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Marklund M, Aminde LN, Wanjau MN, Ale BM, Ojo AE, Okoro CE, Adegboye A, Huang L, Veerman JL, Wu JH, Huffman MD, Ojji DB. Estimated health benefits, costs and cost-effectiveness of eliminating industrial trans -fatty acids in Nigeria: cost-effectiveness analysis. BMJ Glob Health 2024; 9:e014294. [PMID: 38631705 PMCID: PMC11029410 DOI: 10.1136/bmjgh-2023-014294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/14/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Nigeria is committed to reducing industrial trans-fatty acids (iTFA) from the food supply, but the potential health gains, costs and cost-effectiveness are unknown. METHODS The effect on ischaemic heart disease (IHD) burden, costs and cost-effectiveness of a mandatory iTFA limit (≤2% of all fats) for foods in Nigeria were estimated using Markov cohort models. Data on demographics, IHD epidemiology and trans-fatty acid intake were derived from the 2019 Global Burden of Disease Study. Avoided IHD events and deaths; health-adjusted life years (HALYs) gained; and healthcare, policy implementation and net costs were estimated over 10 years and the population's lifetime. Incremental cost-effectiveness ratios using net costs and HALYs gained (both discounted at 3%) were used to assess cost-effectiveness. RESULTS Over the first 10 years, a mandatory iTFA limit (assumed to eliminate iTFA intake) was estimated to prevent 9996 (95% uncertainty interval: 8870 to 11 118) IHD deaths and 66 569 (58 862 to 74 083) IHD events, and to save US$90 million (78 to 102) in healthcare costs. The corresponding lifetime estimates were 259 934 (228 736 to 290 191), 479 308 (95% UI 420 472 to 538 177) and 518 (450 to 587). Policy implementation costs were estimated at US$17 million (11 to 23) over the first 10 years, and US$26 million USD (19 to 33) over the population's lifetime. The intervention was estimated to be cost-saving, and findings were robust across several deterministic sensitivity analyses. CONCLUSION Our findings support mandating a limit of iTFAs as a cost-saving strategy to reduce the IHD burden in Nigeria.
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Affiliation(s)
- Matti Marklund
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Food Policy, The George Institute for Global Health, Newtown, New South Wales, Australia
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
| | - Leopold N Aminde
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Mary Njeri Wanjau
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Boni M Ale
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
- Holo Healthcare, Nairobi, Kenya
| | - Adedayo E Ojo
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
- Department of Epidemiology and Global Health, University Medical Centre Utrecht, Utrecht, Netherlands
| | | | - Abimbola Adegboye
- National Agency for Food and Drug Administration and Control, Abuja, Federal Capital Territory, Nigeria
| | - Liping Huang
- Food Policy, The George Institute for Global Health, Newtown, New South Wales, Australia
| | - J Lennert Veerman
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Jason Hy Wu
- Food Policy, The George Institute for Global Health, Newtown, New South Wales, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark D Huffman
- Food Policy, The George Institute for Global Health, Newtown, New South Wales, Australia
- Washington University in St Louis, St Louis, St Louis, USA
| | - Dike B Ojji
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
- Department of Internal Medicine, Faculty of Clinical Sciences, University of Abuja, Abuja, Federal Capital Territory, Nigeria
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Emmert-Fees KMF, Karl FM, von Philipsborn P, Rehfuess EA, Laxy M. Simulation Modeling for the Economic Evaluation of Population-Based Dietary Policies: A Systematic Scoping Review. Adv Nutr 2021; 12:1957-1995. [PMID: 33873201 PMCID: PMC8483966 DOI: 10.1093/advances/nmab028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/24/2020] [Accepted: 02/24/2021] [Indexed: 01/02/2023] Open
Abstract
