Trends in the trans-fatty acid composition of the diet in a metropolitan area: the Minnesota Heart Survey

Validating Healthy Eating Index, Glycemic Index, and Glycemic Load with Modern Diets for E-Health Era

Predictors of healthy eating parameters, including the Healthy Eating Index (HEI), Glycemic Index (GI), and Glycemic Load (GL), were examined using various modern diets (n = 131) in preparation for personalized nutrition in the e-health era. Using Nutrition Data Systems for Research computerized software and artificial intelligence machine-learning-based predictive validation analyses, we included domains of HEI, caloric source, and various diets as the potentially modifiable factors. HEI predictors included whole fruits and whole grains, and empty calories. Carbohydrates were the common predictor for both GI and GL, with total fruits and Mexican diets being additional predictors for GI. The median amount of carbohydrates to reach an acceptable GL < 20 was predicted as 33.95 g per meal (median: 3.59 meals daily) with a regression coefficient of 37.33 across all daily diets. Diets with greater carbohydrates and more meals needed to reach acceptable GL < 20 included smoothies, convenient diets, and liquids. Mexican diets were the common predictor for GI and carbohydrates per meal to reach acceptable GL < 20; with smoothies (12.04), high-school (5.75), fast-food (4.48), Korean (4.30), Chinese (3.93), and liquid diets (3.71) presenting a higher median number of meals. These findings could be used to manage diets for various populations in the precision-based e-health era.

Personalized Nutrition-Genes, Diet, and Related Interactive Parameters as Predictors of Cancer in Multiethnic Colorectal Cancer Families

To personalize nutrition, the purpose of this study was to examine five key genes in the folate metabolism pathway, and dietary parameters and related interactive parameters as predictors of colorectal cancer (CRC) by measuring the healthy eating index (HEI) in multiethnic families. The five genes included methylenetetrahydrofolate reductase (MTHFR) 677 and 1298, methionine synthase (MTR) 2756, methionine synthase reductase (MTRR 66), and dihydrofolate reductase (DHFR) 19bp, and they were used to compute a total gene mutation score. We included 53 families, 53 CRC patients and 53 paired family friend members of diverse population groups in Southern California. We measured multidimensional data using the ensemble bootstrap forest method to identify variables of importance within domains of genetic, demographic, and dietary parameters to achieve dimension reduction. We then constructed predictive generalized regression (GR) modeling with a supervised machine learning validation procedure with the target variable (cancer status) being specified to validate the results to allow enhanced prediction and reproducibility. The results showed that the CRC group had increased total gene mutation scores compared to the family members (p < 0.05). Using the Akaike’s information criterion and Leave-One-Out cross validation GR methods, the HEI was interactive with thiamine (vitamin B1), which is a new finding for the literature. The natural food sources for thiamine include whole grains, legumes, and some meats and fish which HEI scoring included as part of healthy portions (versus limiting portions on salt, saturated fat and empty calories). Additional predictors included age, as well as gender and the interaction of MTHFR 677 with overweight status (measured by body mass index) in predicting CRC, with the cancer group having more men and overweight cases. The HEI score was significant when split at the median score of 77 into greater or less scores, confirmed through the machine-learning recursive tree method and predictive modeling, although an HEI score of greater than 80 is the US national standard set value for a good diet. The HEI and healthy eating are modifiable factors for healthy living in relation to dietary parameters and cancer prevention, and they can be used for personalized nutrition in the precision-based healthcare era.

Predictors of the Healthy Eating Index and Glycemic Index in Multi-Ethnic Colorectal Cancer Families

For personalized nutrition in preparation for precision healthcare, we examined the predictors of healthy eating, using the healthy eating index (HEI) and glycemic index (GI), in family-based multi-ethnic colorectal cancer (CRC) families. A total of 106 participants, 53 CRC cases and 53 family members from multi-ethnic families participated in the study. Machine learning validation procedures, including the ensemble method and generalized regression prediction, Elastic Net with Akaike’s Information Criterion with correction and Leave-One-Out cross validation methods, were applied to validate the results for enhanced prediction and reproducibility. Models were compared based on HEI scales for the scores of 77 versus 80 as the status of healthy eating, predicted from individual dietary parameters and health outcomes. Gender and CRC status were interactive as additional predictors of HEI based on the HEI score of 77. Predictors of HEI 80 as the criterion score of a good diet included five significant dietary parameters (with intake amount): whole fruit (1 cup), milk or milk alternative such as soy drinks (6 oz), whole grain (1 oz), saturated fat (15 g), and oil and nuts (1 oz). Compared to the GI models, HEI models presented more accurate and fitted models. Milk or a milk alternative such as soy drink (6 oz) is the common significant parameter across HEI and GI predictive models. These results point to the importance of healthy eating, with the appropriate amount of healthy foods, as modifiable factors for cancer prevention.

