Trans fat explained

Trans fat is a type of unsaturated fat that occurs in foods.[1] [2] Small amounts of trans fats occur naturally in animal and dairy products, but large amounts are found in some processed foods made with partially hydrogenated oils.[1] [2] Because consumption of trans fats is associated with increased risk for cardiovascular diseases, artificial trans fats are highly regulated or banned in many countries.[3] [4] [5] [6] However, they are still widely consumed in developing nations where they are associated with increased risk of diabetes, cardiovascular diseases, and death.[7]

In 2015, the US Food and Drug Administration (FDA) determined that artificial trans fats made from partially hydrogenated oils (PHOs) were not generally recognized as safe (GRAS). As a result, these oils were banned from foods sold in the US beginning June 18, 2018, with limited extensions for specific, approved uses until 2020 or 2021.[2]

Following the US action, other governing bodies, including the European Union, Canada, Australia, and New Zealand introduced restrictions or bans on the use of partially hydrogenated oils and industrial trans fats in food manufacturing.[1] [8]

The World Health Organization (WHO) set a global goal to eliminate industrially produced trans fat by the end of 2023.[9] The goal was not fully achieved. In 2024, the WHO announced an updated plan for accelerated action through 2025 to complete global elimination efforts.[10]

Trans fatty acids (also called trans-unsaturated fatty acids) are derived from trans fats, which are triglycerides (esters of glycerin). Trans fats are converted to trans fatty acids in the digestive tract prior to absorption.

Occurrence

Trans fats occur naturally in the fats of products made from ruminant animals, such as cheese or butter. Some trans fats are the result of food processing, especially when applied to cooking oils and margarine.

Naturally-occurring trans fats

Trans fats occur in meat and dairy products from ruminants. For example, butter contains about 3% trans fat by weight.[11] These naturally occurring trans fats include conjugated linoleic acid (CLA) and vaccenic acid. They arise from the action of bacteria in the rumen. Polyunsaturated fats are toxic to the rumen-based bacteria, which detoxify the fats by changing some cis-double bonds to trans-double bonds. In contrast to industrially produced trans fats, this bacterial process produces only a few specific isomers. As industrial sources of trans fats are eliminated, increased attention focuses on ruminant derived trans fats.[12]

Small amounts of trans fats occur in meat and milk fat.

Hydrogenation

See main article: Fat hydrogenation. Trans fat can be an unintentional byproduct of the industrial processing of oils. Unlike naturally derived trans fats, the trans fats that result from hydrogenation consist of many isomers. In food production, liquid cis-unsaturated fats such as vegetable oils are hydrogenated to produce more saturated fats, which have desirable properties:

However, an isomerization side reaction during fat hydrogenation can convert remaining unsaturated fats to the thermodynamically favored trans isomer.

A number of old and new ingredients are available to replace partially hydrogenated oil containing significant levels of trans fat. These include partially hydrogenated oil made with improved processes, plant oils rich in monounsaturated fats and saturated fats, and a mix of fats combined with interesterification.[13] The technology has improved such that a 2021 review indicates that trans fat from hydrogenated fats is no longer a problem in modern countries.[12]

Thermal isomerization

When heated (cooked), some unsaturated fats change from their normal geometry to trans. The rate of isomerization is accelerated by free radicals.[14] [15]

History

There were suggestions in the scientific literature as early as 1956 that trans fats could cause an increase in coronary artery disease.[16] Studies in the early 1990s brought renewed scrutiny and confirmation of the negative health impact of trans fats. In 1994, it was estimated that trans fats caused at least 20,000 deaths annually in the U.S. from heart disease.[17] In the 1990s, activist organization Center for Science in the Public Interest (CSPI) called for reducing trans fats in foods, and later lobbied for them to be disclosed on product labels and menus. Several lawsuits were launched against high-visibility restaurants and food manufacturers with the objective of supporting a broader phase-out of trans fats.[18] [19]

Mandatory food labeling was introduced in several countries[20] and Denmark was first to mandate limits on industrially produced trans fats in 2004.[21] In January 2007, faced with the prospect of an outright ban on the sale of their product, Crisco was reformulated to meet the U.S. Food and Drug Administration (FDA) definition of "zero grams trans fats per serving" (that is less than one gram per tablespoon, or up to 7% by weight; or less than 0.5 grams per serving size)[22] [23] [24] [25] by boosting the saturation and then diluting the resulting solid fat with unsaturated vegetable oils. Noting that elimination of industrially produced trans fat is feasible and achievable, the World Health Organization (WHO) has set a goal to make the world free from industrially produced trans fat by the end of 2023. By the end of 2021, the WHO announced that 40 countries had implemented industrial trans fat elimination policies that "are protecting 1.4 billion people from this deadly food compound" but that 10 of the 15 countries suffering the highest health impacts from trans fats had not yet adopted a policy.