Simulation modeling can be useful to estimate the long-term health and economic impacts of population-based dietary policies. We conducted a systematic scoping review following the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) guideline to map and critically appraise economic evaluations of population-based dietary policies using simulation models. We searched Medline, Embase, and EconLit for studies published in English after 2005. Modeling studies were mapped based on model type, dietary policy, and nutritional target, and modeled risk factor-outcome pathways were analyzed. We included 56 studies comprising 136 model applications evaluating dietary policies in 21 countries. The policies most often assessed were reformulation (34/136), taxation (27/136), and labeling (20/136); the most common targets were salt/sodium (60/136), sugar-sweetened beverages (31/136), and fruit and vegetables (15/136). Model types included Markov-type (35/56), microsimulation (11/56), and comparative risk assessment (7/56) models. Overall, the key diet-related risk factors and health outcomes were modeled, but only 1 study included overall diet quality as a risk factor. Information about validation was only reported in 19 of 56 studies and few studies (14/56) analyzed the equity impacts of policies. Commonly included cost components were health sector (52/56) and public sector implementation costs (35/56), as opposed to private sector (18/56), lost productivity (11/56), and informal care costs (3/56). Most dietary policies (103/136) were evaluated as cost-saving independent of the applied costing perspective. An analysis of the main limitations reported by authors revealed that model validity, uncertainty of dietary effect estimates, and long-term intervention assumptions necessitate a careful interpretation of results. In conclusion, simulation modeling is widely applied in the economic evaluation of population-based dietary policies but rarely takes dietary complexity and the equity dimensions of policies into account. To increase relevance for policymakers and support diet-related disease prevention, economic effects beyond the health sector should be considered, and transparent conduct and reporting of model validation should be improved.
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Affiliation(s)
- Karl M F Emmert-Fees
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Florian M Karl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
| | - Peter von Philipsborn
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Eva A Rehfuess
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Michael Laxy
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
- Pettenkofer School of Public Health, Munich, Germany
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
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Ren X, Vilhjálmsdóttir BL, Rohde JF, Walker KC, Runstedt SE, Lauritzen L, Heitmann BL, Specht IO. Systematic Literature Review and Meta-Analysis of the Relationship Between Polyunsaturated and Trans Fatty Acids During Pregnancy and Offspring Weight Development. Front Nutr 2021; 8:625596. [PMID: 33842522 PMCID: PMC8027310 DOI: 10.3389/fnut.2021.625596] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/17/2021] [Indexed: 12/17/2022] Open
Abstract
Eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and trans fatty acids (TFAs) may have an impact on offspring weight development. We conducted a systematic review and meta-analysis according to PRISMA guidelines to evaluate whether levels of these fatty acids during pregnancy influenced offspring weight development. Randomized controlled trials (RCTs) with DHA and/or EPA supplementation or cohort studies, which examined levels of DHA, EPA, or TFAs in maternal or neonatal blood samples and recorded offspring weight, were included. Overall, 27 RCTs and 14 observational studies were identified. The results showed that DHA and/or EPA supplementation doses >650 mg/day resulted in slightly higher birth weight (MD 87.5 g, 95% CI 52.3-122.6, n = 3,831) and combined BMI and BMI z score at 5-10 years (SMD 0.11, 95% CI 0.04-0.18, n = 3,220). These results were rated as moderate quality. Results from the observational studies were generally inconsistent. High TFA levels during pregnancy seemed to be associated with lower birth weight. Finally, this review and meta-analysis supports a relationship between high maternal or neonatal DHA and/or EPA levels and higher offspring birth weight and weight in childhood. More high-quality long-term studies are still needed.
