Trans fatty acids and cardiovascular health: Translation of the evidence base

The recent interest in the development of evidence-based nutrition recommendations has resulted in the development of frameworks which enable a more structured evaluation of the link between diet and chronic disease. This paper examines the application of the frameworks produced by the Scottish Intercollegiate Guidelines Network (SIGN) and the World Cancer Research Fund (WCRF), by using as a case study the association between trans unsaturated fatty acids (TFAs) and coronary heart disease. TFAs arise during industrial hydrogenation of vegetable or fish fats and oils and the natural digestion process in ruminant animals.Numerous studies have examined the effects of TFA intake on serum lipids and lipoproteins and the association between TFA consumption and cardiovascular disease. Metabolic studies and meta-analyses show a clear and consistent association between increasing TFA intakes and an adverse lipid profile. Evidence from case-control and prospective cohort studies examining the association between TFA intakes and coronary heart disease is more heterogeneous and there are limitations in several of the studies.While the evidence is sufficient to suggest a probable positive association between TFAs and coronary heart disease, and thus to justify a firm recommendation for a reduction in dietary TFA intake, the evaluation of the data underlines the difficulties in extrapolating the principles of evidence-based medicine to evidence-based nutrition. Furthermore, there is a paucity of research into the effects of animal-derived TFAs in amounts typically consumed in a western diet and their association with adverse lipid profiles or cardiovascular outcomes.