Correspondence

Food Reformulations to Reduce Trans Fatty Acids

N Engl J Med 2010; 362:2037-2039May 27, 2010DOI: 10.1056/NEJMc1001841

Article

To the Editor:

Consumption of trans fatty acids raises levels of low-density lipoprotein cholesterol and triglycerides, lowers levels of high-density lipoprotein cholesterol, induces an inflammatory response, and even at low levels of intake (e.g., 2 to 4% of total calories) significantly increases the risk of coronary events.1,2 Efforts to reformulate foods to reduce trans fatty acid content can have substantial effects on health and are relevant to public health policy. Public campaigns and policy measures are motivating food manufacturers and restaurants to replace the trans fatty acids in foods (present largely because of the use of partially hydrogenated oils) with alternative fats. Concerns exist that in reformulating the foods manufacturers may replace the trans fat with saturated fat, in which case the combined content of these fats in the foods could remain about the same or even increase, mitigating health benefits.3 A recent analysis showed that selected products free of trans fat contained substantial amounts of saturated fat, suggesting that reformulations to reduce trans fat might not be achieving net reductions in combined levels of trans fat and saturated fat.4 In this study, however, the investigators did not evaluate actual product reformulations but simply compared different products from different manufacturers at one point in time. To our knowledge, no large-scale assessments have been performed to determine the extent to which U.S. companies are increasing the saturated fat content of foods when they are being reformulated to reduce the trans fat content or whether there is a variation between supermarket foods (which are required to carry labels showing nutrient content) and restaurant foods (for which nutrient labels are not required).

We investigated changes in the levels of trans fat and saturated fat in major brand-name U.S. supermarket and restaurant foods that were reformulated to reduce trans fatty acid content from 1993 through 2006 (first evaluation) and 2008 through 2009 (second evaluation). Our assessment was based on information from consumer magazines, health newsletters, a nonprofit organization database, and food-composition databases at the Food and Drug Administration. We identified 83 reformulated products (58 supermarket foods and 25 restaurant foods) (Figure 1Figure 1Content of Fatty Acids in 58 Supermarket and 25 Restaurant Food Products before and after Reformulation to Reduce Levels of Trans Fatty Acids., and the Supplementary Appendix, available with the full text of this letter at NEJM.org). Trans fat content was reduced to less than 0.5 g per serving in 95% of the supermarket products analyzed and 80% of the restaurant products analyzed; mean absolute reductions were 1.8 g per serving (84 percentage points) and 3.3 g per serving (92 percentage points), respectively. After reformulation, 65% of the supermarket products and 90% of the restaurant products had levels of saturated fat that were lower, unchanged, or only slightly higher (<0.5 g per serving) than before reformulation. The average content of saturated fat in supermarket foods increased slightly owing to increases in one third of the products analyzed; the average content of saturated fat in restaurant foods actually decreased. Reductions in levels of trans fat nearly always exceeded any increase in levels of saturated fat; after reformulation, the overall content of both fats combined was reduced in 90% (52 of 58) of the supermarket products and 96% (24 of 25) of the restaurant products, with average total reductions of 1.2 g and 3.9 g per serving, respectively.

No exhaustive national database exists of product-specific changes in trans fat and saturated fat over time; this analysis represents a broad new assessment of U.S. reformulations. According to our analysis, major brand-name reformulations generally reduced the trans fat content substantially without making equivalent increases in saturated fat content. In fact, in most restaurant foods, levels of saturated fat were also reduced. In most restaurant and supermarket foods, there was a reduction in the total combined level of trans fat and saturated fat. Whereas any reformulation that removed partially hydrogenated oils would be expected to produce health benefits (even if these oils were replaced with animal fats or tropical oils), reformulations that increased levels of cis unsaturated fats over saturated fats would maximize health benefits.2 Our results indicate that there is room for improvement in some reformulation strategies, especially for some supermarket foods. Our findings do not support concerns that voluntary or mandatory reductions in trans fat from partially hydrogenated oils would lead to broad increases in the saturated fat content of U.S. foods.

