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ARTICLE International Food Risk Analysis Journal

Risk Assessment of Exposure to Trans Fat in Canada Sara Krenosky1,*, Mary L’Abbé1, Nora Lee1, Lynne Underhill1, Michel Vigneault1, Samuel Godefroy1 and Nimal Ratnayake1 ȱ 1 Food Directorate, Health Products and Food Branch, Health Canada, Canada * Corresponding author E-mail: [email protected] ȱ Received 24 July 2012; final version received 19 October 2012 © 2012 Krenosky et al.; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstractȱ Transȱ fatsȱ areȱ undesirableȱ becauseȱ theyȱ raiseȱ LDLȬcholesterolȱandȱlowerȱHDLȬcholesterolȱlevelsȱinȱtheȱ blood,ȱ whichȱ canȱ leadȱ toȱ anȱ increasedȱ riskȱ ofȱ coronaryȱ heartȱ disease.ȱ Inȱ theȱ midȬ1990’’s,ȱ researchersȱ estimatedȱ thatȱ Canadiansȱ hadȱ oneȱ ofȱ theȱ highestȱ averageȱ transȱ fatȱ intakesȱ inȱ theȱ world,ȱ estimatedȱ toȱ beȱ approximatelyȱ 3.7%ȱ ofȱ energy.ȱ Theȱ Worldȱ Healthȱ Organizationȱ recommendsȱthatȱaverageȱintakesȱofȱtransȱfatsȱshouldȱbeȱ lessȱ thanȱ 1%ȱ ofȱ totalȱ energy.ȱ Asȱ suchȱ Canadaȱ hasȱ pursuedȱ aȱ multiȬfacetedȱ approachȱ toȱ decreaseȱ transȱ fatȱ levelsȱinȱCanadianȱfoods.ȱInitiativesȱundertakenȱinclude:ȱ mandatoryȱ nutritionȱ labelling,ȱ theȱ establishmentȱ ofȱ aȱ multiȬstakeholderȱ Transȱ Fatȱ Taskȱ Forceȱ toȱ developȱ recommendationsȱandȱstrategiesȱtoȱeliminateȱtransȱfatȱinȱ Canadianȱ foods,ȱ andȱ mostȱ recentlyȱ theȱ monitoringȱ ofȱ industry’’sȱ effortsȱ inȱ reducingȱ transȱ fatsȱ fromȱ theirȱ foodȱ products.ȱ Collectively,ȱ theseȱ initiativesȱ haveȱ provenȱ successfulȱ asȱ averageȱ transȱ fatȱ intakesȱ haveȱ beenȱ reducedȱ toȱ 1.42%ȱ ofȱ overallȱ energy.ȱ Furtherȱ reductionsȱ inȱ transȱ fatȱ levelsȱ inȱ theȱ Canadianȱ foodȱ supplyȱ areȱ neededȱ toȱ meetȱ theȱ targetȱ ofȱ 1%ȱ ofȱ energy,ȱ theȱ associatedȱpublicȱhealthȱobjectives,ȱandȱtheȱprotectionȱofȱ vulnerableȱpopulations.ȱȱ ȱ Keywordsȱ Transȱ fat,ȱ Riskȱ Assessment,ȱ Intakes,ȱ Foodȱ Supply,ȱMonitoringȱ

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1.ȱIntroductionȱ ȱ Theȱ objectivesȱ ofȱ thisȱ paperȱ are:ȱ 1)ȱ toȱ summarizeȱ theȱ findingsȱ fromȱ authoritativeȱ bodiesȱ onȱ theȱ healthȱ risksȱ associatedȱ withȱ transȱ fatȱ intakes,ȱ 2)ȱ toȱ describeȱ theȱ findingsȱ fromȱ monitoringȱ transȱ fatȱ levelsȱ inȱ foodsȱ inȱ Canadaȱ undertakenȱ byȱ Healthȱ Canadaȱ fromȱ 2005Ȭ2009ȱ andȱ theȱ resultingȱ estimatesȱ ofȱ transȱ fatȱ intakesȱ byȱ Canadians,ȱ andȱ 3)ȱ toȱ characterizeȱ theȱ healthȱ risksȱ associatedȱwithȱsuchȱintakes.ȱ ȱ 1.1ȱWhatȱisȱTransȱFat?ȱ ȱ Transȱ fatȱ orȱ transȱ fattyȱ acidsȱ (TFAs)ȱ areȱ chemicallyȱ definedȱ asȱ unsaturatedȱ fattyȱ acidsȱ containingȱ aȱ carbonȬ carbonȱdoubleȱbondȱinȱtheȱfattyȱacidȱchainȱinȱtheȱ““trans””ȱ positionȱ(Figureȱ1)ȱ[1],ȱ[2].ȱȱȱ ȱ Asȱ depictedȱ inȱ theȱ illustration,ȱ inȱ theȱ ““trans””ȱ configurationȱ theȱ hydrogenȱ atomsȱ areȱ onȱ oppositeȱ sidesȱ ofȱ theȱ doubleȱ bondȱ resultingȱ inȱ aȱ fattyȱ acidȱ chainȱ thatȱ isȱ straightȱ [1],ȱ similarȱ toȱ saturatedȱ fatsȱ inȱ thatȱ way.ȱ Inȱ contrast,ȱ whenȱ theȱ hydrogenȱ atomsȱ areȱ inȱ theȱ ““cis””ȱ position,ȱasȱinȱtheȱcaseȱofȱoleicȱacid,ȱtheyȱareȱonȱtheȱsameȱ sideȱofȱtheȱdoubleȱbond.ȱ Thisȱcausesȱaȱbendȱorȱaȱkinkȱinȱ theȱ fattyȱ acidȱ chainȱ [1].ȱ Straightȱ chainsȱ areȱ moreȱ easilyȱ

Int. food riskVigneault, anal. j., 2012, Vol. 2, 1-15 Sara Krenosky, Mary L’Abbé, Nora Lee, Lynne Underhill, Michel Samuel Godefroy and Nimal Ratnayake: Risk Assessment of Exposure to Trans Fat in Canada

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compactedȱ thanȱ bentȱ chainsȱ andȱ resultȱ inȱ aȱ lessȱ fluidȱ material.ȱ Mostȱ naturalȱ unsaturatedȱ fattyȱ acidsȱ areȱ foundȱ inȱ theȱ cisȱ position,ȱ includingȱ oleicȱ acid,ȱ linoleicȱ acid,ȱ ΅Ȭ linolenicȱ acid,ȱ andȱ theȱ marineȱ fattyȱ acidsȱ [2].ȱ Partialȱ hydrogenationȱconvertsȱmanyȱunsaturatedȱdoubleȱbondsȱ fromȱ aȱ cisȬȱ toȱ aȱ transȬconfigurationȱ (calledȱ geometricȱ isomerization).ȱThisȱprocessȱalsoȱoftenȱinducesȱchangesȱinȱ theȱdoubleȱbondȱpositionȱtoȱaȱdifferentȱcarbonȱinȱtheȱfattyȱ acidȱchainȱ(calledȱpositionalȱisomerization)ȱ[2].ȱ ȱ

ȱ

ȱ

Figureȱ1.ȱStructureȱofȱCisȱandȱTransȱFattyȱAcidsȱ[1]ȱ

ȱ 1.2ȱSourcesȱofȱHumanȱExposureȱtoȱTransȱFatȱ ȱ Transȱfatsȱareȱformedȱduringȱtheȱpartialȱhydrogenationȱofȱ unsaturatedȱ fat.ȱ Vegetableȱ oilsȱ areȱ hydrogenatedȱ toȱ increaseȱtheirȱmeltingȱpointȱsoȱthatȱtheyȱareȱsolidȱorȱsemiȬ solidȱ atȱ roomȱ temperature.ȱ Partiallyȱ hydrogenatedȱ oilsȱ (PHO)ȱ areȱ usedȱ toȱ makeȱ shorteningsȱ andȱ margarinesȱ forȱ processing,ȱbaking,ȱandȱfrying.ȱGenerally,ȱproductsȱmadeȱ withȱ PHOsȱ haveȱ aȱ longerȱ shelfȱ lifeȱ thanȱ ifȱ madeȱ withȱ liquidȱoilsȱandȱareȱmoreȱstableȱandȱbreakȱdownȱlessȱeasilyȱ underȱ conditionsȱ ofȱ highȱ temperatureȱ heating.ȱ Transȱ fatsȱ canȱalsoȱbeȱfoundȱatȱlowȱlevelsȱinȱfullyȱhydrogenatedȱoilsȱ andȱinȱrefinedȱoilsȱ[3].ȱ ȱ Transȱfatsȱareȱalsoȱfoundȱnaturallyȱatȱrelativelyȱlowȱlevels,ȱ historicallyȱ betweenȱ 2Ȭ5%ȱ ofȱ theȱ totalȱ fatȱ contentȱ inȱ ruminantȬderivedȱ foodsȱ (forȱ example,ȱ beef,ȱ dairyȱ products,ȱ lamb)ȱ [4].ȱ Recentȱ dataȱ fromȱ Healthȱ Canadaȱ researchȱ indicatedȱ thatȱ TFAȱ levelsȱ measuredȱ inȱ someȱ dairyȱ productsȱ (cheese,ȱ butter,ȱ milk,ȱ andȱ cream)ȱ rangeȱ fromȱ 4.2%Ȭ7.4%ȱ ofȱ totalȱ fatsȱ [4].ȱ Theȱ levelȱ ofȱ fatȱ inȱ theseȱ samplesȱ rangedȱ fromȱ 10%ȱ (halfȬcreamȱ product)ȱ toȱ 80%ȱ (saltedȱ butter)ȱ [4].ȱ Theȱ highestȱ levelsȱ wereȱ foundȱ inȱ cheeseȱandȱbutterȱ[4].ȱȱ ȱ 2.ȱHazardȱCharacterisation:ȱHealthȱHazardsȱofȱTransȱFatȱ ȱ Transȱ fatsȱ areȱ notȱ essential,ȱ areȱ notȱ requiredȱ forȱ anyȱ specificȱ bodyȱ function,ȱ andȱ provideȱ noȱ knownȱ benefitȱ toȱ humanȱ health.ȱ Theȱ adverseȱ effectsȱ onȱ heartȱ healthȱ areȱ wellȱ knownȱ [1],ȱ [2],ȱ [5].ȱ Transȱ fatȱ raisesȱ LDLȬcholesterolȱ (LDLȬC)ȱ andȱ lowersȱ HDLȬcholesterolȱ (HDLȬC)ȱ levelsȱ inȱ

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theȱblood.ȱElevatedȱlevelsȱofȱLDLȬCȱandȱloweredȱlevelsȱofȱ HDLȬCȱ areȱ riskȱ factorsȱ inȱ theȱ developmentȱ ofȱ coronaryȱ heartȱdiseaseȱ(CHD).ȱDietaryȱTFAsȱareȱconsideredȱtoȱposeȱ anȱ evenȱ greaterȱ riskȱ toȱ healthȱ thanȱ saturatedȱ fatsȱ (SFAs)ȱ sinceȱ SFAsȱ raiseȱ bothȱ LDLȬCȱ andȱ HDLȬCȱ levelsȱ [5].ȱ Furthermore,ȱ evidenceȱ fromȱ bothȱ controlledȱ trialsȱ andȱ observationalȱ studiesȱ indicatesȱ thatȱ TFAsȱ fromȱ partiallyȱ hydrogenatedȱ sourcesȱ adverselyȱ affectsȱ multipleȱ cardiovascularȱ diseaseȱ riskȱ factors,ȱ notȱ onlyȱ bloodȱ cholesterolȱprofilesȱ[5],ȱ[6],ȱ[7].ȱȱ ȱ Healthȱ Canadaȱ hasȱ adoptedȱ theȱ recommendationsȱ ofȱ theȱ USȬCanadaȱPanelȱonȱMacronutrientsȱofȱtheȱU.S.ȱNationalȱ Academies’’ȱ Instituteȱ ofȱ Medicineȱ (IOM),ȱ publishedȱ inȱ 2002,ȱwithȱrespectȱtoȱintakesȱofȱtransȱfatȱ[8].ȱTherefore,ȱtheȱ hazardȱ identificationȱ andȱ characterizationȱ ofȱ TFAsȱ uponȱ whichȱ thisȱ riskȱ assessmentȱ isȱ basedȱ wasȱ doneȱ byȱ thisȱ Panel.ȱThisȱwasȱsupplementedȱbyȱreferenceȱtoȱtheȱworkȱofȱ theȱWorldȱHealthȱOrganizationȱ(WHO)ȱ[2],ȱ[9].ȱ ȱ BasedȱonȱtheirȱassessmentȱofȱtheȱevidenceȱlinkingȱTFAsȱtoȱ coronaryȱheartȱdiseaseȱavailableȱatȱthatȱtimeȱ[10],ȱ[11],ȱtheȱ IOMȱ Panelȱ recommendedȱ thatȱ TFAȱ consumptionȱ beȱ asȱ lowȱasȱpossibleȱwhileȱconsumingȱaȱnutritionallyȱadequateȱ dietȱ[5].ȱ TheȱIOMȱalsoȱnotedȱthatȱitȱwouldȱ beȱdifficultȱtoȱ lowerȱtransȱfatȱintakesȱtoȱ0%ȱ energyȱsinceȱaȱnutritionallyȱ adequateȱ dietȱ wouldȱ containȱ someȱ naturallyȱ occurringȱ TFAsȱ [5].ȱ Noȱ Adequateȱ Intakeȱ orȱ Recommendedȱ Dietaryȱ Allowanceȱ wasȱ setȱ forȱ TFAsȱ becauseȱ theyȱ haveȱ noȱ nutritionalȱ function.ȱ Also,ȱ no,ȱ Tolerableȱ Upperȱ Intakeȱ Levelȱ (UL)ȱ wasȱ setȱ becauseȱ anyȱ incrementalȱ increaseȱ inȱ TFAȱintakeȱwasȱfoundȱtoȱincreaseȱCHDȱriskȱ[5].ȱTheȱPanelȱ alsoȱstatedȱthatȱbecauseȱtheȱintakeȱofȱTFAsȱandȱLDLȬCȱisȱ aȱ positiveȱ linearȱ relationship,ȱ evenȱ veryȱ lowȱ intakesȱ ofȱ TFAsȱmayȱincreaseȱtheȱriskȱofȱCHDȱ[5].ȱItȱwasȱdeterminedȱ thatȱ thereȱ wasȱ aȱ doseȬdependentȱ relationshipȱ betweenȱ TFAsȱandȱtheȱLDLȬC:HDLȬCȱratioȱwhenȱtheȱresultsȱfromȱ nineȱ randomizedȱ studiesȱ wereȱ combinedȱ andȱ theȱ magnitudeȱ ofȱ thisȱ effectȱ wasȱ greaterȱ forȱ TFAsȱ thanȱ withȱ SFAsȱ [5],ȱ [11].ȱ Furthermore,ȱ whenȱ thereȱ wasȱ aȱ directȱ comparisonȱ inȱ sixȱ ofȱ theȱ trials,ȱ theȱ effectȱ ofȱ TFAsȱ onȱ theȱ ratioȱ ofȱ LDLȬCȱ toȱ HDLȬCȱ wasȱ statisticallyȱ significantlyȱ largerȱthanȱthatȱofȱSFAsȱ[11].ȱItȱwasȱconcludedȱthatȱtheseȱ studiesȱ providedȱ definitiveȱ evidenceȱ thatȱ TFAsȱ raiseȱ thisȱ ratioȱmoreȱthanȱdoȱSFAsȱ[5],ȱ[11].ȱȱ ȱ Subsequently,ȱ inȱ 2003,ȱ theȱ Worldȱ Healthȱ Organizationȱ (WHO)ȱ advisedȱ thatȱ dietsȱ shouldȱ provideȱ aȱ veryȱ lowȱ intakeȱofȱTFAs;ȱthatȱis,ȱaverageȱintakesȱofȱTFAsȱshouldȱbeȱ lessȱ thanȱ 1%ȱ ofȱ totalȱ energyȱ [9].ȱ Givenȱ theȱ uncertaintyȱ aboutȱ whetherȱ healthȱ effectsȱ differȱ betweenȱ naturallyȱ occurringȱ TFAsȱ andȱ industriallyȱ producedȱTFAsȱ andȱ theȱ analyticalȱdifficultyȱinȱdistinguishingȱthese,ȱtheȱWHOȱdidȱ notȱ distinguishȱ betweenȱ theseȱ sourcesȱ inȱ makingȱ theȱ 1%ȱ recommendationȱ[6].ȱȱȱ ȱ

