Consumption of dietary trans fat and cardiovascular disease.
Trans fat and total cardiovascular disease (CVD).
Results: Data was provided by 2 cohorts, including 822 cases.
No associations were found. The average RR = 1.02.
Effect modification: No data was found.
Subjects with prevalent disease: One cohort included women with type 2 diabetes only (Tanasescu M [13]). No association was found.
Conclusion: No associations were found. No evidence was found for an association between trans fat consumption and total cardiovascular disease.
| Author | Cohort name | Cases | End point | Relative Risk (RR) |
|---|---|---|---|---|
| 45) Houston DK (2010) | The Health ABC Study | 203 | Risk | HR = 0.97 (0.65-1.44; P = 0.85). |
| 13) Tanasescu M (2004) | The Nurses' Health Study | 619 | Risk | RR = 1.03 (0.73-1.44; P = 0.74). |
| Total number of cases: 822 | Average RR = 1.02 |
Trans fat and coronary heart disease (CHD).
Results:
Total trans fat: Data about the relation with CHD risk was provided by 6 cohorts, including 4,774 cases.
Significantly increased risks were found in 2 cohorts (Oomen CM [7], Oh K [13]), including 1,864 cases (39% of all cases). No other associations
were found, but all RR's were > 1. The average RR = 1.22.
Data about the relation with CHD mortality was provided by 4 cohorts, including 1,051 cases.
A significantly increased risk was found in 1 cohort (Pietinen P [19]). No other associations were found. The average RR = 1.33.
Processed/vegetable trans fat: Data was provided by 3 cohorts, including 1,089 cases.
Significantly increased risks were found in 2 cohorts of moderate-large size (Willet WC [13], Pietinen P [19]). The average RR = 1.39.
Ruminant/animal trans fat: Data was provided by 4 cohorts, including 1,463 cases.
A significant protective effect was found in one cohort (Pietinen P [19]). No other associations were found. The average RR = 0.85.
Effect modification:
- No consistent effect modification was found by age (Oh K [13], Jakobsen MU [29], Xu J [35]).
- In one cohort of large size, risk increased significantly among women with a BMI < 25, but not among women with a BMI ≥ 25 (Oh K [13]).
Subjects with prevalent disease: No data was found.
Conclusion: Significantly increased risks of total trans fat against CHD risk were found in 2 out of 6 cohorts, one of which was of very small size.
Suggestive evidence was found that total trans fat consumption increases CHD risk (+ 22%). No clear level of consumption could be defined for this effect, but it
can not be excluded that risk increases at any level of consumption.Stratified analysis showed significant differences between processed and ruminant
trans fat. Significantly increased risks of processed trans fat against CHD risk were found in 2 cohorts of moderate-large size. Processed trans fat possibly
increases CHD risk at consumption ≥ 5.1-5.7 g/day (+ 39%).
| Author | Cohort name | Cases | End point | Relative Risk (RR) |
|---|---|---|---|---|
| 35) Xu J (2006) | The Strong Heart Study | 403 | Risk | HR = 1.06 (0.78-1.44; P = 0.88). |
| 29) Jakobsen MU (2008) | Four Danish cohorts | 374 | Risk | HR = 1.05 (0.92-1.19). |
| 19) Pietinen P (1997) | The ATBC Study | 1,399 | Risk | RR = 1.14 (0.96-1.35; P = 0.16). |
| 13) Oh K (2005) | The Nurses' Health Study | 1,766 | Risk | RR = 1.33 (1.07-1.66; P = 0.01). |
| 13) Ascherio A (1996) | The Health Professionals Follow Up Study | 734 | Risk | RR = 1.21 (0.93-1.58; P = 0.20). |
| 7) Oomen CM (2001) | The Zutphen Elderly Study | 98 | Risk | RR = 2.00 (1.07-3.75; P = 0.03). |
| Total number of cases: 4,774 | Average RR = 1.22 |
| Author | Cohort name | Cases | Relative Risk (RR) |
|---|---|---|---|
