Do high dietary intakes of trans fats really promote cardiovascular disease?November 18, 1999From his assessment of the studies, Dr John Stanley says the conclusion that trans fatty acids promote cardiovascular disease is premature for the following reasons. First, although prospective cohort studies show an association with cardiovascular disease, trans fatty acids are estimated rather than measured. They may also be markers for some other nutrient that affects cardiovascular disease risk. Second, although many intervention trials seem to show a detrimental effect of trans fatty acids on the blood lipid profile, much depends on the comparison used. When trans fatty acids are compared with oleic acid, total and LDL-cholesterol levels (so-called "bad" cholesterol) are higher; when they are compared with palmitic acid they are lower; and when they are compared with stearic acid they are the same. To be set against this argument is the finding that HDL-cholesterol levels ("good" cholesterol) are lower regardless of the comparison. LDL/HDL ratios are sometimes calculated to allow for this. However, the validity of this ratio remains to be established. Many intervention trials have studied unrealistic intakes of trans fatty acids. Third, partially-hydrogenated fish oil is worse for the blood lipid profile than partially-hydrogenated soybean oil. Clearly, some products of hydrogenation are worse than others. Finally, when tested as part of a real food such as a fat spread, the detrimental effects of trans fatty acids can be more than compensated for by the other fatty acids present in the food. However, this should not discourage us from trying to optimize the fatty acid composition of a food. In many ways these reservations reflect the difficulty of designing human nutritional trials which generate clear-cut answers. For example, given the numbers of subjects involved in epidemiological studies and their duration some sympathy can be felt for investigators obliged to estimate rather than measure nutrient intakes. However, the defects in these studies should encourage us to be cautious in drawing conclusions about health effects of trans fatty acids. PJ Barnes & Associates | |||||||||||||||||||||
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