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Inȱ Novemberȱ 2008,ȱ theȱ Foodȱ andȱ Agricultureȱ Organizationȱ(FAO)ȱandȱtheȱWHOȱconvenedȱaȱmeetingȱtoȱ reviewȱtheȱmajorȱdevelopmentsȱinȱtheȱfieldȱofȱfattyȱacidsȱ inȱhumanȱnutrition.ȱItȱwasȱrecognizedȱbyȱexpertsȱthatȱtheȱ currentȱrecommendation,ȱaverageȱtransȱfatȱintakesȱofȱlessȱ thanȱ1%ȱofȱtotalȱenergy,ȱmayȱneedȱtoȱbeȱrevisitedȱinȱlightȱ ofȱ theȱ factȱ thatȱ itȱ doesȱ notȱ fullyȱ takeȱ intoȱ accountȱ theȱ distributionȱofȱintakesȱ[12].ȱThus,ȱtheȱremovalȱofȱpartiallyȱ hydrogenatedȱ fatsȱ andȱ oilsȱ fromȱ theȱ humanȱ foodȱ supplyȱ mayȱ beȱ neededȱ toȱ protectȱ certainȱ groupsȱ fromȱ havingȱ dangerouslyȱhighȱintakesȱ[12].ȱȱ ȱ Inȱ supportȱ ofȱ theȱ expertȱ consultationȱ heldȱ inȱ Novemberȱ 2008,ȱ aȱ scientificȱ updateȱ [6]ȱ whichȱ includedȱ theȱ mostȱ recentȱ dataȱ asȱ wellȱ asȱ earlierȱ studiesȱ availableȱ onȱ heartȱ healthȱ effectsȱ ofȱ TFAsȱ wasȱ publishedȱ inȱ theȱ Europeanȱ Journalȱ ofȱ Clinicalȱ Nutrition’’sȱ Supplementȱ entitledȱ ““WHOȱ Scientificȱ Updateȱ onȱ transȱ fattyȱ acids””.ȱ Thisȱ updateȱ consideredȱ evidenceȱ fromȱ bothȱ controlledȱ andȱ observationalȱ studiesȱ forȱ theȱ effectsȱ ofȱ transȱ fatȱ consumptionȱ onȱ CHD.ȱ Theȱ authorsȱ summarizedȱ theȱ resultsȱ ofȱ overȱ twentyȱ controlledȱ studiesȱ andȱ severalȱ metaȬanalysesȱ(conductedȱinȱ2003ȱandȱ2006)ȱfocussingȱonȱ theȱeffectsȱofȱTFAsȱonȱbloodȱlipidsȱandȱlipoproteins.ȱTheȱ adverseȱ effectsȱ ofȱ TFAsȱ onȱ LDLȬCȱ andȱ HDLȬCȱ wereȱ clearlyȱ demonstrated:ȱ ȱ theyȱ increasedȱ LDLȬC,ȱ decreasedȱ HDLȬC,ȱ andȱ increasedȱ theȱ ratioȱ ofȱ totalȬcholesterolȱ toȱ HDLȬCȱ [6].ȱ Theȱ sameȱ authorsȱ reportȱ inȱ aȱ separateȱ paperȱ theirȱownȱmetaȬanalysesȱofȱ13ȱcontrolledȱtrialsȱconductedȱ fromȱ1982ȱuntilȱ2007.ȱTheyȱreportȱthatȱforȱeachȱ1%ȱenergyȱ replacementȱ ofȱ TFAsȱ withȱ SFAs,ȱ monounsaturatedȱ fatsȱ (MUFAs)ȱ orȱ polyunsaturatedȱ fatsȱ (PUFAs),ȱ theȱ totalȬ cholesterol:HDLȬCȱratioȱdecreasedȱbyȱ0.31,ȱ0.54ȱandȱ0.67,ȱ respectivelyȱ[7].ȱ ȱ Aȱ limitationȱ ofȱ theseȱ typesȱ ofȱ studies,ȱ acknowledgedȱ byȱ theȱ authors,ȱ isȱ thatȱ theyȱ areȱ generallyȱ shortȱ term,ȱ highȱ dose,ȱ andȱ inȱ generallyȱ healthyȱ individuals.ȱ Ethicalȱ concernsȱ limitȱ theȱ possibilityȱ ofȱ longerȱ termȱ trials,ȱ whenȱ almostȱcertainȱharmȱwillȱoccurȱinȱindividualsȱsubjectedȱtoȱ aȱ highȱ transȱ fatȱ intervention.ȱ Theȱ authorsȱ alsoȱ reviewedȱ observationalȱ studiesȱ examiningȱ theȱ correlationȱ betweenȱ transȱfatȱconsumptionȱandȱCHD,ȱinȱbothȱprospectiveȱandȱ retrospectiveȱ studyȱ designs.ȱ Theseȱ typesȱ ofȱ studiesȱ haveȱ differentȱ limitations,ȱ suchȱ asȱ difficultyȱ inȱ adjustingȱ forȱ confoundingȱ riskȱ factors,ȱ relianceȱ onȱ dietaryȱ estimates,ȱ andȱ changeȱ inȱ dietaryȱ habitsȱ overȱ time.ȱ Sevenȱ retrospectiveȱ andȱ fiveȱ prospectiveȱ studiesȱ wereȱ summarized.ȱ Fiveȱ ofȱ theȱ retrospectiveȱ andȱ fourȱ ofȱ theȱ prospectiveȱ studiesȱ showedȱ aȱ clearȱ associationȱ betweenȱ transȱ fatȱ consumptionȱ andȱ CHDȱ events.ȱ Aȱ metaȬanalysisȱ ofȱ justȱ theȱ fourȱ prospectiveȱ cohortȱ studiesȱ estimatedȱ aȱ 17%,ȱ 21%ȱ andȱ 24%ȱ lowerȱ riskȱ ofȱ CHDȱ forȱ everyȱ 2%ȱ ofȱ energyȱfromȱtransȱfatȱintakeȱthatȱisȱreplacedȱwithȱSFA,ȱcisȱ MUFAȱandȱcisȱPUFA,ȱrespectivelyȱ[7].ȱȱ ȱ

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Theȱ evidenceȱ fromȱ controlledȱ trialsȱ orȱ observationalȱ studiesȱ provideȱ concordantȱ dataȱ thatȱ consumptionȱ ofȱ transȱ fatȱ fromȱ PHOȱ adverselyȱ affectsȱ multipleȱ cardiovascularȱriskȱfactorsȱandȱcontributesȱsignificantlyȱtoȱ increasedȱriskȱofȱCHD.ȱȱ ȱ 3.ȱExposureȱAssessmentȱȱ ȱ 3.1ȱHistoricalȱIntakesȱandȱSourcesȱofȱTFAsȱinȱCanadaȱ ȱ Inȱ Canada,ȱ scientistsȱ raisedȱ concernsȱ aboutȱ theȱ potentialȱ detrimentalȱeffectsȱofȱTFAsȱandȱtheȱlevelsȱinȱtheȱCanadianȱ dietȱasȱfarȱbackȱasȱtheȱ1970s,ȱrecommendingȱthatȱtheȱtransȱ fatȱlevelsȱnotȱincreaseȱ[13],ȱ[14].ȱTheȱevidenceȱatȱtheȱtimeȱ wasȱ largelyȱ fromȱ animalȱ studiesȱ andȱ wasȱ inconclusive.ȱ However,ȱtheȱuseȱofȱPHOȱcontinuedȱtoȱincrease.ȱPartiallyȱ hydrogenatedȱoilsȱwereȱattractiveȱtoȱtheȱfoodȱindustryȱinȱ theȱ manufactureȱ ofȱ margarines,ȱ shorteningsȱ andȱ theȱ preparationȱ ofȱ commercialȱ bakedȱ productsȱ becauseȱ ofȱ theirȱ betterȱ functionalȱ properties,ȱ longerȱ shelfȱ life,ȱ oxidativeȱ stabilityȱ andȱ semiȬsolidityȱ [1],ȱ [2].ȱ Also,ȱ theyȱ wereȱ promotedȱ asȱ anȱ alternativeȱ toȱ butterȱ andȱ otherȱ animalȱ fatsȱ andȱ tropicalȱ oilsȱ whichȱ wereȱ theȱ fatsȱ mostȱ associatedȱ withȱ havingȱ negativeȱ healthȱ attributesȱ atȱ thatȱ time.ȱ Byȱ theȱ midȬ1990’’s,ȱ researchersȱ estimatedȱ thatȱ Canadiansȱhadȱoneȱofȱtheȱhighestȱaverageȱtransȱfatȱintakesȱ inȱtheȱworld,ȱestimatedȱtoȱbeȱapproximatelyȱ8.4ȱg/dayȱorȱ 3.7%ȱ ofȱ energyȱ [15].ȱ Thisȱ estimateȱ wasȱ madeȱ usingȱ bothȱ dietaryȱintakeȱdataȱandȱanalysisȱofȱhumanȱmilkȱsamples.ȱ Foodsȱthatȱwereȱcontributingȱtoȱtheȱhighȱtransȱfatȱintakesȱ includedȱ crackers,ȱ margarines,ȱ shortenings,ȱ donuts,ȱ cookies,ȱ pieȱ shells,ȱ breadedȱ chicken,ȱ cakeȱ mixesȱ andȱ cakes,ȱfrenchȱfries,ȱsauces,ȱandȱgraviesȱ[16],ȱ[17].ȱDetailedȱ fatȱ analysisȱ ofȱ overȱ 200ȱ locallyȱ andȱ nationallyȱ availableȱ foodsȱindicatedȱthatȱtheȱTFAȱlevelsȱinȱsomeȱfoodsȱreachedȱ asȱ highȱ asȱ 50Ȭ56%ȱ TFAȱ asȱ percentȱ ofȱ totalȱ fatȱ [16].ȱ Theȱ variabilityȱ ofȱ TFAȱ levelsȱ inȱ certainȱ foodȱ categoriesȱ wasȱ quiteȱ largeȱ asȱ wellȱ [16].ȱ Inȱ lightȱ ofȱ oneȱ ofȱ theȱ highestȱ intakesȱofȱtransȱfatȱinȱtheȱworld,ȱCanadaȱbecameȱtheȱfirstȱ countryȱinȱtheȱworldȱtoȱrequireȱtheȱdeclarationȱofȱtransȱfatȱ inȱ nutritionȱ labelling.ȱ Theȱ regulationsȱ requiringȱ theȱ mandatoryȱ declarationȱ ofȱ transȱ fatȱ wereȱ promulgatedȱ inȱ Decemberȱ 2002ȱ andȱ cameȱ intoȱ effectȱ forȱ mostȱ prepackagedȱfoodsȱinȱDecemberȱ2005ȱ[18].ȱ ȱ Theȱ availabilityȱ ofȱ transȱ fatȱ informationȱ onȱ theȱ Nutritionȱ Factsȱ tableȱ helpedȱ drawȱ theȱ attentionȱ ofȱ consumersȱ andȱ publicȱ healthȱ professionalsȱ toȱ theȱ presenceȱ ofȱ TFAsȱ inȱ prepackagedȱ foods,ȱ whichȱ resultedȱ inȱ aȱ significantȱ reductionȱofȱtheȱtransȱfatȱcontentȱofȱtheseȱfoodsȱ[19],ȱ[20],ȱ [21].ȱ However,ȱ thereȱ wasȱ alsoȱ interestȱ expressedȱ byȱ Canadianȱ healthȱ organizationsȱ thatȱ moreȱ actionsȱ wereȱ neededȱtoȱensureȱthatȱtransȱfatȱlevelsȱwereȱreducedȱacrossȱ theȱfoodȱsupply.ȱȱ ȱ

Sara Krenosky, Mary L’Abbé, Nora Lee, Lynne Underhill, Michel Vigneault, Samuel Godefroy and Nimal Ratnayake: Risk Assessment of Exposure to Trans Fat in Canada

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Therefore,ȱ inȱ lightȱ ofȱ thisȱ increasedȱ interestȱ andȱ inȱ responseȱtoȱotherȱfactorsȱ[22],ȱinȱ2005,ȱaȱmultiȬstakeholderȱ taskȱ forceȱ wasȱ establishedȱ toȱ studyȱ transȱ fatȱ inȱ theȱ Canadianȱfoodȱsupply.ȱTheȱmandateȱandȱtheȱfinalȱreportȱ ofȱ theȱ Transȱ Fatȱ Taskȱ Forceȱ (TFTF),ȱ ““TRANSformingȱ theȱ Foodȱ Supply””,ȱ wereȱ publishedȱ onȱ Healthȱ Canada’’sȱ websiteȱ[23].ȱȱ ȱ AmongȱtheȱanalysesȱconductedȱforȱtheȱTaskȱForceȱinȱ2005ȱ wasȱ aȱ newȱ estimateȱ ofȱ transȱ fatȱ intake.ȱ Transȱ fatȱ compositionȱ valuesȱ andȱ intakesȱ wereȱ obtainedȱ fromȱ theȱ CanadianȱNutrientȱFileȱ(CNF)ȱarchivedȱrecords,ȱfromȱtheȱ Nutritionȱ Surveyȱ Systemȱ (NSS)ȱ databasesȱ usedȱ duringȱ thisȱ timeȱ period,ȱ asȱ wellȱ asȱ dataȱ filesȱ fromȱ threeȱ Provincialȱ nutritionȱ surveys.ȱ Theȱ analysesȱ indicatedȱ thatȱ averageȱ intakesȱ ofȱ TFAsȱ byȱ Canadiansȱ inȱ 2005ȱ hadȱ decreasedȱtoȱ4.4g/dayȱfromȱtheȱpreviousȱhighȱofȱ8.4ȱg/dayȱ asȱ ofȱ 1995ȱ [24].ȱ Thisȱ levelȱ was,ȱ nevertheless,ȱ stillȱ wellȱ aboveȱ theȱ WHOȱ recommendationȱ ofȱ lessȱ thanȱ 1%ȱ ofȱ overallȱenergyȱintakeȱ(approximatelyȱ2.2ȱg/day).ȱ ȱ InȱresponseȱtoȱtheȱTFTF’’sȱfinalȱreport,ȱwhichȱcalledȱforȱaȱ regulatoryȱ approachȱ toȱ limitȱ theȱ levelsȱ ofȱ TFAȱ inȱ theȱ Canadianȱ foodȱ supplyȱ [23],ȱ inȱ Juneȱ 2007,ȱ itȱ wasȱ announcedȱthatȱtheȱfoodȱindustryȱwouldȱhaveȱtwoȱyearsȱ toȱ achieve,ȱ onȱ aȱ voluntaryȱ basis,ȱ limitsȱ ofȱ 2%ȱ ofȱ totalȱ fatȱ contentȱforȱvegetableȱoilsȱandȱsoft,ȱspreadableȱmargarinesȱ andȱ 5%ȱ ofȱ totalȱ fatȱ contentȱ forȱ allȱ otherȱ foodsȱ [25].ȱ Additionally,ȱ itȱ wasȱ announcedȱ thatȱ progressȱ wouldȱ beȱ monitoredȱbyȱHealthȱCanadaȱ[25],ȱ[26].ȱTheseȱlimitsȱwereȱ establishedȱ withȱ theȱ aimȱ ofȱ achievingȱ anȱ averageȱ Canadianȱ intakeȱ ofȱ 1%ȱ ofȱ energyȱ asȱ transȱ fat,ȱ asȱ recommendedȱbyȱtheȱWHOȱ[23].ȱ ȱ Theȱ Transȱ Fatȱ Monitoringȱ Programȱ (TFMP)ȱ wasȱ establishedȱtoȱanalyzeȱtheȱTFAȱcontentȱofȱfoods,ȱfocussingȱ onȱthoseȱfoodsȱknownȱtoȱcontributeȱhighȱlevelsȱofȱTFAsȱtoȱ theȱCanadianȱdiet.ȱTheȱprimaryȱobjectiveȱofȱtheȱprogramȱ wasȱ toȱ assessȱ theȱ foodȱ industry’’sȱ performanceȱ inȱ reducingȱ TFAsȱ inȱ theirȱ productsȱ toȱ meetȱ theȱ 2%ȱ andȱ 5%ȱ limits,ȱ ratherȱ thanȱ toȱ gatherȱ dataȱ toȱ estimateȱ changesȱ inȱ intake.ȱFoodsȱthatȱwereȱmonitoredȱoverȱtheȱ2Ȭyearȱperiodȱ includedȱ preȬpackagedȱ foods,ȱ bakeryȱ productsȱ andȱ desserts,ȱ margarines,ȱ shortenings,ȱ andȱ foodsȱ fromȱ fastȱ foodȱ andȱ restaurantȱ chains.ȱ Resultsȱ wereȱ obtainedȱ fromȱ laboratoryȱ analysesȱ conductedȱ inȱ threeȱ Healthȱ Canadaȱ laboratoriesȱasȱwellȱasȱbyȱlabelȱreviewȱandȱwereȱreleasedȱ approximatelyȱ everyȱ 6Ȭ7ȱ monthsȱ onȱ theȱ Healthȱ Canadaȱ website.ȱDetailsȱandȱfullȱresultsȱofȱtheȱTFMPȱcanȱbeȱfoundȱ inȱAppendicesȱAȱandȱB.ȱ ȱ 3.2ȱChangesȱinȱFoodȱSourcesȱofȱTFAsȱasȱshownȱbyȱtheȱTFMPȱ ȱ Overall,ȱ resultsȱ obtainedȱ fromȱ theȱ TFMPȱ fromȱ 2005Ȭ2009ȱ indicateȱ thatȱ throughȱ theȱ voluntaryȱ approach,ȱ industryȱ hasȱ madeȱ progressȱ inȱ reducingȱ TFAȱ levelsȱ inȱ theirȱ