| 35) Xu J (2006) | The Strong Heart Study | 46 aged < 60, and 92 aged ≥ 60 | Aged < 60: HR = 1.15 (0.49-2.68; P = 0.66). Aged ≥ 60: HR = 0.83 (0.42-1.66; P = 0.54). |
| 19) Pietinen P (1997) | The ATBC Study | 635 | RR = 1.39 (1.09-1.78; P = 0.004). |
| 13) Ascherio A (1996) | The Health Professionals Follow Up Study | 229 | RR = 1.41 (0.86-2.32; P = 0.42). |
| 7) Oomen CM (2001) | The Zutphen Elderly Study | 49 | RR = 1.33 (0.96-1.86). |
| Total number of cases: 1,051 | Average RR = 1.33 |
| Author | Cohort name | Cases | End point | Relative Risk (RR) |
|---|---|---|---|---|
| 19) Pietinen P | The ATBC Study | 635 | Mortality | RR = 1.23 (0.97-1.55; P = 0.004). |
| 13) Willet WC (1993) | The Nurses' Health Study | 356 | Risk | RR = 1.78 (1.12-2.83; P = 0.009). |
| 7) Oomen CM (2001) | The Zutphen Elderly Study | 98 | Risk | RR = 1.05 (0.94-1.17). |
| Total number of cases: 1,089 | Average RR = 1.39 |
| Author | Cohort name | Cases | End point | Relative Risk (RR) |
|---|---|---|---|---|
| 29) Jakobsen MU (2008) | 4 Danish cohorts | 374 | Risk | HR = 1.05 (0.92-1.19). |
| 19) Pietinen P | The ATBC Study | 635 | Mortality | RR = 0.83 (0.62-1.11; P = 0.035). |
| 13) Willet WC (1993) | The Nurses' Health Study | 356 | Risk | RR = 0.59 (0.30-1.17; P = 0.23). |
| 7) Oomen CM (2001) | The Zutphen Elderly Study | 98 | Risk | RR = 1.17 (0.69-1.98). |
| Total number of cases: 1,463 | Average RR = 0.85 |
Trans fat and stroke.
Results: Data was provided by 2 cohorts, including 654 cases.
No associations were found, though in one cohort risk increased among subjects with very low consumption (Iso H [13]). The average RR = 0.97.
Effect modification: No data was found.
Subjects with prevalent disease: No significant association was found among women with hypertension (Iso H [13]).
Conclusion: No associations were found. No evidence was found for an association between trans fat consumption and stroke.
| Author | Cohort name | Cases | End point | Relative Risk (RR) |
|---|---|---|---|---|
| 13) He K (2003) | The Health Professionals Follow Up Study | 455 ischaemic stroke, and 125 haemorrhagic stroke | Risk | Ischaemic stroke: RR = 0.80 (0.54-1.17; P = 0.26). Haemorrhagic stroke: RR = 1.90 (0.90-3.98; P = 0.13). |
| 13) Iso H (2001) | The Nurses' Health Study | 74 | Intraparenchymal hemorrhage risk | RR = 0.43 (0.17-1.10; P = 0.15). |
| Total number of cases: 654 | Average RR = 0.97 |
| Author | Cohort name | Subjects | Years of follow-up | Cases | End point | Consumption of | Relative Risk (RR) | Adjustments |
| 45) Houston DK (2010) | The Health ABC Study | 1,941 black and white men and women aged 70-79 without prevalent CVD. (USA) | 9 (1999-?) | 203? | CVD incidence (nonfatal MI, coronary death, or stroke) | Trans fat (not defined) |
HR = 0.97 (0.65-1.44; P = 0.85) for the highest vs lowest tertile of consumption. Amount specific data (% of energy): 2.1: HR = 1. 3.1: HR = 1.05 (0.74-1.49). 4.4: HR = 0.97 (0.65-1.44). | Age, gender, race, education, field center, smoking, alcohol use, physical activity, BMI, total energy intake, protein intake, fiber intake, multivitamin use, supplemental vitamin E use, statin use, aspirin use, oral estrogen use (women only), prevalent diabetes or hypertension, saturated fat, MUFA, PUFA, and cholesterol. |
| 13) Tanasescu M (2004) | The Nurses' Health Study | 5,672 women with type 2 diabetes, but without CVD or cancer. | 1980 to 1994-98 | 619? | CVD events (nonfatal myocardial infarction, fatal coronary heart disease, and stroke) | Trans unsaturated fat (not defined) |