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Affiliation(s)
- Xuan Ren
- Research Unit for Dietary Studies at the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Birgitta Lind Vilhjálmsdóttir
- Research Unit for Dietary Studies at the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jeanett Friis Rohde
- Research Unit for Dietary Studies at the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Karen Christina Walker
- Research Unit for Dietary Studies at the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Suzanne Elizabeth Runstedt
- Research Unit for Dietary Studies at the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lotte Lauritzen
- Department of Nutrition, Exercise and Sports, Paediatric and International Nutrition, University of Copenhagen, Copenhagen, Denmark
| | - Berit Lilienthal Heitmann
- Research Unit for Dietary Studies at the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
- Sydney Medical School, The Boden Institute of Obesity, Nutrition, Exercise, and Eating Disorders, Sydney University, Sydney, NSW, Australia
- Section for General Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ina Olmer Specht
- Research Unit for Dietary Studies at the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
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Marklund M, Zheng M, Veerman JL, Wu JHY. Estimated health benefits, costs, and cost-effectiveness of eliminating industrial trans-fatty acids in Australia: A modelling study. PLoS Med 2020; 17:e1003407. [PMID: 33137090 PMCID: PMC7605626 DOI: 10.1371/journal.pmed.1003407] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 09/29/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND trans-fatty acids (TFAs) are a well-known risk factor of ischemic heart disease (IHD). In Australia, the highest TFA intake is concentrated to the most socioeconomically disadvantaged groups. Elimination of industrial TFA (iTFA) from the Australian food supply could result in reduced IHD mortality and morbidity while improving health equity. However, such legislation could lead to additional costs for both government and food industry. Thus, we assessed the potential cost-effectiveness, health gains, and effects on health equality of an iTFA ban from the Australian food supply. METHODS AND FINDINGS Markov cohort models were used to estimate the impact on IHD burden and health equity, as well as the cost-effectiveness of a national ban of iTFA in Australia. Intake of TFA was assessed using the 2011-2012 Australian National Nutrition and Physical Activity Survey. The IHD burden attributable to TFA was calculated by comparing the current level of TFA intake to a counterfactual setting where consumption was lowered to a theoretical minimum distribution with a mean of 0.5% energy per day (corresponding to TFA intake only from nonindustrial sources, e.g., dairy foods). Policy costs, avoided IHD events and deaths, health-adjusted life years (HALYs) gained, and changes in IHD-related healthcare costs saved were estimated over 10 years and lifetime of the adult Australian population. Cost-effectiveness was assessed by calculation of incremental cost-effectiveness ratios (ICERs) using net policy cost and HALYs gained. Health benefits and healthcare cost changes were also assessed in subgroups based on socioeconomic status, defined by Socio-Economic Indexes for Areas (SEIFA) quintile, and remoteness. Compared to a base case of no ban and current TFA intakes, elimination of iTFA was estimated to prevent 2,294 (95% uncertainty interval [UI]: 1,765; 2,851) IHD deaths and 9,931 (95% UI: 8,429; 11,532) IHD events over the first 10 years. The greatest health benefits were accrued to the most socioeconomically disadvantaged quintiles and among Australians living outside of major cities. The intervention was estimated to be cost saving (net cost <0 AUD) or cost-effective (i.e., ICER < AUD 169,361/HALY) regardless of the time horizon, with ICERs of 1,073 (95% UI: dominant; 3,503) and 1,956 (95% UI: 1,010; 2,750) AUD/HALY over 10 years and lifetime, respectively. Findings were robust across several sensitivity analyses. Key limitations of the study include the lack of recent data of TFA intake and the small sample sizes used to estimate intakes in subgroups. As with all simulation models, our study does not prove that a ban of iTFA will prevent IHD, rather, it provides the best quantitative estimates and corresponding uncertainty of a potential effect in the absence of stronger direct evidence. CONCLUSIONS Our model estimates that a ban of iTFAs could avert substantial numbers of IHD events and deaths in Australia and would likely be a highly cost-effective strategy to reduce social-economic and urban-rural inequalities in health. These findings suggest that elimination of iTFA can cost-effectively improve health and health equality even in countries with low iTFA intake.
