Angell Sonia Y, Silver Lynn Dee, Goldstein Gail P, Johnson Christine M, Deitcher Deborah R, Frieden Thomas R, Bassett Mary T
New York City Department of Health and Mental Hygiene, New York, New York 10007, USA.
Ann Intern Med. 2009 Jul 21;151(2):129-34. doi: 10.7326/0003-4819-151-2-200907210-00010.
Decades after key modifiable risk factors were identified, cardiovascular disease remains the leading cause of preventable death, and only one quarter of persons with high cholesterol levels have attained recommended levels of control. Cholesterol control efforts have focused on consumer education and medical treatment. A powerful, complementary approach is to change the makeup of food, a route the New York City Department of Health and Mental Hygiene took when it restricted artificial trans fat--a contributor to coronary heart disease--in restaurants. The Department first undertook a voluntary campaign, but this effort did not decrease the proportion of restaurants that used artificial trans fat. In December 2006, the Board of Health required that artificial trans fat be phased out of restaurant food. To support implementation, the Department provided technical assistance to restaurants. By November 2008, the restriction was in full effect in all New York City restaurants and estimated restaurant use of artificial trans fat for frying, baking, or cooking or in spreads had decreased from 50% to less than 2%. Preliminary analyses suggest that replacement of artificial trans fat has resulted in products with more healthful fatty acid profiles. For example, in major restaurant chains, total saturated fat plus trans fat in French fries decreased by more than 50%. At 2 years, dozens of national chains had removed artificial trans fat, and 13 jurisdictions, including California, had adopted similar laws. Public health efforts that change food content to make default choices healthier enable consumers to more successfully meet dietary recommendations and reduce their cardiovascular risk.
在确定了关键的可改变风险因素几十年后，心血管疾病仍然是可预防死亡的主要原因，而且只有四分之一的高胆固醇患者达到了推荐的控制水平。胆固醇控制工作主要集中在消费者教育和药物治疗上。一种强有力的补充方法是改变食物的成分，纽约市卫生和精神卫生部门在限制餐馆使用人造反式脂肪（冠心病的一个成因）时就采取了这条途径。该部门首先开展了一项自愿行动，但这项努力并没有降低使用人造反式脂肪的餐馆比例。2006年12月，卫生局要求逐步淘汰餐馆食品中的人造反式脂肪。为支持实施这一规定，该部门向餐馆提供了技术援助。到2008年11月，这项限制在纽约市所有餐馆全面生效，据估计餐馆用于油炸、烘焙或烹饪的人造反式脂肪或涂抹酱中的人造反式脂肪使用量已从50%降至不到2%。初步分析表明，人造反式脂肪的替代使得产品的脂肪酸谱更健康。例如，在主要的连锁餐厅中，薯条中的总饱和脂肪加反式脂肪减少了50%以上。两年后，数十家全国性连锁餐厅已去除了人造反式脂肪，包括加利福尼亚州在内的13个司法管辖区也通过了类似法律。通过改变食物成分以使默认选择更健康的公共卫生努力，能使消费者更成功地满足饮食建议并降低心血管疾病风险。
