Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark.
Department of Cardiology, North Denmark Region Hospital, Hjoerring, Denmark.
PLoS One. 2022 Aug 17;17(8):e0272744. doi: 10.1371/journal.pone.0272744. eCollection 2022.
Denmark has experienced a remarkable reduction in CVD mortality over recent decades. The scale of the health contribution from the Danish regulation on industrially produced trans fatty acid (ITFA) has therefore long been of interest. Thus the objective was to determine health and equity benefits of the Danish regulation on ITFA content in Danish food, by quantifying the relative contributions of changes in ITFA intake, other risk factors and treatments on coronary heart disease (CHD) mortality decline from 1991 to 2007 in Denmark, stratified by socioeconomic group. To evaluate the effects of the ITFA ban (Danish Order no. 160 of March 2003) the Danish IMPACTSEC model was extended to quantify reductions in CHD deaths attributable to changes in ITFA (%E) intake between 1991-2007. Population counts were obtained from the Danish Central Office of Civil Registration, financial income from Statistics Denmark and ITFA intake from Dan-MONICA III (1991) and DANSDA (2005-2008). Participants were adults aged 25-84 years living in Denmark in 1991 and 2007, stratified by socioeconomic quintiles. The main outcome measure was CHD deaths prevented or postponed (DPP). Mean energy intake from ITFA was decimated between 1991 and 2007, falling from 1.1%E to 0.1%E in men and from 1·0%E to 0·1%E in women. Approximately 1,191 (95% CI 989-1,409) fewer CHD deaths were attributable to the ITFA reduction, representing some 11% of the overall 11,100 mortality fall observed in the period. The greatest attributable mortality falls were seen in the most deprived quintiles. Adding ITFA data to the original IMPACTsec model improved the overall model fit from 64% to 73%. In conclusion: Denmark's mandatory elimination of ITFA accounted for approximately 11% of the substantial reduction in CHD deaths observed between 1991 and 2007. The most deprived groups benefited the most, thus reducing inequalities. Adopting the Danish ITFA regulatory approach elsewhere could substantially reduce CHD mortality while improving health equity.
丹麦在过去几十年中经历了 CVD 死亡率的显著下降。因此，丹麦对工业生产的反式脂肪酸（ITFA）的规定所带来的健康贡献规模一直受到关注。因此，本研究的目的是通过量化 1991 年至 2007 年期间 ITFA 摄入量变化、其他风险因素和治疗方法对冠心病（CHD）死亡率下降的相对贡献，来确定丹麦食品中 ITFA 含量的规定对健康和公平的益处，并按社会经济群体进行分层。为了评估 ITFA 禁令（2003 年 3 月丹麦第 160 号法令）的效果，丹麦 IMPACTSEC 模型进行了扩展，以量化 1991 年至 2007 年间由于 ITFA 摄入量变化而导致的 CHD 死亡人数的减少比例（%E）。人口计数来自丹麦中央民事登记处，财务收入来自丹麦统计局，ITFA 摄入量来自 Dan-MONICA III（1991 年）和 DANSDA（2005-2008 年）。参与者为 1991 年和 2007 年居住在丹麦的 25-84 岁成年人，按社会经济五分位数分层。主要结局指标为预防或推迟的 CHD 死亡（DPP）。1991 年至 2007 年间，ITFA 的平均能量摄入量减少了一半，男性从 1.1%E 降至 0.1%E，女性从 1.0%E 降至 0.1%E。大约有 1191 例（95%CI 989-1409）CHD 死亡归因于 ITFA 减少，占该期间观察到的 11100 例死亡率下降的 11%左右。在最贫困的五分位数中，归因于死亡率下降的最大。将 ITFA 数据添加到原始的 IMPACTsec 模型中，提高了模型的整体拟合度，从 64%提高到 73%。结论：丹麦强制性消除 ITFA 占 1991 年至 2007 年间观察到的 CHD 死亡人数大幅下降的约 11%。最贫困群体受益最大，从而减少了不平等。在其他地方采用丹麦的 ITFA 监管方法可能会大大降低 CHD 死亡率，同时改善健康公平。