Structure

A fatty acid is characterized as either saturated or unsaturated based on the respective absence or presence of C=C double bonds in its backbone. If the molecule contains no double C=C bonds, it is said to be saturated; otherwise, it is unsaturated to some degree.[26] [27]

The C=C double bond is rotationally rigid. If the hydrogen atoms bonded to each of the carbons in this double bond are on the same side, this is called cis, and leads to a bent molecular chain. If the two hydrogens are on opposite sides, this is called trans, and leads to a straight chain.

Because trans fats are more linear, they crystallize more easily, allowing them to be solid (rather than liquid) at room temperatures. This has several processing and storage advantages.

In nature, unsaturated fatty acids generally have cis configurations as opposed to trans configurations.[30] Saturated fatty acids (those without any carbon-carbon double bonds) are abundant (see tallow), but they also can be generated from unsaturated fats by the process of fat hydrogenation. In the course of hydrogenation, some cis double bonds convert into trans double bonds. Chemists call this conversion an isomerization reaction.[31]

Any molecule with a C=C double bond can be either a trans or a cis fatty acid depending on the configuration of the double bond. For example, oleic acid and elaidic acid are both unsaturated fatty acids with the chemical formula C9H17C9H17O2. They both have a double bond located midway along the carbon chain. It is the geometry of this bond that sets oleic and elaidic acids apart. They have distinct physical-chemical properties of the molecule. For example, the melting point of elaidic acid is 45 Â°C, which is higher than that of oleic acid.[32] This notably means that it is a solid at human body temperatures.

Hydrogenation as a source of trans fats

See main article: Fat hydrogenation. The hydrogenation process was widely adopted by the food industry in the early 1900s; first for the production of margarine, a replacement for butter and shortening,[33] and eventually for various other fats used in snack food, packaged baked goods, and deep fried products.

Full hydrogenation of a fat or oil produces a fully saturated fat. For food purposes, hydrogenation generally is not allowed to go to completion. The main target is a specific melting point and hardness, and this fine-tuning requires that some unsaturation (C=C bonds) remain. This partial hydrogenation turns some of the cis double bonds into trans bonds by an isomerization reaction.[34] This side reaction accounts for most of the trans fatty acids consumed today, by far.[35]

The standard 140 kPa (20 psi) process of hydrogenation produces a product of about 40% trans fatty acid by weight, compared to about 17% using higher pressures of hydrogen. Blended with unhydrogenated liquid soybean oil, the high-pressure-processed oil produced margarine containing 5 to 6% trans fat. Based on current U.S. labeling requirements (see below), the manufacturer could claim the product was free of trans fat.[36] The level of trans fat may also be altered by modification of the temperature and the length of time during hydrogenation.

The trans fat levels can be quantified using various forms of chromatography.[37]

Presence in food

Trans fat contents in various foods, ranked in g per 100 g
Food typeTrans fat content
shortenings10–33
margarine, stick6.2–16.8[38]
butter2–7
whole milk0.07–0.1
breads/cake products0.1–10
cookies and crackers1–8
tortilla chips5.8
cake frostings, sweets0.1–7
animal fat0–5
ground beef1

Animal fats

Trans fatty acids (TFAs) occur in small amounts in meat and milk of ruminants (such as cattle and sheep),[39] [40] typically 2–5% of total fat.[41] Natural TFAs, which include conjugated linoleic acid (CLA) and vaccenic acid, originate in the rumen of these animals. CLA has two double bonds, one in the cis configuration and one in trans, which makes it simultaneously a cis- and a trans-fatty acid.[42] A type of trans fat occurs naturally in the milk and body fat of ruminants (such as cattle and sheep) at a level of 2–5% of total fat.[43]

The US National Dairy Council has asserted that the trans fats present in foods of animal origin are of a different type than those in partially hydrogenated oils, and do not appear to exhibit the same negative effects.[44] A scientific review agrees with the conclusion (stating that "the sum of the current evidence suggests that the Public health implications of consuming trans fats from ruminant products are relatively limited") but cautions that this may be due to the low consumption of trans fats from animal sources compared to artificial ones.[38]

Despite this concern, the NAS dietary recommendations have not included eliminating trans fat from the diet. This is because trans fat is naturally present in many animal foods in trace quantities, and thus its removal from ordinary diets might introduce undesirable side effects and nutritional imbalances if proper nutritional planning is not undertaken. The NAS has, thus, "recommended that trans fatty acid consumption be as low as possible while consuming a nutritionally adequate diet".[45] Like the NAS, the World Health Organization has tried to balance public health goals with a practical level of trans fat consumption, recommending in 2003 that trans fats be limited to less than 1% of overall energy intake.[43]