A Fat to Forget: Trans Fat Consumption and Memory

Purpose

We sought to assess the relation of dietary trans fatty acid (dTFA) consumption to word-memory.

Methods

We analyzed cross-sectional data from the 1999-2005 UCSD Statin Study. Participants were 1018 adult men and non-procreative women age ≥20 without diagnosed diabetes, CVD, or extreme LDL-cholesterol. Primary analyses focused on men, as only men (N = 694) were effectively represented in younger adult ages. “Recurrent words” assessed word memory. dTFA (grams/day) estimates were calculated from the Fred Hutchinson Food Frequency Questionnaire. Regression, stratified at age 45, assessed the relation between memory and dTFA in various adjustment models. Major findings were replicated in the full sample (including women). Potential mediators were examined.

Results

An age-by-dTFA interaction was significant. dTFA adversely predicted memory in younger adults (only), robust to adjustment model. Each gram/day dTFA was associated with an estimated 0.76 fewer words recalled (full model) (SE = 0.27, 95%CI = 0.22,1.3, P = 0.006). Adjustment for systolic blood pressure, waist circumference and BMI (but not lipid or glycemic variables) attenuated the relationship, consistent with mediation by factors involving, relating to, or concurrently influencing, these factors.

Conclusion

Greater dTFA was significantly associated with worse word recall in younger adults. Prooxidant and energetic detriments of dTFA and triangulation with other evidence offer prospects for causality.

Trends in fatty acid intake of adults in the Minneapolis-St Paul, MN Metropolitan Area, 1980-1982 through 2007-2009

Background

Intake of dietary fatty acids has been linked to cardiovascular disease risk. However, data available to evaluate trends in fatty acid intake in the US population are limited, particularly with regard to trans fatty acids, docosahexaenoic acid (DHA), and eicosapentaenoic acid (EPA).

Methods and Results

The present analysis examined trends in fatty acid intake from 1980–1982 through 2007–2009 and compared levels of intake to those recommended in the 2010 Dietary Guidelines for Americans and by the American Heart Association. Twenty‐four‐hour dietary recalls were collected from 12 526 participants enrolled in the Minnesota Heart Survey, a series of 6 independent cross‐sectional surveys designed to monitor cardiovascular risk factors in noninstitutionalized adults residing in the Minneapolis‐St Paul, MN metropolitan area. Mean intake estimates were generated for each survey, and a generalized linear mixed model was used to test the null hypothesis of no difference in the age‐adjusted, sex‐specific means across survey years. Downward trends were observed for total, saturated, and trans fat as a percent of total energy in both men and women. However, mean intakes were still above recommended levels for both trans and saturated fatty acids. Mean intakes of DHA and EPA were also below recommended levels.

Conclusions

Despite promising trends, mean intakes of trans and saturated fatty acids do not meet current recommendations. Additional public health strategies are needed to promote recommended intakes of dietary fats.

Trans fatty acids in diets act as a precipitating factor for gut inflammation?

Fatty acids in our daily diet are broadly classified into cis and trans fatty acids (TFAs). TFAs are formed during the manufacturing process of hydrogenated vegetable oils such as margarine. Modern diets such as deep-fried products, frozen foods, and packaged snacks commonly include large quantities of margarine containing TFAs. Although an increased report in the effects of the diet containing TFAs on a risk factor of metabolic syndrome, diabetes mellitus, and coronary heart disease has been observed in the recent years, influence on intestinal inflammation remains unknown. This review describes pro-inflammatory effects of TFAs in our diary diet on various systemic disorders and also discusses a possible role of TFAs on gut inflammation.

Plasma concentrations of trans fatty acids in persons with type 2 diabetes between September 2002 and April 2004

BACKGROUND

transFatty acids (TFAs) increase cardiovascular disease risk. TFAs and polyunsaturated fatty acids (PUFAs) in the food supply may be declining with reciprocal increases in cis-monounsaturated fatty acids (MUFAs) and saturated fatty acids (SFAs).

