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expert reaction to study estimating the effects of banning trans fats in England on numbers of heart deaths, and accompanying editorial

An article and an editorial in The BMJ both address the issue of trans fats public health, with the article reporting that bans or labelling or food with trans fats would reduce deaths from coronary heart disease, inequality from mortality and save money.

 

Dr Alison Tedstone, chief nutritionist at Public Health England, said:

“We know that trans fats are harmful to health, but UK consumption is already well within recommended levels and is falling. The majority of trans fat in our diets comes from natural sources in meat and milk.

“The bigger issue is that we are all consuming too many calories and too much saturated fat and sugar leading to weight gain and obesity which increases your risk of heart disease and type 2 diabetes.”

Notes to editors:

  • In 2007 SACN recommended that intake of trans fats should not exceed 2% daily energy (kcal) intake.
  • Average intake of trans fats for adults 19-64 years is 0.7% of daily energy (kcal) intake. This reflects the efforts of food manufacturers and retailers in the UK to remove artificial trans fats from their products.
  • Average intake of saturated fats for adults 19-64 years is 12.6% of daily energy (kcal) intake.
  • The official dietary recommendation for saturated fat is to consume no more that 10% of daily energy (kcal) intake.

 

Prof. Peter Weissberg, Medical Director, British Heart Foundation, said:

“There is no question that the trans fats, being added by the food industry to make their products more appealing, increase a person’s risk of coronary heart disease, stroke and type 2 diabetes. Trans fats have no known health benefits but have clear health risks. This study compares the likely health benefits of three public health policies to limit the level of trans fats that the population eats and concludes, not surprisingly, that a total ban on industrial trans fats would be the most effective. Even though England has made steps towards reducing the levels of trans fats in our diets, other countries are well ahead of us.”

 

Prof. Tom Sanders, Professor emeritus of Nutrition and Dietetics, King’s College London, said:

“The claim that a ban on trans fats in England will prevent 7,200 deaths between 2015-2020 is flawed because industrial trans fats are virtually absent from UK diets. The higher intakes of trans fats in low income groups can mainly be explained by their higher consumption of full fat milk, butter and fatty ruminant meat products. Naturally occurring sources of trans fats are not associated with increased risk of coronary heart disease.”

 

Prof. Christine Williams, Professor of Human Nutrition, University of Reading, said:

“The authors have used a highly sophisticated approach to solve a problem that no longer exists, since in 2015 there are virtually no industrial trans fats in the UK food chain, with total trans fat intake levels now averaging 0.6% of energy compared with double that in 2001/2. Virtually all the trans fat eaten in the UK today represents  trans fats from ruminant meat and dairy due to removal of industrial trans fat from the UK food chain by government supported action from the food industry.

“The data used in the modelling are flawed due to biased data; the authors have used historical dietary data for the low income group (2003/5 diet assessments for the 2007 report), but recent dietary data for ‘estimating’ trans fat intakes in average and high income groups (2011/12 measurements for 2014 NDNS). The differences in intake they have used are an artefact of the different time points at which the two dietary surveys were undertaken for low income group (2007) versus the whole UK (2014) over which time period average trans fat intakes fell by over 50%.

“There was no evidence from the low income survey of 2007 that low income groups had higher levels of industrial trans fat than other income groups at that time – and since the removal of trans fat from the food chain has been applied across the full range of foods eaten, the fall in trans fat in low income groups will have been the same as in other income groups. Therefore, statements the authors have made about differences in dietary trans intakes for low and high income groups have no basis in fact; the assumptions made nullify the modelled outcomes.”

 

Dr Gavin Sandercock, Senior Lecturer in Clinical Physiology (Cardiology), University of Essex, said:

“How was the 7,200 figure arrived at, and were appropriate statistical analyses used? This figure is ‘modelled’ on figures from the National Dietary survey and it has quite a few assumptions. Most of the data come from other countries, particularly Denmark where a similar ban has already been brought into place. Although Denmark has greatly reduced rates of cardiovascular disease in the population, the authors point out that we can’t tell how much of the reduction was due to trans fats. The costs to industry and savings to the NHS are also modelled.