RR = 1.03 (0.73-1.44; P = 0.74) for the highest vs lowest quintile of consumption. Amount specific data (% of energy): 1.3: RR = 1. 1.7: RR = 0.90 (0.68-1.19). 2.1: RR = 1.15 (0.87-1.52). 2.4: RR = 0.95 (0.69-1.30). 3: RR = 1.03 (0.73-1.44). | Age, smoking, postmenopausal hormone use, parental history of MI before age 60, alcohol intake, moderate vigorous activities, BMI, total caloric intake, protein intake, fiber intake, multivitamin use, vitamin E supplement use, medication use, saturated, monounsaturated, and polyunsaturated fats and cholesterol. |
| Author | Cohort name | Subjects | Years of follow-up | Cases | End point | Consumption of | Relative Risk (RR) | Adjustments | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 38) Nettleton JA (2008) | The Atherosclerosis Risk In Communities (ARIC) Study. | 14,153 African-American and white adults age 45-64. (USA) | 13.3 (1987-89 to 2003) | 1,140? (639 men, 501 women) | Incident heart failure | Trans fat (not defined) | Cases consumed less trans fat (1.5% of energy) than controls (1.6% of energy; P = 0.001). | Total energy. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 35) Xu J (2006) | The Strong Heart Study | 2,938 American Indians aged 47-79, and free of CHD, dialysis treatment, liver cirrhosis, or having had a kidney transplant. (USA) | 7.2 (1993-95 to 2002) | See variables | First CHD event (nonfatal CHD [definite MI, definite CHD, and electrocardiogram-evident definite MI], and fatal CHD [death from definite MI, definite sudden death due to CHD, definite fatal CHD, and possible fatal CHD]) | Trans fatty acids (not defined) |
Variable of interest as a % of energy, sex, age, study center, diabetes status, BMI, HDL, LDL, triaglycerol, smoking, alcohol, hypertension, protein, and total energy. |
29) Jakobsen MU (2008) | Four cohort studies: | -The 1914 Cohort. -The 1936 Cohort. -The MONICA-I Cohort. -The MONICA-III Cohort. 3,686 subjects (1,911 women, and 1,886 men) aged 30-71, and without coronary heart disease or diabetes mellitus. | (Denmark) 18 | (1974-93 to 2000) 374 | (121 women, and 253 men) Coronary heart disease events (fatal or nonfatal) | Ruminant trans fatty acids (Mostly from butter, but also from cheese [products], milk [products], and ruminant meat) |
HR = 1.05 (0.92-1.19) per 0.5 g increase.. |
Total energy, cohort identification, sex, BMI, systolic blood pressure, familial history of myocardial infarction, education, leisure-time physical activity, smoking, alcohol intake, % of energy from protein, monounsaturated fatty acids, polyunsaturated fatty acids, and saturated fatty acids, dietary fibre, dietary cholesterol, and foods containing high amounts of industrially produced trans fatty acids |
19) Pietinen P (1997) | The Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study | 21,930 male smokers (≥ 5 cigarettes/day) aged 50-69, and free of CVD, diabetes or cancer. | (Finland) 6.1 | (1985-88 to 1993) See variables | Major coronary events (first nonfatal myocardial infarction, or coronary heart disease death) | Trans fatty acids (mainly from soft margarines) |
|
Age, treatment group, smoking, BMI, blood pressure, intakes of energy, alcohol, and fiber, education, and physical activity. |
19) Pietinen P (1997) | The Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study | 21,930 male smokers (≥ 5 cigarettes/day) aged 50-69, and free of CVD, diabetes or cancer. | (Finland) 6.1 | (1985-88 to 1993) 635? | Coronary heart disease death | Vegetable trans-fatty acids (not defined) |
RR = 1.23 (0.97-1.55; P = 0.004) for the highest vs lowest quintile of consumption. | Amount specific data (intake in g): 0.1: RR = 1. 0.4: RR = 0.87 (0.68-1.11). 0.8: RR = 0.77 (0.60-1.01). 1.6: RR = 0.94 (0.73-1.20). 5.1: RR = 1.23 (0.97-1.55). Age, treatment group, smoking, BMI, blood pressure, intakes of energy, alcohol, and fiber, education, and physical activity. |