A meta-analysis showed that all trans fats, regardless of natural or artificial origin equally raise LDL and lower HDL levels.[6] Other studies though have shown different results when it comes to animal based trans fats like conjugated linoleic acid (CLA). Although CLA is known for its anticancer properties, researchers have also found that the cis-9, trans-11 form of CLA can reduce the risk for cardiovascular disease and help fight inflammation.[46] [47]

Natural "trans fats" in dairy products

Some trans fatty acids occur in natural fats and traditionally processed foods. Vaccenic acid occurs in breast milk, and some isomers of conjugated linoleic acid (CLA) are found in meat and dairy products from ruminants. Butter, for example, contains about 3% trans fat.[48]

Processed foods

Partially hydrogenated vegetable oils were an increasingly significant part of the human diet for about 100 years, especially after 1950 as processed food rose in popularity.[49]

Animal-based fats were once the only trans fats consumed, but by far the largest amount of trans fat consumed today is created by the processed food industry as a side effect of partially hydrogenating unsaturated plant fats (generally vegetable oils). These partially hydrogenated fats have displaced natural solid fats and liquid oils in many areas, the most notable ones being in the fast food, snack food, fried food, and baked goods industries.[50]

Up to 45% of the total fat in those foods containing human-made trans fats formed by partially hydrogenating plant fats may be trans fat.[43] [41] An analysis of some industrialized foods in 2006 found up to 30% "trans fats" in artificial shortening, 10% in breads and cake products, 8% in cookies and crackers, 4% in salty snacks, 7% in cake frostings and sweets, and 26% in margarine and other processed spreads. Another 2010 analysis however found only 0.2% of trans fats in margarine and other processed spreads.[51]

Foods containing higher amounts of trans fat are associated with fast food restaurants.[49] They are consumed in greater quantities by people who lack access to a diet consisting of fewer partially hydrogenated fats, or who often consume fast food. A diet high in trans fats can contribute to obesity, high blood pressure, and higher risk for heart disease. Trans fat is also implicated in Type 2 diabetes.[52]

Shortenings

Shortenings, because they are widely used, are of particular concern. Baking shortenings, unless reformulated, contain around 30% trans fats compared to their total fats. High-fat dairy products such as butter contain about 4%. Margarines not reformulated to reduce trans fats may contain up to 15% trans fat by weight,[53] but some reformulated ones are less than 1% trans fat. Shortenings for deep-frying in restaurants can be used for longer than most conventional oils before becoming rancid. In the early 21st century, non-hydrogenated vegetable oils that have lifespans exceeding that of the frying shortenings became available.[54]

Trans fat contents in various natural and traditionally processed foods, in g per 100 g [55]
Food typeTrans fat content
butter2 to 7 g
whole milk0.07 to 0.1 g
animal fat0 to 5 g
ground beef1 g

High levels of TFAs have been recorded in popular "fast food" meals. In fast-food chains, trans fat levels can vary with location. An analysis of samples of McDonald's French fries collected in 2004 and 2005 found that fries served in New York City contained twice as much trans fat as in Hungary, and 28 times as much as in Denmark, where trans fats are restricted. For Kentucky Fried Chicken products, the pattern was reversed: the Hungarian product containing twice the trans fat of the New York product. Even within the United States, there was variation, with fries in New York containing 30% more trans fat than those from Atlanta.[56]

Breast milk

It has been established that trans fats in human breast milk fluctuate with maternal consumption of trans fat, and that the amount of trans fats in the bloodstream of breastfed infants fluctuates with the amounts found in their milk. In 1999, reported percentages of trans fats (compared to total fats) in human milk ranged from 1% in Spain, 2% in France, 4% in Germany, and 7% in Canada and the U.S.[57]

Regulatory action

See main article: Trans fat regulation. In the last few decades, there has been substantial amount of regulation in many countries, limiting trans fat contents of industrialized and commercial food products.