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productsȱ whileȱ notȱ increasingȱ saturatedȱ fatȱ contentȱ [26],ȱ [28].ȱ Moreȱ thanȱ 1100ȱ foodȱ itemsȱ wereȱ analyzedȱ overȱ theȱ twoȱ yearȱ monitoringȱ periodȱ andȱ itȱ wasȱ foundȱ thatȱ approximatelyȱ75%ȱofȱthoseȱfoodsȱanalyzedȱandȱreviewedȱ usingȱlabelȱdataȱwereȱmeetingȱtheȱ2%ȱandȱ5%ȱlimitsȱthatȱ wereȱrecommendedȱbyȱtheȱ TFTFȱandȱadoptedȱbyȱ Healthȱ Canadaȱ[28]ȱ(seeȱAppendixȱB).ȱ ȱ Theȱ resultsȱ alsoȱ demonstratedȱ that,ȱ asȱ ofȱ 2008Ȭ2009ȱ asȱ reportedȱinȱtheȱ4thȱdataȱset,ȱthereȱremainȱcertainȱsegmentsȱ ofȱ theȱ foodȱ supplyȱ thatȱ areȱ notȱ fullyȱ meetingȱ theȱ targetsȱ [26],ȱ[28].ȱForȱexample,ȱproductsȱthatȱcouldȱstillȱbeȱfoundȱ toȱ containȱ highȱ levelsȱ ofȱ TFAsȱ (fromȱ 5%Ȭ67%ȱ transȱ fatȱ ofȱ totalȱ fat)ȱ includedȱ hardȱ margarines,ȱ garlicȱ spreads,ȱ shortenings,ȱ coffeeȱ whitener,ȱ garlicȱ bread,ȱ softȱ margarines,ȱ desserts,ȱ andȱ bakeryȱ productsȱ (cookies,ȱ donuts,ȱcroissants,ȱtarts,ȱpies,ȱbrownies)ȱ[26],ȱ[28].ȱȱ ȱ 3.3ȱCurrentȱTransȱFatȱIntakesȱinȱCanadaȱ ȱ Theȱ 2008ȱ averageȱ intakeȱ ofȱ TFAsȱ byȱ Canadiansȱ wasȱ estimatedȱ usingȱ dataȱ obtainedȱ fromȱ theȱ Canadianȱ Communityȱ Healthȱ Surveyȱ (CCHS)ȱ Cycleȱ 2.2ȱ onȱ Nutritionȱ (2004),ȱ dataȱ collectedȱ fromȱ theȱ TFMP,ȱ andȱ byȱ makingȱ certainȱ assumptionsȱ regardingȱ TFAsȱ inȱ theȱ foodȱ supply.ȱ Thisȱ allowedȱ Healthȱ Canadaȱ toȱ verifyȱ thatȱ theseȱ estimates,ȱwhichȱwereȱdoneȱforȱtheȱTFTFȱbasedȱonȱearlierȱ provincialȱ data,ȱ wereȱ stillȱ validȱ usingȱ moreȱ current,ȱ nationallyȱ representativeȱ data.ȱ Theȱ methodologyȱ employedȱandȱtheȱresultingȱestimateȱofȱtransȱfatȱintakesȱinȱ Canadaȱareȱdescribedȱbelow.ȱ ȱ 3.3.1ȱMethodologyȱ ȱ Theȱ CCHSȱ Cycleȱ 2.2ȱ wasȱ aȱ nutritionȬfocussedȱ surveyȱ carriedȱ outȱ byȱ Statisticsȱ Canadaȱ thatȱ includedȱ dataȱ fromȱ overȱ33,000ȱrespondentsȱfromȱallȱprovinces,ȱexcludingȱtheȱ territoriesȱ [31].ȱ Forȱ thisȱ survey,ȱ aȱ 24Ȭhourȱ recallȱ wasȱ completedȱ onȱ allȱ respondents,ȱ withȱ aȱ repeatȱ recallȱ doneȱ onȱ aȱ subsetȱ ofȱ overȱ 10,000ȱ respondents.ȱ Thisȱ analysisȱ includedȱ respondentsȱ agedȱ oneȱ yearȱ andȱ over;ȱ respondentsȱ withȱ nullȱ orȱ invalidȱ recallsȱ andȱ breastfedȱ childrenȱwereȱexcluded.ȱȱȱ ȱ Transȱandȱsaturatedȱfatȱcompositionȱvaluesȱwereȱobtainedȱ forȱaȱnumberȱofȱfoodsȱatȱtwoȱtimeȱpoints:ȱ2004ȱandȱ2008.ȱ Transȱandȱsaturatedȱfatȱcompositionȱvaluesȱforȱ2004ȱwereȱ obtainedȱ fromȱ theȱ archivedȱ recordsȱ ofȱ theȱ CNFȱ [32]ȱ andȱ fromȱ theȱ NSSȱ databasesȱ usedȱ duringȱ thisȱ timeȱ period.ȱ Transȱandȱsaturatedȱfatȱcompositionȱvaluesȱforȱ2008ȱwereȱ obtainedȱ fromȱ laboratoryȱ analysesȱ ofȱ foodȱ productsȱ asȱ partȱ ofȱ theȱ TFMP.ȱ Theȱ 2008ȱ transȱ fatȱ compositionȱ estimatesȱ wereȱ calculatedȱ asȱ theȱ averageȱ forȱ theȱ brandsȱ sampledȱforȱaȱgivenȱfood,ȱtakingȱtheȱaverageȱweightedȱbyȱ salesȱvolumeȱwhenȱavailable.ȱ ȱ

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Transȱ andȱ saturatedȱ fatȱ compositionȱ valuesȱ whenȱ availableȱ wereȱ appliedȱ toȱ foodsȱ reportedȱ inȱ theȱ CCHSȱ Cycleȱ2.2ȱandȱallȱrecallsȱwereȱthenȱcombinedȱtoȱobtainȱtheȱ totalȱ transȱ andȱ saturatedȱ fatȱ consumedȱ byȱ respondentsȱ duringȱ theirȱ recallȱ day.ȱ Usualȱ intakeȱ distributionsȱ wereȱ estimatedȱ usingȱ theȱ Softwareȱ forȱ Intakeȱ Distributionȱ Estimationȱ (SIDE)ȱ [33],ȱ andȱ theȱ ageȬsexȱ groupsȱ wereȱ pooledȱ forȱ theȱ 2008ȱ dataȱ asȱ theyȱ wereȱ inȱ theȱ 2005ȱ modellingȱconductedȱforȱtheȱTFTFȱ[23].ȱȱ ȱ

Populationȱweightsȱwereȱappliedȱtoȱobtainȱrepresentativeȱ estimates.ȱTheȱBootstrapȱreplicationȱmethodȱwasȱusedȱtoȱ calculateȱ standardȱ errorsȱ forȱ theȱ estimatesȱ ofȱ transȱ fatȱ intakeȱ distributionsȱ [34].ȱ Reliabilityȱ rulesȱ basedȱ onȱ theȱ Coefficientȱ ofȱ Variationȱ (CV)ȱ wereȱ appliedȱ toȱ identifyȱ estimatesȱofȱmarginalȱreliabilityȱ(16.6%ȱȱ 33.3%).ȱ Theȱ Bootstrapȱ replicationȱ methodȱ accountsȱ onlyȱ forȱ theȱ samplingȱ error.ȱ Thereȱ areȱ otherȱ sourcesȱ ofȱ errorȱ notȱ quantifiedȱ inȱ thisȱ reportȱ suchȱ asȱ respondentsȱ misunderstandingȱquestionsȱorȱanswersȱbeingȱincorrectlyȱ processed.ȱ Inȱ particular,ȱ theȱ methodologyȱ doesȱ notȱ propagateȱ toȱ theȱ populationȱ estimatesȱ theȱ potentialȱ variationȱ betweenȱ theȱ nutrientȱ compositionȱ ofȱ brandsȱ ofȱ productsȱ consumedȱ byȱ respondents.ȱ Asȱ aȱ result,ȱ careȱ mustȱbeȱexercisedȱinȱinterpretingȱtheȱstandardȱerrorsȱandȱ confidenceȱintervalsȱ(CI)ȱestimatedȱinȱthisȱreport.ȱ ȱ

3.3.2ȱResultsȱ

areȱ listedȱ inȱ Tableȱ 1ȱ [28].ȱ Theȱ 2008ȱ dataȱ showsȱ thatȱ theȱ subȬgroupȱthatȱappearsȱtoȱhaveȱtheȱhighestȱintakeȱofȱtransȱ fatsȱonȱaȱ%ȱenergyȱbasisȱisȱchildren;ȱtheȱsameȱobservationȱ isȱmadeȱfromȱtheȱ2004ȱdata.ȱAccordingȱtoȱTableȱ1,ȱcurrentȱ averageȱ transȱ fatȱ intakesȱ forȱ childrenȱ (1Ȭ8ȱ years)ȱ areȱ equivalentȱ toȱ 1.55Ȭ1.57%ȱ ofȱ overallȱ energy.ȱ Anotherȱ subȬ groupȱ withȱ highȱ levelsȱ ofȱ transȱ fatȱ intakesȱ appearsȱ toȱ beȱ womenȱ 71ȱ yearsȱ andȱ above,ȱ whoseȱ averageȱ transȱ fatȱ intakesȱareȱequivalentȱtoȱ1.47%ȱofȱoverallȱenergy.ȱȱ ȱ DRIȱageȬsexȱ Sampleȱ Transȱ%ȱofȱEnergyȱ groupȱ Sizeȱ 2004ȱ 2008ȱ Childrenȱ1Ȭ3yȱ 2117ȱ 2.07ȱ 1.55ȱ Childrenȱ4Ȭ8yȱ 3235ȱ 2.31ȱ 1.57ȱ Boysȱ9Ȭ13yȱ 2080ȱ 2.31ȱ 1.54ȱ Boysȱ14Ȭ18yȱ 2288ȱ 2.25ȱ 1.53ȱ Girlsȱ9Ȭ13yȱ 1980ȱ 2.32ȱ 1.54ȱ Girlsȱ14Ȭ18yȱ 2277ȱ 2.17ȱ 1.52ȱ Malesȱ19Ȭ30yȱ 1804ȱ 2.01ȱ 1.40ȱ Malesȱ31Ȭ50yȱ 2596ȱ 1.94ȱ 1.38ȱ Malesȱ51Ȭ70yȱ 2550ȱ 1.89ȱ 1.36ȱ Malesȱ71+yȱ 1520ȱ 1.92ȱ 1.44ȱ Femalesȱ19Ȭ30yȱ 2017ȱ 2.05ȱ 1.39ȱ Femalesȱ31Ȭ50yȱ 2755ȱ 1.94ȱ 1.39ȱ Femalesȱ51Ȭ70yȱ 3201ȱ 1.87ȱ 1.36ȱ Femalesȱ71+yȱ 2610ȱ 1.96ȱ 1.47ȱ AllȱAdultsȱ19+yȱ 19053ȱ 1.94ȱ 1.39ȱ AllȱPersonȱ1+yȱ 33030ȱ 2.01ȱ 1.42ȱ ȱ

ȱ

ForȱallȱCanadiansȱagedȱoneȱyearȱandȱabove,ȱaverageȱtransȱ fatȱintakesȱ(fromȱallȱsources)ȱwereȱestimatedȱtoȱbeȱ3.44ȱ±ȱ 0.03ȱg/dayȱorȱ1.42ȱ±ȱ0.01ȱ%ȱofȱenergyȱ[28].ȱFigureȱ2ȱdepictsȱ theȱ declineȱ inȱ averageȱ transȱ fatȱ intakesȱ (g/day)ȱ byȱ Canadiansȱ sinceȱ 1995ȱ andȱ comparesȱ theȱ intakesȱ toȱ theȱ WHOȱ recommendedȱ limit.ȱ Onȱ average,ȱ whileȱ transȱ fatȱ intakesȱofȱCanadiansȱhaveȱdroppedȱbyȱ1.5ȱg/dayȱorȱ0.8%ȱ ofȱ energyȱ sinceȱ 2004,ȱ theyȱ areȱ stillȱ aboveȱ theȱ WHOȱ recommendedȱlimitȱofȱ1%ȱofȱoverallȱenergy.ȱ ȱ 10 8.4 (3.7% energy)

TFA (g/day)

8 4.9 (2.0% energy )

6

3.4 (1.4% energy)

4

2.0 (1.0% energy)

2 0 1995

2004

2008

WHO recommended limit ȱ

Figureȱ 2.ȱ Averageȱ transȱ fatȱ intakesȱ (g/day)ȱ ofȱ Canadiansȱ 1ȱ yearȱ andȱ aboveȱ inȱ 1995,ȱ 2004,ȱ andȱ 2008ȱ vs.ȱ theȱ Worldȱ Healthȱ Organization’’sȱ(WHO)ȱrecommendedȱlimit.ȱ

ȱ Averageȱ intakesȱ ofȱ transȱ fatȱ (asȱ %ȱ ofȱ energy)ȱ byȱ CanadiansȱwereȱcalculatedȱforȱcertainȱageȬsexȱgroupsȱandȱ

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Tableȱ1.ȱEstimatedȱtransȱfatȱintakesȱasȱpercentȱofȱenergyȱinȱ2004ȱ vs.ȱ 2008ȱ inȱ differentȱ ageȬsexȱ groupsȱ inȱ Canadaȱ [28].ȱ Theȱ resultsȱ containedȱ inȱ thisȱ tableȱ areȱ basedȱ onȱ theȱ Canadianȱ Communityȱ HealthȱSurveyȱ––ȱCycleȱ2.2ȱonȱNutrition,ȱStatisticsȱCanada,ȱ2004.ȱ