19) Pietinen P (1997) | The Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study | 21,930 male smokers (≥ 5 cigarettes/day) aged 50-69, and free of CVD, diabetes or cancer. | (Finland) 6.1 | (1985-88 to 1993) 635? | Coronary heart disease death | Animal trans-fatty acids (not defined) |
RR = 0.83 (0.62-1.11; P = 0.035) for the highest vs lowest quintile of consumption. | Amount specific data (intake in g): 0.6: RR = 1. 1.1: RR = 0.97 (0.75-1.25). 1.5: RR = 0.91 (0.70-1.19). 1.9: RR = 0.90 (0.69-1.17). 2.5: RR = 0.83 (0.62-1.11). Age, treatment group, smoking, BMI, blood pressure, intakes of energy, alcohol, and fiber, education, and physical activity. |
13) Sun Q (2008) | The Nurses' Health Study | 32,826 participants who provided blood samples in 1989-90 and were free of cancer or CVD. | (Nested case-control) 6 | (1990-?) 146? | Nonfatal MI | Trans fat (not defined) | No significant difference in trans fat intake was found between cases (3.1 g/d) and controls (3.0 g/d; P = 0.54). | Matched for age, smoking status, and fasting status. |
Unadjusted. 13) Sun Q (2007) | The Nurses' Health Study | 32,826 women free of cancer and cardiovascular diseases. | (Nested case-control) 6 | (1989-90 to ?) 166? | CHD incidence (nonfatal myocardial infarction or CHD death) | Trans fat (not defined) | Cases did not consume significantly more trans fat (3.1 g/d) than controls (3.0 g/d; P = 0.53). | Unadjusted. |
Case-control pairs matched for age, smoking status, fasting status at blood drawing, and date of blood drawing. 13) Oh K (2005) | The Nurses' Health Study | 78,778 women free of CVD, diabetes, hypercholesterolemia, or cancer. | 20 | (1980-2000) 1,766? | CHD incidence (nonfatal myocardial infarction and CHD death) | Trans fat (not defined) |
RR = 1.33 (1.07-1.66; P = 0.01) for the highest vs lowest quintile of consumption. | Amount specific data (% of energy): 1.3: RR = 1. 1.6: RR = 1.08 (0.92-1.26). 1.9: RR = 1.29 (1.09-1.53). 2.2: RR = 1.19 (0.99-1.44). 2.8: RR = 1.33 (1.07-1.66).
Age, BMI, smoking, alcohol intake, parental history of MI, history of hypertension, menopausal status and hormone use, aspirin use, multivitamin use, vitamin E supplement use, physical activity, and energy, protein, cholesterol, saturated, monounsaturated, polyunsaturated, alpha-linolenic acid, marine N-3 fatty acids, cereal fiber, and fruits and vegetables intake. |
13) Stampfer MJ (2000) | The Nurses' Health Study | 84,129 women who were free of CVD, cancer, and diabetes. | (USA) 14 | (1980-1994) 1,128? | Major coronary events (nonfatal myocardial infarction or coronary heart disease death) | Trans fat (not defined) | A significant protective effect was found for the lowest vs highest quintile of consumption (< 1.56% of energy supplied by trans fat; no data shown). | Age, time periods, parental history of MI before age 60, menopausal status, use of postmenopausal hormones, history of hypertension, and history of high cholesterol levels. |
13) Hu FB (1999) | The Nurses' Health Study | 80,082 women aged 34-59, and without CHD, stroke, cancer, hypercholesterolemia, or diabetes. | 14 | (1980-1994) 939? | Coronary heart disease (nonfatal myocardial infarction and fatal CHD) | Trans fat (not defined) |
RR's are from the standard multivariate model: | RR = 1.47 (1.02-2.12; P = 0.06) for the highest vs lowest quintile of consumption. Amount specific data (Quintiles not defined): Q1: RR = 1. Q2: RR = 1.21 (0.95-1.55). Q3: RR = 1.25 (0.95-1.66). Q4: RR = 1.39 (1.02-1.90). Q5: RR = 1.47 (1.02-2.12). Age, time period, BMI, cigarette smoking, menopausal status, parental history of myocardial infarction, multiple vitamin use, vitamin E supplement use, alcohol consumption, history of hypertension, aspirin use, vigorous exercise, cholesterol intake, and total energy intake. |
