High Trans Fatty Acids Research Articles

Abstract MP023: Novel Patterns of Circulating Fatty Acids and Risk of Cardiovascular Disease: the Cardiovascular Health Study

Background: Circulating fatty acids (FA) reflect complex interrelations of diet and metabolism. Few studies have evaluated circulating FA as patterns related to cardiovascular diseases (CVD). Methods: We applied principal component analysis (PCA) to 39 plasma phospholipid FA measured in 2,972 older adults (mean age=72.1) at baseline (1992) in the Cardiovascular Health Study, and derived FA patterns. We evaluated prospective associations of identified FA patterns with 14-year incidence of CVD, adjudicated by centralized committee, using multivariate Cox proportional hazards corrected for regression dilution bias. The CHS-derived FA patterns were evaluated in a separate cohort for associations with angiographically-defined atherosclerosis progression over 3.5 years in 1,912 coronary segments of 228 postmenopausal women (mean age=65.4) with established CHD, including FA in phospholipids, triglycerides, and cholesteryl esters. Results: Three distinct patterns were identified, that we characterized as having higher trans FA (TFA pattern), de novo lipogenesis FA (DNL pattern), and dairy and long-chain monounsaturated FA (dairy-LCMUFA pattern). During 32,265 person-years, 780 CVD events occurred, including 512 CHD and 346 stroke. The TFA pattern was associated with higher CVD risk (HR for quintiles 5 vs. 1=2.47 [95% CI 1.35–4.51]; p trend=0.006) (Figure), primarily due to stroke (HR=4.68 [1.85–11.8]; p trend=0.003) but not CHD (HR=1.08 [0.50–2.32]; p trend=0.6). The DNL and dairy-LCMUFA patterns were not associated with CVD, or with CHD or stroke examined separately (p>0.1). In the second cohort, the TFA pattern, but not the other 2 patterns, in all lipid compartments was positively associated with progression of coronary stenosis (p trend<0.05). Conclusions: Our results suggest PCA can derive informative FA patterns for assessing disease risk. A pattern mainly reflecting higher trans FA levels is linked to higher risk of stroke in older adults, and coronary stenosis progression in women with CHD.

Dietary transfatty acids and cancer risk

This study assesses the association between dietary transfatty acid (TFA) intake and the risk of selected cancers. Mailed questionnaires were completed between 1994 and 1997 in eight Canadian provinces by 1182 incident, histologically confirmed cases of the stomach, 1727 of the colon, 1447 of the rectum, 628 of the pancreas, 3341 of the lung, 2362 of the breast, 442 of the ovary, 1799 of the prostate, 686 of the testis, 1345 of the kidney, 1029 of the bladder, 1009 of the brain, 1666 non-Hodgkin's lymphomas, 1069 leukemias, and 5039 population controls. Information on dietary habits and nutrition intake was obtained using a food frequency questionnaire, which provided data on eating habits 2 years before the study. Odds ratios (OR) and 95% confidenc530e intervals (CI) were derived by unconditional logistic regression to adjust for total energy intake and other potential confounding factors. Dietary TFA were positively associated with the risk of cancers of the colon (OR: 1.38 for the highest vs. the lowest quartile), breast in premenopause (OR: 1.60), and prostate (OR: 1.42). There were a borderline association for pancreas cancer (OR: 1.38; P=0.06). No significant association was observed for cancers of the stomach, rectum, lung, ovary, testis, kidney, bladder, brain, non-Hodgkin's lymphomas, and leukemia, although the ORs for the highest quartile were above unity for all neoplasms considered, except testis. Our findings add evidence that high TFA is associated with an increased risk of various cancers. Thus, a diet low in transfat may play a role in the prevention of several cancers.

Trans fatty acid isomers and the trans-9/trans-11 index in fat containing foods.