ȱ Theȱusualȱintakeȱdistributionsȱofȱtransȱfatȱ(asȱ%ȱofȱenergy)ȱ wereȱ alsoȱ calculatedȱ forȱ certainȱ ageȬsexȱ groupsȱ (Tableȱ 2)ȱ [28].ȱ Theȱ 95thȱ percentilesȱ forȱ allȱ ageȬsexȱ groupsȱ haveȱ droppedȱ fromȱ approximatelyȱ 3.00%ȱ inȱ 2004ȱ toȱ 2.12%ȱ inȱ 2008.ȱ Theȱ 95thȱ percentileȱ forȱmalesȱ 51ȱ yearsȱ andȱ olderȱ isȱ theȱhighestȱatȱ2.30%ȱofȱoverallȱenergy.ȱTheȱ5thȱpercentileȱ forȱ bothȱ boysȱ andȱ girlsȱ 9Ȭ18ȱ yearsȱ ofȱ ageȱ areȱ reportedȱ toȱ beȱ1.22%ȱandȱ1.06%ȱofȱenergy.ȱThisȱindicatesȱthatȱalmostȱ allȱchildrenȱandȱteenagersȱexceedȱtheȱtransȱfatȱlimitȱofȱ1%ȱ energyȱintakeȱrecommendedȱbyȱtheȱWHO.ȱ ȱ Estimationsȱwereȱalsoȱcalculatedȱforȱaverageȱsaturatedȱfatȱ intakes.ȱ Theȱ resultsȱ indicateȱ thatȱ averageȱ saturatedȱ fatȱ intakesȱ haveȱ remainedȱ constantȱ sinceȱ 2004ȱ [28].ȱ Forȱ allȱ Canadiansȱagedȱoneȱyearȱandȱabove,ȱsaturatedȱfatȱintakesȱ areȱestimatedȱnowȱtoȱbeȱonȱaverage,ȱ25ȱg/dayȱwhichȱisȱtheȱ sameȱ estimateȱ fromȱ 2004ȱ [28].ȱ Thisȱ suggestsȱ thatȱ manyȱ foodȱ manufacturersȱ areȱ replacingȱ TFAsȱ withȱ monoȬȱ andȱ polyȬunsaturatedȱ fatsȱ andȱ notȱ withȱ saturatedȱ fat.ȱ Thisȱ wasȱ confirmedȱ throughȱ theȱ scientificȱ assessmentȱ ofȱ theȱ fullȱfattyȱacidȱ profileȱofȱtheȱfoodsȱthatȱwereȱincludedȱforȱ analysisȱinȱtheȱTFMPȱ[28].ȱ

Sara Krenosky, Mary L’Abbé, Nora Lee, Lynne Underhill, Michel Vigneault, Samuel Godefroy and Nimal Ratnayake: Risk Assessment of Exposure to Trans Fat in Canada

5

AgeȬSexȱ Boysȱ9Ȭ18yȱ ȱȱ Girlsȱ9Ȭ18yȱ ȱȱ Malesȱ19Ȭ50yȱ ȱȱ Malesȱ51+yȱ ȱȱ Femalesȱ19Ȭ50yȱ ȱȱ Femalesȱ51+yȱ ȱȱ

SampleȱSizeȱ 4368ȱ ȱȱ 4257ȱ ȱȱ 4400ȱ ȱȱ 4070ȱ ȱȱ 4772ȱ ȱȱ 5811ȱ ȱȱ

Yearȱ 2004ȱ 2008ȱ 2004ȱ 2008ȱ 2004ȱ 2008ȱ 2004ȱ 2008ȱ 2004ȱ 2008ȱ 2004ȱ 2008ȱ

5thȱ 1.55ȱ 1.22ȱ 1.58ȱ 1.06ȱ 1.16ȱ 0.90ȱ 0.96ȱ 0.71ȱ 1.27ȱ 0.92ȱ 1.10ȱ 0.79ȱ

10thȱ 1.70ȱ 1.20ȱ 1.71ȱ 1.15ȱ 1.31ȱ 0.99ȱ 1.11ȱ 0.82ȱ 1.40ȱ 1.00ȱ 1.24ȱ 0.89ȱ

25thȱ 1.96ȱ 1.34ȱ 1.94ȱ 1.30ȱ 1.58ȱ 1.15ȱ 1.40ȱ 1.03ȱ 1.65ȱ 1.16ȱ 4.50ȱ 1.08ȱ

Percentileȱ 50thȱ 75thȱ 2.27ȱ 2.62ȱ 1.51ȱ 1.71ȱ 2.22ȱ 2.53ȱ 1.49ȱ 1.73ȱ 1.92ȱ 2.29ȱ 1.36ȱ 1.59ȱ 1.80ȱ 2.27ȱ 1.31ȱ 1.66ȱ 1.95ȱ 2.30ȱ 1.36ȱ 1.59ȱ 1.84ȱ 2.23ȱ 1.33ȱ 1.64ȱ

90thȱ 2.96ȱ 1.91ȱ 2.82ȱ 1.96ȱ 2.67ȱ 1.81ȱ 2.78ȱ 2.04ȱ 2.64ȱ 1.82ȱ 2.63ȱ 1.96ȱ

95thȱ 3.18ȱ 2.04ȱ 3.00ȱ 2.12ȱ 2.91ȱ 1.96ȱ 3.12ȱ 2.30ȱ 2.85ȱ 1.97ȱ 2.89ȱ 2.18ȱ

Tableȱ2.ȱUsualȱdistributionsȱofȱestimatedȱtransȱfatȱintakesȱasȱpercentȱofȱenergyȱinȱ2004ȱvs.ȱ2008ȱinȱdifferentȱageȬsexȱgroupsȱinȱCanadaȱ [28].ȱ Theȱ resultsȱ containedȱ inȱ thisȱ tableȱ areȱ basedȱ onȱ theȱ Canadianȱ Communityȱ Healthȱ Surveyȱ ––ȱ Cycleȱ 2.2ȱ onȱ Nutrition,ȱ Statisticsȱ Canada,ȱ2004.ȱ

ȱ Theȱestimatesȱofȱtransȱfatȱintakeȱwereȱcalculatedȱusingȱtheȱ monitoringȱ dataȱ thatȱ wasȱ analyzedȱ untilȱ lateȱ 2008/earlyȱ 2009.ȱ Moreȱ recentlyȱ aȱ Costȱ Benefitȱ Analysisȱ (CBA)ȱ wasȱ commissionedȱbyȱHealthȱCanadaȱtoȱestimateȱtheȱpotentialȱ costsȱandȱbenefitsȱofȱfurtherȱeffortsȱtoȱreachȱtheȱtargetȱofȱ 1%ȱ [35].ȱ Interviewsȱ conductedȱ asȱ partȱ ofȱ theȱ CBAȱ indicatedȱ thatȱ someȱ otherȱ companiesȱ wereȱ readyȱ toȱ rollȱ outȱnewȱproductsȱthatȱwereȱmeetingȱtheȱtransȱfatȱlimitsȱinȱ aȱ matterȱ ofȱ weeksȱ orȱ byȱ theȱ endȱ ofȱ 2009ȱ [35].ȱ Thus,ȱ itȱ isȱ possibleȱthatȱthereȱwereȱadditionalȱreductionsȱinȱtransȱfatȱ intakesȱresultingȱfromȱfoodȱreformulationȱsinceȱtheȱ1.42%ȱ ofȱenergyȱestimateȱwasȱcalculated.ȱHowever,ȱdecreasesȱinȱ transȱ fatȱ intakeȱ areȱ notȱ expectedȱ toȱ beȱ asȱ largeȱ asȱ inȱ pastȱ years,ȱsinceȱmostȱcompaniesȱthatȱexpressedȱtheirȱintentȱtoȱ voluntarilyȱ reduceȱ TFAȱ contentȱ inȱ theirȱ foodsȱ haveȱ alreadyȱ doneȱ so.ȱ Therefore,ȱ theȱ authorsȱ ofȱ theȱ CBAȱ decidedȱ toȱ assumeȱ thatȱ furtherȱ reductionsȱ sinceȱ theȱ lastȱ dataȱcollectionȱwouldȱoccurȱatȱhalfȱofȱtheȱaverageȱrateȱofȱ theȱ previousȱ 4ȱ yearsȱ (fromȱ 2.01%ȱ toȱ 1.42%ȱ ofȱ energyȱ intakeȱ overȱ fourȱ years,ȱ orȱ approximatelyȱ 0.15%ȱ perȱ year,ȱ andȱ thenȱ anȱ approximateȱ reductionȱ ofȱ 0.075%ȱ energy).ȱ Basedȱ onȱ thisȱ assumption,ȱ theȱ averageȱ transȱ fatȱ intakeȱ wouldȱ beȱ estimatedȱ atȱ 1.35%ȱ ofȱ energyȱ (withȱ anȱ 80%ȱ confidenceȱintervalȱofȱ0.92%ȱtoȱ1.93%)ȱinȱ2009ȱ[35],ȱaȱyearȱ afterȱtheȱcompletionȱofȱtheȱmonitoringȱprogram,ȱwhichȱisȱ stillȱaboveȱtheȱWHOȱrecommendationȱofȱ1%ȱofȱenergy.ȱInȱ children,ȱ theȱ 2009ȱ averageȱ transȱ fatȱ intakeȱ wouldȱ beȱ estimatedȱatȱ1.49%.ȱȱ Ifȱ weȱ wereȱ toȱ continueȱ withȱ theȱ assumptionȱ thatȱ thereȱ haveȱbeenȱadditionalȱreductionsȱinȱtransȱfatȱintakesȱsinceȱ theȱ 1.42%ȱ ofȱ energyȱ estimateȱ wasȱ calculated,ȱ andȱ thatȱ additionalȱ reductionsȱ continuedȱ atȱ theȱ sameȱ rateȱ ofȱ 0.075%ȱenergyȱperȱyear,ȱtheȱestimatedȱtransȱfatȱintakesȱinȱ 2012ȱ wouldȱ beȱ 1.12%ȱ ofȱ energyȱ andȱ 1.27%ȱ ofȱ energyȱ inȱ children.ȱ However,ȱ inȱ estimatingȱ theȱ anticipatedȱ healthȱ benefitsȱ ofȱ theȱ reductionsȱ inȱ transȱ fatȱ intake,ȱ theȱ CBAȱ assumedȱ thatȱ thereȱ wouldȱ notȱ beȱ anyȱ furtherȱ reductionsȱ 6

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inȱtransȱfatȱintakesȱinȱCanadaȱbeyondȱtheȱ2009ȱlevels,ȱi.e.ȱ overȱ 2010Ȭ2029ȱ [35],ȱ basedȱ onȱ interviewsȱ withȱ foodȱ industryȱ stakeholdersȱ aboutȱ theirȱ intentȱ toȱ makeȱ furtherȱ reductionsȱ inȱ transȱ contentȱ ofȱ foods.ȱ Therefore,ȱ assumptionsȱ ofȱ similarȱ reductionsȱ beyondȱ 2009ȱ asȱ inȱ previousȱ yearsȱ haveȱ notȱ beenȱ substantiated.ȱ Furtherȱ analysisȱ wouldȱ beȱ requiredȱ toȱ confirmȱ whetherȱ suitableȱ alternativeȱ ingredientsȱ forȱ troubledȱ sectorsȱ haveȱ beenȱ developedȱ andȱ whetherȱ orȱ notȱ thereȱ hasȱ beenȱ uptakeȱ ofȱ alternativesȱinȱtheseȱsectorsȱleadingȱtoȱfurtherȱreductions.ȱ ȱ 3.4ȱAdditionalȱConsiderationsȱ ȱ 3.4.1ȱAvailabilityȱofȱHighȱTFAȱFoodsȱ ȱ Amongȱ theȱ foodsȱ thatȱ remainȱ highȱ inȱ TFAȱ areȱ someȱ houseȱ brandȱ productsȱ thatȱ areȱ stillȱ madeȱ withȱ PHOȱ andȱ doȱ notȱ meetȱ theȱ recommendedȱ transȱ fatȱ limitsȱ [26,ȱ [28].ȱ Thereȱ areȱ atȱ leastȱ threeȱ examplesȱ ofȱ theȱ sameȱ margarineȱ manufacturerȱproducingȱtwoȱlinesȱofȱmargarines,ȱoneȱthatȱ containsȱ transȱ fatȱ andȱ oneȱ thatȱ isȱ transȱ fatȬfreeȱ [26],ȱ [28].ȱ Theȱ continuedȱ marketingȱ ofȱ highȱ TFAȱ productsȱ suchȱ asȱ softȱmargarines,ȱshortening,ȱhardȱmargarines,ȱandȱbakeryȱ productsȱthatȱhaveȱTFAȱcontentȱupȱtoȱ21%,ȱ31%,ȱ40%,ȱandȱ 45%ȱofȱtotalȱfat,ȱrespectively,ȱisȱofȱparticularȱconcernȱsinceȱ theseȱ categoriesȱ ofȱ foodsȱ haveȱ beenȱ andȱ continueȱ toȱ beȱ topȱcontributorsȱtoȱtransȱfatȱintakeȱbyȱCanadiansȱ[16],ȱ[17],ȱ [26],ȱ[28].ȱ ȱ 3.4.2ȱFoodȱServiceȱEstablishmentsȱ ȱ Theȱ beneficialȱ impactȱ ofȱ Canadianȱ nutritionȱ labellingȱ regulationsȱonȱalertingȱconsumersȱtoȱtheȱlevelsȱofȱtransȱfatȱ doesȱ notȱ extendȱ toȱ foodsȱ soldȱ inȱ restaurantsȱ andȱ foodȱ serviceȱ establishmentsȱ asȱ theȱ nutritionȱ labellingȱ regulationsȱonlyȱapplyȱtoȱprepackagedȱfoods.ȱRecentlyȱitȱ wasȱ reportedȱ thatȱ mostȱ Canadiansȱ eatȱ outȱ (48%Ȭ74%)ȱ orȱ orderȱtakeȬoutȱ(20Ȭ67%)ȱaboutȱonceȱperȱweekȱ[36]ȱandȱonȱ www.intechopen.com

