DOI: 10.

4149/BLL_2016_048 Bratisl Med J 2016; 117 (5)

PERSPECTIVES

New data on harmful effects of trans-fatty acids

Slovak Medical University, Bratislava, Slovakia. [Link]@[Link]

ABSTRACT
Various margarines containing trans-fatty acids were marketed as being healthier because of the absence of
cholesterol, suggesting to use margarine instead of butter. Fifteen years ago, research documented the grave
health risk of trans-fats (T-fat). US FDA in 2015 finalized its decision that T-fat is not safe and set a three-year
time limit for complete removal of T-fat from all foods. The greatest danger from T-fat lies in its capacity to dis-
tort the cell membranes. The primary health risk identified for T-fat consumption is an elevated risk of coronary
heart disease. T-fats have an adverse effect on the brain and nervous system. T-fat from the diet is incorporated
into brain cell membranes and alter the ability of neurons to communicate. This can diminish mental perfor-
mance. Relationship between T-fat intake and depression risk was observed. There is growing evidence for a
possible role of T-fat in the development of Alzheimer´s disease and cognitive decline with age (Fig. 1, Ref. 23).
Text in PDF [Link].
KEY WORDS: cis-fatty acids, trans-fatty acids, hydrogenated fat, plant oil, margarine, membranes, heart dis-
ease, cognitive defects, Alzheimer’s disease, food labeling.

More than 100 years have passed since Dr. Wilhelm Normann
filed a patent on “Process for Converting Unsaturated Fatty Acids
or their Glycerides into Saturated Compounds” at the British Pat-
ent Office. Dr. Normann could not have predicted that his inven-
tion of converting natural vegetable oil into solid fat could result
in a major health problem.
The food industry eagerly started to market trans-fat (T-fat)
because of its convenience: fat in a solid form is easier to package
and artificial glycerides can be stored longer. For many decades,
the households and food preparers in the world were flooded with
millions of tons of various margarines deceptively marketed as
being healthier because of the absence of cholesterol, suggesting
to use margarine instead of butter. A major change in nutritional
understanding of fat came only about 15 years ago when research
documented the grave health risk of T-fat. In the USA the Food
and Drug Administration (FDA) in 2015 finalized its decision
that T-fat is not generally recognized as safe and set a three-year Fig. 1. Different structures of cis- and trans-fatty acids.
time limit for complete removal of T-fat from all processed foods.
The major players in the food industry all over the world and microwave popcorn. The ban on T-fat has to mean absolutely
showed to be resistant to change. It took several years for US zero trans-fat.
nutritionists to succeed in forcing mandatory food labelling that The purpose of this review is to highlight the recent data on
includes a statement on T-fat. A statement declaring that a prod- health risk posed by T-fat. T-fat accounts for about 1-2% of energy
uct contains no trans-fat, however still allows the presence of a in the European and North American diets. Hydrogenated oils con-
small amount of this artificial fat. Additionally, the food industry tain a large proportion of T-fat. The major industrially produced
has pressed to exempt from removing T-fat in their products in- trans-fatty acids in the food supply are elaidic acid isomers (Fig. 1).
cluding for example shortening, pie crust, brownies, peanut butter
Trans-fatty acids and membranes
1
Slovak Medical University, Bratislava, Slovakia (emeritus), and 2State
University of New York, Downstate Medical Center at Brooklyn, USA The greatest danger from T-fat lies in its capacity to distort
Address for correspondence: E. Ginter, RND, DSc, Racianska 17, SK- the cell membranes. Just consider the substantial spatial change
831 02 Bratislava, Slovakia. in the fatty acid molecule altered by hydrogenation. The fluidity

Indexed and abstracted in Science Citation Index Expanded and in Journal Citation Reports/Science Edition
Bratisl Med J 2016; 117 (5)
251 – 253