OBJECTIVES

We sought to determine whether plasma 18-carbon TFA and PUFA concentrations might decrease over time and whether there might be reciprocal increases in plasma cis-MUFAs and SFAs.

DESIGN

We studied 305 persons (171 women) taking part in Look AHEAD (Action for Health in Diabetes), a randomized trial of lifestyle intervention for weight loss to reduce major cardiovascular events in overweight and obese adults (aged 45-76 y) with type 2 diabetes who also participated in an ancillary study of oxidative stress. This study was a cross-sectional analysis of TFAs, cis-MUFAs, SFAs, and PUFAs measured in plasma before intervention (September 2002-April 2004).

RESULTS

In a model that included demographic characteristics, plasma total fatty acid concentration, BMI, serum insulin, statin use, season, and longitudinal time trend (R(2) = 0.167, P < 0.0001), plasma TFAs decreased by 13.5%/y (95% CI: -22.7, -3.2%/y; absolute decrease 7.0 mg · L(-1) · y(-1); 95% CI: -12.5, -1.6 mg · L(-1) · y(-1); P = 0.012). This longitudinal trend was not significantly altered by further adjustment for dietary variables and physical activity. In contrast, longitudinal trends for PUFAs, cis-MUFAs, and SFAs were weak and not significant.

CONCLUSIONS

This change in plasma concentrations of TFAs is consistent with changes in fatty acid composition that food manufacturers are likely to have made to avoid declaring TFAs on food labels. Further research will be needed to determine the overall effect of these changes on cardiovascular risk. The Look AHEAD trial is registered at clinicaltrials.govas NCT00017953.

Effects of trans fatty acids on glucose homeostasis: a meta-analysis of randomized, placebo-controlled clinical trials

BACKGROUND

Although evidence from cohort studies has suggested that trans fatty acid (TFA) consumption may be associated with insulin resistance and diabetes, randomized placebo-controlled trials (RCTs) have yielded conflicting results.

OBJECTIVE

In a meta-analysis, we combined all available RCTs that examined the role of TFA intake on glucose homeostasis.

DESIGN

A systematic review of PubMed was performed, and a total of 7 RCTs were included in the meta-analysis. Primary outcomes were glucose and insulin concentrations. Secondary outcomes were total, LDL-, and HDL-cholesterol and triglyceride concentrations. The pooled effect size (ES) was calculated through fixed- and random-effects meta-analyses. The potential existence of publication bias was evaluated by using funnel-plot analysis. Metaregression analysis was performed to evaluate for potential dose-response relations between the ES of outcomes and TFA intake.

RESULTS

Increased TFA intake did not result in significant changes in glucose or insulin concentrations. Increased TFA intake led to a significant increase in total and LDL-cholesterol [ES (95% CI): 0.28 (0.04, 0.51) and 0.36 (0.13, 0.60), respectively] and a significant decrease in HDL-cholesterol concentrations [ES (95% CI): -0.25 (-0.48, -0.01)]. Our analysis also showed the absence of publication bias and any dose-response relations between the ES and TFA intake.

CONCLUSIONS

Increased TFA intake does not result in changes in glucose, insulin, or triglyceride concentrations but leads to an increase in total and LDL-cholesterol and a decrease in HDL-cholesterol concentrations. There is no evidence to support a potential benefit of the reduction of dietary TFA intake on glucose homeostasis.

Consistency between increasing trends in added-sugar intake and body mass index among adults: the Minnesota Heart Survey, 1980-1982 to 2007-2009

OBJECTIVES

We described 27-year secular trends in added-sugar intake and body mass index (BMI) among Americans aged 25 to 74 years.

METHODS

The Minnesota Heart Survey (1980-1982 to 2007-2009) is a surveillance study of cardiovascular risk factors among residents of the Minneapolis-St Paul area. We used generalized linear mixed regressions to describe trends in added-sugar intake and BMI by gender and age groups and intake trends by weight status.

RESULTS

BMI increased concurrently with added-sugar intake in both genders and all age and weight groups. Percentage of energy intake from added sugar increased by 54% in women between 1980 to 1982 and 2000 to 2002, but declined somewhat in 2007 to 2009; men followed the same pattern (all P < .001). Added-sugar intake was lower among women than men and higher among younger than older adults. BMI in women paralleled added-sugar intake, but men's BMI increased through 2009. Percentage of energy intake from added sugar was similar among weight groups.