aȱ givenȱ day,ȱ oneȱ outȱ ofȱ fourȱ adultsȱ andȱ childrenȱ inȱ Canadaȱ eatsȱ orȱ drinksȱ aȱ foodȱ orȱ beverageȱ inȱ aȱ fastȱ foodȱ outletȱ [37].ȱ Thisȱ figureȱ isȱ likelyȱ higherȱ sinceȱ theȱ reportȱ alsoȱ indicatedȱ thatȱ anȱ additionalȱ 23%ȱ consumedȱ foodȱ inȱ someȱ otherȱ combinationȱ (eitherȱ somethingȱ preparedȱ atȱ aȱ restaurant,ȱbar,ȱschoolȱandȱnonȬschoolȱcafeteria,ȱetc.)ȱ[37].ȱ Furthermore,ȱ informationȱ fromȱ nutritionȱ surveysȱ indicatesȱ thatȱ 22%ȱ ofȱ theȱ averageȱ transȱ fatȱ intakeȱ ofȱ Canadianȱadultsȱ(andȱasȱmuchȱasȱ31%ȱinȱtheȱcaseȱofȱmalesȱ agedȱ19ȱtoȱ30ȱyears)ȱisȱprovidedȱbyȱfoodsȱconsumedȱawayȱ fromȱhome,ȱoftenȱinȱfastȱfoodȱrestaurantsȱandȱotherȱfoodȱ serviceȱ environmentsȱ [23].ȱ Resultsȱ fromȱ theȱ TFMPȱ suggestȱ thatȱ whileȱ aȱ numberȱ ofȱ popularȱ fastȬfoodȱ andȱ familyȱ restaurantȱ chainsȱ inȱ Canadaȱ haveȱ beenȱ successfulȱ inȱ decreasingȱ TFAȱ levels,ȱ thereȱ areȱ stillȱ establishmentsȱ thatȱcontinueȱtoȱofferȱmenuȱitemsȱhighȱinȱTFAsȱ[26],ȱ[28].ȱ ȱ 3.4.3ȱAnalysisȱofȱspecificȱsubȬpopulationsȱȱ andȱsocioeconomicȱconsiderationsȱ ȱ Besidesȱ overallȱ estimatesȱ ofȱ exposureȱ inȱ theȱ population,ȱ theȱpotentialȱforȱsomeȱgroupsȱtoȱhaveȱhigherȱexposureȱtoȱ transȱfatȱneedsȱtoȱbeȱconsidered.ȱAsȱnotedȱinȱtheȱexposureȱ assessmentȱ section,ȱ exposureȱ inȱ childrenȱ tendsȱ toȱ beȱ higherȱ thanȱ exposureȱ inȱ adultsȱ onȱ theȱ basisȱ ofȱ percentȱ energy.ȱ ȱ Anotherȱ potentiallyȱ vulnerableȱ populationȱ includesȱ peopleȱlivingȱinȱremoteȱareasȱsuchȱasȱtheȱCanadianȱInuitȱ population.ȱ Overȱ theȱ lastȱ fiveȱ decadesȱ orȱ so,ȱ Inuitȱ populationsȱhaveȱtransitionedȱfromȱaȱtraditional,ȱmarineȱ dietȱ toȱ oneȱ whichȱ incorporatesȱ moreȱ processedȱ foods,ȱ typicalȱ ofȱ aȱ westernȱ diet.ȱ Foodsȱ containingȱ industriallyȱ producedȱ TFAsȱ offerȱ qualitiesȱ thatȱ areȱ requiredȱ forȱ processedȱ foodsȱ inȱ remoteȱ communities,ȱ namely,ȱ storabilityȱ atȱ roomȱ temperatureȱ andȱ aȱ longerȱ shelfȬlife.ȱ Aȱrecentȱdietaryȱsurveyȱconductedȱinȱ2004Ȭ2005ȱinȱInuitȱ populationsȱ fromȱ Nunavik,ȱ Canadaȱ andȱ Greenlandȱ indicatedȱthatȱonȱaverage,ȱstoreȬboughtȱfoodsȱaccountedȱ forȱ 75%ȱ andȱ 84%ȱ ofȱ energyȱ intakes,ȱ respectivelyȱ [38].ȱ Thisȱstudyȱshowedȱthatȱwhileȱtheȱcontributionȱofȱenergyȱ fromȱ storeȬboughtȱ foodsȱ wasȱ comparableȱ betweenȱ theȱ twoȱ Inuitȱ populations,ȱ theȱ averageȱ transȱ fatȱ intakesȱ amongȱ theȱ Nunavikȱ Inuitȱ wereȱ threeȱ timesȱ higherȱ thanȱ thoseȱ ofȱ theȱ Greenlandȱ Inuitȱ (asȱ measuredȱ byȱ theȱ fattyȱ acidȱ compositionȱ ofȱ erythrocyteȱ membraneȱ phospholipids)ȱ [38].ȱ Furthermore,ȱ whileȱ Inuitȱ youthȱ consumedȱ aȱ significantlyȱ higherȱ proportionȱ ofȱ storeȬ boughtȱ foodsȱ thanȱ theirȱ eldersȱ (90%ȱ ofȱ caloriesȱ vs.ȱ 70%ȱ ofȱ calories)ȱ inȱ bothȱ populations,ȱ erythrocyteȱ TFAȱ levelsȱ wereȱ similarȱ acrossȱ allȱ ageȱ groupsȱ inȱ Greenlandȱ Inuit,ȱ whileȱ inȱ Nunavikȱ youthȱ hadȱ significantlyȱ higherȱ erythrocyteȱ TFAȱ levelsȱ thanȱ theirȱ eldersȱ (0.67%ȱ vs.ȱ 0.39%).ȱTheȱstudyȱreportedȱthatȱtheȱavailabilityȱofȱgoodȱ qualityȱ storeȬboughtȱ foods,ȱ atȱ leastȱ asȱ itȱ relatesȱ toȱ transȱ fat,ȱ wasȱ betterȱ forȱ theȱ Greenlandȱ Inuitȱ becauseȱ mostȱ

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industriallyȱ producedȱ foodsȱ soldȱ inȱ Greenlandȱ areȱ importedȱ fromȱ Denmark,ȱ whereȱ aȱ transȱ limitȱ ofȱ 2%ȱ ofȱ totalȱfatȱhasȱbeenȱimposedȱsinceȱ2003ȱ[38].ȱ ȱ Whileȱ familiarityȱ withȱ theȱ foodȱ productȱ isȱ aȱ factorȱ influencingȱCanadians’’ȱfoodȱbuyingȱpracticesȱ[39],ȱoneȱofȱ theȱ topȱ factorsȱ influencingȱ foodȱ buyingȱ decisionsȱ isȱ costȱ [36],ȱ [39].ȱ Researchȱ showsȱ aȱ negativeȱ relationshipȱ betweenȱ priceȱ andȱ theȱ SFAȱ andȱ TFAȱ contentsȱ ofȱ margarinesȱ[40].ȱItȱwasȱreportedȱthatȱmargarinesȱsoldȱonȱ theȱCanadianȱmarketȱthatȱareȱlowerȱinȱSFA,ȱTFA,ȱandȱtheȱ sumȱofȱSFA+TFA,ȱcostȱsignificantlyȱmoreȱthanȱmargarineȱ withȱhigherȱlevelsȱofȱtheseȱfatsȱ[40].ȱAdditionally,ȱdespiteȱ controllingȱ forȱ confoundingȱ variablesȱ suchȱ asȱ packageȱ size,ȱstoreȱtype,ȱandȱbrand,ȱthisȱrelationshipȱwasȱstillȱseenȱ [40].ȱ Moreȱ recentȱ dataȱ isȱ consistentȱ withȱ thisȱ priceȱ disparityȱ amongȱ highȱ andȱ lowȱ TFAȱ margarinesȱ [41].ȱ Inȱ 2002,ȱthoseȱthatȱwereȱ““transȬfatȱfree””ȱ(i.e.ȱlessȱthanȱ0.2ȱgȱofȱ transȱ fatȱ perȱ referenceȱ amountȱ andȱ servingȱ ofȱ statedȱ sizeȱ andȱlowȱinȱsaturatedȱfats)ȱcostȱ$4.62ȱperȱkgȱandȱthoseȱthatȱ wereȱnotȱ““transȬfatȱfree””ȱcostȱ$3.05ȱperȱkg.ȱInȱcomparison,ȱ inȱ 2006ȱ thoseȱ thatȱ wereȱ ““transȬfatȱ free””ȱ costȱ $5.10ȱ perȱ kgȱ andȱthoseȱthatȱwereȱnotȱ““transȬfatȱfree””ȱcostȱ$3.55ȱperȱkgȱ [41].ȱ Similarȱ researchȱ indicatesȱ thatȱ nutritionallyȱ improvedȱproductsȱtendȱtoȱbeȱhigherȱinȱpriceȱ[42]ȱwhichȱ isȱ ofȱ aȱ particularȱ concernȱ forȱ lowerȱ incomeȱ groups.ȱ Budgetȱ constraintsȱ haveȱ aȱ significantȱ influenceȱ onȱ lowerȱ incomeȱ groupsȱ makingȱ themȱ veryȱ priceȱ sensitive.ȱ Theȱ implicationȱ isȱ thatȱ theseȱ groupsȱ willȱ beȱ likelyȱ toȱ haveȱ aȱ higherȱ exposureȱ toȱ transȱ fatȱ throughȱ theirȱ selectionȱ ofȱ lowerȱpricedȱfoodsȱ[43].ȱ ȱ 4.ȱRiskȱCharacterizationȱȱ ȱ Coronaryȱ heartȱ diseaseȱ isȱ amongȱ theȱ leadingȱ causesȱ ofȱ deathȱ inȱ Canadaȱ contributingȱ toȱ approximatelyȱ 50,000ȱ annualȱ deathsȱ [44].ȱ Theȱ heartȱ healthȱ effectsȱ ofȱ TFAsȱ areȱ wellȱ known:ȱ theyȱ raiseȱ LDLȬcholesterolȱ andȱ lowerȱ HDLȬ cholesterol,ȱ whichȱ leadsȱ toȱ increasedȱ riskȱ ofȱ CHD.ȱ Evenȱ veryȱlowȱintakesȱofȱTFAsȱmayȱincreaseȱtheȱriskȱofȱCHDȱ[5].ȱȱ ȱ Inȱ prospectiveȱ cohortȱ studiesȱ reviewedȱ byȱ Mozaffarianȱ andȱClarke,ȱeachȱ2%ȱenergyȱreplacementȱofȱtransȱfatȱwithȱ monounsaturatedȱ orȱ polyunsaturatedȱ fatȱ loweredȱ theȱ CHDȱriskȱbyȱ21%ȱorȱ24%,ȱrespectivelyȱ[7].ȱBasedȱonȱtheseȱ ratesȱ (andȱ usingȱ theȱ moreȱ conservativeȱ estimateȱ ofȱ transȱ fatȱ intakeȱ basedȱ onȱ theȱ interviewsȱ summarizedȱ inȱ theȱ 2009ȱ CBAȱ [35]),ȱ reducingȱ theȱ averageȱ transȱ fatȱ intakesȱ ofȱ childrenȱ fromȱ 1.49%ȱ toȱ 1%ȱ ofȱ overallȱ energyȱ wouldȱ decreaseȱ theȱ CHDȱ riskȱ byȱ 5Ȭ6%.ȱ Reducingȱ theȱ averageȱ transȱ fatȱ intakesȱ ofȱ adultsȱ fromȱ 1.35%ȱ (usingȱ theȱ moreȱ conservativeȱ transȱ fatȱ intakeȱ estimate)ȱ toȱ 1%ȱ ofȱ overallȱ energyȱwouldȱdecreaseȱtheȱCHDȱriskȱbyȱ3Ȭ4%.ȱ ȱ PopulationȬattributableȱ risksȱ basedȱ onȱ epidemiologicalȱ data,ȱ suchȱ asȱ thoseȱ mentionedȱ above,ȱ mayȱ overestimateȱ

Sara Krenosky, Mary L’Abbé, Nora Lee, Lynne Underhill, Michel Vigneault, Samuel Godefroy and Nimal Ratnayake: Risk Assessment of Exposure to Trans Fat in Canada

7

theȱtrueȱeffectȱofȱeliminatingȱaȱriskȱfactorȱowingȱtoȱotherȱ unrelatedȱ (competing)ȱ riskȱ factorsȱ [45],ȱ [46].ȱ Thereforeȱ furtherȱ estimatesȱ ofȱ decreasedȱ riskȱ wereȱ obtainedȱ fromȱ controlledȱ trialsȱ andȱ shortȱ termȱ clinicalȱ studies.ȱ Onȱ theȱ basisȱofȱpredictedȱchangesȱinȱtheȱtotalȬcholesterol:HDLȬCȱ ratioȱfromȱcontrolledȱtrials,ȱaccordingȱtoȱMozaffarianȱandȱ colleagues,ȱ 3%ȱ ofȱ CHDȱ eventsȱ couldȱ beȱ avertedȱ whenȱ transȱ fatȱ intakesȱ areȱ reducedȱ fromȱ 2.1%ȱ energyȱ toȱ 1.1%ȱ energyȱ [1].ȱ Asȱ citedȱ byȱ theȱ Foodȱ andȱ Drugȱ Administration,ȱ findingsȱ fromȱ otherȱ shortȬtermȱ feedingȱ trialsȱthatȱmeasuredȱchangesȱinȱserumȱlipidsȱ(LDL+HDL),ȱ showedȱ aȱ 0.184%,ȱ 0.287%ȱ andȱ 0.296%ȱ reducedȱ riskȱ ofȱ CHDȱ forȱ eachȱ 0.1%ȱ ofȱ energyȱ replacementȱ ofȱ TFAsȱ withȱ SFAs,ȱMUFAsȱorȱPUFAs,ȱrespectivelyȱ[47].ȱThisȱequalsȱanȱ averageȱ 2.6%ȱ reductionȱ inȱ theȱ riskȱ ofȱ CHDȱ forȱ everyȱ 1%ȱ energyȱ replacementȱ ofȱ TFAsȱ withȱ SFAs,ȱ MUFAsȱ andȱ PUFAsȱ[((0.184%ȱ+ȱ0.287%ȱ+ȱ0.296%)ȱ/3)*10ȱ=ȱ2.6%].ȱȱ ȱ

Toȱ accountȱ forȱ theȱ rangeȱ ofȱ publishedȱ estimatesȱ usingȱ clinicalȱ trialsȱ measuringȱ changesȱ inȱ serumȱ lipids,ȱ anȱ averageȱ ofȱ theȱ twoȱ estimates,ȱ 2.6%ȱ andȱ 3.0%,ȱ isȱ taken.ȱ Thus,ȱthereȱisȱanȱestimatedȱreductionȱinȱCHDȱriskȱofȱ2.8%ȱ forȱ eachȱ 1%ȱ ofȱ energyȱ replacementȱ ofȱ TFAsȱ withȱ SFAs,ȱ MUFAsȱorȱPUFAsȱ(inȱequalȱproportions).ȱȱ

ȱ

6.ȱAcknowledgementsȱ ȱ

Theȱ authorsȱ wouldȱ likeȱ toȱ thank:ȱ Williamȱ Yan,ȱ Mayaȱ Villeneuve,ȱ Claudeȱ Gagnon,ȱ Isabelleȱ Rondeau,ȱ Brianȱ Lampi,ȱ Zeshawnȱ Awan,ȱ Amandaȱ Whitfield,ȱ Michaelȱ Masotti,ȱ Valerieȱ Casey,ȱ Dayaniȱ Mohottalage,ȱ Williamȱ Lillycrop,ȱ Maryȱ Meleta,ȱ Lynnȱ Wong,ȱ Tranȱ Ng,ȱ Yuȱ Gao,ȱ Keriȱ Kwong,ȱ Shirleyȱ Chalouh,ȱ Peterȱ Pantazopoulos,ȱ Hasanthaȱ Gunaratna,ȱ Richardȱ Blagden,ȱ Veronicaȱ Roscoe,ȱ TomȱKrakalovich,ȱGaryȱNeumann,ȱandȱGaryȱLombaertȱforȱ theirȱextensiveȱandȱinvaluableȱcontributionsȱtoȱtheȱvariousȱ aspectsȱofȱthisȱpaper.ȱTheȱauthorsȱwouldȱalsoȱlikeȱtoȱthankȱ Lydiaȱ Dumais,ȱ Kevinȱ Cockell,ȱ andȱ Lisaȱ Pavoneȱ forȱ theirȱ helpfulȱreviews.ȱ ȱ

APPENDIXȱAȱȬȱTransȱFatȱMonitoringȱProgramȱ

ȱ

ȱ

Usingȱ theȱ averageȱ estimateȱ ofȱ 2.8%,ȱ onȱ theȱ basisȱ ofȱ theȱ changesȱ inȱ cholesterolȱ levelsȱ alone,ȱ decreasingȱ theȱ averageȱtransȱfatȱintakesȱofȱchildrenȱfromȱ1.49%ȱtoȱ1%ȱofȱ overallȱ energyȱ wouldȱ decreaseȱ theȱ CHDȱ riskȱ byȱ 1.37%.ȱ Reducingȱ theȱ averageȱ transȱ fatȱ intakesȱ acrossȱ allȱ agesȱ fromȱ 1.35%ȱ toȱ 1%ȱ ofȱ overallȱ energyȱ wouldȱ decreaseȱ theȱ lifetimeȱ CHDȱ riskȱ byȱ 0.98%.ȱ Accordingȱ toȱ theȱ CBAȱ commissionedȱ byȱ Healthȱ Canadaȱ thatȱ factoredȱ inȱ theȱ reducedȱ riskȱ ofȱ CHDȱ alongȱ withȱ annualȱ growthȱ rateȱ ofȱ heartȱ attackȱ casesȱ inȱ Canada,ȱ thisȱ furtherȱ reductionȱ ofȱ averageȱtransȱfatȱintakeȱtoȱ1%ȱofȱenergyȱisȱconservativelyȱ estimatedȱ toȱ preventȱ anȱ averageȱ ofȱ 12,354ȱ heartȱ attackȱ casesȱinȱCanadaȱoverȱ2010Ȭ2029ȱ[35].ȱ

