unequivocal position is that only regulatory intervention will minimise the content of TFAs in food.
This is also the position of Steen Stender of Copenhagen University Hospital, who will speak at a Symposium on nutrition and coronary health later this morning. His argument is that, while the consumption of trans fats has declined in recent years because of the food industry’s ‘voluntary reduction’ in the face of social pressure, there are still some countries where levels of TFAs are unacceptably high in processed foods, and that only legislation will force their reduction.
The overall tide of opinion against trans fats increased its momentum in July this year when the FDA determined ‘to remove artificial trans fat from the food supply’ of the USA. The FDA has thus given the food industry three years to phase out all TFAs from processed foods and thereby reduce the risks of CHD. The agency declared that the elimination of partially hydrogenated oils (PHOs), the main source of athersclerotic artificial trans fat, could prevent 20,000 heart attacks and 7000 deaths from heart disease each year. This FDA move followed a conclusion that PHOs could no longer be classified as ‘generally recognised as safe’ based on available scientific evidence.
In Europe only a few countries - Denmark, Switzerland, Austria, Iceland, Norway and Hungary - have enacted legislation to restrict TFA content in foods. Stender himself chaired the TFA working group of the Danish nutrition council responsible for assembling the data and introducing the legislation in 2003 - and in parallel with the TFA reductions, Denmark has seen its CHD mortality rates decline more than any other EU country. ‘Legislation has virtually eliminated the intake of industrially produced trans fatty acids in Denmark within a few years,’ says Stender, ‘without any side effects for the population’ - or difference in taste or cost!
Yet not all countries share the restrictive policies of Denmark, and nearly all European countries rely on producers to voluntarily reduce the TFA content in food. Stender himself has trod the streets of European capitals to assess just how effective these ‘voluntary’ efforts have been and in 2014, after visiting three supermarkets in the capitals of 20 countries, reported that ‘subgroups’ of population in many of these countries still consume industrial trans fats in amounts that increase their risk of CHD. Almost 600 samples of biscuits and cakes with PHOs on their list of ingredients were analysed: 312 products had more than 2% of fat content listed as industrial TFA, exceeding the legislatively determined limit in Austria and Denmark. Nine predominantly Eastern European countries had products with very high TFA content. Studies conclusively indicate that consumption of around 5 grams TFA per day is associated with a 25% increase in the risk of CHD.
The USA is also responsible for another game-changing initiative in its recent abandon of national guidelines setting an upper limit on total fat intake, a reversal of a 40-year policy which UK GP and author Simon Poole describes as a ‘pivotal point’ in the progress of public health nutrition. Poole, who will also speak at this morning’s Symposium, notes a shift of dietary emphasis from what you shouldn’t be doing to what you should be doing, which in his case is reflected in the loose definition of a Mediterranean diet. ‘The evidence in favour is strong,’ says Poole, who in the latest US initiative recognises the potential for greater consumption of monounsaturated and omega-3 polyunsaturated fats consistent with a Mediterranean diet of fresh fruit, vegetables, fish, beans, nuts and olive oil. Such a diet, says Poole, would have a beneficial effect on cardiovascular risk comparable to that of statins, as reflected in the 2013 PREDIMED study in more than 7000 Spanish subjects; a Mediterranean diet supplemented with olive oil or nuts reduced the incidence of major cardiovascular events by around 30%.
What should you eat to live a heart healthy life? 31 Aug 11:00-12:30 Bratislava Village 2
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