1. Christine Williams Reading University 12 December 2007

2. Overview Trans fatty acids, dietary sources, current levels, recent changes in intakes

3. Overview Trans fatty acids, dietary sources, current levels, recent changes in intakes Impacts on human health- CHD, cancers, type 2 diabetes, weight gain, fetal development

4. Overview Trans fatty acids, dietary sources, current levels, recent changes in intakes Impacts on human health- CHD, cancers, type 2 diabetes, weight gain, fetal development Epidemiology (disease end points), human dietary intervention studies (biomarker end points)

5. Overview Trans fatty acids, dietary sources, current levels, recent changes in intakes Impacts on human health- CHD, cancers, type 2 diabetes, weight gain, fetal development Epidemiology (disease end points), human dietary intervention studies (biomarker end points) Predicted disease risk reduction for further reduction in trans fatty acid intakes

6. Trans fatty acids (FA) and health CHD risk is moderately increased at levels of intake over the range or slightly higher than UK intakes. Plausible mechanism via increased LDL and decreased HDL

7. Trans fatty acids (FA) and health CHD risk is moderately increased at levels of intake over the range or slightly higher than UK intakes. Plausible mechanism via increased LDL and decreased HDL Cancers – epidemiological evidence weak; no plausible mechanism

8. Trans fatty acids (FA) and health CHD risk is moderately increased at levels of intake over the range or slightly higher than UK intakes. Plausible mechanism via increased LDL and decreased HDL Cancers – epidemiological evidence weak; no plausible mechanism Diabetes- epidemiology limited and inconsistent data. Intervention studies either negative or used un physiological levels

9. Trans fatty acids (FA) and health CHD risk is moderately increased at levels of intake over the range or slightly higher than UK intakes. Plausible mechanism via increased LDL and decreased HDL Cancers – epidemiological evidence weak; no plausible mechanism Diabetes- epidemiology limited and inconsistent data. Intervention studies either negative or used un physiological levels Weight gain- small number of studies. Estimated impact of 1% energy as trans was 0.5-1kg/ 8 years

10. Trans fatty acids (FA) and health CHD risk is moderately increased at levels of intake over the range or slightly higher than UK intakes. Plausible mechanism via increased LDL and decreased HDL Cancers – epidemiological evidence weak; no plausible mechanism Diabetes- epidemiology limited and inconsistent data. Intervention studies either negative or used un physiological levels Weight gain- small number of studies. Estimated impact of 1% energy as trans was 0.5-1kg/ 8 years Fetal development- studies poorly designed, failed to control for confounding factors

11. Evidence CHD Seven of 10 prospective epidemiological studies show positive association with CHD risk (1% energy trans increase risk by 12.5%)

12. Evidence CHD Seven of 10 prospective epidemiological studies show positive association with CHD risk (1% energy trans increase risk by 12.5%) Controlled interventions consistently show trans FA increase LDL and decrease HDL. Trans FA the only fat shown to reduce HDL

13. Epidemiology: trans and CHD

14. Health effects – conclusions Sufficient evidence to estimate risk of CHD arising from trans FA intakes.

15. Health effects – conclusions Sufficient evidence to estimate risk of CHD arising from trans FA intakes. If all individuals consumed < 1% energy as trans FA the reduction in risk CHD = 5-7.5%

16. Health effects – conclusions Sufficient evidence to estimate risk of CHD arising from trans FA intakes. If all individuals consumed < 1% energy as trans FA the reduction in risk CHD = 5-7.5% Likely to be over estimated due to extrapolation from much higher levels than UK intakes and recent reductions in intakes

17. Health effects – conclusions Sufficient evidence to estimate risk of CHD arising from trans FA intakes. If all individuals consumed < 1% energy as trans FA the reduction in risk CHD = 5-7.5% Likely to be over estimated due to extrapolation from much higher levels than UK intakes and recent reductions in intakes Insufficient evidence for other diseases. Need to monitor effects on insulin/ diabetes and genotype dependent prostate cancer

18. Natural versus synthetic trans Trans FA formed in rumen by action of gut bacteria Found in milk, milk products cheese, beef, lamb Main trans FA is vaccenic acid 18;2, n-7 NATURAL

19. Natural versus synthetic trans Trans FA formed in rumen by action of gut bacteria Found in milk, milk products cheese, beef, lamb Main trans FA is vaccenic acid 18;2, n-7 Trans FA formed during chemical hydrogenation of vegetable oils to form solid and semi solid fats Found in margarines, cakes, biscuits, fries Main trans FA is elaidic acid 18,2-n-9 NATURALSYNTHETIC

20. Are synthetic trans FA more harmful than natural form? Early epidemiological studies suggested effects on CHD were due to trans from margarines, biscuits etc but not milk, cheese, ruminant meats Later studies have not reported on different effects of the two types of trans FA No evidence form metabolic studies to suggest the two forms differ in their effects on lipoproteins