Background In 2004, the Danish Transfat Ban was implemented (Order no. 160, 2003). To determine health and equity benefits of this regulation on industrially produced trans fatty acid (ITFA) content in Danish food, we quantified the changes in ITFA intake from 1991 to 2007. We then estimated the relative contributions of changes in ITFA consumption, other cardiovascular risk factors and treatments on Coronary Heart Disease (CHD) mortality, all stratified by socioeconomic group.
Methods Participants included adult Danes aged 25–84 years living in Denmark in 1991 and 2007, stratified by socioeconomic quintiles. Population counts were obtained from the Danish Central Office of Civil Registration, and financial income data from Statistics Denmark. ITFA intake data as grams/day and% total energy intake (%E) were obtained from dietary assessments from the DanMonica 3 Study (1991) and the Danish National Surveys of Dietary Habits and Physical Activity (DANSDA, 2005- 2007) combined with estimated ITFA content in foods on the Danish market. We extended the previously validated Danish IMPACTSEC model to quantify reductions in CHD mortality; the principal output being the number of CHD deaths prevented or postponed attributable to changes in ITFA (%E) intake between 1991 – 2007, all stratified by socioeconomic group. To quantify degrees of uncertainty, we conducted robust sensitivity analyses.
Results Between 1991 and 2007, mean ITFA intake in Denmark fell dramatically from 2.9 g/d to 0.3 g/d in men, and from 2.2 g/d to 0.2 g/d in women. Mean energy intake from ITFA was likewise decimated, falling from 1.1%E to 0.1%E in both men and women. Eleven hundred and ninety-three fewer CHD deaths (BEST UI 1,149 – 1,688), were potentially attributable to the ITFA reduction, representing some 11% of the overall 11,100 CHD mortality fall in Denmark between 1991 and 2007. The greatest attributable mortality falls were seen in the most deprived quintiles (reflecting their bigger reductions in ITFA consumption). Adding ITFA data to the original IMPACTsec model improved the overall model fit from 64% to 73%. The major contributions to the fall in CHD mortality remained consistent across a wide range of sensitivity analyses.
Conclusion Denmark’s mandatory elimination of ITFA was very effective. Furthermore, it may well have accounted for approximately 11% of the substantial reduction in CHD deaths achieved between 1991 and 2007. The most deprived groups benefited the most, thus reducing inequalities. Adopting the Danish ITFA regulatory approach elsewhere could substantially reduce CHD mortality while also improving health equity.
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