To determine trans fatty acid (TFA) distribution of contemporary foods, especially regarding individual trans octadecenoic acids (trans C18:1), 339 German foods of six categories (semi-solid fats, deep-fried potato products, bakery products, confectioneries, instant products and butter) were analysed using two GC methods. Results showed a high variation of TFA content between and within the categories containing between 0 and 40.5% of FAME except in butter, which is a source of natural TFA. The mean TFA values were below 2.0% of FAME, however, bakery products contained 4.5% and butter fat 3.2%, respectively. In addition, the distribution of individual trans C18:1 differed. In samples containing ruminant fat (butter and various confectioneries), vaccenic acid (t11-C18:1, t11) predominated, while in foods containing industrially hydrogenated fats, elaidic acid (trans-9, t9-) and t10-C18:1 were the major trans isomers.. This was reflected by a low t9/t11 index of 0.3 and 0.5 in butter and ruminant fat containing confectioneries, respectively, whilst the highest index was observed in shortenings and deep-fried potato products at 5.2 and 6.8, respectively. In conclusion, the TFA content of foods available on the German market is generally declining, but substantial variations are present. The t9/t11 index could be used as an indicator to determine ruminant fat.Practical applications: A number of studies provide evidence that a high TFA intake, particularly of industrial origin, adversely affects human health. The TFA content of foods could be reduced due to the introduction of several mandatory regulations and modifications regarding the hydrogenation process of oils. The most abundant dietary TFA are the isomers of trans C18:1. Unfortunately, the differentiation of these isomers is not yet very common, though the trans C18:1 profile differs depending on its origin (bacterial hydrogenation in the rumen or industrial hydrogenation). To date, data for TFA content including the trans C18:1 profile of different food categories are limited. The present study confirmed that the TFA contents in German foods are declining. However, TFA are still elevated, especially in bakery products and confectioneries, which are produced using mainly industrial but also ruminant fats. Therefore, the t9/t11 index imparts important information on the source of TFA in processed foods.

The Role of Dietary Cholesterol and Transfatty Acids in the Aetiology of Gallstones. A UK Prospective Cohort Study (EPIC-Norfolk) Using 7-Day Food Diaries

Introduction Dietary cholesterol may prevent gallstone formation by upregulating the enzyme cholesterol 7-α hydroxlase (Cyp7A1), which converts cholesterol to primary bile acids and prevents biliary cholesterol supersaturation, a prerequisite for cholesterol stone formation. Trans fatty acids promote hyperinsulinaemia which inhibits Cyp7A1 and could promote gallstone disease. This study investigated dietary cholesterol and trans fatty acid intake on the risk of developing symptomatic gallstones, for the first time using 7-day food diaries (7-DFDs), the most accurate feasible method of estimating food intake in large studies. Methods 25 639 participants (56% women), aged 40–74 years were recruited into the European Prospective Investigation into Cancer-Norfolk (EPIC-Norfolk) with 23 658 completing 7-DFDs at enrolment. The cohort was monitored for 14 years for new symptomatic gallstones, with diagnoses confirmed by review of the clinical notes. The 7-DFDs recorded 1 week9s diet including food types, frequency of consumption, quantities and cooking methods. A representative sample of 3 970 and those with gallstone disease had their 7-DFDs coded by nutritionists using a computer program containing nutrient information on 11 000 food and 55 000 portion sizes. A cohort analysis used Cox regression to estimate sex specific HRs for developing gallstones for fifths of dietary cholesterol and trans fatty acid intake, adjusted for known risk factors: age, body mass index, energy, alcohol and physical activity in men and also parity and hormone replacement therapy use in women. Results 177 women (mean age of diagnosis 66.5 years SD 9.5 years) and 90 men (64.2 years SD 9.2 years) developed symptomatic gallstones. In women, increased dietary cholesterol was associated with a decreased risk of disease (highest vs lowest fifth, HR 0.52, 95% CI 0.31 to 0.86, per fifth increase HR 0.83, 95% CI 0.74 to 0.93, p for trend=0.002), with no effect in men (trend across fifths HR 0.92, 95% CI 0.78 to 1.08). Increased trans fatty acid intake in women increased the risk of disease (highest vs lowest fifth, HR 2.18, 95% CI 1.21 to 3.92, per fifth increase HR 1.17, 95% CI 1.02 to 1.35, p=0.023), with no effect in men (trend across fifths HR 1.01, 95% CI 0.84 to 1.23). Conclusion In women, low dietary cholesterol and high trans fatty acid intake increased the risk of developing symptomatic gallstones, for which there are plausible biological mechanisms. No effects were found in men, though this could be due to a lack of power with only half the number of cases diagnosed. Dietary cholesterol and trans fatty acids should be measured in future aetiological studies of gallstones.

