[MUSIC] >> Hi, my name is Steen Stender and I am Chief Physician at the University Hospital in Herlev, Gentofte I am also an affiliated professor within Preventive Cardiology. at the department of nutrition, exercise and sports at the University of Copenhagen. I will give you a short presentation of how industrially produced trans fat also known as artificial trans fat was removed from the Danish diet back in 2004. And to present trans fat situation in Europe. What you see here are examples of the three major classes of fatty acids. The blue balls are carbon atoms and the red balls are hydrogen atoms. This is a saturated fatty acid. It is saturated with hydrogen and has a linear structure which causes a high melting point of 70 degree Celsius. This means that the fat is solid at room temperature. This fatty acid is a mono-unsaturated fatty acid. It is unsaturated with hydrogen atoms around the double bond between the two carbon atoms. A double bond introduces a kink in the molecule. This means a more non-linear molecular structure and consequently, a lower melting point of 13 degrees Celsius. This fat is oil, it's fluid at room temperature. About 100 years ago, a German chemist discovered how to convert unsaturated fat to saturated fat by populating the oil with hydrogen during high temperatures in the presence of certain catalysts. During this chemical conversion, another type of fatty acids appear. That was the fatty acid you see here. This fatty acid has the linear structure of a saturated fatty acid and is solid at room temperature. Note that it has a melting point of about 44 degrees Celsius, but still has a double bond. One of the hydrogen atoms is now on the other side of the carbon atom. This is a trans fatty acid. If all unsaturated fat and trans fat are converted to saturated fats, we speak about fully hydrogenated fat. If the fats still contains appreciable amounts of artificial trans fat, we speak about partially hydrogenated fat. The partial hydrogenation of unsaturated chip, plant oil and fish oil soon became industrialized and partially hydrogenated fat became an important constituent of margarine. Trans fat is not a completely new fat in human diets. Rumen in animals such as cows, sheep, goats and deer produce small amounts of trans fat in their rumen. However, the chemical reactor fat can contain up to 50% trans fat whereas a ruminant fat only contains up to 5%. After intake of trans fat, the molecules are incorporated in cellular membranes all over the body. They stay in the cells, including the brain, for longer time than most of the saturated and unsaturated fats. But are eventually degraded in the body. The human body cannot make trans fat from other fatty acids. Margarine, with high amounts of industrial produced trans fat, was soon incorporated into many different foods in the Western world. The use was favored by the food industry, and removal resisted for several reasons. One, it is cheap. Two, it is semi-solid at room temperature, which makes it easier to use in baked products. Three, it has a long shelf life. And four, it can withstand repeated heating. Trans fats have technical properties similar to saturated fats. But around 1990, it became clear that intake of artificial trans fat had a more harmful effect on plasma cholesterol than intake of the same amount of saturated fat. This led to a number of studies of the associations between intake of trans fat and coronary heart disease. The findings are summarized here. You see that intake of 5 grams of trans fat per day is associated with a 23% higher risk of coronary heart disease. This value is derived from four different studies. The first two are from US studies, among males and females. The third is among Finns. And the polls result is among a Dutch population. In all four studies the intake of trans fat increased the risk of coronary heart disease. The first report from the US study was published in The Lancet in 1993 and made the Danish Nutrition Council form a trans fat working group where I was a chairman. During the following ten years, the working group published four reports, primarily based on the available relevant literature. The final report from 2003 recommended that artificial trans fat should not be used in food. The arguments were the association between intake and heart disease. A plausible mechanism, namely the harmful effect on blood cholesterol but also the fact that we were not able to find any consistent beneficial effect of trans fat on other aspects of human health. In addition, in 2001 we demonstrated that a serving of food from McDonald in Copenhagen, certain brands of biscuits/cakes/wafers and certain brands of microoven popcorn contained up to 10 gram, 17 gram and 10 gram of trans fat respectively per serving. We named this combination of food a high trans fat menu. The menu here contains about 37 grams of trans fat. This finding and the recommendation of the Danish Nutrition Council made the Danish government introduce a legislation that made it illegal to use fat with more than 2% artificial trans fat in foods. The legislation did not apply to trans fat in ruminant fat but applied to both imported food as well as food produced in Denmark. In order to investigate the efficiency of the legislation, we sampled ingredients from the high trans fat menu in 2005, from Denmark and other countries, to compare the trans fat situation in these countries