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Affiliation(s)
- Matti Marklund
- The George Institute for Global Health and the Faculty of Medicine, University of New South Wales, Sydney, Australia
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, United States of America
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - Miaobing Zheng
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, Australia
| | | | - Jason H. Y. Wu
- The George Institute for Global Health and the Faculty of Medicine, University of New South Wales, Sydney, Australia
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Rippin HL, Hutchinson J, Jewell J, Breda JJ, Cade JE. Assessing diet in European populations using national dietary surveys. Proc Nutr Soc 2020; 79:1-11. [PMID: 31969200 DOI: 10.1017/s0029665119001174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The WHO encourages countries to conduct national dietary surveys (NDS) to inform preventative policies targeting malnutrition and noncommunicable diseases. Previous reviews have found inadequate nutrient intakes and survey provision across Europe. This research is the first to provide an updated review of NDS provision within the whole WHO European Region, across the lifecourse, with reference to disadvantaged groups, obesity and nutrients of concern. Over a third of WHO European countries, mainly Central and Eastern European countries (CEEC), had no identifiable NDS. Where countries reported nutrient intakes, poor WHO recommended nutrient intake attainment was Europe-wide across the lifecourse, particularly in CEEC. Lower educated individuals had poorer diet quality. However, heterogeneity in age group sampled, dietary assessment method, nutrient composition database and under-reporting hindered inter-country comparisons. Average population trans fatty acid intakes below WHO recommended limits may hide inequalities in disadvantaged groups; legislative bans may help alleviate this. There were few associations between NDS-derived consumed food portion size (FPS) and BMI. However, consumed FPS was greater than on-pack serving-size in the majority of foods studied. This review illustrates how NDS can generate information on diet, nutrient intakes and the food environment. However, to enable valid inter-country comparisons, countries should be encouraged to conduct and report harmonised NDS, particularly in the age groups sampled, dietary assessment methodology, nutrient range, underpinning food composition database and treatment of under-reporters. This will aid effective, coordinated policy development that can have a real impact on dietary improvement, on a population and subgroup level, throughout Europe.
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Affiliation(s)
- Holly L Rippin
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, LeedsLS2 9JT, UK
| | - Jayne Hutchinson
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, LeedsLS2 9JT, UK
| | - Jo Jewell
- Division of Noncommunicable Diseases and Promoting Health through the Life-Course, World Health Organization Regional Office for Europe, UN City, Marmorvej 51, 21000Copenhagen, Denmark
| | - Joao J Breda
- Division of Noncommunicable Diseases and Promoting Health through the Life-Course, World Health Organization Regional Office for Europe, UN City, Marmorvej 51, 21000Copenhagen, Denmark
| | - Janet E Cade
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, LeedsLS2 9JT, UK
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Downs SM, Bloem MZ, Zheng M, Catterall E, Thomas B, Veerman L, Wu JHY. The Impact of Policies to Reduce trans Fat Consumption: A Systematic Review of the Evidence. Curr Dev Nutr 2017; 1:cdn.117.000778. [PMID: 29955689 PMCID: PMC5998794 DOI: 10.3945/cdn.117.000778] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 05/17/2017] [Accepted: 11/10/2017] [Indexed: 12/22/2022] Open
Abstract
Background: The consumption of industrially produced trans fatty acids (TFAs) has been associated with an increased risk of heart disease. In recognition of this, countries, states, and cities worldwide have implemented TFA policies aimed at reducing their availability in the food supply. Objective: This article aims to provide an update of the evidence of the effectiveness of policies aimed at reducing TFAs in the food supply. Methods: A systematic review of the literature from 2013 onward was conducted, building on a previously published review that examined the evidence of the impact of TFA policies worldwide from 2000 to 2012. Studies that were 1) empirical, 2) examined a TFA policy, and 3) examined the effect of the policy on TFA amounts and availability pre- and post-policy intervention were included. Modeling studies examining the impact of TFA policies on cardiovascular, equity, and economic outcomes were also included. Results: A total of 18 articles from the updated search were combined with 14 articles from the previous review (total = 32 articles). All types of TFA policies led to their reduction; however, trans fat bans had a larger impact (TFAs virtually eliminated) than did voluntary (range: 20-38% reduction in TFA intakes) or labeling (range: 30-74% reduction in TFA intakes, plasma serum, or breast-milk concentrations) approaches to reducing TFA amounts in the food supply. Product reformulation to reduce TFAs had variable effects on saturated fatty acid (SFA) contents in these foods; however, the combined amount of TFAs and SFAs declined in most products. Overall, the modeling studies indicated that TFA bans would reduce heart disease risk, benefit socioeconomically disadvantaged populations the most, and be cost-saving. Conclusions: Policies aimed at reducing TFAs in the food supply are effective and will likely reduce the burden of diet-related disease, particularly among the most vulnerable socioeconomic groups. Although all policy approaches lead to reductions in TFAs in foods, TFA bans are likely the most effective, economical, and equitable policy approach to reducing TFAs in the food supply.