The role of dietary cholesterol and transfatty acids in the aetiology of gallstones: a uk prospective cohort study (EPIC-Norfolk) using 7-day food diaries

IntroductionDietary cholesterol may prevent gallstone formation by upregulating the enzyme cholesterol 7-α hydroxlase (Cyp7A1), which converts cholesterol to primary bile acids and prevents biliary cholesterol supersaturation, a prerequisite for cholesterol...

Effect of trans-fatty acid intake on insulin sensitivity and intramuscular lipids—a randomized trial in overweight postmenopausal women

Intake of industrially produced trans-fatty acids (TFA) has been linked to increased risk of type 2 diabetes mellitus in observational studies. We investigated the causality of this association by examining if a high intake of TFA impairs measures of glucose homeostasis and induces intramuscular lipid deposition in abdominally obese women. In a double-blind, parallel dietary intervention study, 52 healthy but overweight postmenopausal women were randomized to receive either partially hydrogenated soybean oil (15 g/d TFA) or a control oil (mainly oleic and palmitic acid) for 16 weeks. Three markers of glucose homeostasis and 4 markers of lipolysis were derived from glucose, insulin, C-peptide, nonesterified fatty acid, and glycerol concentrations during a 3-hour frequent sampling oral glucose tolerance test. Intramuscular lipids were assessed by magnetic resonance spectroscopy. Forty-nine women completed the study. Insulin sensitivity (assessed by ISI composite), β-cell function (the disposition index), and the metabolic clearance rate of insulin were not significantly affected by the dietary intervention. Neither was the ability of insulin to suppress plasma nonesterified fatty acid and glycerol during oral glucose ingestion nor the intramuscular lipid deposition. In conclusion, high TFA intake did not affect glucose metabolism over 16 weeks in postmenopausal overweight women. A study population with a stronger predisposition to insulin resistance and/or a longer duration of exposure may be required for insulin sensitivity to be affected by intake of industrial TFA.

A high-fat challenge increases airway inflammation and impairs bronchodilator recovery in asthma

Dietary fat activates systemic innate immune responses, but the effect on airway responses is unknown. To examine effects of a high-fat versus low-fat meal on systemic and airway inflammation in asthma. Nonobese subjects with asthma were randomized to consume a high-fat (n= 19; 48% [49 g] fat) or low-fat (n= 18; 15% [3 g] fat) meal. Fourteen obese patients with asthma and 21 healthy controls also consumed a high-fat meal. Another group of patients with asthma consumed a high-trans (n= 5; 5.2 g trans fat) or nontrans (n= 5, <0.3 g trans fat) fatty acid meal. Lung function was measured at baseline (prebronchodilator) and 2, 3, and 4 hours after bronchodilator. Airway inflammation was assessed by using induced sputum cell counts and Toll-like receptor 4 mRNA expression by real-time PCR. Systemic inflammation was measured by ELISA quantification of plasma TNF-α, high-sensitivity C-reactive protein, and IL-6 concentrations. In patients with asthma, at 4 hours postmeal, increases in sputum % neutrophils and Toll-like receptor 4 mRNA expression were higher and increases in FEV(1)/forced vital capacity (FVC) were lower in the high-fat versus low-fat groups. Changes in plasma fatty acids correlated with changes in sputum % neutrophils and were negatively associated with changes in % FEV(1), % FVC, and FEV(1)/FVC. After the high-trans fatty acid meal, sputum % neutrophils were significantly higher than after the nontrans meal. A high-fat meal augments neutrophilic airway inflammation, with the effect dependent on the type of fatconsumed. Ahigh-fat meal also suppresses bronchodilator recovery in asthma. Modifying dietary fat intake may beuseful in asthma.