of membranes determines the extent to which molecules can be pression, found a detrimental relationship between T-fat intake
transported and signals can be transmitted through the membrane. and depression risk (14). A strong relation between dietary T-fat
Membrane fluidity is a function of its fatty acid and cholesterol intake and self-reported behavioral aggression and irritability was
content. Trans-fatty acid chains may disorder the membrane phos- also observed.
pholipids and influence the fluidity of the membranes. This has The prevalence of Alzheimer’s disease (AD) increases expo-
wide implications for the body systems and functions, including nentially with age. There is growing evidence for possible dietary
heart disease and brain function. Persons who eat large amounts of risk factors, e.g. T-fat, in the development of AD and cognitive
foods containing T-fat, have been found with cell membranes that decline with age (15). Morris et al. (16) performed clinical evalu-
contain up to 20 percent T-fat. Trans-fatty acids cannot be used to ations on community residents aged over 65, who were unaffected
produce useful mediators because the molecules have unnatural by AD at baseline. After a mean follow-up of 3.9 years, intake of
shapes that are not recognized by enzymes such as cyclooxygen- T-fat was positively associated with risk of AD; the top 80 per-
ase and lipoxygenase. cent in T-fat consumption had four times the risk of developing
AD than the 20 percent with the lowest T-fat consumption. These
Coronary heart disease data are consistent with increased membrane phospholipid deg-
radation in AD brain (17).
The primary health risk identified for T-fat consumption is Several lines of evidence support the theory that an elevated
an elevated risk of coronary heart disease (CHD). Metabolic blood cholesterol level is related to the development of AD. A
studies have shown that T-fat has adverse effect on blood lipid study of 444 Finnish men found that an elevated blood cholesterol
levels, namely by increasing LDL-cholesterol while decreasing level in midlife was associated with 3 times the risk of develop-
HDL-cholesterol. A comprehensive review published in 2006 (1) ing AD in late life (18).
concluded that “On a per-calorie basis, trans-fats appear to increase
the risk of CHD more than any other macronutrient, conferring a Diabetes
substantially increased risk at low levels of consumption (1 to 3
% of total energy intake)”. Although there is some support from observational and ex-
A meta-analysis related to the risk posed by T-fat was recently perimental studies for the hypothesis that high intake of T-fat may
published (2). Total T-fat intake was associated with increased increase the risk for type 2 diabetes (19), inconsistencies across
all-cause and CHD mortality rates. Reliable and strong positive studies and methodological problems make it premature to draw
associations between T-fat intake and CHD mortality, consistent definitive conclusions at this time. More experimental research in
with several previous systematic reviews and meta-analyses (3, humans is needed to further address this question. More convinc-
4) were found. The risk of heart disease is mediated via blood ing are experiments in monkeys where T-fat consumption induced
lipids and pro-inflammatory processes (5–8). The 2 % increase in obesity and increased the risk of diabetes (20). Recently, reports
energy from T-fat is associated with about 30 % increase in CHD were published on the trans-palmitoleic acid inducing diabetes
mortality. The consumption of T-fat increases plasma activity of in man (21, 22).
cholesteryl ester transfer protein, the main enzyme for the trans-
fer of cholesterol esters from HDL to LDL and VLDL cholesterol. Obesity
This increased activity may explain the drop in the levels of HDL
and the rise in the levels of LDL and VLDL cholesterol seen with A 6-year experiment revealed that monkeys fed a T-fat diet
intake of T-fat (9). More recent reports confirm the detrimental gained 7.2 % of their body weight, as compared to 1.8 % for mon-
effect of T-fat on heart health (10, 11). keys on a mono-unsaturated fat diet (23). While in the popular
media obesity is frequently linked to T-fat, there is not a strong
Cognitive disorders and Alzheimer’s disease scientific consensus associating T-fat and obesity in people.

The brain is a fatty organ, comprising about 70 percent fat. T-fat Cancer
from the diet is incorporated into brain cell membranes, including
the myelin sheath that insulates neurons, playing a role in the send- There is no scientific consensus that consumption of T-fat
ing of communication signals. Thus, T-fat may alter the ability of significantly increases cancer risk. The American Cancer Society
neurons to communicate. This can diminish mental performance. states that a relationship between T-fat and cancer has not been
Recently published review on the role of saturated fat and T- determined.
fat in dementia concluded that prospective studies indicate rela-
tionships between intakes of saturated fat and T-fat and the risk of Conclusion
cognitive disorders (12). Morris et al (13) related fat consumption
to a 6-year change in cognitive function among 2,560 participants The invention of fat hydrogenation leading to T-fat was con-
in Chicago. A diet high in saturated fat or T-fat may be associated sidered a major technical breakthrough. Food industry enthusi-
with cognitive decline among older persons. Prospective cohort astically accepted the mass production of a convenient form of
study of 12,059 Spanish university graduates, initially free of de- artificially modified fat. Unlike the liquid unsaturated fatty acid

252
 Ginter E, Simko V. New data on harmful effects of trans-fatty acids
xx

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