CONCLUSIONS

Limiting added-sugar intake should be part of energy balance strategies in response to the obesity epidemic.

Trans fat consumption and aggression

Background

Dietary trans fatty acids (dTFA) are primarily synthetic compounds that have been introduced only recently; little is known about their behavioral effects. dTFA inhibit production of omega-3 fatty acids, which experimentally have been shown to reduce aggression. Potential behavioral effects of dTFA merit investigation. We sought to determine whether dTFA are associated with aggression/irritability.

Methodolgy/Prinicpal Findings

We capitalized on baseline dietary and behavioral assessments in an existing clinical trial to analyze the relationship of dTFA to aggression. Of 1,018 broadly sampled baseline subjects, the 945 adult men and women who brought a completed dietary survey to their baseline visit are the target of this analysis. Subjects (seen 1999–2004) were not on lipid medications, and were without LDL-cholesterol extremes, diabetes, HIV, cancer or heart disease. Outcomes assessed adverse behaviors with impact on others: Overt Aggression Scale Modified-aggression subscale (primary behavioral endpoint); Life History of Aggression; Conflict Tactics Scale; and self-rated impatience and irritability. The association of dTFA to aggression was analyzed via regression and ordinal logit, unadjusted and adjusted for potential confounders (sex, age, education, alcohol, and smoking). Additional analyses stratified on sex, age, and ethnicity, and examined the prospective association. Greater dTFA were strongly significantly associated with greater aggression, with dTFA more consistently predictive than other assessed aggression predictors. The relationship was upheld with adjustment for confounders, was preserved across sex, age, and ethnicity strata, and held cross-sectionally and prospectively.

Conclusions/Significance

This study provides the first evidence linking dTFA with behavioral irritability and aggression. While confounding is always a concern in observational studies, factors including strength and consistency of association, biological gradient, temporality, and biological plausibility add weight to the prospect of a causal connection. Our results may have relevance to public policy determinations regarding dietary trans fats.

Clinicaltrials.gov # NCT00330980

Trends in vitamin D intake from food sources among adults in the Minneapolis-St Paul, MN, metropolitan area, 1980-1982 through 2007-2009

BACKGROUND

Changes in eating habits could potentially be contributing to vitamin D insufficiency among US adults.

OBJECTIVE

Describe secular trends in vitamin D intake from food sources during the past 25 years.

DESIGN

Trends in dietary vitamin D intake from 1980-1982 to 2007-2009 were examined using data collected from the Minnesota Heart Survey, a surveillance study of trends in risk factors for cardiovascular disease among probability samples of adults aged 25 to 74 years in the Minneapolis-St Paul, MN, metropolitan area. Surveys were conducted in 1980-1982, 1985-1987, 1990-1992, 1995-1997, 2000-2002, and 2007-2009. One 24-hour recall was collected from survey participants during each survey period.

RESULTS

Vitamin D intake from food sources decreased between 1980-1982 and 2007-2009 among men, with age-adjusted mean vitamin D intake decreasing from 7.24 μg/day in 1980-1982 to 6.15 μg/day in 2007-2009 (P for trend <0.001). A decrease was also observed among women (4.77 μg/day in 1980-1982 in comparison to 4.53 μg/day in 2007-2009; P for trend <0.001).

CONCLUSIONS

Results suggest that vitamin D intake from food sources has been on the decline during the past 25 years among men and women, potentially contributing to vitamin D insufficiency.

Intake of trans fatty acid in Japanese university students

Because trans fatty acids (TFAs) are a potent risk factor for coronary heart disease, it is important to know the amount of TFA consumed. We estimated TFA intakes of Japanese university students by direct measurement. Subjects included 118 students (57 males and 61 females) in two regions of Japan: Kanto (Tokyo area) and Okinawa. A dietary survey was conducted over six consecutive days using dietary records and photographic records. A single-day meal in the survey period was reproduced to measure TFA content by gas chromatography. The median values of TFA intakes (and energy percentage) estimated by the contents of reproduced meals for men were 0.43 g/d (0.22%) in Kanto and 0.30 g/d (0.14%) in Okinawa. Corresponding values for women were 0.49 g/d (0.29%) and 0.73 g/d (0.35%), respectively. Compared to the group with a low TFA intake, the subjects with a high TFA intake consumed significantly more energy from total fat and saturated fatty acids, and had a high ratio of TFA/linoleic acid. In addition, multiple regression analysis showed the intakes of TFA were positively associated with those of saturated fatty acids and groups of nonessential groceries such as cookies, cakes and pastries. In conclusion, the TFA intakes of these survey subjects were relatively lower than the WHO recommended energy ratio (<1%). However, nutritional education on dietary habits seems indispensable for those subjects who are consuming high volumes of TFA.