with the situation in Denmark. In each country, we collected a fast food serving from McDonald and from Kentucky Fried Chicken. We also visited three different supermarkets in each capital. And bought micro-oven popcorn and prepackaged biscuits/cakes/wafers, if the list of ingredients had the words partially hydrogenated fat or similar terms. In all of the countries we visited, we found trans fat in the three types of food we have bought. But the maximum amounts vary considerably from country to country. The lengths of the yellow bar reflects the amount of trans fat in a large serving from a fast food outlet. The purple bar reflects the biscuits/cakes/wafers, and the blue bar, the popcorn. The levels found in Denmark in 2005 were negligible. The difference in amount of trans fat in 2001 and 2005 demonstrates the power of legislation. And Danes didn't even notice a change in price or taste when trans fat was removed from their diet. Our findings, a large amount of trans fat in products from McDonald and KFC in the various countries, were published in New England Journal of Medicine in 2006. Six months later, the two fast food providers announced that they intended to reduce the amount of artificial trans fat to less than 2% of the fat they were going to use in their outlets worldwide. In 2009, we went to the capitals of three large countries in Eastern Europe and to three large countries in Western Europe, and bought foods from the same outlets as in 2005, 2006. Including biscuits/cakes/wafers and micro-oven popcorn from the same supermarkets. We did not find trans fat in any of the foods we bought from McDonald and Kentucky Fried Chicken. Their action has caused a major reduction in the intake of trans fat around the globe since McDonald and KFC collaboratively served more than 100 million meals daily. The example also demonstrate that it is possible for fast food providers to produce fast food without artificial trans fat. It is the general opinion among food authorities and food politician in most European countries that artificial trans fat will gradually disappear from food due to societal pressure. In 2012, 2013 I visited 20 different European capitals including the capitals of the six countries in the former Yugoslavia. In three different supermarkets in the capitals, we bought pre-packaged biscuit/cakes/wafers with the words partly hydrogenated fat in the list of ingredients. The lengths of each line in the panel for a city reflects the amount of trans fat per 100 gram of the product. Only samples with more than 2% of the fat as trans fat are included in the panel. It is obvious that trans fat is present in this type of food in several European countries, including some countries in EU. It is also obvious that it was not possible to find artificial trans fat in this type of foods in several other cities such as Copenhagen but also in London, Paris, Berlin, Oslo and Stockholm as indicated here. Apparently voluntary reduction of trans fats has work in some countries. In 2014, I revisited the capitals in the six countries of former Yugoslavia, and went to exactly the same supermarkets as in 2012, and use the same criteria for purchasing the pre-packaged biscuit/cakes/wafers. In 2014, I found about 50% more products with high amounts of trans fat than I found in 2012. The findings in three of the capitals are shown here. It was the same pattern in the three other capitals. The conclusion was that voluntary reduction of trans fat does not work in all countries. It is appropriate to ask if the Danish trans fat legislation from 2004 has changed the incidences of coronary artery disease in Denmark. During 2000 to 2009, Denmark had the highest reduction among the EU countries. Danish females, seen as the red bar in the top of the list had a reduction of about 9% per year and Danish males a reduction about 8% per year. That is why Denmark is placed in the very top of the list. Of course this finding does not prove that trans fat reduction in foods was the only explanation. The findings reported in a scientific journal in the spring of 2016 come somewhat closer. In this publication, the researcher wanted to predict the change in coronary mortality in Denmark after 2004 if there hadn't been a trans fat legislation. They constructed a curve of the change in coronary mortality from 1996 to 2004 that was exactly like the observed mortality in Denmark. This curve named Synthetic Denmark was based on a combination of mortality curves from a number of other OECD countries. Although there was a nearly perfect match before 2004, Denmark went below the Synthetic Denmark the following years. The publication concludes in the 3 years after the policy was implemented, mortality attributable to coronary heart disease decreased on average by 14.2 deaths per 100,000 people per year in Denmark relative to the synthetic control group. For Denmark with 5,3 million people it means about 700 fewer coronary deaths per year. Denmark is no longer the only country with a trans fat legislation. Since 2004, a number of other countries, Switzerland, Austria, Iceland, Hungary, Norway, Latvia, and from 2018, also the US, has removed artificial trans fat from their food by legislation. However, the majority of people in Europe are still not protected from this unnecessary metabolic poison. Volunteer reduction does not always work, legislation does. Thank you for your attention. [MUSIC]