13) Hu FB (1997) | The Nurses' Health Study | 80,082 women aged 34-59 and without CVD, diabetes, hypercholesterolemia, or cancer. | 14 | (1980-1994) 939? | Coronary heart disease incidence (nonfatal myocardial infarction or fatal coronary disease) | Trans unsaturated fat (not defined) |
RR = 1.53 (1.16-2.02; P = 0.002) for the highest vs lowest quintile of consumption. | Amount specific data (% of energy): 1.3: RR = 1. 1.7: RR = 1.09 (0.87-1.37). 2.0: RR = 1.16 (0.91-1.47). 2.4: RR = 1.24 (0.96-1.60). 2.9: RR = 1.53 (1.16-2.02). Age, time period, BMI, cigarette smoking, menopausal status, parental history of MI before age 65, multivitamin use, vitamin E supplement use, alcohol consumption, history of hypertension, aspirin use, vigorous exercise, % energy from protein, dietary cholesterol, saturated fat, monounsaturated fat, and polyunsaturated fats. |
13) Ascherio A (1996) | The Health Professionals Follow Up Study | 43,757 men aged 40-75. | (USA) 6 | (1986-1992) See variables | Coronary heart disease | Trans unsaturated fat (not defined) |
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Age, BMI, smoking habits, alcohol consumption, physical activity, history of hypertension or high blood cholesterol, family history of before age 60, profession, and fibre intake. |
13) Willet WC (1993) | The Nurses' Health Study | 85,095 women without angina, myocardial infarction, stroke, diabetes, or hypercholesterolemia. | (USA) 8 | (1980-1988) 431 | CHD incidence (nonfatal MI or death from CHD) | Trans-fatty acids (60% from processed vegetable fats and 40% from animal sources, primarily beef and dairy fat. The most important sources were margarine; beef, prok, or lamb as a main dish; cookies [biscuits]; and white bread) |
RR = 1.47 (0.98-2.20; P = 0.006) for the highest vs lowest quintile of consumption. | Amount specific data (g/day): 2.4: RR = 1. 3.2: RR = 1.12 (0.81-1.55). 3.9: RR = 0.99 (0.69-1.43). 4.5: RR = 1.16 (0.80-1.70). 5.7: RR = 1.47 (0.98-2.20).
Age, smoking, body-mass Index, hypertension, alcohol intake, menopausal status, postmenopausal oestrogen use, energy intake, family history of myocardial infarction, intake of saturated fat, monounsaturated fat, linoleic acid, and use of multivitamins. |
The 50% excess risk of CHD among women in the highest quintile of trans-isomer intake did not change appreciably and the tests for trends remained significant with further adjustments individually for intakes of carotene, vitamin E including supplements, vitamin C including supplements, dietary fibre, or cholesterol (data not shown). The inclusion of a term for vigorous physical activity did not affect the relative risks. 7) Oomen CM (2001) | The Zutphen Elderly Study | (The Dutch contribution to The Seven Countries Study) 667 men aged 64-84, and free of myocardial infarction or angina pectoris. | 10 | (1985-1995) 98 | Primary & secondary coronary heart disease (fatal coronary heart disease, and non-fatal myocardial infarction) | Trans fatty acids (e.g., from biscuits, pastries, dairy products, and meats) |
RR = 2.00 (1.07-3.75; P = 0.03) for the highest vs lowest tertile of consumption. | Amount specific data (% of energy): 2.36: RR = 1. 3.87: RR = 1.34 (0.76-2.37). 6.38: RR = 2.00 (1.07-3.75).
Age, energy, BMI, smoking, alcohol, use of vitamin supplements, intake of saturated fat, monounsaturated fat, polyunsaturated fat, cholesterol, and fiber. |
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