Use of trans fat information on food labels and its determinants in a multiethnic college student population

OBJECTIVES

To examine the correlates of trans fat knowledge and trans fat label use; to examine the influence of trans fat knowledge, trans fat label use, and dietary attitudes on intake of high trans fat food.

DESIGN

Cross-sectional survey.

SETTING

An urban commuter college.

SUBJECTS

Two hundred twenty-two college students.

VARIABLES MEASURED

Trans fat knowledge, food label use, high trans fat food consumption, dietary attitudes, and sociodemographic factors.

ANALYSIS

Chi-square tests and multivariate logistic regression analysis assessed relationships between trans fat knowledge, trans fat label use, and consumption of high trans fat food.

RESULTS

Thirty-seven percent of participants reported never using trans fat information on food labels. Males and minority ethnic groups were less likely to report always using trans fat label information and displayed lower trans fat knowledge compared to females and non-Hispanic whites, respectively. Trans fat knowledge and importance of eating a low-fat diet were positively associated with both food label use and use of trans fat information on food labels. Nonuse of food labels and trans fat information on food labels were associated with higher consumption of fried food.

CONCLUSIONS AND IMPLICATIONS

Trans fat education and promotion of food label use is needed in college students, especially in high-risk groups such as males and ethnic minorities.

Trans fats in America: a review of their use, consumption, health implications, and regulation

Trans fatty acids have long been used in food manufacturing due in part to their melting point at room temperature between saturated and unsaturated fats. However, increasing epidemiologic and biochemical evidence suggest that excessive trans fats in the diet are a significant risk factor for cardiovascular events. A 2% absolute increase in energy intake from trans fat has been associated with a 23% increase in cardiovascular risk. Although Denmark has shown it is possible to all but eliminate commercial sources of trans fats from the diet, total elimination is not possible in a balanced diet due to their natural presence in dairy and meat products. Thus, the American Heart Association recommends limiting trans fats to <1% energy, and the American Dietetic Association, the Institute of Medicine, US Dietary Guidelines, and the National Cholesterol Education Project all recommend limiting dietary trans-fat intake from industrial sources as much as possible. The presence of small amounts of trans fat in hydrogenated or partially hydrogenated oils/food products will likely cause many Americans to exceed their recommended maximum. This likelihood is exacerbated by the Food and Drug Administration labeling rules, which allow products containing <0.5 g trans fat per serving to claim 0 g trans fat. Many products with almost 0.5 g trans fat, if consumed over the course of a day, may approximate or exceed the 2 g maximum as recommended by American Heart Association, all while claiming to be trans-fat free. Accordingly, greater transparency in labeling and/or active consumer education is needed to reduce the cardiovascular risks associated with trans fats.

Trans fatty acid intake among the population of the city of São Paulo, Brazil

OBJECTIVE: To analyze the monounsaturated and polyunsaturated trans fatty acid intake among the general population. METHODS: A cross-sectional study was conducted in São Paulo, Southeastern Brazil, in 2003, on a representative sample of 2,298 male and female subjects, including 803 adolescents (12 to 19 years), 713 adults (20 to 59 years) and 782 elderly people (60 years or over). Food intake was measured using 24-hour recall. Mean trans fatty acid intake was described according to gender and age group. RESULTS: The mean trans fatty acid intake was 5.0 g/day (SE = 0.1), accounting for 2.4% (SE = 0.1) of total energy and 6.8% (SE = 0.1) of total lipids. The adolescents had the highest mean intake levels (7.4 g/day; 2.9% of energy) while the adults and the elderly had similar intake (2.2% of energy for both; 6.4% of lipids and 6.5% of lipids, respectively). The mean trans fatty acid intake among adult and elderly women (approximately 2.5% of energy and 7.0% of lipids) was higher than among men in the same age group. The food item with the highest contribution towards trans fatty acids was margarine, accounting for more than 30% of total intake, followed by filled cookies among adolescents and meat among adults and the elderly. CONCLUSIONS: The trans fatty acid intake is above the level recommended by the World Health Organization. Replacement of the trans fatty acids in manufactured food items may be an effective measure for reducing trans fatty acid intake in Brazil.

