Trans fatty acids (TFA)
The Institute of Food Science & Technology
(IFST) Information Statement, November
2004
www.ifst.org
SUMMARY
Trans fatty acids,
like saturated fatty acids (SFA), raise LDL (or “bad”)
cholesterol levels in the blood, thereby increasing the risk
of coronary
heart disease (CHD).
While there is no evidence of risk at current UK levels of
intake, and the reduction of the intake of energy from fat,
including from saturated fatty acids (SFA), is of major importance,
IFST supports the WHO recommendations and subsequent recommendations
from the UK Food Standards Agency (FSA), the European Food
Safety Authority (EFSA) and authorities elsewhere, that manufacturers
should reduce the levels of TFA arising from hydrogenation;
and notes the progress that industry has made in that direction.
Consumption in the UK has been declining (Hulshof, 1999).
While that statement sums up the present state of knowledge,
scientists have to act on existing knowledge while recognising
that further research will bring new information and knowledge,
which may in turn lead to revised conclusions. IFST continues
to support the need for continuing research in this whole
area. |
What are trans
fatty acids?
Saturated fatty acids have a chain
of carbon atoms joined by single bonds, allowing for rotation
about the bonds. In unsaturated fatty acids the double bond (or
bonds) restricts rotation. Therefore an unsaturated acid with
one double bond can exist in two forms. The cis or z form (z
for zusammen - German for together) has the two parts of the
carbon chain bent towards each other and the trans or e form
(e from entgegen German for opposed) has the two parts of the
chain almost linear. The trans fatty acids are therefore rather
similar in conformation and behaviour to the saturated acids.
The structure of saturated and unsaturated chemical bonds is represented
in the diagram below. (source: US FDA)
|
Saturated
Fatty Acid
|
Unsaturated
Fatty Acid
(cis fatty acid)
|
Trans Fatty
Acid |
|
|
|
|
When do TFA occur?
The unsaturated fatty acids of vegetable oils are normally in the
cis form. When an oil is partially hydrogenated some TFA are formed.
Furthermore, some double bonds move along the fatty acid chain,
so that a family of cis and trans isomers are formed.
Some of the unsaturated fats ingested by ruminants are partially
hydrogenated by bacteria in the rumen. In consequence, milk fat,
diary products and beef and mutton fat also contain cis and trans
fatty acid isomers, although the proportions are somewhat different.
The levels found are about 2-9%. In ruminants the main component
of the trans fatty acid is transvaccenic (1 8: 1 t 11) while in
processed fats it is elaidic (18:1t9).
Small amounts of TFA are also present in poultry and pork fat,
derived from the feed.
TFA are also formed during heating and frying of oils at high
temperatures.
How much TFA are consumed?
(Hulshof 1999) reported the results of the TRANSFAIR co-operative
study in 14 Western European countries of the dietary intake
of trans and other fatty
acids. For the UK the consumption estimate was based on a seven day survey
of 8000 households carried out by in 1994 (MAFF, 1995). 99 representative
foods were purchased in the period June 1995 to April 1996, representing
95 % of total mean fat intake, and analysed. The mean total fat intake was
77g/day, equivalent to 35.7% of energy intake. Mean TFA consumption was 2.8g/day
(= 1.3% of energy) and 28.5g/day (= 13.2% of energy) was as saturated fatty
acids.
A recent review by The Scientific Panel on Dietetic Products,
Nutrition and Allergies (NDA) of EFSA (2004) found that the intake
of TFA varies between countries, with lowest intakes found in the
Mediterranean countries. The contribution of TFAs to daily energy
intake (based on estimates for 1995/1996) is approximately 0.5-2.0%
in comparison with that of saturated fats which ranges from 10.5
to 18%. Recent dietary surveys indicate that TFA intakes have decreased
in a number of EU countries, mainly due to the reformulation of
food products (e.g. fat spreads) to reduce the TFA content. The
panel concluded that at equivalent dietary levels, the effect of
trans fatty acids on heart health may be greater than that of saturated
fatty acids. However, current intakes of trans fatty acids are
generally more than 10-fold lower than those of saturated fatty
acids whose intakes in many European countries exceed dietary recommendations.
The NDA panel also evaluated other health effects and concluded
that scientific evidence with regards to a possible relationship
of TFA intake with cancer, type 2 diabetes or allergies is weak
or inconsistent.