Physicochemical and textural properties of puff pastry margarines

AbstractIn this paper some physicochemical and textural characteristics of four puff pastry margarines are defined: MLT1 and MLT2 with low trans fatty acid (TFA) content, MLT3 with relatively low and MLT4 with high TFA content. Analyzing the solid trigliceride content (SFC), the crystallization kinetics in isothermal conditions and the margarine firmness, it is determined whether the technological characteristics of margarines (which are very important for puff pastry quality) are significantly changed due to TFA decrease in margarines. The highest SFC at 10, 20, 25 i 30°C have samples MLT1 and MLT4. Despite of significant differences in fatty acid composition of these margarines, SFC content at temperatures at 20, 25, and 30°C do not differ significantly, at the level of significance of 95% (p&gt;0.05). The SFC of MLT1 and MLT2 samples, which have practically the same fatty acid composition at every investigated temperature, statistically have significant difference (p&lt;0.05). The crystallization kinetics are in the range from 2.6 to 10.1% per min. The significance of the induction period at every observed samples is negligible. The average firmness of margarine samples MLT1, MLT2, MLT3, and MLT4 at 20, 25, and 30°C is significantly different (p&lt;0.05). The firmness changes of the samples MLT1 and MLT2 in the most important temperature interval for puff pastry production (between 20 and 30°C) are at level of 5 to 25%, and for margarine samples MLT3 and MLT4 these values reach even 70%.

Differential effect of corn oil-based low trans structured fat on the plasma and hepatic lipid profile in an atherogenic mouse model: comparison to hydrogenated trans fat

BackgroundTrans fat are not desirable in many aspects on health maintenance. Low trans structured fats have been reported to be relatively more safe than trans fats.MethodsWe examined the effects of low trans structured fat from corn oil (LC), compared with high trans fat shortening, on cholesterol and fatty acid metabolism in apo E deficient mice which is an atherogenic animal model. The animals were fed a high trans fat (10% fat: commercial shortening (CS)) or a low trans fat (LC) diet for 12 weeks.ResultsLC decreased apo B and hepatic cholesterol and triglyceride concentration compared to the CS group but significantly increased plasma total cholesterol and triglyceride concentration and fecal lipids with a simultaneous increase in HDL-cholesterol level, apo A-I, and the ratio of HDL-cholesterol to total cholesterol (HTR). Reduction of hepatic lipid levels by inclusion of LC intake was observed alongside modulation of hepatic enzyme activities related to cholesterol esterification, fatty acid metabolism and fecal lipids level compared to the CS group. The differential effects of LC intake on the plasma and hepatic lipid profile seemed to be partly due to the fatty acid composition of LC which contains higher MUFA, PUFA and SFA content as well as lower content of trans fatty acids compared to CS.ConclusionsWe suggest that LC may exert a dual effect on plasma and hepatic lipid metabolism in an atherogenic animal model. Accordingly, LC, supplemented at 10% in diet, had an anti-atherogenic effect on these apo E-/- mice, and increased fecal lipids, decreased hepatic steatosis, but elevated plasma lipids. Further studies are needed to verify the exact mode of action regarding the complex physiological changes and alteration in lipid metabolism caused by LC.

Trans fatty acids, insulin resistance and diabetes

The possible relationship between consumption of trans fatty acids (TFAs) and risk of insulin resistance or development of diabetes mellitus type II has been considered by a number of human and animal studies over the past decade. This review evaluates the evidence, and concludes that there is limited evidence for a weak association at high TFA intakes, but very little convincing evidence that habitual exposure as part of a standard western diet has a significant contribution to risk of diabetes or insulin resistance. The possibility of increased risk for individuals with particular genotypes (such as the FABP2 Thr54 allele) is of interest, but further work would be required to provide sufficient evidence of any association.

E0001 The effects of trans fatty acids on fatty acid constitution ratios of erythrocyte membrane in rabbits

ObjectiveTo investigate the influences of high trans fatty acids (TFA) intake on fatty-acid constitution ratios of erythrocyte membrane in rabbits.Method32 New Zealand white rabbits were randomly divided into four groups:...