Formação de toxinas durante o processamento de alimentos e as possíveis conseqüências para o organismo humano

A produção de alimentos envolve inúmeras reações químicas, durante as quais podem ser geradas substâncias tóxicas ao organismo humano. A produção destas substâncias pode ocorrer de diferentes maneiras, variando em quantidade e em grau de toxicidade. Este trabalho objetivou estudar a produção de toxinas no processamento de alimentos, assim como as conseqüências da ingestão dessas substâncias para o ser humano. O estudo foi realizado a partir de extensa pesquisa bibliográfica. As principais reações na formação de compostos tóxicos apresentadas no decorrer do estudo são: degradação de lipídios, hidrogenação, pirólise e defumação. Entre as substâncias formadas, destacam-se: peróxidos, ácidos graxos trans, aminas heterocíclicas e hidrocarbonetos aromáticos policíclicos. O profissional nutricionista necessita conhecer como ocorre a formação de toxinas durante os variados processamentos que envolvem alimentos, assim como os riscos para a saúde de quem consome essas substâncias. Também é preciso propor técnicas de processamento adequadas, visando ao bem-estar do consumidor e à manutenção das propriedades nutricionais do alimento.

Trends in diet quality for coronary heart disease prevention between 1980-1982 and 2000-2002: The Minnesota Heart Survey

OBJECTIVE

Describe secular trends in overall diet quality for coronary heart disease (CHD) prevention during the past two decades (1980-1982 through 2000-2002).

DESIGN

Dietary data were drawn from the Minnesota Heart Survey, a repeated population-based survey designed to examine trends in mortality, morbidity, and risk factors for CHD within geographically defined independent probability samples.

SUBJECTS/SETTING

Adults residing in the Minneapolis/St Paul, MN, metropolitan area.

MAIN OUTCOMES MEASURES

Dietary intake was assessed by an interviewer administered 24-hour dietary recall from a subsample of survey participants. A Heart Disease Prevention Eating Index was developed to measure overall diet quality by compliance with the current American Heart Association Dietary Guidelines.

STATISTICAL ANALYSES

A generalized linear mixed model was used to examine trends in Heart Disease Prevention Eating Index scores and trends in each element of the index.

RESULTS

Age-adjusted mean Heart Disease Prevention Eating Index scores increased in both sexes during the past 2 decades, particularly driven by improvements in total grain, whole grain, total fat, saturated fatty acids, trans-fatty acids, and cholesterol intake. Energy balance, sodium intake, and fish intake were observed to change unfavorably or stay at a low compliance level.

CONCLUSIONS

Of concern is that improvements in mean Heart Disease Prevention Eating Index appear to have plateaued in 1995-1997, with the mean Heart Disease Prevention Eating Index scores similar between the 1995-1997 and 2000-2002 survey periods. Public health programs for CHD prevention may benefit by applying findings from this study in designing interventions to promote further improvements in the diets of American adults.

Dietary trans fatty acids: Review of recent human studies and food industry responses

Dietary trans FA at sufficiently high levels have been found to increase low density lipoprotein (LDL)-cholesterol and decrease high density lipoprotein (HDL)-cholesterol (and thus to increase the ratio of LDL-cholesterol/HDL-cholesterol) compared with diets high in cis monounsaturated FA or PUFA. The dietary levels of trans FA at which these effects are easily measured are around 4% of energy or higher to increase LDL-cholesterol and around 5 to 6% of energy or higher to decrease HDL-cholesterol, compared with essentially trans-free control diets. Very limited data at lower levels of intake (less than 4% of energy) are available. Most health professional organizations and some governments now recommend reduced consumption of foods containing trans FA, and effective January 1, 2006, the U.S. Food and Drug Administration requires the labeling of the amounts of trans FA per serving in packaged foods. In response, the food industry is working on ways to eliminate or greatly reduce trans FA in food products. Current efforts focus on four technological options: (i) modification of the hydrogenation process, (ii) use of interesterification, (iii) use of fractions high in solids from natural oils, and (iv) use of trait-enhanced oils. Challenges to the food industry in replacing trans FA in foods are to develop formulation options that provide equivalent functionality, are economically feasible, and do not greatly increase saturated FA content.