More recent dietary surveys have taken place
(including a recent study in the UK (Which? Magazine, October
2004) in which 30 groups
of foods were analysed but the TFA contents were expressed as “g
per portion” without any indication of the varying portion
sizes, and with no indication of the accompanying SFA
In some countries TFA levels in many edible fats for household
use have been reduced (e.g. Sweden, Becker, 2003; Norway, Norwegian
food composition table, 2001; Denmark, Hansen and Leth, 2000; Greece,
Triantafillou et al., 2003). In many cases, however, this has been
accompanied by an increased level of saturated fatty acids.
Which foods contribute to
the TFA intake?
In the TRANSFAIR survey the contributions (%) of various foods
to TFA intake was as follows:
| Milk and cheese |
18.8 |
Natural |
| Butter |
5.9 |
Natural |
| Eggs |
0.9
|
Natural |
| Meat and meat products
|
10.3 |
Natural |
| Oils and fats |
35.5 |
Mainly resulting from
hydrogenation |
| Biscuits and cakes |
16.5 |
Mainly resulting from
hydrogenation |
| Savoury pies, etc |
3.5 |
Mainly resulting from
hydrogenation |
| Chips, french fries |
4.5 |
Mainly resulting from
hydrogenation |
| Other |
4.1 |
Mainly resulting from
hydrogenation |
| Total |
100.0 |
. |
However, Innis et al (1999) carried out detailed fatty acid analysis
of over 200 foods for the purpose of determining the variability
in TFA content among foods within a product category, and the significance
of this variability to the estimation of TFA intakes from analysis
of dietary intake data.
The results showed that the amount of TFA varies considerably
among foods within a category, reflecting differences in the fats
and oils used in the manufacturing or preparation process. For
example, the range of TFA in 17 brands of crackers was 23 to 51%
total fatty acids, representing differences of from 1 to 13 g trans
fatty acids per 100 g cracker. The large errors that may arise
in estimates of the trans fatty acid intake of an individual are
illustrated by analyses of the potential TFA intake in a sample
diet, for each food as calculated using the minimum and maximum
values for trans fatty acids within a given category. The results
of these analyses show estimates of TFA intake from a low of 1.4
to 25.4 g a day for the same diet. This study showed that the wide
variability in TFA content of different foods may result in large
errors in the estimation of TFA intake of individuals and, potentially,
groups;and calls into question the reliability of published data
derived in that way.
What are the effects of TFA?
In most respects the digestion, absorption and metabolism of
TFA are the same as that of cis isomers. They are incorporated
into
lipids in the tissues, are present in human milk and are catabolised
in the same way as the cis isomers. Selective accumulation in
tissues does not occur. TFA are oxidised to provide energy. Although
there is some evidence from in vitro and animal studies that
conversion of essential fatty acids is inhibited by TFA, metabolism
of essential fatty acids is unlikely to be impaired by TFA when
intakes of essential fatty acids meet recommended levels.
Correlations have been unscientifically drawn between the increased
use of hydrogenation and the increase in coronary heart disease
(CHD) and other health problems. Such correlations have been criticised
(British Nutrition Foundation 1995). Correlation does not demonstrate
causation. However, concern has arisen from a number of investigations:
1. Adipose tissue samples of those who have died from CHD have
been found to have a higher concentration of TFA than average (Thomas
et al 1981).
2. Rats fed partially hydrogenated fish oils showed a proliferation
of peroxisomes in the liver (these are subcellular organelles which
provide additional oxidation capacity and are indicative of increased
free radical formation). However, since the same effect was observed
after feeding a longer chain length vegetable oil that did not
contain any TFA, it has been concluded that the effect was due
to the longer chain length of the fatty acid of fish oils.
3. Essential fatty acids (EFA) are transformed in the body by
a series of reactions into long chain polyunsaturated fatty acids
essential for development of the nervous system and eyesight. TFA
compete with EFA for the enzyme systems involved in these reactions.
High intakes of TFA have been shown to influence the metabolism
of EFA in experimental animals when the EFA intake was low. Frank
deficiency in EFA is only found in abnormal circumstances in human
adults. However, new-born infants, and especially if premature,
show borderline deficiency in EFA, and their TFA intake from the
mothers milk is related to her TFA intake. This consideration led
the Danish Nutrition Council to recommend the reduction of intakes
of TFA from vegetable fats to an average of 2g/day.