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Affiliation(s)
- Shauna M Downs
- Department of Health Systems and Policy, School of Public Health, Rutgers University, New Brunswick NJ
| | - Milan Z Bloem
- Division of Human Nutrition, Wageningen University, Wageningen, Netherlands
| | - Miaobing Zheng
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Elise Catterall
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Beth Thomas
- National Heart Foundation of Australia, Brisbane, Australia
| | - Lennert Veerman
- Cancer Research Division, Cancer Council NSW, Sydney, Australia
| | - Jason HY Wu
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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Hyseni L, Bromley H, Kypridemos C, O’Flaherty M, Lloyd-Williams F, Guzman-Castillo M, Pearson-Stuttard J, Capewell S. Systematic review of dietary trans-fat reduction interventions. Bull World Health Organ 2017; 95:821-830G. [PMID: 29200523 PMCID: PMC5710076 DOI: 10.2471/blt.16.189795] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 09/11/2017] [Accepted: 09/12/2017] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To systematically review published studies of interventions to reduce people's intake of dietary trans-fatty acids (TFAs). METHODS We searched online databases (CINAHL, the CRD Wider Public Health database, Cochrane Database of Systematic Reviews, Ovid®, MEDLINE®, Science Citation Index and Scopus) for studies evaluating TFA interventions between 1986 and 2017. Absolute decrease in TFA consumption (g/day) was the main outcome measure. We excluded studies reporting only on the TFA content in food products without a link to intake. We included trials, observational studies, meta-analyses and modelling studies. We conducted a narrative synthesis to interpret the data, grouping studies on a continuum ranging from interventions targeting individuals to population-wide, structural changes. RESULTS After screening 1084 candidate papers, we included 23 papers: 12 empirical and 11 modelling studies. Multiple interventions in Denmark achieved a reduction in TFA consumption from 4.5 g/day in 1976 to 1.5 g/day in 1995 and then virtual elimination after legislation banning TFAs in manufactured food in 2004. Elsewhere, regulations mandating reformulation of food reduced TFA content by about 2.4 g/day. Worksite interventions achieved reductions averaging 1.2 g/day. Food labelling and individual dietary counselling both showed reductions of around 0.8 g/day. CONCLUSION Multicomponent interventions including legislation to eliminate TFAs from food products were the most effective strategy. Reformulation of food products and other multicomponent interventions also achieved useful reductions in TFA intake. By contrast, interventions targeted at individuals consistently achieved smaller reductions. Future prevention strategies should consider this effectiveness hierarchy to achieve the largest reductions in TFA consumption.
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Affiliation(s)
- Lirije Hyseni
- Department of Public Health and Policy, Whelan Building, University of Liverpool, Liverpool L69 3GB, England
| | - Helen Bromley
- Department of Public Health and Policy, Whelan Building, University of Liverpool, Liverpool L69 3GB, England
| | - Chris Kypridemos
- Department of Public Health and Policy, Whelan Building, University of Liverpool, Liverpool L69 3GB, England
| | - Martin O’Flaherty
- Department of Public Health and Policy, Whelan Building, University of Liverpool, Liverpool L69 3GB, England
| | - Ffion Lloyd-Williams
- Department of Public Health and Policy, Whelan Building, University of Liverpool, Liverpool L69 3GB, England
| | - Maria Guzman-Castillo
- Department of Public Health and Policy, Whelan Building, University of Liverpool, Liverpool L69 3GB, England
| | | | - Simon Capewell
- Department of Public Health and Policy, Whelan Building, University of Liverpool, Liverpool L69 3GB, England
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Wilczek MM, Olszewski R, Krupienicz A. Trans-Fatty Acids and Cardiovascular Disease: Urgent Need for Legislation. Cardiology 2017; 138:254-258. [PMID: 28946140 DOI: 10.1159/000479956] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 08/03/2017] [Indexed: 12/31/2022]
Abstract
Hydrogenated oils containing trans-fatty acids (TFA) are used to produce margarine and various processed foods. TFA affect serum lipid levels, fatty acid metabolism, and endothelial function. High TFA intake is linked to increased all-cause mortality, coronary heart disease mortality, and cardiovascular disease (CVD) incidence. Denmark was the first country to introduce a law that limited TFA content in food; this action led to lower CVD mortality. So far 7 European countries have followed this practice, in a few others the food industry voluntarily reduced TFA use. The issue remains mostly unaddressed in the rest of the world. Legal TFA limits should be commonly established as they are the optimal solution considering both CVD prevention and the associated cost savings in public healthcare.