World-wide consumption of trans fatty acids

Dietary trans fatty acids (TFA) originate from commercially hydrogenated oils and from dairy and meat fats. Estimates of dietary TFA consumption vary with dietary habits and food supply as well as methods used to estimate consumption. Methods include: (1) market share data, (2) laboratory analysis of duplicate portions or composite diets, (3) analysis of consumption data of a representative population, and (4) biomarkers, such as human milk. In North America, daily intakes have been estimated by food frequency questionnaire to be 3-4 g/person and by extrapolation of human milk data to be greater than 10 g/person. Diets in northern Europe traditionally have contained more TFA than in Mediterranean countries where olive oil is used. Intakes in Europe range from minimal values in Italy, Portugal, Greece and Spain (1.4-2.1 g/day) to greater values for Germany, Finland, Denmark, Sweden, France, United Kingdom, Belgium, Norway, The Netherlands, and Iceland (2.1-5.4 g/day) Recent decreases in dietary TFA have been observed due to modifications of commercial fats and changes in consumer choices. The impact of legislation restricting use of hydrogenated fats and requiring TFA content on food labels awaits future studies.

Trends and dietary determinants of overweight and obesity in a multiethnic population

OBJECTIVES

To describe trends in BMI among different ethnic groups in Hawaii and to explore the relation of nutrient and food intake with excess weight.

RESEARCH METHODS AND PROCEDURES

We pooled demographic, anthropometric, and nutritional data derived from a detailed diet history for 159,683 participants of 18 population-based epidemiological studies conducted in Hawaii over a 25-year period. The age-adjusted prevalence of excess weight (BMI > or = 25 kg/m(2)) was estimated for 5-year intervals. To explore dietary determinants of excess weight, we computed odds ratios using logistic regression.

RESULTS

During the study period, the prevalence of excess weight increased considerably among all ethnic groups. Native Hawaiians had the highest and Asian Americans had the lowest prevalence of excess weight at all times. Although the percentage of calories consumed from carbohydrates increased, the percentage of calories from fat decreased over time. On an individual level, fat and protein consumption predicted a higher BMI, and dietary fiber intake predicted a lower BMI. Similarly, a higher consumption of meat, poultry, and fish was related to excess weight, whereas fruit and vegetable intake were inversely associated with excess weight. After stratification by ethnicity, the associations were not materially altered among women, but carbohydrates seemed to have a stronger association with excess weight among Native Hawaiian and Japanese men than among white men.

DISCUSSION

In this large ethnically diverse population, plant-based foods and dietary fiber emerged as a potential protective factor against excess weight regardless of ethnicity.

Twenty-Year Trends in Serum Cholesterol, Hypercholesterolemia, and Cholesterol Medication Use

Background— Although US cholesterol concentrations have dropped, &50% of adults have total cholesterol concentrations ≥5.18 mmol/L, putting them at “borderline-high risk” for heart disease. Whether the decline has continued into the 21st century is unknown. We assessed 20-year trends in cholesterol, hypercholesterolemia, lipid-lowering drug use, and cholesterol awareness, treatment, and control from Minnesota Heart Survey (MHS) data.

Methods and Results— Five independent, cross-sectional, population-based surveys of 2500 to 5000 adults were conducted in the Minneapolis–St. Paul, Minn, area from 1980 to 2002. Mean (nonfasting) total cholesterol concentrations have continued a 20-year decline, punctuated by an intervening lull. Age-adjusted mean total cholesterol concentrations in 2000 to 2002 were 5.16 and 5.09 mmol/L for men and women, respectively (in 1980 to 1982, 5.49 and 5.38 mmol/L for men and women, respectively) However, the decline has not been uniform across all age groups. Middle-aged to older people have shown substantial decreases, but younger people have shown little overall change and recently had increased total cholesterol values. The mean prevalence of hypercholesterolemia in 2000 to 2002 was 54.9% for men and 46.5% for women and has decreased significantly for both during the study. Age-adjusted mean high-density lipoprotein cholesterol concentrations in 2000 to 2002 were 1.09 and 1.40 mmol/L for men and women, respectively, and were not different from the prior survey. Lipid-lowering drug use rose significantly for both sexes aged 35 to 74 years. Awareness, treatment, and control of hypercholesterolemia have increased; however, more than half of those at borderline-high risk remain unaware of their condition.

Conclusions— Although hypercholesterolemia prevalence continued to fall, significant population segments still have cholesterol concentrations near or at the level of increased risk.