“This is not a study on people in England and is not a trial. While it is robust science, modelling of this type always has a number of assumptions. The assumptions are based largely around industry taking action through labelling of foods (which is already quite common) and through reformulation. This would be costly to the food industry and likely cause a knock-on effect for food prices. Most benefits from reformulation would be seen in the least well-off members of society whose diet tends to be higher in trans fats already but would have little benefit for the majority of the population. The 7,200 figure is not actually a very big effect – it is less than a fifth of the potential benefits of regular exercise, as outlined in a recent study showing the potential benefits of getting people to walk for 20 minutes per day, which could save 37,000 lives.

“The study focusses mainly on processed foods, such as cakes, biscuits and confectionary. While it does account for sources of trans-fats such as repeatedly-used cooking oils in restaurants and particularly take-always, it’s important to note that repeated home frying is also a source of trans fats.

“The idea of reformulating foods is made to sound quite simple – the authors say that there would be no need to add saturated fats to make up for the loss of trans fats.  However, recent studies have suggested that intake of saturated fats may not be strongly associated with heart disease and food manufacturers would still need to add something to foods to make up for the trans fats.

“There is no doubt that trans fats are toxic, cause heart disease and that we are better off without them. But their place in food manufacturing is longstanding and they will need to be replaced. Previously, when reformulating to make ‘low fat’ versions of processed food, manufacturers added sugars for bulking and taste, for example, although it’s important to note that there is no link between sugar intake and heart disease – the current debate over sugar contributed to by Jamie Oliver might cause even more confusion in food choices, particularly for those on lower incomes.”

 

Dr Tim Chico, Reader in Cardiovascular Medicine / consultant cardiologist, University of Sheffield, said:

“Although there is debate about whether or not saturated fat (such as fat from animal and dairy sources) is as bad as previously suggested, it seems clear that artificially manufactured trans fats, whose use only benefits the food industry, increase the risk of cardiovascular disease. Countries such as Denmark that have legislated to reduce trans fat intake have seen a reduction in rates of cardiovascular disease. If I know a food contains high levels of trans fats, then I don’t eat it.

“This study estimates how many lives might be saved by various ways to reduce trans fats in the diet. Unsurprisingly, a total ban would be the most effective way to do this, compared to labelling, or only banning restaurants. It is very hard to estimate exactly how many lives would be saved, or how much this would cost, although the study uses the best evidence and methods to calculate these estimates. The bottom line from this study is that a ban on trans fats would save a significant number of lives (in the thousands, not hundreds) and actually save public money. This does not even account for the emotional costs to patients and families who have suffered the effects of heart disease.”

 

*Study: ‘Potential of trans fats policies to reduce socioeconomic inequalities in mortality from coronary heart disease in England: cost effectiveness modelling study’ by Kirk Allen et al. published in the BMJ on Tuesday 15 September 2015.

ǂEditorial: ‘Dietary fats, health, and inequalities’ by J Lennert Veerman published in the BMJ on Tuesday 15 September 2015.

 

Declared interests

Prof. Tom Sanders: “I was a member of the FAO/WHO Joint Expert Committee that recommended that TFAs be removed from the human food chain. I have previously acted as a member of the Global Dairy Platform Scientific Advisory Panel and I am a member of the Programme Advisory Committee of the Malaysian Palm Oil Board. In the past I have acted as a consultant to Archer Daniel Midland Company and received honoraria for meetings sponsored by Unilever PLC. My research on fats was funded by Public Health England/Food Standards Agency.”

Prof. Christine Williams: Member of the governing bodies of the IFR, the BNF, the SRUC; chair of the BBSRC Food Security  and Agriculture Strategy Advisory Panel; lead member of the writing group for the  FSA report on ‘Trans fats and human health’, 2007. Previous research funding from Unilever, Hoffman La Roche and Nestle. No personal honoraria received from the food industry or related bodies.

Dr Tim Chico: “I’m a committee member and Treasurer of the British Atherosclerosis Society, a registered charity established in 1999 with the aim of promoting UK atherosclerosis research.”

None others received.

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