Onȱ Juneȱ 20,ȱ 2007,ȱ Healthȱ Canadaȱ adoptedȱ theȱ recommendationsȱofȱtheȱTFTFȱwithȱrespectȱtoȱtheȱamountȱ ofȱTFAȱinȱfoodsȱandȱannouncedȱtheȱTransȱFatȱMonitoringȱ Programȱ [25].ȱ Theȱ Ministerȱ ofȱ Healthȱ calledȱ onȱ theȱ foodȱ industryȱ toȱ achieveȱ theȱ 2%ȱ andȱ 5%ȱ limitsȱ withinȱ twoȱ yearsȱ[25].ȱȱ

ȱ

5.ȱConclusionȱ ȱ

Collectively,ȱ theȱ monitoringȱ programȱ resultsȱ indicateȱ that,ȱ whileȱ thereȱ areȱ aȱ largeȱ numberȱ ofȱ foodsȱ onȱ theȱ marketȱ inȱ mostȱ categoriesȱ meetingȱ theȱ 2%ȱ andȱ 5%ȱ transȱ fatȱ limitsȱ recommendedȱ byȱ theȱ TFTF,ȱ thereȱ wereȱ stillȱ someȱfoodsȱthatȱcontainȱhighȱlevelsȱofȱTFAȱ[26],ȱ[28].ȱȱȱ ȱ

Theȱ progressȱ madeȱ byȱ theȱ industryȱ toȱ reformulateȱ andȱ decreaseȱ theȱ TFAȱ contentȱ ofȱ theirȱ productsȱ hasȱ beenȱ reflectedȱinȱanȱoverallȱdecreaseȱinȱtheȱtransȱfatȱintakesȱofȱ Canadians.ȱ However,ȱ theȱ estimatedȱ averageȱ transȱ fatȱ intakeȱforȱCanadiansȱinȱ2008ȱatȱ1.42%ȱofȱenergyȱcontinuesȱ toȱbeȱaboveȱtheȱWHOȱrecommendationȱthatȱaverageȱtransȱ fatȱintakeȱbeȱlimitedȱtoȱlessȱthanȱ1%ȱofȱtotalȱenergy.ȱItȱalsoȱ confirmsȱ thatȱ theȱ averageȱ transȱ fatȱ intakesȱ ofȱ Canadiansȱ couldȱ reachȱ 1%ȱ ofȱ totalȱ energyȱ ifȱ mostȱ productsȱ wereȱ reformulatedȱtoȱmeetȱtheȱ2%ȱandȱ5%ȱlimit.ȱ 8

Despiteȱtheȱprogressȱmadeȱbyȱindustryȱtoȱreduceȱtheȱtransȱ fatȱ contentȱ ofȱ theirȱ foods,ȱ thereȱ remainȱ foodsȱ inȱ theȱ Canadianȱ marketȱ placeȱ thatȱ containȱ highȱ levelsȱ ofȱ transȱ fat.ȱFurtherȱreductionsȱinȱtransȱfatȱlevelsȱinȱtheȱCanadianȱ foodȱ supplyȱ areȱ neededȱ toȱ meetȱ theȱ targetȱ ofȱ 1%ȱ ofȱ energy,ȱ theȱ associatedȱ publicȱ healthȱ objectives,ȱ andȱ theȱ protectionȱofȱvulnerableȱpopulations.ȱ

Int. food risk anal. j., 2012, Vol. 2, 1-15

ȱ

Healthȱ Canadaȱ hasȱ beenȱ analyzingȱ TFAsȱ inȱ foodsȱ intermittentlyȱ sinceȱ theȱ 1970’’s,ȱ focusingȱ thenȱ onȱ margarinesȱ[13].ȱTheȱanalysisȱofȱTFAsȱinȱfoodsȱincreasedȱ atȱtheȱtimeȱtheȱTFTFȱwasȱestablishedȱinȱorderȱtoȱsupportȱ theirȱ work.ȱ Theȱ Transȱ Fatȱ Monitoringȱ Programȱ wasȱ establishedȱ followingȱ theȱ announcementȱ ofȱ theȱ Ministerȱ inȱ Juneȱ 2007ȱ toȱ analyzeȱ theȱ TFAȱ contentȱ ofȱ foodsȱ thatȱ were,ȱ asȱ indicatedȱ byȱ earlierȱ surveys,ȱ significantȱ sourcesȱ ofȱTFAs,ȱi.e.ȱfoodsȱwithȱhighȱlevelsȱofȱTFAsȱorȱfoodsȱwithȱ lowerȱ levelsȱ ofȱ TFAsȱ thatȱ wereȱ consumedȱ inȱ largeȱ quantitiesȱbyȱaȱlargeȱnumberȱofȱconsumers.ȱȱ ȱ

Forȱprepackagedȱfoods,ȱtheȱindividualȱproductsȱthatȱwereȱ chosenȱforȱlaboratoryȱanalysisȱwereȱrepresentativeȱofȱtheȱ majorityȱ ofȱ productsȱ soldȱ withinȱ aȱ particularȱ foodȱ category.ȱ Inȱ mostȱ cases,ȱ theyȱ representedȱ aȱ groupȱ ofȱ productsȱ thatȱ coveredȱ approximatelyȱ 80%ȱ ofȱ theȱ marketȱ shareȱ (asȱ volumeȱ share).ȱ Marketȱ shareȱ dataȱ wasȱ purchasedȱ fromȱ ACȱ Nielsenȱ [27].ȱ Bakeryȱ productsȱ thatȱ wereȱ predominantlyȱ unlabelledȱ itemsȱ fromȱ variousȱ groceryȱ storesȱ wereȱ alsoȱ chosenȱ forȱ laboratoryȱ analysisȱ sinceȱtheyȱrepresentȱfoodsȱthatȱwereȱpreviouslyȱidentifiedȱ asȱ significantȱ sourcesȱofȱ TFAsȱ [16],ȱ [17],ȱ [23].ȱ Itemsȱ wereȱ collectedȱfromȱmajorȱgroceryȱstoresȱthatȱrepresentedȱretailȱ chainsȱfoundȱacrossȱCanada.ȱ www.intechopen.com

Foodsȱfromȱtheȱmajorȱfastȱfoodȱchains,ȱfamilyȱrestaurants,ȱ donut/coffeeȱ shops,ȱ andȱ restaurantsȱ servingȱ variousȱ ethnicȱ cuisinesȱ underwentȱ laboratoryȱ analysisȱ asȱ well.ȱ Aȱ smallerȱsampleȱofȱfoodsȱwereȱalsoȱcollectedȱandȱanalysedȱ fromȱ smallȱ andȱ mediumȬsizedȱ familyȱ andȱ quickȱ serviceȱ restaurants,ȱ asȱ wellȱ asȱ cafeteriasȱ locatedȱ inȱ institutions.ȱ Allȱlaboratoryȱanalysesȱwereȱconductedȱfromȱ2005Ȭ2009.ȱȱ ȱ Forȱ theȱ labelȱ review,ȱ theȱ foodȱ categoriesȱ chosenȱ wereȱ thoseȱ thatȱ wereȱ previouslyȱ identifiedȱ asȱ significantȱ sourcesȱ ofȱ TFAsȱ [16],ȱ [17],ȱ [23].ȱ Theȱ individualȱ productsȱ withinȱ eachȱ ofȱ theseȱ categoriesȱ wereȱ selectedȱ basedȱ onȱ marketȱ shareȱ data.ȱ Collectively,ȱ groupsȱ ofȱ productsȱ representedȱ moreȱ thanȱ 99%ȱ ofȱ theȱ marketȱ shareȱ (asȱ volumeȱ share).ȱ However,ȱ certainȱ productsȱ wereȱ notȱ collectedȱ becauseȱ previousȱ monitoringȱ dataȱ suggestedȱ thatȱ theȱ levelsȱ ofȱ TFAsȱ wereȱ alreadyȱ lowȱ inȱ theseȱ productsȱandȱsoȱaȱlabelȱreviewȱofȱtheseȱproductsȱwasȱnotȱ repeated.ȱ Allȱ foodȱ labelsȱ wereȱ collectedȱ forȱ labelȱ reviewȱ ȱ Itemȱ Totalȱ Numberȱ Numberȱ samplesȱ ofȱsamplesȱ samplesȱ meetingȱ meetingȱ cookiesȱ 79ȱ 53ȱ 26ȱ crackersȱ 62ȱ 58ȱ 4ȱ popcornȱ 22ȱ 18ȱ 4ȱ pizzaȱ 6ȱ 4ȱ 2ȱ coffeeȱwhitenerȱ 17ȱ 8ȱ 9ȱ garlicȱspreadsȱ 6ȱ 2ȱ 4ȱ garlicȱbreadȱ 11ȱ 6ȱ 5ȱ breadȱ 21ȱ 21ȱ 0ȱ muffinsȱ 2ȱ 2ȱ 0ȱ snacksȱ 90ȱ 84ȱ 6ȱ chickenȱproductsȱ 6ȱ 5ȱ 1ȱ hardȱmargarinesȱ 6ȱ 0ȱ 6ȱ softȱmargarinesȱ 37ȱ 23ȱ 14ȱ shorteningȱ 4ȱ 2ȱ 2ȱ lardȱ 4ȱ 4ȱ 0ȱ bakedȱpackagedȱ 87ȱ 73ȱ 14ȱ dessertsȱ granolaȱbarsȱ 21ȱ 17ȱ 4ȱ instantȱnoodlesȱ 22ȱ 22ȱ 0ȱ frozenȱpotatoesȱ 21ȱ 20ȱ 1ȱ frozenȱpackagedȱ dessertsȱ snackȱpuddingȱ appetizersȱ entrées/dinnersȱ

inȱ Marchȱ andȱ Octoberȱ 2008ȱ fromȱ majorȱ groceryȱ storesȱ fromȱ acrossȱ Canadaȱ (Toronto,ȱ ON;ȱ Scarborough,ȱ ON;ȱ Vancouver,ȱBC;ȱHalifax,ȱNS;ȱandȱMontreal,ȱQC).ȱ ȱ Threeȱ Healthȱ Canadaȱ laboratoriesȱ (Ottawa,ȱ Toronto,ȱ andȱ Winnipeg)ȱ performedȱ theȱ collectionȱ andȱ laboratoryȱ analysesȱasȱwellȱasȱtheȱlabelȱreview.ȱTheȱfullȱdetailsȱofȱtheȱ sampleȱ collection,ȱ analyticalȱ methods,ȱ qualityȱ assuranceȱ program,ȱ wereȱ postedȱ onȱ theȱ Healthȱ Canadaȱ websiteȱ alongȱwithȱtheȱdataȱ[26],ȱ[28].ȱ ȱ Briefly,ȱ theȱ foodȱ samplesȱ wereȱ analysedȱ byȱ theȱ Associationȱ ofȱ Officialȱ Analyticalȱ Chemistsȱ (AOAC)ȱ Methodȱ 996.06ȱ [29],ȱ theȱ recommendedȱ methodȱ forȱ TFAȱ analysisȱ inȱ Canada.ȱ Thisȱ laboratoryȱ procedureȱ andȱ methodologyȱ isȱ usedȱ toȱ determineȱ theȱ totalȱ fatȱ andȱ fattyȱ acidsȱ inȱ aȱ wideȱ varietyȱ ofȱ foodsȱ thatȱ requireȱ nutritionȱ labellingȱinȱCanadaȱandȱtheȱUnitedȱStates.ȱ ȱ ofȱ Percentȱ ofȱ notȱ samplesȱ meetingȱ 67ȱ 94ȱ 82ȱ 67ȱ 47ȱ 33ȱ 55ȱ 100ȱ 100ȱ 93ȱ 83ȱ 0ȱ 62ȱ 50ȱ 100ȱ

Percentȱ ofȱ Min.ȱ %ȱ samplesȱ notȱ TFA*ȱ meetingȱ 33ȱ 0.0ȱ 6ȱ 0.0ȱ 18ȱ 0.0ȱ 33ȱ 2.2ȱ 53ȱ 0.0ȱ 67ȱ 0.6ȱ 45ȱ 0.9ȱ 0ȱ 0.4ȱ 0ȱ 0.5ȱ 7ȱ 0.0ȱ 17ȱ 2.0ȱ 100ȱ 35.7ȱ 38ȱ 0.5ȱ 50ȱ 3.8ȱ 0ȱ 1.1ȱ

33.3ȱ 33.3ȱ 50.0ȱ 9.8ȱ 66.7ȱ 17.2ȱ 25.1ȱ 3.3ȱ 1.9ȱ 28.6ȱ 19.0ȱ 44.5ȱ 32.8ȱ 30.9ȱ 2.0ȱ

84ȱ

16ȱ

0.0ȱ

28.6ȱ

81ȱ 100ȱ 95ȱ

19ȱ 0ȱ 5ȱ

0.3ȱ 0.0ȱ 0.0ȱ

17.5ȱ 0.9ȱ 37.5ȱ

Maxȱ %ȱ TFAȱ

49ȱ

36ȱ

13ȱ

73ȱ

27ȱ

0.0ȱ

22.2ȱ

27ȱ 109ȱ 85ȱ

21ȱ 93ȱ 69ȱ

6ȱ 16ȱ 16ȱ

78ȱ 85ȱ 81ȱ

22ȱ 15ȱ 19ȱ

0.0ȱ 0.0ȱ 0.0ȱ

33.3ȱ 40.9ȱ 12.5ȱ

ȱ

Tableȱ3.ȱResultsȱofȱprepackagedȱfoodsȱcollectedȱandȱanalysedȱ(labelȱreviewȱandȱlaboratoryȱanalysis)ȱfromȱ2005Ȭ2008.ȱ *ȱForȱsamplesȱthatȱwereȱlaboratoryȱanalyzed,ȱtheȱ0.0%ȱindicatesȱthatȱtheȱlevelȱofȱtransȱfatȱdetectedȱwasȱbelowȱtheȱlimitȱofȱdetection.ȱForȱ samplesȱthatȱunderwentȱlabelȱreview,ȱtheȱ0.0%ȱindicatesȱtheȱamountȱofȱtransȱfatȱthatȱisȱdeclaredȱonȱtheȱlabelȱandȱthusȱsubjectȱtoȱlabellingȱ regulationsȱ(includingȱrounding).ȱ

ȱ ȱ

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9

Itemȱ

Totalȱnumberȱofȱsamplesȱ

Percentȱ ofȱ samplesȱ notȱ rangeȱofȱTFAȱinȱsamplesȱ meetingȱTFAȱlimitȱ (asȱ%ȱofȱtotalȱfat)ȱ

hardȱmargarinesȱ garlicȱspreadsȱ shorteningȱ coffeeȱwhitenerȱ garlicȱbreadȱ softȱmargarinesȱ pizzaȱ cookiesȱ

6ȱ 6ȱ 4ȱ 17ȱ 11ȱ 37ȱ 6ȱ 79ȱ

100ȱ 67ȱ 50ȱ 53ȱ 45ȱ 38ȱ 33ȱ 33ȱ

35.7Ȭ44.5ȱ 5.1Ȭ17.2ȱ 30.6Ȭ30.9ȱ 13.3Ȭ66.7ȱ 11.5Ȭ25.1ȱ 14.7Ȭ32.8ȱ 7.3Ȭ9.8ȱ 6.7Ȭ33.3ȱ