Trans fatty acids and metabolic syndrome

There is a close relationship between high trans fatty acids intake and occurrence of metabolic syndrome. Trans fatty acids intake may lead to metabolic disorders. It affects lipid level, induces visceral obesity and insulin resistance, triggers systemic inflammation, and significantly increases cardiometabolic risks. If the chain of trans fatty acids-metabolic syndrome-cardiovascular disease is understood, a new effective way to prevent metabolic syndrome and cardiovascular events may be provided. Key words: Trans fatty acids; Metabolic syndrome; Insulin resistance; Visceral obesity; Cardiovascular disease

Rapid characterization and identification of fatty acids in margarines using horizontal attenuate total reflectance Fourier transform infrared spectroscopy (HATR-FTIR)

Fourier transform infrared spectroscopy (FTIR) with horizontal attenuated total reflectance (HATR) coupled to multivariate analysis was used to predict chemical composition, fatty acid profile, nutritional relationships between fatty acids, and to identify trans fatty acids (TFA) of margarines. For model building and validation, a set of 42 margarines samples were analyzed in terms of fatty acid profile, total fat, moisture, and salt content. The quantitative models were based on incorporating the above chemical parameters of the different margarines and HATR-FTIR spectral information into the calibration model using chemometric analysis. Chemical parameters for total fat, moisture, and salt content ranged 39–84.5%, 14.5–59%, and 0.3–2.6%, respectively. Regarding fatty acids, the concentration of TFA, saturated fatty acid (SFA), monounsaturated fatty acid (MUFA), and polyunsaturated fatty acid (PUFA) ranged 0–34.06%, 17.17–54.20%, 15.26–34.49%, and 4.02–53.89% (g/100 g margarine), respectively. Principal components regression (PCR) and partial least square analysis (PLS) were used to inspect the variation within the sample set. The best model to predict the chemical composition was obtained using the algorithm partial least squares (PLS) with a R2 greater than 0.933 and SEC and SEP less than 1.294 and 1.406, respectively. The optimized SIMCA model used to identify high or low TFA content showed 100% correct classification rate of both margarines with less than 2.0 g TFA/100 g fat as more than 2.0 g TFA/100 g fat. Compared with traditional chemical analysis, the FTIR-HATR models analyzed margarines in minutes and directly in their neat form.

Lipid profiles and trans fatty acids in serum phospholipids of semi-nomadic Fulani in northern Nigeria.

The Fulani are semi-nomadic pastoralists of West Africa whose diet, culture, and economy are centred on cattle. Previous studies have shown that the Fulani of northern Nigeria derive 50% of their total calories from fat and 30% of their calories from milk, cheese, yogurt, and butter oil that contain significant amounts of trans fatty acids (TFAs), primarily vaccenic acid, which raise total serum cholesterol and low-density lipoproteincholesterol (LDL-C), and lower high-density lipoprotein-cholesterol (HDL-C). The study was conducted to know how the consumption of relatively large amounts of dairy products by adult Fulani affected the TFA content of their serum phospholipids. Blood samples were collected from 22 male and 29 female Fulani, aged 35-60 years, who were living in rural areas of Gombe state in northeastern Nigeria. The total serum phospholipid fraction was isolated, and its fatty acid composition was determined. Surprisingly, vaccenic acid was not detected, and three other TFAs--18:1-t6, 18:1-t9, and 18:2-t9,t12--together accounted for only 0.16% of the total fatty acid. The mean serum total cholesterol, LDL-C, and triglyceride concentrations of the subjects were within the normal range for populations in developed countries; however, at 32 mg/dL, the mean serum HDL-C concentration of the Fulani males was slightly below the lower limit of the reference range. No correlations were observed between the total TFA percentage or that of the three individual TFAs and any of the parameters of the serum lipid profile. These findings indicate that, with respect to TFAs at least, the fatty acid pattern of the serum phospholipids of Fulani pastoralists does not reflect the high TFA content of their traditional diet. Despite the consumption of rumenic acid-rich dairy products, for unknown reasons, the semi-nomadic Fulani manage to maintain a low level of TFAs in their blood and a relatively healthful serum lipid profile. While the mechanism that accounts for this disconnect between the consumption of TFAs by Fulani pastoralists and the proportion of TFAs in their serum phospholipids is obscure, possibilities include discrimination against rumenic acid during the process of triglyceride synthesis and chylomicron synthesis in the intestine and the preferential oxidation of TFAs by Fulani the people compared to other ethnic groups.