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Affiliation(s)
- Mateusz M Wilczek
- Medical Faculty, Poznan University of Medical Sciences, Poznan, Poland
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Trans Fat Intake and Its Dietary Sources in General Populations Worldwide: A Systematic Review. Nutrients 2017; 9:nu9080840. [PMID: 28783062 PMCID: PMC5579633 DOI: 10.3390/nu9080840] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 07/28/2017] [Accepted: 07/31/2017] [Indexed: 12/25/2022] Open
Abstract
After the discovery that trans fat increases the risk of coronary heart disease, trans fat content of foods have considerably changed. The aim of this study was to systematically review available data on intakes of trans fat and its dietary sources in general populations worldwide. Data from national dietary surveys and population studies published from 1995 onward were searched via Scopus and websites of national public health institutes. Relevant data from 29 countries were identified. The most up to date estimates of total trans fat intake ranged from 0.3 to 4.2 percent of total energy intake (En%) across countries. Seven countries had trans fat intakes higher than the World Health Organization recommendation of 1 En%. In 16 out of 21 countries with data on dietary sources, intakes of trans fat from animal sources were higher than that from industrial sources. Time trend data from 20 countries showed substantial declines in industrial trans fat intake since 1995. In conclusion, nowadays, in the majority of countries for which data are available, average trans fat intake is lower than the recommended maximum intake of 1 En%, with intakes from animal sources being higher than from industrial sources. In the past 20 years, substantial reductions in industrial trans fat have been achieved in many countries.
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Iglesia I, Huybrechts I, González-Gross M, Mouratidou T, Santabárbara J, Chajès V, González-Gil EM, Park JY, Bel-Serrat S, Cuenca-García M, Castillo M, Kersting M, Widhalm K, De Henauw S, Sjöström M, Gottrand F, Molnár D, Manios Y, Kafatos A, Ferrari M, Stehle P, Marcos A, Sánchez-Muniz FJ, Moreno LA. Folate and vitamin B12 concentrations are associated with plasma DHA and EPA fatty acids in European adolescents: the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study. Br J Nutr 2017; 117:124-133. [PMID: 28098048 DOI: 10.1017/s0007114516004414] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
This study aimed to examine the association between vitamin B6, folate and vitamin B12 biomarkers and plasma fatty acids in European adolescents. A subsample from the Healthy Lifestyle in Europe by Nutrition in Adolescence study with valid data on B-vitamins and fatty acid blood parameters, and all the other covariates used in the analyses such as BMI, Diet Quality Index, education of the mother and physical activity assessed by a questionnaire, was selected resulting in 674 cases (43 % males). B-vitamin biomarkers were measured by chromatography and immunoassay and fatty acids by enzymatic analyses. Linear mixed models elucidated the association between B-vitamins and fatty acid blood parameters (changes in fatty acid profiles according to change in 10 units of vitamin B biomarkers). DHA, EPA) and n-3 fatty acids showed positive associations with B-vitamin biomarkers, mainly with those corresponding to folate and vitamin B12. Contrarily, negative associations were found with n-6:n-3 ratio, trans-fatty acids and oleic:stearic ratio. With total homocysteine (tHcy), all the associations found with these parameters were opposite (for instance, an increase of 10 nmol/l in red blood cell folate or holotranscobalamin in females produces an increase of 15·85 µmol/l of EPA (P value <0·01), whereas an increase of 10 nmol/l of tHcy in males produces a decrease of 2·06 µmol/l of DHA (P value <0·05). Positive associations between B-vitamins and specific fatty acids might suggest underlying mechanisms between B-vitamins and CVD and it is worth the attention of public health policies.
