Background Trans fatty acids (TFA) increase coronary heart disease (CHD) incidence by 11% for each 1% of dietary energy from TFA. Many countries have already taken action to reduce or eliminate TFA from processed foods. Currently the UK relies on the voluntary cooperation of industry. In this study, we determined and compared the health and equity benefits and cost effectiveness of additional, contrasting policies to reduce or eliminate TFA from processed foods in England.

Methods Using the IMPACT Food Policy model, we estimated the reduction in CHD mortality and incidence in England that might result from four distinct policy options to reduce or eliminate TFA from processed foods: total legislative ban; improved labelling; bans in restaurants; or bans in take-aways. Average TFA consumption was taken from the National Diet and Nutrition Survey, and a socioeconomic gradient in TFA consumption was inferred from the Low Income Diet and Nutrition Survey. Potential reductions in TFA consumption were based on policy implementations in other countries. Health outcomes, including deaths prevented or postponed (DPP) and quality-adjusted life years (QALY), were stratified by socioeconomic circumstance using quintiles of the Index of Multiple Deprivation (IMDQ). Economic analysis considered policy costs to government and industry and savings in direct health care, informal care, and averted productivity loss. We calculated cost-effectiveness of each policy as incremental societal cost per QALY. Analyses were conducted in R software, and probabilistic sensitivity analysis was used to assess uncertainty.

Results A total ban on TFA in processed foods might prevent or postpone approximately 7,200 (95% CI: 3,000–12,700) CHD deaths in England from 2015–2020 and reduce inequality in CHD mortality by some 3,000 (1,200–5,200) deaths. Policies to improve labelling or remove TFA from restaurants or take-aways could save between 1,800 and 3,500 (700–6,100) CHD deaths and reduce inequalities by 600 to 1,500 (300–2,600) deaths, thus making them less than half as effective.

Any policy we evaluated would be cost effective from a total societal perspective, even if industry incurred substantial reformulation costs. A total ban would be the most cost effective, with savings of around £15,000 (£9,000–£40,000) per QALY in 2020.

Conclusion The most effective and equitable policy option would be regulation to eliminate TFA from processed foods in England (as successfully achieved in various other countries). Intermediate policies would also have some benefits. However, simply continuing to rely on industry to voluntary reformulate products could have negative health and economic outcomes.