Effects of different levels of trans fatty acids and oxidised lipids in diet on cholesterol and cholesterol oxidation products formation in rabbit

The objective was to assess the effects of trans fatty acids and oxidised lipids, present in dietary fat by-products used in feeds, on cholesterol and oxycholesterols in meat, liver and plasma of rabbits. A palm fatty acid distillate, before and after hydrogenation ( trans fatty acid trial), and a sunflower–olive oil blend (70/30, v/v), before and after use in a commercial frying process (oxidised lipid trial), were used in experimental feeds (at 3%, w/w). High trans fatty acid and oxidised lipid diets caused significantly higher cholesterol and oxycholesterol levels in all tissues of rabbit (0.01 < p ⩽ 0.05). The content of oxycholesterols in rabbit meat, liver and plasma obtained from trans fatty acid experiments varied from 9 to 34 μg/100 g, 24 to 61 μg/100 g and 60 to 138 μg/dl, respectively, from low to high levels. In the oxidised lipid experiments, content of oxycholesterols varied from 16 to 52 μg/100 g, 14 to 108 μg/100 g and 52 to 269 μg/dl in meat, liver and plasma, respectively. As a consequence, meat products from rabbits fed a diet containing higher levels of trans fatty acids or oxidised lipids may result in higher intakes of cholesterol and oxycholesterols by humans.

Role of Estradiol, Progestins, Insulines and Adipocytokines in Breast Cancer Promotion in Post-Menopausal Women

Estrogens and artificial progestins used in hormone replacement therapy increase breast cancer risk. This seems to bedue to a promoting and not initiating effect. A synergic effect of estradiol and hyperinsulinism has been shown. Insulinplays a role in the increase of breast cancer risk when associated with android obesity, sedentariness, type II diabetes,and high glycemic index food, alcohol and trans fatty acids intake. Natural menopause induces insulin resistance anddoes not induce a risk decrease. The role of insulin gives a new outlook on the influence of HRT in breast cancer promotion:estradiol alone, which improves insulin-sensitivity, does not increase breast cancer risk. Artificial progestinsassociated with estrogens increase the risk, whereas estrogens associated with progesterone do not. This could be dueto the fact that artificial progestins increase insulin resistance, whereas natural progesterone does not. Adipose tissue,which is an endocrine gland, is insulin dependant. Breast cancer and its seriousness are correlated to adipocytokincirculating levels such as resistin, leptin, interleukin 1, adipocyte fatty acid-binding protein, and are inversely correlatedto the level of adiponectin. Insulin could play a synergic role with sexual steroids by a direct effect and by increasingadipose tissue secretions.

Intake of Trans Fatty Acid in Japanese University Students

Because trans fatty acids (TFAs) are a potent risk factor for coronary heart disease, it is important to know the amount of TFA consumed. We estimated TFA intakes of Japanese university students by direct measurement. Subjects included 118 students (57 males and 61 females) in two regions of Japan: Kanto (Tokyo area) and Okinawa. A dietary survey was conducted over six consecutive days using dietary records and photographic records. A single-day meal in the survey period was reproduced to measure TFA content by gas chromatography. The median values of TFA intakes (and energy percentage) estimated by the contents of reproduced meals for men were 0.43 g/d (0.22%) in Kanto and 0.30 g/d (0.14%) in Okinawa. Corresponding values for women were 0.49 g/d (0.29%) and 0.73 g/d (0.35%), respectively. Compared to the group with a low TFA intake, the subjects with a high TFA intake consumed significantly more energy from total fat and saturated fatty acids, and had a high ratio of TFA/linoleic acid. In addition, multiple regression analysis showed the intakes of TFA were positively associated with those of saturated fatty acids and groups of nonessential groceries such as cookies, cakes and pastries. In conclusion, the TFA intakes of these survey subjects were relatively lower than the WHO recommended energy ratio (<1%). However, nutritional education on dietary habits seems indispensable for those subjects who are consuming high volumes of TFA.

Improving Plasticity of Milk Fat for Use in Baking by Fractionation

AbstractMilk fat is soft with a low solids content at all temperatures up to 37 °C, which makes its usage limited. To extend its usage, the fat was fractionated to obtain stearin (St) with a 50–55% yield by dry fractionation. The stearin was found to contain an increased solids content at all temperatures and to have improved plasticity compared to its native fat. The physical properties of St were found to be similar to those of commercial bakery shortenings or vanaspati. The melting profiles and the solidification properties of milk fat St are similar to those of commercial bakery shortening. Also, St does not require extended stabilization or tempering, as it transferred to the most stable form quickly like commercial bakery fat. Milk fat St showed higher proportions of saturated fatty acids including those with short chains, compared to commercial vanaspati, the later having a high trans fatty acid content (15%). The olein obtained could also be used as a cooking medium or as a salad oil since it contains a lower solids content at ambient temperatures compared to its parent milk fat.