4. Suggestions that ingestion of TFA is implicated in coronary
heart disease (CHD) are based on changes induced in plasma cholesterol
levels. Within the range of intakes of 3 - 11 % of dietary energy
there is a dose-response relationship; an increase of 1 % of the
total energy intake (at the expense of oleic acid) increased low
density lipoproteins (LDL) by 0.04 mmol/l and decreased high density
lipoproteins (HDL) by 0.0 1 3 mmol/l. This amounts to a 1 % reduction
in HDL and a 1 % increase in LDL. TFA increase LDL to the same
extent as SFA, but reduce the beneficial HDL. One study (Thomas
et al, 1981) claimed that the level of TFA in adipose tissue was
associated with the evidence of CHD. However, the methodology in
this work has been criticised (Sanders, 1988) and Kritchevsky (1982)
concluded that TFA in hydrogenated vegetable fat when fed in amounts
up to 14% of energy intake were not atherogenic; nor were partially
hydrogenated fish oils (Sanders, 1988).
5. TFA can cause an increase in plasma lipoprotein (a) concentration
(especially in individuals with a high starting level) which is
considered by some workers in the field to be an independent risk
factor for CHD. Hu et al (1997) made an epidemiological assessment
drawn from data in the US-based Nurses' Health Study. The authors
prospectively studied 80,082 women who were 34 to 59 years of age
and had no known coronary disease, stroke, cancer, hypercholesterolemia,
or diabetes in 1980. Information on diet was obtained at base line
and updated during follow-up by means of validated questionnaires.
During 14 years of follow-up, they documented 939 cases of nonfatal
myocardial infarction or death from coronary heart disease. Multivariate
analyses included age, smoking status, total energy intake, dietary
cholesterol intake, percentages of energy obtained from protein
and specific types of fat, and other risk factors. Total fat intake
was not significantly related to the risk of coronary disease.
However they estimated that the replacement of 5 percent of energy
from saturated fat with energy from unsaturated fats would reduce
risk by 42 percent, and that the replacement of 2 percent of energy
from trans fat with energy from unhydrogenated, unsaturated fats
would reduce risk by 53 percent.
They concluded
"Our findings suggest that replacing saturated
and trans unsaturated fats with unhydrogenated, monounsaturated
and polyunsaturated
fats is more effective in preventing coronary heart disease
in women than reducing overall fat intake."
Commenting on these findings, Ronald Krauss,
M.D., chairman of the American Heart Association’s Nutrition
Committee stated
"the study supports previous evidence
that trans fats, like saturated fats, should be reduced in
the diet. But because Americans
consume more saturated fat than trans fat, the opportunities
to reduce saturated fat should still be emphasised."
The UK intakes reported above (mean total fat intake 77g/day,
equivalent to 35.7% of energy intake; mean TFA consumption 2.8g/day
(= 1.3% of energy); and mean saturated fatty acids intake 28.5g/day
(= 13.2% of energy)) suggest that here too the scope for reducing
the intake of saturated fatty acids should continue to be emphasised.
It should be noted that aspects of the Hu et
al study have been
called into question. Ockene and Nicolosi (1998) have pointed out
some inconsistencies in data that suggest the possibility that
the method of assessing either the diet or exercise may be flawed,
and also the danger of drawing conclusions from a study in which
there was much lower risk of coronary heart disease (27 deaths
per 100,000 per year) in the group of women studied, who were all
nurses, than the overall risk in the population of women in the
United States (rates of death from heart disease among white women
45 to 64 years of age in the United States: 62.5 and 51.0 per 100,000
per year, respectively, in 1985 and 1989). Hegsted (1998) points
out that the range of total fat intake recorded in these studies
is limited and has little relevance to the protective effect of
really low fat diets. However, he suggests that, within these limits,
the composition of dietary fat, rather than the level, is of primary
importance.
6. There is conflicting evidence concerning the possible role
of TFA in breast cancer. As part of the EURAMIC study (European
Community Multicentre Study on Antioxidants, Myocardial Infarction,
and Breast Cancer) Kohlmeier et al (1997) investigated the relationship
between TFA and postmenopausal breast cancer in European populations
differing greatly in their dietary fat intakes. A case control
study using adipose tissue stores of TFA as a biomarker of exposure
was conducted. Subjects included 698 postmenopausal incident cases
of primary breast cancer and controls randomly drawn from local
population and patient registries, ages 50-74. Concentrations of
individual TFA in gluteal fat biopsies were measured in these women.
The adipose concentration of TFA showed a positive association
with breast cancer, not attributable to differences in age, body
mass index, exogenous hormone use, or socio-economic status. The
authors conclude that these findings suggest an association of
adipose stores of TFA with postmenopausal breast cancer in European
women, but point out that they require confirmation in other populations,
with concomitant consideration of the potential roles of dietary
saturated and monounsaturated fats.
