title: Trans fatty acids: are its cardiovascular risks fully appreciated?
abstract: OBJECTIVE
  The goal of this article was to review the causal link between trans fatty acids (TFA) produced from partially hydrogenated vegetable oil (PHVO) and cardiovascular disease (CVD) risk and its likely mechanisms. The potential risk of TFA from ruminant dairy and meats, which are currently the major sources of dietary TFA, is also discussed.
  
  
  METHODS
  Evidence was derived from observational studies of large cohorts followed up prospectively; from randomized controlled trials of clinical interventions; and from specific case-control studies that investigated biomarkers in tissues. Searches included PubMed and Medline from 1990 to 2013.
  
  
  RESULTS
  Despite TFA from PHVO being associated more strongly with CVD risk than even saturated fats, it may prove difficult to totally eliminate PHVO from all foods. This raises the issue of the lower limit of TFA consumption below which CVD risk is not increased. Limits of <1% of total energy have been suggested. The major mechanism underlying the increased CVD risk from TFA is an increase in LDL-C and Lp(a) lipoproteins and a decrease in HDL-C; increased inflammation and adverse effects on vascular function have also been shown. Both PHVO and ruminant TFA comprise a range of isomers, some specific to each source but including a substantial commonality that supports findings of similar adverse effects at equivalent intakes of TFA. However, the amount of TFA in ruminant fat is relatively small; this limits the CVD risk from eating ruminant products, an inference supported by analysis of prospective cohort studies.
  
  
  CONCLUSIONS
  Two key challenges to the health industry arise from this evidence. They must first determine whether a small intake of TFA from PHVO is safe and what constitutes a safe amount. They must also determine whether TFA from ruminant fat in currently consumed amounts represent limited cardiovascular risk that is balanced by the nutritional benefits of dairy products.
authors.affiliation: Baker Heart IDI, and Diabetes Institute, Melbourne, Australia. Electronic address: paul.nestel@bakeridi.edu.au.
authors.forename: Paul
authors.initials: P
authors.lastname: Nestel
mesh_terms: D000818:Animals; D002318:Cardiovascular Diseases / Q000209:etiology*; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003611:Dairy Products; D004032:Diet; D004041:Dietary Fats / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D006865:Hydrogenation; D007249:Inflammation; D017270:Lipoprotein(a) / Q000097:blood; D008460:Meat; D010938:Plant Oils / Q000737:chemistry*; D012307:Risk Factors; D012418:Ruminants; D044242:Trans Fatty Acids / Q000008:administration & dosage / Q000009:adverse effects* / Q000502:physiology*
chemical_list: D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D004041:Dietary Fats; D017270:Lipoprotein(a); D010938:Plant Oils; D044242:Trans Fatty Acids
keywords: TFA isomers; biomarkers; cardiovascular risk; ruminant fat; trans fatty acids