ȱ

Tableȱ4.ȱPrepackagedȱfoodȱwithȱhighȱlevelsȱofȱTFAs.ȱ

ȱ Theȱdataȱwereȱpresentedȱalphabeticallyȱbyȱfoodȱcategoryȱ inȱaȱstandardȱformatȱandȱincludedȱtheȱsamplingȱdate,ȱtheȱ percentageȱofȱtotalȱfatȱinȱtheȱfood,ȱasȱwellȱasȱTFAȱandȱSFAȱ contentȱ asȱ aȱ percentageȱ ofȱ totalȱ fat.ȱ Allȱ resultsȱ wereȱ postedȱ onȱ theȱ Healthȱ Canadaȱ website.ȱ Resultsȱ fromȱ theȱ 1st,ȱ 2nd,ȱ 3rd,ȱ andȱ 4thȱ setȱ ofȱ transȱ fatȱ monitoringȱ dataȱ wereȱ releasedȱinȱDecemberȱ2007,ȱJulyȱ2008,ȱFebruaryȱ2009,ȱandȱ Septemberȱ 2009ȱ respectivelyȱ [26]ȱ andȱ publishedȱ inȱ 2009ȱ [28].ȱTheȱresultsȱpresentedȱinȱthisȱriskȱassessmentȱincludeȱ dataȱfromȱallȱfourȱdataȱsets.ȱ ȱ APPENDIXȱBȱȬȱTransȱFatȱMonitoringȱProgramȱResultsȱ ȱ PrepackagedȱFoodsȱ ȱ Inȱ total,ȱ 792ȱ prepackagedȱ foodsȱ (notȱ includingȱ theȱ repeatedȱ items)ȱ wereȱ collectedȱ andȱ analysedȱ (byȱ labelȱ reviewȱ andȱ laboratoryȱ analysis)ȱ fromȱ 2005Ȭ2008.ȱ Theȱ foodȱcategoriesȱincludedȱareȱlistedȱinȱTableȱ3.ȱBasedȱonȱ theȱmostȱrecentȱresults,ȱapproximatelyȱ76%ȱ(orȱ655ȱoutȱ ofȱtheȱ792)ȱofȱprepackagedȱfoodsȱanalyzedȱareȱmeetingȱ theȱ 2%ȱ andȱ 5%ȱ transȱ fatȱ limits.ȱ Theȱ foodȱ categoriesȱ withȱtheȱhighestȱpercentagesȱofȱitemsȱnowȱmeetingȱtheȱ limitsȱ include:ȱ instantȱ noodlesȱ (100%),ȱ lardȱ (100%),ȱ muffinsȱ (100%),ȱ breadsȱ andȱ bunsȱ (100%),ȱ frozenȱ potatoesȱ (95%),ȱ crackersȱ (94%),ȱ snacksȱ (93%),ȱ bakedȱ packagedȱ dessertsȱ (84%),ȱ popcornȱ (81%),ȱ andȱ granolaȱ barsȱ (80%).ȱ Theȱ foodȱ categoriesȱ withȱ theȱ lowestȱ percentagesȱ ofȱ itemsȱ nowȱ meetingȱ theȱ transȱ fatȱ limitsȱ include:ȱ hardȱ margarinesȱ (0%),ȱ garlicȱ spreadsȱ (33%),ȱ shorteningsȱ (50%),ȱ coffeeȱ whitenerȱ (47%),ȱ garlicȱ breadȱ (55%),ȱsoftȱmargarinesȱ(62%),ȱpizzaȱ(67%),ȱandȱcookiesȱ (67%).ȱ ȱ TheȱTFAȱcontentȱofȱsomeȱfoodsȱisȱstillȱquiteȱhigh,ȱwithȱ levelsȱ asȱ highȱ asȱ nearlyȱ 70%.ȱ Forȱ example,ȱ theȱ TFAȱ contentȱ ofȱ someȱ coffeeȱ whitenersȱ rangesȱ fromȱ 13.3%Ȭ 66.7%,ȱ theȱ TFAȱ contentȱ ofȱ someȱ popcornȱ productsȱ rangesȱfromȱ20.0%Ȭ50.0%,ȱandȱtheȱTFAȱcontentȱofȱsomeȱ softȱ margarinesȱ rangesȱ fromȱ 14.7%Ȭ32.8%.ȱ Otherȱ highȱ TFAȬcontainingȱfoodsȱareȱlistedȱinȱTableȱ4.ȱ ȱ ȱ

10 Int. food risk anal. j., 2012, Vol. 2, 1-15

Marketȱ shareȱ forȱ mostȱ ofȱ theȱ foodsȱ thatȱ areȱ stillȱ highȱ inȱ TFAsȱ isȱ marginalȱ exceptȱ forȱ theȱ cookiesȱ thatȱ areȱ notȱ meetingȱ theȱ transȱ fatȱ limits,ȱ whichȱ collectivelyȱ representȱ closeȱ toȱ 10%ȱ ofȱ theȱ marketȱ (asȱ volumeȱ share).ȱ Also,ȱ theȱ highȱ TFAȬcontainingȱ softȱ margarinesȱ representȱ approximatelyȱ 16%ȱ ofȱ theȱ marketȱ andȱ theȱ highȱ TFAȬ containingȱhardȱmargarinesȱrepresentȱcloseȱtoȱ30%ȱofȱtheȱ market.ȱ Theȱ proportionȱ ofȱ theȱ marketȱ thatȱ theseȱ foodsȱ actuallyȱ representȱ isȱlikelyȱ higherȱ sinceȱ theȱmarketȱ shareȱ ofȱ houseȱ brands,ȱ whichȱ isȱ unknownȱ forȱ individualȱ products,ȱ hasȱ notȱ beenȱ included.ȱ Thereȱ areȱ aȱ numberȱ ofȱ houseȱ brandȱ productsȱ thatȱ areȱ stillȱ usingȱ PHOȱ andȱ asȱ suchȱareȱnotȱmeetingȱtheȱtransȱfatȱlimits.ȱȱ ȱ Inȱallȱotherȱcases,ȱtheȱfoodȱproductsȱthatȱareȱhigherȱthanȱtheȱ transȱ fatȱ limitsȱ representȱ lessȱ thanȱ 5%ȱ ofȱ theȱ market.ȱ Forȱ exampleȱtheȱsnackȱproductsȱcollectivelyȱrepresentȱlessȱthanȱ 1%ȱ ofȱ theȱ market,ȱ theȱ popcornȱ productsȱ collectivelyȱ representȱlessȱthanȱ3%ȱofȱtheȱmarket,ȱandȱtheȱgarlicȱspreadsȱ collectivelyȱrepresentȱlessȱthanȱ0.5ȱ%ȱofȱtheȱmarket.ȱ ȱ Bakeryȱproductsȱfromȱgroceryȱstores:ȱ ȱ Theȱ transȱ fatȱ monitoringȱ programȱ analysedȱ 81ȱ bakeryȱ productsȱfromȱvariousȱgroceryȱstores.ȱTheȱresultsȱfromȱtheȱ bakeryȱproductsȱanalysesȱindicateȱthatȱtheȱfollowingȱwereȱ meetingȱtheȱ5%ȱTFAȱlimit:ȱ25%ȱofȱcroissantsȱ(nȱ=ȱ16),ȱ45%ȱ ofȱdanishesȱ(nȱ=ȱ11),ȱ36%ȱofȱpiesȱ(nȱ=ȱ11),ȱ67%ȱofȱtartsȱ(nȱ=ȱ 15),ȱ 43%ȱ ofȱ cakesȱ (nȱ =ȱ 14),ȱ 45%ȱ ofȱ browniesȱ (nȱ =ȱ 11),ȱ andȱ 33%ȱofȱdonutsȱ(nȱ=ȱ3).ȱTheȱdetailsȱcanȱbeȱfoundȱinȱTableȱ5.ȱ ȱ Onȱaverage,ȱoutȱofȱtheȱtotalȱofȱ81ȱbakeryȱproducts,ȱ46ȱ(orȱ 58%)ȱ wereȱ meetingȱ theȱ transȱ fatȱ limitȱ ofȱ 5%ȱ ofȱ totalȱ fat.ȱ TheȱTFAȱcontentȱofȱthoseȱ46ȱitemsȱthatȱwereȱstillȱhighȱinȱ TFAsȱrangedȱfromȱ5.4%ȱTFAȱ(tart)ȱtoȱ39.2%ȱ(danish)ȱandȱ 43.7%ȱ TFAȱ (croissant).ȱ Thus,ȱ theȱ levelsȱ ofȱ certainȱ bakeryȱ productsȱremainȱquiteȱhigh.ȱThereȱareȱhoweverȱexamplesȱ ofȱ lowȱ transȱ fatȱ bakeryȱ productsȱ inȱ eachȱ category,ȱ someȱ withȱ levelsȱ asȱ lowȱ asȱ 0.6%ȱ TFA,ȱ indicatingȱ thatȱ itȱ isȱ possibleȱ toȱ reformulateȱ andȱ produceȱ lowȱ transȱ fatȱ productsȱofȱallȱtypes,ȱincludingȱcroissantsȱandȱtarts.ȱȱ

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Itemȱ

Totalȱ Numberȱofȱ samplesȱ samplesȱmeetingȱ

Numberȱofȱsamplesȱ Percentȱofȱ notȱmeetingȱ samplesȱmeetingȱ

Percentȱofȱsamplesȱ notȱmeetingȱ

croissantsȱ danishesȱ piesȱ tartsȱ cakesȱ browniesȱ donutsȱ

16ȱ 11ȱ 11ȱ 15ȱ 14ȱ 11ȱ 3ȱ

12ȱ 6ȱ 7ȱ 5ȱ 8ȱ 6ȱ 2ȱ

75ȱ 55ȱ 64ȱ 33ȱ 57ȱ 55ȱ 67ȱ

4ȱ 5ȱ 4ȱ 10ȱ 6ȱ 5ȱ 1ȱ

25ȱ 45ȱ 36ȱ 67ȱ 43ȱ 45ȱ 33ȱ

ȱ

Tableȱ5.ȱResultsȱofȱbakeryȱitemsȱcollectedȱfromȱgroceryȱstores.ȱ

ȱ Itemȱ

Fatȱȱ (%ȱbyȱweightȱofȱfood)ȱ

TFAȱȱ (%ȱofȱtotalȱfat)ȱ

SFAȱȱ (%ȱofȱtotalȱfat)ȱ

TFAȱ+ȱSFAȱ (%ȱofȱtotalȱfat)ȱ

croissantsȱ croissantsȱ danishesȱ danishesȱ blueberryȱpieȱ lemonȱmeringueȱpieȱ butterȱtartȱ fruitȱtartsȱ chocolateȱcakeȱȱ withȱicingȱ chocolateȱcakeȱ browniesȱ browniesȱ donutȱ donutȱ

20.6ȱ 20.5ȱ 13.1ȱ 9.3ȱ 14.4ȱ 8.6ȱ 18.9ȱ 10.0ȱ

0.7ȱ 43.7ȱ 1.0ȱ 39.2ȱ 0.8ȱ 29.0ȱ 0.6ȱ 23.0ȱ

45.1ȱ 18.9ȱ 44.6ȱ 22.9ȱ 46.3ȱ 22.5ȱ 41.0ȱ 39.4ȱ

45.8ȱ 62.6ȱ 45.6ȱ 62.1ȱ 47.1ȱ 51.5ȱ 41.6ȱ 62.4ȱ

25.6ȱ

0.8ȱ

46.2ȱ

47.0ȱ

13.7ȱ 14.8ȱ 9.9ȱ 17.7ȱ 27.8ȱ

27.1ȱ 0.7ȱ 26.2ȱ 3.4ȱ 26.0ȱ

32.2ȱ 32.6ȱ 21.9ȱ 45.1ȱ 33.5ȱ

59.3ȱ 33.3ȱ 48.1ȱ 48.5ȱ 59.5ȱ

ȱ

Tableȱ6.ȱDataȱindicatingȱtheȱsumȱofȱtransȱfatȱ+ȱsaturatedȱfatȱdecreasingȱinȱlowȱtransȱfatȱbakeryȱproducts.ȱ

ȱ Bakeryȱ productsȱ areȱ knownȱ toȱ requireȱ aȱ hardȱ fatȱ toȱ maintainȱ functionalȱ characteristics.ȱ Oneȱ suchȱ substituteȱ forȱtransȱfatȱisȱsaturatedȱfat.ȱTheȱdata,ȱasȱreportedȱinȱTableȱ 6,ȱ indicatesȱ thatȱ whileȱ saturatedȱ fatȱ inȱ someȱ ofȱ theȱ lowȱ transȱfatȱbakeryȱproductsȱhaveȱincreased,ȱinȱeachȱcaseȱtheȱ sumȱ ofȱ transȱ fatȱ +ȱ saturatedȱ fatȱ isȱ muchȱ lowerȱ thanȱ theȱ highȱtransȱfatȱbakeryȱproducts.ȱThisȱsuggestsȱthatȱaȱmuchȱ lowerȱ amountȱ ofȱ saturatedȱ fatȱ isȱ requiredȱ toȱ produceȱ aȱ comparableȱproduct.ȱThereȱareȱalsoȱexamplesȱofȱlowȱtransȱ fatȱbakeryȱproductsȱwithȱlowȱsaturatedȱfatȱlevelsȱasȱwell,ȱ indicatingȱ theȱ replacementȱ ofȱ TFAsȱ withȱ otherȱ fatsȱ suchȱ asȱmonounsaturatedȱandȱpolyunsaturatedȱfats.ȱ ȱ Theȱresultsȱalsoȱindicateȱthatȱtheȱmajorityȱofȱtheȱproductsȱ thatȱareȱhighȱinȱtransȱfat,ȱandȱthusȱnotȱmeetingȱtheȱlimit,ȱ doȱnotȱhaveȱaȱNutritionȱFactsȱtable.ȱTheseȱincludeȱinȬstoreȱ bakeryȱproductsȱthatȱareȱexemptȱfromȱnutritionȱlabellingȱ requirements.ȱ Specifically,ȱ 62ȱ productsȱ wereȱ notȱ labelledȱ withȱ Nutritionȱ Factsȱ tablesȱ versusȱ 19ȱ productsȱ thatȱ wereȱ labelledȱwithȱNutritionȱFactsȱtables.ȱAsȱindicatedȱinȱTableȱ 7,ȱofȱtheȱ62ȱproductsȱnotȱlabelled,ȱ38ȱofȱ(61%)ȱwereȱhighȱinȱ transȱ fat.ȱ Whereasȱ outȱ ofȱ theȱ 19ȱ productsȱ thatȱ wereȱ labelledȱeightȱ(42%)ȱwereȱhighȱinȱtransȱfat.ȱ

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Foodsȱfromȱrestaurantsȱservingȱvariousȱethnicȱcuisines:ȱ ȱ Ratesȱ ofȱ meetingȱ theȱ transȱ fatȱ limitȱ wereȱ highȱ forȱ manyȱ menuȱ itemsȱ fromȱ restaurantsȱ servingȱ variousȱ ethnicȱ cuisines,ȱincludingȱThai,ȱVietnamese,ȱCaribbean,ȱChinese,ȱ Japanese,ȱ andȱ Eastȱ Indian.ȱ Inȱ total,ȱ 70ȱ menuȱ itemsȱ wereȱ collectedȱfromȱ16ȱdifferentȱestablishmentsȱandȱ63ȱ(orȱ90%)ȱ ofȱ thoseȱ itemsȱ wereȱ meetingȱ theȱ TFAȱ limit.ȱ Foodsȱ collectedȱ andȱ analysedȱ includedȱ friedȱ foodsȱ andȱ thoseȱ thatȱ areȱ pastryȬbasedȱ suchȱ as:ȱ naanȱ bread,ȱ samosa,ȱ Chineseȱ cookies,ȱ mooncake,ȱ Generalȱ Tao’’sȱ chicken,ȱ friedȱ beefȱandȱpork,ȱroti,ȱeggȱrolls,ȱandȱspringȱrolls.ȱ ȱ Foodsȱfromȱfastȱfoodȱchains,ȱfamilyȱrestaurants,ȱȱ andȱcoffeeȱshops:ȱ ȱ Foodsȱ collectedȱ andȱ analyzedȱ fromȱ 2006Ȭ2008ȱ included:ȱ frenchȱ fries,ȱ chickenȱ productsȱ (suchȱ asȱ chickenȱ nuggetsȱ andȱ chickenȱ strips),ȱ fishȱ products,ȱ onionȱ rings,ȱ donuts,ȱ cookiesȱ(includingȱbiscuitsȱandȱcroissants),ȱmiscellaneousȱ (cheeseȱ sticks,ȱ hashȱ browns),ȱ desserts,ȱ muffins,ȱ pizzas,ȱ andȱpizzaȱdippingȱsauces.ȱȱ ȱ

