Coronary heart disease
The primary health risk identified for trans fat consumption is an elevated risk of coronary heart disease (CHD).[43] A comprehensive review of studies of trans fats was published in 2006 in the New England Journal of Medicine reports a strong and reliable connection between trans fat consumption and CHD, concluding that "On a per-calorie basis, trans fats appear to increase the risk of CHD more than any other macronutrient, conferring a substantially increased risk at low levels of consumption (1 to 3% of total energy intake)".[4] This study estimates that between 30,000 and 100,000 cardiac deaths per year in the United States are attributable to the consumption of trans fats.[44]
The major evidence for the effect of trans fat on CHD comes from the Nurses' Health Study — a cohort study that has been following 120,000 female nurses since its inception in 1976. In this study, Hu and colleagues analyzed data from 900 coronary events from the study's population during 14 years of followup. He determined that a nurse's CHD risk roughly doubled (relative risk of 1.94, CI: 1.43 to 2.61) for each 2% increase in trans fat calories consumed (instead of carbohydrate calories).
By contrast, it takes more than a 15% increase in saturated fat calories (instead of carbohydrate calories) to produce a similar increase in risk. "The replacement of saturated fat or trans unsaturated fat by cis (unhydrogenated) unsaturated fats was associated with larger reductions in risk than an isocaloric replacement by carbohydrates."[45] Hu also reports on the benefits of reducing trans fat consumption. Replacing 2% of food energy from trans fat with non-trans unsaturated fats more than halves the risk of CHD (53%). By comparison, replacing a larger 5% of food energy from saturated fat with non-trans unsaturated fats reduces the risk of CHD by 43%.[45]
Another study considered deaths due to CHD, with consumption of trans fats being linked to an increase in mortality, and consumption of polyunsaturated fats being linked to a decrease in mortality.[43][46]
There are two accepted tests that measure an individual's risk for coronary heart disease, both blood tests. The first considers ratios of two types of cholesterol, the other the amount of a cell-signalling cytokine called C-reactive protein. The ratio test is more accepted, while the cytokine test may be more powerful but is still being studied.[43] The effect of trans fat consumption has been documented on each as follows:
- Cholesterol ratio: This ratio compares the levels of LDL (so-called "bad" cholesterol) to HDL (so-called "good" cholesterol). Trans fat behaves like saturated fat by raising the level of LDL, but, unlike saturated fat, it has the additional effect of decreasing levels of HDL. The net increase in LDL/HDL ratio with trans fat is approximately double that due to saturated fat.[47] (Higher ratios are worse.) One randomized crossover study published in 2003 comparing the effect of eating a meal on blood lipids of (relatively) cis and trans fat rich meals showed that cholesteryl ester transfer (CET) was 28% higher after the trans meal than after the cis meal and that lipoprotein concentrations were enriched in apolipoprotein(a) after the trans meals.[48]
- C-reactive protein (CRP): A study of over 700 nurses showed that those in the highest quartile of trans fat consumption had blood levels of CRP that were 73% higher than those in the lowest quartile.[49]
There are suggestions that the negative consequences of trans fat consumption go beyond the cardiovascular risk. In general, there is much less scientific consensus asserting that eating trans fat specifically increases the risk of other chronic health problems:
- Alzheimer's Disease: A study published in Archives of Neurology in February 2003 suggested that the intake of both trans fats and saturated fats promote the development of Alzheimer disease.[50]
- Cancer: There is no scientific consensus that consumption of trans fats significantly increases cancer risks across the board.[43] The American Cancer Society states that a relationship between trans fats and cancer "has not been determined."[51] One study has found a positive connection between trans fat and prostate cancer.[52] However, a larger study found a correlation between trans fats and a significant decrease in high-grade prostate cancer.[53] An increased intake of trans fatty acids may raise the risk of breast cancer by 75%, suggest the results from the French part of the European Prospective Investigation into Cancer and Nutrition.[54][55]
- Diabetes: There is a growing concern that the risk of type 2 diabetes increases with trans fat consumption.[43] However, consensus has not been reached.[4] For example, one study found that risk is higher for those in the highest quartile of trans fat consumption.[56] Another study has found no diabetes risk once other factors such as total fat intake and BMI were accounted for.[57]
- Obesity: Research indicates that trans fat may increase weight gain and abdominal fat, despite a similar caloric intake.[58] A 6-year experiment revealed that monkeys fed a trans fat diet gained 7.2% of their body weight, as compared to 1.8% for monkeys on a mono-unsaturated fat diet.[59][60] Although obesity is frequently linked to trans fat in the popular media,[61] this is generally in the context of eating too many calories; there is not a strong scientific consensus connecting trans fat and obesity, although the 6-year experiment did find such a link, concluding that "under controlled feeding conditions, long-term TFA consumption was an independent factor in weight gain. TFAs enhanced intra-abdominal deposition of fat, even in the absence of caloric excess, and were associated with insulin resistance, with evidence that there is impaired post-insulin receptor binding signal transduction."[60]
- Liver Dysfunction: Trans fats are metabolized differently by the liver than other fats and interfere with delta 6 desaturase. Delta 6 desaturase is an enzyme involved in converting essential fatty acids to arachidonic acid and prostaglandins, both of which are important to the functioning of cells.[62]
- Infertility in women: One 2007 study found, "Each 2% increase in the intake of energy from trans unsaturated fats, as opposed to that from carbohydrates, was associated with a 73% greater risk of ovulatory infertility...".[63]
- Depression: Spanish researchers analysed the diets of 12,059 people over six years and found those who ate the most trans fats had a 48 per cent higher risk of depression than those who did not eat trans fats.[64]