7. However, Holmes et al (1999) reported on the Cohort Study (Nurses'
Health Study) conducted in the United States beginning in 1976.
A total of 88,795 women free of cancer in 1980 and followed up
for 14 years. Relative risk (RR) of invasive breast cancer for
an incremental increase of fat intake, was ascertained by food
frequency questionnaire in 1980, 1984, 1986, and 1990. A total
of 2956 women were diagnosed as having breast cancer. Compared
with women obtaining 30.1% to 35% of energy from fat, women consuming
20% or less had a multivariate RR of breast cancer of 1.15 (95%
confidence interval [CI], 0.73-1.80). In multivariate models, the
RR (95% CI) for a 5%-of-energy increase was 0.97 (0.94-1.00) for
total fat, 0.98 (0.96-1.01) for animal fat, 0.97 (0.93-1.02) for
vegetable fat, 0.94 (0.88-1.01) for saturated fat, 0.91 (0.79-1.04)
for polyunsaturated fat, and 0.94 (0.88-1.00) for monounsaturated
fat. For a 1% increase in energy from TFA, the values were 0.92
(0.86-0.98), and for a 0.1% increase in energy from omega-3 fat
from fish, the values were 1.09 (1.03-1.16). In a model including
fat, protein, and energy, the RR for a 5% increase in total fat,
which can be interpreted as the risk of substituting this amount
of fat for an equal amount of energy from carbohydrate, was 0.96
(95% CI, 0.93-0.99). In similar models, no significant association
of risk was evident with any major types of fat. They concluded
that they found no evidence that lower intake of total fat or specific
major types of fat was associated with a decreased risk of breast
cancer.
8. There is conflicting evidence about the
role of conjugated linoleic acid (CLA). In a review and meta-analysis,
in mouse feeding
trials at different total fat and different linoleic acid levels,
Ritskes-Hoitinga et al (1996) found that mean mammary tumour incidence
was higher and mean onset time shorter in the four high-fat groups
than in the low-fat groups. However, no (linear) dose-response
relationship between dietary linoleic acid and mammary tumour incidence
and latency period was observed. This indicates that a higher dietary
linoleic acid does not increase the incidence or shorten the latency
period of breast cancer in the Balb/c-MMTV mouse strain at two
different dietary fat levels. Zock and Katan (1998) concluded that
'controlled studies of coronary artery disease in men did not,
except for one study, show an increased cancer incidence after
consumption of diets with a very high linoleic acid content for
several years. Animal experiments indicated that a minimum amount
of linoleic acid is required to promote growth of artificially
induced tumors in rodents; but above (sic - they obviously mean "below")
this threshold, linoleic acid did not appear to have a specific
tumor-promoting effect. Although current evidence cannot exclude
a small increase in risk, it seems unlikely that a high intake
of linoleic acid substantially raises the risks of breast, colorectal,
or prostate cancer in humans. Conversely, however, Cesano et al
(1998) determined the effect of three different diets on the local
growth and metastatic properties of DU-145 human prostatic carcinoma
cells in severe combined immunodeficient (SCID) mice. Animals were
fed a standard diet or diets supplemented with 1% linoleic acid
(LA) or 1% conjugated linoleic acid (CLA) for 2 weeks prior to
subcutaneous (s.c.) inoculation of DU-145 cells and throughout
the study (total of 14 weeks). Mice receiving LA-supplemented diet
displayed significantly higher body weight, lower food intake and
increased local tumour load as compared to the other two groups
of mice. Mice fed the CLA-supplemented diet displayed not only
smaller local tumours than the regular diet-fed group, but also
a drastic reduction in lung metastases. It appears from Cezano
et al, that one particular TFA has anti-cancer activity. The acid
concerned is CLA, which is produced by the anaerobe butyrivibrio
fibrisolvens in the cow's rumen, and hence found in milk. The main
CLA isomer is cis-9, trans 11, with lesser amounts of trans 10,
cis 12 octadecadienoic acid (Parodi, 1997). The CLA content of
milk lies between 0.24 and 2.81% and is highest when the animals
are pasture fed..