Erythrocyte fatty acid profiles can predict acute non-fatal myocardial infarction

The risk of CHD has been linked to n-3 and trans-fatty acids. The purpose of the present study was to evaluate the hypothesis that lower n-3 fatty acids and higher trans-fatty acids in erythrocytes are associated with an increased risk of acute non-fatal myocardial infarction (MI), and that fatty acid profiles can discriminate MI cases from controls. Fifty cases with acute non-fatal MI and fifty age- and sex-matched controls without MI were recruited. The Omega-3 Index (the sum of EPA and DHA in erythrocytes) was significantly lower in cases than controls (9.57 (SEM 0.28) v. 11.81 (SEM 0.35) %; P < 0.001), while total trans-fatty acids were significantly higher (1.01 (SEM 0.04) v. 0.56 (SEM 0.03) %; P < 0.001). The Omega-3 Index was associated with decreased risk of MI (OR 0.08 (95 % CI 0.02, 0.38); P = 0.001), while total trans-fatty acids were associated with an increased risk of MI (OR 72.67 (95 % CI 6.68, 790.74); P < 0.001). The area under the receiver operating characteristic curve of fatty acid profiles was larger than that for traditional risk factors, suggesting that fatty acid profiles make a higher contribution to the discrimination of MI cases from controls compared with modified Framingham risk factors. In conclusion, a higher Omega-3 Index and lower trans-fatty acids in erythrocytes are associated with a decreased risk of MI. Furthermore, fatty acid profiles improve discrimination of acute non-fatal MI compared with established risk factors.

The Preventable Causes of Death in the United States: Comparative Risk Assessment of Dietary, Lifestyle, and Metabolic Risk Factors

Knowledge of the number of deaths caused by risk factors is needed for health policy and priority setting. Our aim was to estimate the mortality effects of the following 12 modifiable dietary, lifestyle, and metabolic risk factors in the United States (US) using consistent and comparable methods: high blood glucose, low-density lipoprotein (LDL) cholesterol, and blood pressure; overweight-obesity; high dietary trans fatty acids and salt; low dietary polyunsaturated fatty acids, omega-3 fatty acids (seafood), and fruits and vegetables; physical inactivity; alcohol use; and tobacco smoking. We used data on risk factor exposures in the US population from nationally representative health surveys and disease-specific mortality statistics from the National Center for Health Statistics. We obtained the etiological effects of risk factors on disease-specific mortality, by age, from systematic reviews and meta-analyses of epidemiological studies that had adjusted (i) for major potential confounders, and (ii) where possible for regression dilution bias. We estimated the number of disease-specific deaths attributable to all non-optimal levels of each risk factor exposure, by age and sex. In 2005, tobacco smoking and high blood pressure were responsible for an estimated 467,000 (95% confidence interval [CI] 436,000-500,000) and 395,000 (372,000-414,000) deaths, accounting for about one in five or six deaths in US adults. Overweight-obesity (216,000; 188,000-237,000) and physical inactivity (191,000; 164,000-222,000) were each responsible for nearly 1 in 10 deaths. High dietary salt (102,000; 97,000-107,000), low dietary omega-3 fatty acids (84,000; 72,000-96,000), and high dietary trans fatty acids (82,000; 63,000-97,000) were the dietary risks with the largest mortality effects. Although 26,000 (23,000-40,000) deaths from ischemic heart disease, ischemic stroke, and diabetes were averted by current alcohol use, they were outweighed by 90,000 (88,000-94,000) deaths from other cardiovascular diseases, cancers, liver cirrhosis, pancreatitis, alcohol use disorders, road traffic and other injuries, and violence. Smoking and high blood pressure, which both have effective interventions, are responsible for the largest number of deaths in the US. Other dietary, lifestyle, and metabolic risk factors for chronic diseases also cause a substantial number of deaths in the US.