Abstract
BackgroundUnhealthy diet, especially consumption of trans fatty acids (TFAs), is a known risk factor for cardiovascular disease (CVD), a leading cause of death in Austria. In 2009, Austria introduced a law regulating the content of TFAs in foods. The aim of this study was to assess the impact of the TFA regulation on CVD-related outcomes.MethodsThe study evaluated the TFA regulation as an intervention in a natural experiment. Two study periods were assessed: pre-intervention (1995–2009) and post-intervention (2010–14). The study compared the age-standardized death rates per 100 000 population for CVD outcomes with those of a ‘synthetic’ international comparator population, created from data of OECD countries where TFA regulation has not been implemented, but where the population is otherwise comparable.ResultsThere was a continuous decrease in CVD-related mortality throughout the study period in both the synthetic international comparator population, as well as in the adult Austrian population, with no significant change in this trend observed as an effect of TFA regulation.ConclusionsWhilst the results are counterintuitive, given the established link between TFA consumption and an increased risk of CVD, there are many possible explanations: high prevalence of tobacco smoking, changes in TFA content in foods due to international guidance as opposed to formal regulation and a beneficial impact of TFA regulation on sub-groups of the population that might not be detected with nationally aggregated data. However, reduction in TFAs should still be considered an important part of risk factor reduction for CVD and other non-communicable diseases.
Highlights
A growing number of health problems [such as cardiovascular diseases (CVD), obesity, hypertension, stroke, type II diabetes mellitus, chronic kidney disease, cognitive insufficiency, atrial fibrillation] are caused or influenced by dietary patterns through adverse effects on glucose-insulin homeostasis, oxidative stress, inflammation, endothelial health, hepatic function, adipocyte metabolism, visceral adiposity etc.[1,2] The cardio-metabolic consequences of different dietary patterns and nutrient intakes have been researched to varying degrees, using a variety of methods, including interventional trials, prospective cohorts and randomized controlled trials.[2]
We aimed to investigate if these regulations led to a significant reduction in cardiovascular outcomes such as CVD and mortality due to coronary heart disease (CHD) in Austria
A comparison of Austrian data for all-cause mortality as well as CVD and CHD specific mortality and synthesized data for synthetic Austria is shown in figure 1, where both the comparison as well as plotted gaps may be seen
Summary
A growing number of health problems [such as cardiovascular diseases (CVD), obesity, hypertension, stroke, type II diabetes mellitus, chronic kidney disease, cognitive insufficiency, atrial fibrillation] are caused or influenced by dietary patterns through adverse effects on glucose-insulin homeostasis, oxidative stress, inflammation, endothelial health, hepatic function, adipocyte metabolism, visceral adiposity etc.[1,2] The cardio-metabolic consequences of different dietary patterns and nutrient intakes have been researched to varying degrees, using a variety of methods, including interventional trials, prospective cohorts and randomized controlled trials.[2]. Especially consumption of trans fatty acids (TFAs), is a known risk factor for cardiovascular disease (CVD), a leading cause of death in Austria. Results: There was a continuous decrease in CVD-related mortality throughout the study period in both the synthetic international comparator population, as well as in the adult Austrian population, with no significant change in this trend observed as an effect of TFA regulation. Conclusions: Whilst the results are counterintuitive, given the established link between TFA consumption and an increased risk of CVD, there are many possible explanations: high prevalence of tobacco smoking, changes in TFA content in foods due to international guidance as opposed to formal regulation and a beneficial impact of TFA regulation on sub-groups of the population that might not be detected with nationally aggregated data. Reduction in TFAs should still be considered an important part of risk factor reduction for CVD and other non-communicable diseases
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