A very thorough consideration of the health effects and implications
of TFA consumption is given in the July 2004 Opinion of the EFSA
Scientific Panel on Dietetic Products, Nutrition and Allergies
Trans fatty acid legislation
On 11 July 2003, the US Food and Drug Administration
(FDA) published a final rule in the Federal Register that amended
its regulations
on food labelling to require that trans fatty acids be declared
in the nutrition label of conventional foods and dietary supplements
(68 FR 41434). This rule will take effect on 1 January 2006. In
August 2003 FDA issued a detailed guidance document on interpretation
of the regulations “Guidance for Industry: “Food Labeling:
Trans Fatty Acids in Nutrition Labeling, Nutrient Content Claims,
and Health Claims”.
In March 2003, following notification in 2002, the Danish food
authorities, on the grounds that the measure was justified on public
health grounds and was aiming at minimising the risk of cardiovascular
disease, adopted legislation which introduced, with effect from
1 June 2003, a limit on the level of TFA, not more than 2 g of
TFA per 100 g of fats or oil in the product as sold to the final
consumer. This restriction would not apply to naturally occurring
TFA in animal fats, in oils and all processed foodstuffs containing
fats and oils as ingredients and conjugated linoleic acid (CLA).
Apart from this no legislation exists in the EU, or in USA, limiting
the level of TFA in food. Following the notification by the Danish
authorities for the proposed measure some EU Member States made
comments on the proposal and it emerged that views differed on
this issue. Certain Member States considered that the level of
trans fatty acids in foodstuffs should be restricted as much as
possible. Other Member States did not consider there was evidence
that TFA consumed in a varied diet give rise to health problems.
Several Member States considered that the issue should be discussed
at the European Community level. In view of the divergent opinions
of the Member States and the Community interest in this matter
the European Commission decided to seek the opinion of the European
Food Safety Authority.
Trans fatty acid analysis
The EFSA Scientific Opinion (2004) states
TFA may be measured in a wide range of food products by infra
red spectroscopy, which estimates total non-conjugated TFA, or
by gas chromatography or high pressure liquid chromatography, which
can measure individual TFA with a high degree of precision. At
present, there are no methods of analysis applicable to a wide
range of foods that can distinguish between TFA which are naturally
present in foods (e.g. in ruminant products) and those formed during
the processing of fats, oils or foods. This is because of the overlap
in TFA profiles of ruminant fats and hydrogenated oils and the
varying proportions of TFA isomers among different hydrogenated
fats.
According to Leatherhead Food International:
TFA can be determined simply by infrared analysis, although this
is generally not accurate below 5%, and may be subject to interferences.
Leatherhead Food International uses GC analysis of fatty acid methyl
esters (FAMES), which is more accurate. Where there are high levels
of trans fatty acids present, it can be difficult to quantify the
trans compounds because of interferences from cis fatty acids in
the sample. In this case, silver-ion chromatography is used to
separate the trans and cis isomers, and the trans isomers are then
re-analysed by GC. The combination of the data from the two GC
analyses is then used to provide a value for the TFA content.
Comparative studies of the two analytical methods have shown that
the GC based analysis generally provides the more accurate determination
of the TFA content of a sample.
General Comment
Recommendations from a number of authoritative bodies have been
published (for example UK Department of Health 1994, WHO 1994,
BNF 1995, US FDA 2003, UK Food Standards Agency 2004). The consensus
is that, although the risk to health of TFA intake at average
consumption levels is small, the intake should not be increased.
A recommendation of the WHO report was that:
"food manufacturers should reduce the
levels of trans isomers of fatty acids arising from hydrogenation."
There is clear evidence that in the UK (and elsewhere in Europe)
the industry has responded positively to the various recommendations
(MAFF 1990, Hulshof 1999). Further reductions in TFA have been
effected in major brands of margarine in the UK since the Hulshof
survey. For example some soft margarines had 8-12% TFA in 1994
and now have less than 1%, while TFA in packet margarines have
been reduced from 18-26% to 10-12% (stated in a paper by A Baldock,
at SCI Oils and Fats group meeting on Hydrogenation, 26 February
1998). Reduction in TFA can be effected by modifying the conditions
during the hydrogenation process. In addition, interesterification
can be used to raise the melting point of fats without affecting
the degree of saturation or causing significant isomerisation.
Another reported technique is complete hydrogenation of a small
proportion of the oil, which thus provides a matrix for the unhydrogenated
greater part, resulting in the desired physical properties with
much lower TFA than if all the oil were partially-hydrogenated.
IFST continues to support the need for continuing research in
this whole area.
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Copyright © 2004 by the Institute of Food
Science & Technology, 5 Cambridge Court, 210 Shepherd's Bush
Road, London W6 7NJ, UK.
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