Dariush Mozaffarian, M.D., Dr.P.H.
Harvard Medical School, Boston, MA
dmozaffa@hsph.harvard.edu

Michael F. Jacobson, Ph.D.
Julie S. Greenstein, M.H.S.
Center for Science in the Public Interest, Washington, DC

Supported by the Searle Scholar Award from the Searle Funds at the Chicago Community Trust and the Helena Rubenstein Foundation. The funders had no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; or preparation, review, or approval of the manuscript.

Disclosure forms provided by the authors are available with the full text of this letter at NEJM.org.

4 References

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   Mozaffarian D, Clarke R. Quantitative effects on cardiovascular risk factors and coronary heart disease risk of replacing partially hydrogenated vegetable oils with other fats and oils. Eur J Clin Nutr 2009;63:Suppl 2:S22-S33
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   Eckel RH, Borra S, Lichtenstein AH, Yin-Piazza SY. Understanding the complexity of trans fatty acid reduction in the American diet: American Heart Association Trans Fat Conference 2006: report of the Trans Fat Conference Planning Group. Circulation 2007;115:2231-2246
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Citing Articles (10)

Citing Articles

1. 1

   Fadar O. Otite, Michael F. Jacobson, Aspan Dahmubed, Dariush Mozaffarian. (2013) Trends in Trans Fatty Acids Reformulations of US Supermarket and Brand-Name Foods From 2007 Through 2011. Preventing Chronic Disease 10,
   

2. 2

   Cynthia Tyburczy, Magdi M. Mossoba, Jeanne I. Rader. (2013) Determination of trans fat in edible oils: current official methods and overview of recent developments. Analytical and Bioanalytical Chemistry
   

3. 3

   Diana Ansorena, Andrea Echarte, Rebeca Ollé, Iciar Astiasarán. (2013) 2012: No trans fatty acids in Spanish bakery products. Food Chemistry 138:1, 422-429
   

4. 4

   Shauna M Downs, Anne Marie Thow, Stephen R Leeder. (2013) The effectiveness of policies for reducing dietary trans fat: a systematic review of the evidence. Bulletin of the World Health Organization 91:4, 262-269H
   

5. 5

   Walter C. Willett, Meir J. Stampfer. (2013) Current Evidence on Healthy Eating. Annual Review of Public Health 34:1, 77-95
   

6. 6

   Farid Menaa, Abder Menaa, Jacques Tréton, Bouzid Menaa. (2013) Technological Approaches to Minimize Industrial Trans Fatty Acids in Foods. Journal of Food Science 78:3, R377-R386
   

7. 7

   Cynthia Tyburczy, Pierluigi Delmonte, Ali Reza Fardin-Kia, Magdi M. Mossoba, John K. G. Kramer, Jeanne I. Rader. (2012) Profile of trans Fatty Acids (FAs) Including Trans Polyunsaturated FAs in Representative Fast Food Samples. Journal of Agricultural and Food Chemistry120426164753006
   

8. 8

   Debra Van Camp, Neal H Hooker, Chung-Tung Jordan Lin. (2012) Changes in fat contents of US snack foods in response to mandatory trans fat labelling. Public Health Nutrition1-8
   

9. 9

   D. Doell, D. Folmer, H. Lee, M. Honigfort, S. Carberry. (2012) Updated estimate of trans fat intake by the US population. Food Additives & Contaminants: Part A1-14
   

10. 10

    S. A. Missmer, J. E. Chavarro, S. Malspeis, E. R. Bertone-Johnson, M. D. Hornstein, D. Spiegelman, R. L. Barbieri, W. C. Willett, S. E. Hankinson. (2011) Reply: Dietary fat consumption and endometriosis risk. Human Reproduction 26:3, 732-733