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#BrainHealth: another reason to hate margerine

Information rarely changes health outcomes on its own, which is why we need policy #PreventiveNeurology #BrainHealth

Although we have known about the cardiovascular risks associated with the consumption of trans fatty acids (TFAs) for decades little has been done by individuals to reduce their consumption. Therefore when the state of New York put in place restrictions on their use in 11 counties between 2007 and 2011 they set-up an experiment. This experiment now reports out: the study below included 25 counties and compared cardiovascular outcomes in the TFA non-restricted populations of 14 counties with the populations in the 11 TFA restricted counties. Three or more years after restrictions were put in place the people living in the counties with TFA restrictions experienced a significant decline in combined myocardial infarction and stroke events (-6.2%) compared with the TFA non-restricted populations. 

I sincerely hope you appreciate the significance of these findings? 

Lessons learnt:

1. Information alone rarely changes behaviour; policy and legislation are needed. 
2. TFA consumption is bad for you and increases your cardiovascular risk, which sets up a cascade of events that raises your risks of myocardial infarction, stroke and likely in time all-cause dementia.
3. If you want to optimise your brain health you need to eliminate TFAs from your diet. Easier said than done?

By Kagor at the Ukrainian language Wikipedia, CC BY-SA 3.0


Trans fats, or trans-unsaturated fatty acids, trans fatty acids, are a type of unsaturated fat that occur in small amounts in nature but became widely produced industrially from vegetable fats for use in margarine, snack food, packaged baked goods and frying fast food. Trans fat has been shown to consistently be associated, in an intake-dependent way, with increased risk of coronary heart disease.

In 2003 the World Health Organisation recommended that trans fats make up no more than 1% of a person's diet. In 2013, the United States Food and Drug Administration (FDA) issued a preliminary determination that partially hydrogenated oils (which contain trans fats) are not "generally recognised as safe", which was expected to lead to a ban on industrially produced trans fats from the American diet. On 16 June 2015, the FDA finalised its determination that trans fats are not generally recognised as safe, and set a three-year time limit for their removal from all processed foods.

Brandt et al. Hospital Admissions for Myocardial Infarction and Stroke Before and After the Trans-Fatty Acid Restrictions in New York. JAMA Cardiol. 2017 Apr 12. doi: 10.1001/jamacardio.2017.0491.

IMPORTANCE:  Trans-fatty acids (TFAs) have deleterious cardiovascular effects. Restrictions on their use were initiated in 11 New York State (NYS) counties between 2007 and 2011. The US Food and Drug Administration plans a nationwide restriction in 2018. Public health implications of TFA restrictions are not well understood.

OBJECTIVE: To determine whether TFA restrictions in NYS counties were associated with fewer hospital admissions for myocardial infarction (MI) and stroke compared with NYS counties without restrictions.

DESIGN, SETTING, AND PARTICIPANTS: We conducted a retrospective observational pre-post study of residents in counties with TFA restrictions vs counties without restrictions from 2002 to 2013 using NYS Department of Health's Statewide Planning and Research Cooperative System and census population estimates. In this natural experiment, we included those residents who were hospitalized for MI or stroke. The data analysis was conducted from December 2014 through July 2016.

EXPOSURE: Residing in a county where TFAs were restricted.

MAIN OUTCOMES AND MEASURES: The primary outcome was a composite of MI and stroke events based on primary discharge diagnostic codes from hospital admissions in NYS. Admission rates were calculated by year, age, sex, and county of residence. A difference-in-differences regression design was used to compare admission rates in populations with and without TFA restrictions. Restrictions were only implemented in highly urban counties, based on US Department of Agriculture Economic Research Service Urban Influence Codes. Nonrestriction counties of similar urbanicity were chosen to make a comparison population. Temporal trends and county characteristics were accounted for using fixed effects by county and year, as well as linear time trends by county. We adjusted for age, sex, and commuting between restriction and nonrestriction counties.

RESULTS: In 2006, the year before the first restrictions were implemented, there were 8.4 million adults (53.6% female) in highly urban counties with TFA restrictions and 3.3 million adults (52.3% female) in highly urban counties without restrictions. Twenty-five counties were included in the nonrestriction population and 11 in the restriction population. Three or more years after restriction implementation, the population with TFA restrictions experienced significant additional decline beyond temporal trends in MI and stroke events combined (-6.2%; 95% CI, -9.2% to -3.2%; P < .001) and MI (-7.8%; 95% CI, -12.7% to -2.8%; P = .002) and a nonsignificant decline in stroke (-3.6%; 95% CI, -7.6% to 0.4%; P = .08) compared with the nonrestriction populations.

CONCLUSIONS AND RELEVANCE: The NYS populations with TFA restrictions experienced fewer cardiovascular events, beyond temporal trends, compared with those without restrictions.
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Comments

  1. Anonymous30 April 2017 at 03:20

    Is this blog a new initiative or a hobby?

    ReplyDelete
  2. Carlos Navas30 April 2017 at 07:19

    excellent, #BrainHealth

    ReplyDelete
  3. Gavin Giovannoni10 May 2017 at 00:18

    Re: "Is this blog a new initiative or a hobby?"

    A new initiative. We want to expand the Wolfson's work into neurological disease.

    ReplyDelete

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