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Affiliation(s)
- I Iglesia
- 1Growth Exercise, Nutrition and Development (GENUD) Research Group,Universidad de Zaragoza, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria de Aragón (IIS), 50009 Zaragoza,Spain
| | - I Huybrechts
- 3Department of Public Health, Ghent University,University Hospital, De Pintelaan 185, entrance 42 (building K3),4th floor, B-9000 Ghent,Belgium
| | - M González-Gross
- 5ImFINE Research Group,Department of Health and Human Performance,Universidad Politécnica de Madrid,C/ Martín Fierro, 7, 28040 Madrid,Spain
| | - T Mouratidou
- 1Growth Exercise, Nutrition and Development (GENUD) Research Group,Universidad de Zaragoza, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria de Aragón (IIS), 50009 Zaragoza,Spain
| | - J Santabárbara
- 7Department of Preventive Medicine and Public Health,Universidad de Zaragoza,50009 Zaragoza,Spain
| | - V Chajès
- 4International Agency for Research on Cancer (IARC),150 Cours Albert Thomas,69372 Lyon Cedex 08,France
| | - E M González-Gil
- 1Growth Exercise, Nutrition and Development (GENUD) Research Group,Universidad de Zaragoza, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria de Aragón (IIS), 50009 Zaragoza,Spain
| | - J Y Park
- 4International Agency for Research on Cancer (IARC),150 Cours Albert Thomas,69372 Lyon Cedex 08,France
| | - S Bel-Serrat
- 1Growth Exercise, Nutrition and Development (GENUD) Research Group,Universidad de Zaragoza, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria de Aragón (IIS), 50009 Zaragoza,Spain
| | - M Cuenca-García
- 8Department of Physiology,School of Medicine,University of Granada,Avenida de Madrid 11,18012 Granada,Spain
| | - M Castillo
- 8Department of Physiology,School of Medicine,University of Granada,Avenida de Madrid 11,18012 Granada,Spain
| | - M Kersting
- 10Research Institute of Child Nutrition Dortmund,Pediatric University Clinic,Ruhr-University Bochum,Heinstück 11, D-44225 Dortmund,Germany
| | - K Widhalm
- 11Department of Pediatrics,Division of Clinical Nutrition and Prevention,Medical University of Vienna,1090 Vienna,Austria
| | - S De Henauw
- 3Department of Public Health, Ghent University,University Hospital, De Pintelaan 185, entrance 42 (building K3),4th floor, B-9000 Ghent,Belgium
| | - M Sjöström
- 12Department of Public Health Sciences,Division of Social Medicine,Karolinska Institutet,Norrbacka,level 3,17176 Stockholm,Sweden
| | - F Gottrand
- 15Inserm U995, Faculté de Médecine,Université Lille 2,F-59045 Lille Cedex,France
| | - D Molnár
- 16Department of Paediatrics,University of Pécs,Szigeti str 12, H-7624 Pécs,Hungary
| | - Y Manios
- 17Department of Nutrition and Dietetics,Harokopio University,E. Venizelou 70, 17671 Kallithea, reece, Kallithea-Athens,Greece
| | - A Kafatos
- 18School of Medicine,University of Crete,GR-71033 Crete,Greece
| | - M Ferrari
- 19CREA - Council for Agricultural Research and Economics - Research Center for Food and Nutrition,Via Ardeatina 546 - 00178 Roma,Italy
| | - P Stehle
- 20Department of Nutrition and Food Science,University of Bonn,D-53115 Bonn,Germany
| | - A Marcos
- 21Immunonutrition Research Group,Department of Metabolism and Nutrition,Institute of Food Science,Technology and Nutrition (ICTAN),Spanish National Research Council (CSIC),E-28040 Madrid,Spain
| | - F J Sánchez-Muniz
- 22Departamento de Nutrición, Facultad de Farmacia,Universidad Complutense de Madrid,28040 Madrid,Spain
| | - L A Moreno
- 1Growth Exercise, Nutrition and Development (GENUD) Research Group,Universidad de Zaragoza, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria de Aragón (IIS), 50009 Zaragoza,Spain
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