The new BMJ study suggests that a believe a total ban of trans fats in processed foods in England could potentially prevent or postpone more than 7,000 deaths from coronary heart disease over the next five years.
Led by Dr Kirk Allen from the University of Liverpool, the team evaluated three policy options to reduce consumption of trans fats in England: a total ban on trans fats in all processed foods; or better food labelling; or a ban on trans fats just in restaurants and takeaways.
They concluded that a ‘total ban’ in England is ‘technically feasible’ and have called for ‘decisive action’ to prioritise the most effective and cost effective policy options.
“There should be no place in our society for trans fats and a total ban would clearly improve the health of the nation,” commented Professor Simon Capewell, also from the University of Liverpool, who co-authored the study. “Elimination of trans fats from processed foods is an eminently achievable target for policy makers. It should be pursued rigorously.”
Flawed study … but a ban may be most effective?
Several public health and nutrition experts in the UK have reacted to the study by warning that the findings may be ‘flawed’ and use “a highly sophisticated approach to solve a problem that no longer exists” – since the data used in the new study is based largely on figures from Public Health England’s national diet and nutrition survey results between 2008 and 2012.
Indeed, Dr Alison Tedstone, chief nutritionist at Public Health England, noted that while it is well known that trans fats are harmful to health, consumption “is already well within recommended levels and is falling” – adding that the majority of trans fat in diets now comes from natural sources in meat and milk, which are not associated with increased risk of coronary heart disease.
Meanwhile, Professor Tom Sanders of King’s College London, and Professor Christine Williams from the University of Reading both pointed out that the levels of industrial trans fats in the diet are virtually zero already – with Williams adding that statements made in the study regarding differences in dietary trans intakes for low and high income groups ‘have no basis in fact’ because of the assumptions made in the modelling of the study.
Despite these potential flaws, Professor Peter Weissberg, medical director at the British Heart Foundation, said a total ban on industrial trans fats would be the most effective.
“Even though England has made steps towards reducing the levels of trans fats in our diets, other countries are well ahead of us,” he said.
“Countries such as Denmark that have legislated to reduce trans fat intake have seen a reduction in rates of cardiovascular disease,” added Dr Tim Chico from the University of Sheffield. “The bottom line from this study is that a ban on trans fats would save a significant number of lives (in the thousands, not hundreds) and actually save public money.”
Reformulation and replacement
The team behind the BMJ study also warned that if reformulation costs to industry occur as part of the regular business cycle, “any policy we modelled would be dominant over a ‘do nothing’ scenario, where consumption of trans fatty acids remains constant, even when we consider uncertainty in the estimates.”
“If reformulation costs to industry are substantial, these policy options would still be dominant over a ‘do nothing’ scenario based on the best estimates, though the uncertainty leaves some possibility of net losses in the short term horizon that we focused on,” wrote the authors.
“Complete elimination in countries such as Denmark, however, shows that continued reformulationis technically feasible,” the team added.
Dr Gavin Sandercock at the University of Essex added that the idea of reformulating foods is made to sound quite simple in the BMJ study.
“The authors say that there would be no need to add saturated fats to make up for the loss of trans fats. However, recent studies have suggested that intake of saturated fats may not be strongly associated with heart disease and food manufacturers would still need to add something to foods to make up for the trans fats,” he said.
He noted that previously, when reformulating to make ‘low fat’ versions of processed food, manufacturers have added sugars for bulking and taste, for example, which is something that given the current debate over sugar and health may cause even more confusion in food choices.
Published online ahead of print, doi: 10.1136/bmj.h4583
“Potential of trans fats policies to reduce socioeconomic inequalities in mortality from coronary heart disease in England: cost effectiveness modelling study”
Authors: Kirk Allen, et al