Sara Krenosky, Mary L’Abbé, Nora Lee, Lynne Underhill, Michel Vigneault, Samuel Godefroy and Nimal Ratnayake: Risk Assessment of Exposure to Trans Fat in Canada

11

Itemȱ

Totalȱ samplesȱ

Numberȱofȱ samplesȱmeetingȱ

Numberȱofȱsamplesȱ notȱmeetingȱ

Percentȱofȱ samplesȱmeetingȱ

Percentȱofȱsamplesȱ notȱmeetingȱ

labelledȱ unlabelledȱ

19ȱ 62ȱ

11ȱ 24ȱ

8ȱ 38ȱ

58ȱ 39ȱ

42ȱ 61ȱ

ȱ

Tableȱ7.ȱBakeryȱitemsȱlabelledȱandȱunlabelledȱthatȱareȱhighȱandȱlowȱinȱtransȱfat.ȱ ȱ

Itemȱ

Totalȱ Numberȱofȱ samplesȱ samplesȱmeetingȱ

Numberȱofȱsamplesȱ notȱmeetingȱ

Percentȱofȱ Percentȱofȱsamplesȱ samplesȱmeetingȱ notȱmeetingȱ

pizzaȱ pizzaȱdippingȱsauceȱ muffinsȱ ethnicȱfoodsȱ popcornȱ miscellaneousȱ frenchȱfriesȱ chickenȱproductsȱ fishȱproductsȱ onionȱringsȱ dessertsȱ cookiesȱ donutsȱ

13ȱ 8ȱ 18ȱ 70ȱ 17ȱ 11ȱ 90ȱ 95ȱ 25ȱ 12ȱ 35ȱ 13ȱ 35ȱ

0ȱ 0ȱ 1ȱ 7ȱ 2ȱ 2ȱ 19ȱ 20ȱ 6ȱ 3ȱ 12ȱ 7ȱ 25ȱ

100ȱ 100ȱ 94ȱ 90ȱ 88ȱ 82ȱ 79ȱ 79ȱ 76ȱ 75ȱ 66ȱ 46ȱ 29ȱ

13ȱ 8ȱ 17ȱ 63ȱ 15ȱ 9ȱ 71ȱ 75ȱ 19ȱ 9ȱ 23ȱ 6ȱ 10ȱ

0ȱ 0ȱ 6ȱ 10ȱ 12ȱ 18ȱ 21ȱ 21ȱ 24ȱ 25ȱ 34ȱ 54ȱ 71ȱ

ȱ

Tableȱ8.ȱResultsȱofȱfoodsȱcollectedȱfromȱfastȱfoodȱchainsȱandȱfamilyȱrestaurants.ȱ ȱ

Inȱtotal,ȱ355ȱfastȱfoodsȱitemsȱ(notȱincludingȱrepeatedȱitems)ȱ wereȱcollectedȱandȱanalysedȱfromȱ2006Ȭ2009.ȱBasedȱonȱtheȱ mostȱrecentȱresultsȱincludedȱinȱTableȱ8,ȱonȱaverageȱ75%ȱorȱ 260ȱ outȱ ofȱ theȱ 355ȱ fastȱ foodȱ itemsȱ meetȱ theȱ 5%ȱ transȱ fatȱ limits.ȱ Theȱ fastȱ foodȱ productȱ categoriesȱ withȱ theȱ highestȱ percentagesȱ thatȱ meetȱ theȱ limitsȱ include:ȱ pizzasȱ (100%),ȱ pizzaȱdippingȱsaucesȱ(100%),ȱmuffinsȱ(94%),ȱmiscellaneousȱ fastȱ foodsȱ (82%),ȱ frenchȱ friesȱ (79%),ȱ andȱ chickenȱ productsȱ (79%).ȱ Someȱ ofȱ theȱ fastȱ foodȱ productȱ categoriesȱ withȱ theȱ lowestȱ percentagesȱ thatȱ meetȱ theȱ limitsȱ areȱ donutsȱ (29%),ȱ cookiesȱ(46%),ȱandȱdessertsȱ(66%).ȱTheȱtransȱfatȱcontentȱinȱ someȱ ofȱ theseȱ foodsȱ isȱ stillȱ quiteȱ high.ȱ Forȱ example,ȱ croissantsȱ andȱ donutsȱ collectedȱ fromȱ donutȱ shopsȱ wereȱ reportedȱ toȱ beȱ asȱ highȱ asȱ 44%ȱ transȱ fatȱ andȱ 56%ȱ transȱ fat,ȱ respectively,ȱandȱaȱfriedȱfishȱproductȱfromȱaȱpopularȱfamilyȱ restaurantȱwasȱreportedȱtoȱbeȱasȱhighȱasȱ42%ȱtransȱfat.ȱȱ

nursingȱ homesȱ wereȱ collectedȱ andȱ analysed.ȱ Whileȱ thisȱ wasȱ aȱ smallȱ sample,ȱ itȱ helpedȱ provideȱ aȱ baselineȱ ofȱ theȱ levelsȱ ofȱ TFAsȱ inȱ theseȱ typesȱ ofȱ establishmentsȱ sinceȱ manyȱ ofȱ theseȱ foodsȱ areȱ notȱ consideredȱ toȱ beȱ prepackagedȱandȱareȱexemptȱfromȱtheȱnutritionȱlabellingȱ regulations.ȱFoodsȱwereȱcollectedȱfromȱinstitutionsȱinȱtheȱ followingȱ citiesȱ acrossȱ Canada:ȱ Victoria,ȱ Britishȱ Columbia;ȱ Winnipeg,ȱ Manitoba;ȱ Ottawa,ȱ Ontario;ȱ Montreal,ȱ Quebec;ȱ andȱ Charlottetown,ȱ Princeȱ Edwardȱ Island.ȱȱ

ȱ

Onȱ averageȱ 67%ȱ orȱ 88ȱ outȱ ofȱ theȱ 104ȱ itemsȱ meetȱ theȱ 2%ȱ andȱ 5%ȱ transȱ fatȱ limits.ȱ Theȱ foodȱ categoriesȱ withȱ theȱ highestȱ percentagesȱ nowȱ meetingȱ theȱ limitsȱ include:ȱ muffinsȱ (100%),ȱ chickenȱ productsȱ (80%),ȱ andȱ cookiesȱ (76%).ȱFoodsȱcategoriesȱthatȱhadȱlowȱpercentagesȱofȱitemsȱ butȱ areȱ nowȱ meetingȱ theȱ limitsȱ wereȱ margarinesȱ (25%),ȱ fishȱproductsȱ(50%),ȱandȱdessertsȱ(63%).ȱTheseȱdetailsȱareȱ reportedȱ inȱ Tableȱ 9.ȱ Theȱ TFAȱ contentȱ inȱ someȱ ofȱ theseȱ foodsȱ isȱ stillȱ quiteȱ high.ȱ Specifically,ȱ theȱ TFAȱ contentȱ ofȱ theȱ 24ȱ itemsȱ thatȱ wereȱ stillȱ highȱ inȱ transȱ fatȱ rangedȱ fromȱ 5.3%ȱ (onionȱ ringsȱ servedȱ inȱ hospitalȱ cafeteria)ȱ toȱ 29%ȱ (sconesȱ servedȱ inȱ highȱ school)ȱ toȱ 47.0%ȱ (chickenȱ fingersȱ servedȱinȱnursingȱhome).ȱȱȱ ȱ

Resultsȱfromȱtheȱmonitoringȱprogramȱindicateȱthatȱmanyȱofȱ theȱ topȱ fastȱ foodȱ andȱ topȱ familyȱ restaurantȱ chainsȱ inȱ Canadaȱ haveȱ beenȱ successfulȱ inȱ reducingȱ transȱ fatȱ fromȱ menuȱ itemsȱ thatȱ haveȱ beenȱ previouslyȱ highȱ inȱ transȱ fat.ȱ Revenuesȱ forȱ theseȱ establishments,ȱ accordingȱ toȱ theȱ 2007ȱ FoodserviceȱandȱHospitalityȱtopȱ100ȱreportȱ[30],ȱrangeȱfromȱ $25.5ȱ millionȱ toȱ $4.2ȱ billion.ȱ Revenuesȱ forȱ establishmentsȱ thatȱareȱstillȱofferingȱmenuȱitemsȱthatȱareȱhighȱinȱtransȱfatȱ rangeȱfromȱ$47ȱmillionȱtoȱ$474.6ȱmillionȱ[30].ȱ ȱ

Foodsȱfromȱcafeteriaȱinȱinstitutionsȱ(highȱschools,ȱhospitals,ȱ collegeȱcampuses,ȱandȱnursingȱhomes):ȱ ȱ

ȱ

Foodsȱ thatȱ wereȱ collectedȱ includedȱ frenchȱ fries,ȱ chickenȱ productsȱ (suchȱ asȱ chickenȱ nuggetsȱ andȱ chickenȱ strips),ȱ fishȱ products,ȱ onionȱ rings,ȱ cookies,ȱ margarines,ȱ desserts,ȱ andȱmuffins.ȱ ȱ

Oneȱhundredȱandȱfourȱitemsȱfromȱcafeteriasȱinȱinstitutionsȱ suchȱ asȱ highȱ schools,ȱ hospitals,ȱ collegeȱ campuses,ȱ andȱ 12 Int. food risk anal. j., 2012, Vol. 2, 1-15

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Itemȱ

Totalȱ samplesȱ

Numberȱofȱ samplesȱmeetingȱ

Numberȱofȱsamplesȱ Percentȱofȱ notȱmeetingȱ samplesȱmeetingȱ

Percentȱofȱsamplesȱ notȱmeetingȱ

frenchȱfriesȱ chickenȱproductsȱ cookiesȱ muffinsȱ onionȱringsȱ fishȱ margarinesȱ dessertsȱ

21ȱ 15ȱ 29ȱ 22ȱ 3ȱ 2ȱ 4ȱ 8ȱ

15ȱ 12ȱ 22ȱ 22ȱ 2ȱ 1ȱ 2ȱ 5ȱ

6ȱ 3ȱ 7ȱ 0ȱ 1ȱ 1ȱ 2ȱ 3ȱ

29ȱ 20ȱ 24ȱ 0ȱ 33ȱ 50ȱ 50ȱ 37ȱ

71ȱ 80ȱ 76ȱ 100ȱ 67ȱ 50ȱ 50ȱ 63ȱ

ȱ

Tableȱ9.ȱResultsȱofȱfoodsȱcollectedȱfromȱinstitutionsȱ(cafeteriaȱinȱhospitals,ȱonȱcollegeȱcampuses,ȱinȱhighȱschools).ȱ

ȱ Theȱ resultsȱ showȱ thatȱ foodsȱ servedȱ inȱ cafeteriaȱ inȱ institutionsȱ areȱ notȱ meetingȱ theȱ limitsȱ asȱ wellȱ asȱ foodsȱ servedȱ inȱ otherȱ foodȱ serviceȱ establishmentsȱ suchȱ asȱ restaurantsȱ andȱ fastȱ foodȱ chains.ȱ Twoȱ ofȱ theȱ topȱ foodȱ serviceȱ providers/caterersȱ areȱ servingȱ foodsȱ thatȱ areȱ stillȱ highȱ inȱ transȱ fat,ȱ namelyȱ margarinesȱ (24%ȱ TFAȱ andȱ 26%ȱ TFA),ȱ cookiesȱ (20%ȱ TFA),ȱ andȱ frenchȱ friesȱ (13%ȱ TFA)ȱ inȱ nursingȱhomesȱandȱonȱcollegeȱcampuses.ȱTheȱrevenueȱforȱ twoȱ ofȱ theȱ topȱ foodȱ serviceȱ providers/caterersȱ rangesȱ fromȱ485ȱmillionȱtoȱ$707ȱmillionȱ[30].ȱ ȱ 7.ȱReferencesȱȱ ȱ [1] MozaffarianȱD,ȱKatanȱMB,ȱAscherioȱA,ȱStampferȱMJ,ȱ Willettȱ WC.ȱ 2006.ȱ Transȱ Fattyȱ acidsȱ andȱ cardiovascularȱdisease.ȱNȱEnglȱJȱMedȱ354:1601Ȭ1613.ȱ [2] NishidaȱC,ȱUauyȱR.ȱ2009.ȱWHOȱScientificȱUpdateȱonȱ healthȱ consequencesȱ ofȱ transȱ fattyȱ acids.ȱ Eurȱ Jȱ Clinȱ Nutrȱ63:ȱS1ȬS4.ȱ [3] Greytȱ Wȱ De,ȱ Kintȱ A,ȱ Kellensȱ M,ȱ Huyghebaertȱ A.ȱ 1998.ȱ Determinationȱ ofȱ Lowȱ transȱ Levelsȱ inȱ Refinedȱ Oilsȱ byȱ Fourierȱ Transformȱ Infraredȱ Spectroscopy.ȱ JAOCSȱ75(2):115Ȭ118ȱ [4] Mendisȱ S,ȱ CruzȬHernandezȱ C,ȱ Ratnayakeȱ WMN.ȱ 2008.ȱ Fattyȱ acidȱ profileȱ ofȱ Canadianȱ dairyȱ productsȱ withȱ specialȱ attentionȱ toȱ theȱ transȬoctadecenoicȱ acidȱ andȱ conjugatedȱ linoleicȱ acidȱ isomers.ȱ Jȱ AOACȱ Int.ȱ 91:811Ȭ819.ȱ [5] Instituteȱ ofȱ Medicine.ȱ 2002.ȱ Dietaryȱ Referenceȱ Intakesȱ forȱ Energy,ȱ Carbohydrate,ȱ Fiber,ȱ Fat,ȱ Fattyȱ Acids,ȱ Cholesterol,ȱ Protein,ȱ andȱ Aminoȱ Acids.ȱ Nationalȱ AcademiesȱPress:ȱWashington,ȱD.C.ȱ [6] MozaffarianȱD,ȱAroȱA,ȱWilletȱWC.ȱ2009.ȱHealthȱeffectȱ ofȱ transȬfattyȱ acids:ȱ experimentalȱ andȱ observationalȱ evidence.ȱEurȱJȱClinȱNutrȱ63:S5ȬS21.ȱ [7] MozaffarianȱD,ȱClarkeȱR.ȱ2009.ȱQuantitativeȱeffectsȱonȱ cardiovascularȱriskȱfactorsȱandȱcoronaryȱheartȱdiseaseȱ riskȱofȱreplacingȱpartiallyȱhydrogenatedȱvegetableȱoilsȱ withȱotherȱfatsȱandȱoils.ȱEurȱJȱClinȱNutrȱ63:ȱS22ȬS33.ȱ [8] Healthȱ Canada.ȱ 2006.ȱ Dietaryȱ Referenceȱ Intakeȱ Tables.ȱ Availableȱ at:ȱ http://www.hcȬsc.gc.ca/fnȬan/nutrition/ȱ reference/table/indexȬeng.php#rvmȱ Accessed:ȱ Julyȱ 13,ȱ2009ȱ

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Sara Krenosky, Mary L’Abbé, Nora Lee, Lynne Underhill, Michel Vigneault, Samuel Godefroy and Nimal Ratnayake: Risk Assessment of Exposure to Trans Fat in Canada

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Sara Krenosky, Mary L’Abbé, Nora Lee, Lynne Underhill, Michel Vigneault, Samuel Godefroy and Nimal Ratnayake: Risk Assessment of Exposure to Trans Fat in Canada

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