The trans-fat ban--food regulation and long-term health.

n engl j med 370;19 nejm.org may 8, 2014 1773 Crisco, companies have used artificial trans fats because of their commercially favorable properties, such as long shelf life, stability during deep frying, and palatability. These fats have therefore been incorporated into a great many foods, including snack and deep-fried foods, baked goods, margarines, and crackers (see graph). The primary dietary source of artificial trans fat is partially hydrogenated oils, created by adding hydrogen to vegetable oils. In the early 1990s, studies began revealing negative health effects of trans fats, and by the mid2000s, it was clear beyond doubt that trans fats increase the risk of coronary heart disease, probably through their deleterious effect on low-density lipoprotein and high-density lipoprotein cholesterol levels.1 Denmark banned partially hydrogenated oils in 2003, and several other countries followed suit; in the United States, New York City passed such a ban for restaurant foods in 2006, and the state of California did the same in 2008. Now, more than a decade after the first ban, the Food and Drug Administration (FDA) has proposed a regulation that would declare partially hydrogenated oils unsafe and allow only a small amount of remaining artificial trans fats in foods sold in the United States.2 A strong argument can be made for eliminating artificial trans fats entirely3; the Centers for Disease Control and Prevention estimates that this action could prevent as many as 20,000 coronary events and 7000 deaths from coronary causes each year in the United States. Still, the FDA action represents a significant advance. Essentially banning artificial trans fats would be a public health victory, made possible in part by limited resistance from the food industry. When New York City proposed its ban, the restaurant industry resisted, claiming that foods would cost more and taste worse and that consumer choices would be restricted because the supply chain could not produce alternative fats in sufficient amounts. None of these predictions were borne out, and industry has adapted. What may have worried indusThe Trans-Fat Ban — Food Regulation and Long-Term Health