In light of recognized evidence and scientific agreement, nutritional authorities consider all trans fats equally harmful for health and recommend that their consumption be reduced to trace amounts.[1] [2] [4] [5] [8] In 2003, the WHO recommended that trans fats make up no more than 0.9% of a person's diet[41] and, in 2018, introduced a 6-step guide to eliminate industrially produced trans-fatty acids from the global food supply.[58]

The National Academy of Sciences (NAS) advises the U.S. and Canadian governments on nutritional science for use in public policy and product labeling programs. Their 2002 Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids[59] contains their findings and recommendations regarding consumption of trans fat.[60]

Their recommendations are based on two key facts. First, "trans fatty acids are not essential and provide no known benefit to human health",[61] whether of animal or plant origin.[62] Second, given their documented effects on the LDL/HDL ratio, the NAS concluded "that dietary trans fatty acids are more deleterious with respect to coronary artery disease than saturated fatty acids". A 2006 review stated "from a nutritional standpoint, the consumption of trans fatty acids results in considerable potential harm but no apparent benefit."[38]

Because of these facts and concerns, the NAS has concluded there is no safe level of trans fat consumption. There is no adequate level, recommended daily amount or tolerable upper limit for trans fats. This is because any incremental increase in trans fat intake increases the risk of coronary artery disease.

Despite this concern, the NAS dietary recommendations have not included eliminating trans fat from the diet. This is because trans fat is naturally present in many animal foods in trace quantities, and thus its removal from ordinary diets might introduce undesirable side effects and nutritional imbalances. The NAS has, thus, "recommended that trans fatty acid consumption be as low as possible while consuming a nutritionally adequate diet".[63] Like the NAS, the WHO has tried to balance public health goals with a practical level of trans fat consumption, recommending in 2003 that trans fats be limited to less than 1% of overall energy intake.[41]

Health effects

Cardiovascular disease

The primary health risk identified for trans fat consumption is an elevated risk of coronary artery disease (CAD).[38] [64] [65] [66] A 1994 study estimated that over 30,000 cardiac deaths per year in the United States are attributable to the consumption of trans fats. By 2006 upper estimates of 100,000 deaths were suggested.[67]

Major evidence for the effect of trans fat on CAD comes from the Nurses' Health Study – a cohort study that has been following 120,000 female nurses since its inception in 1976. In this study, Hu and colleagues analyzed data from 900 coronary events from the study's population during 14 years of followup. He determined that a nurse's CAD risk roughly doubled (relative risk of 1.93, CI: 1.43 to 2.61) for each 2% increase in trans fat calories consumed (instead of carbohydrate calories). By contrast, for each 5% increase in saturated fat calories (instead of carbohydrate calories) there was a 17% increase in risk (relative risk of 1.17, CI: 0.97 to 1.41). "The replacement of saturated fat or trans unsaturated fat by cis (unhydrogenated) unsaturated fats was associated with larger reductions in risk than an isocaloric replacement by carbohydrates." Hu also reports on the benefits of reducing trans fat consumption. Replacing 2% of food energy from trans fat with non-trans unsaturated fats more than halves the risk of CAD (53%). By comparison, replacing a larger 5% of food energy from saturated fat with non-trans unsaturated fats reduces the risk of CAD by 43%.

Another study considered deaths due to CAD, with consumption of trans fats being linked to an increase in mortality, and consumption of polyunsaturated fats being linked to a decrease in mortality.[66] [68]

Analytical data (blood work)

Consuming trans fats has been shown to increase the risk of coronary artery disease in part by raising levels of low-density lipoprotein (LDL, often termed "bad cholesterol"), lowering levels of high-density lipoprotein (HDL, often termed "good cholesterol"), increasing triglycerides in the bloodstream and promoting systemic inflammation.[69]

Trans fat has been found to act like saturated in raising the blood level of LDL ("bad cholesterol"); but, unlike saturated fat, it also decreases levels of HDL ("good cholesterol"). The net increase in LDL/HDL ratio with trans fat, a widely accepted indicator of risk for coronary artery disease, is approximately double that due to saturated fat.[70] [71] [72] One randomized crossover study published in 2003 comparing the effect of eating a meal on blood lipids of (relatively) cis and trans-fat-rich meals showed that cholesteryl ester transfer (CET) was 28% higher after the trans meal than after the cis meal and that lipoprotein concentrations were enriched in apolipoprotein(a) after the trans meals.[73]

The cytokine test is a potentially more reliable indicator of CAD risk, although is still being studied.[66] A study of over 700 nurses showed that those in the highest quartile of trans fat consumption had blood levels of C-reactive protein (CRP) that were 73% higher than those in the lowest quartile.[74]

Intake of dietary trans fat perturbs the body's ability to metabolize essential fatty acids (EFAs, including omega-3) leading to changes in the phospholipid fatty acid composition of the arterial walls, thereby raising risk of coronary artery disease.[75]

There are two accepted tests that measure an individual's risk for coronary artery disease, both blood tests. The first considers ratios of two types of cholesterol, the other the amount of a cell-signalling cytokine called C-reactive protein. The effect of trans fat consumption has been documented on each as follows:

Biochemical mechanisms

The mechanisms through which trans fatty acids contribute to coronary artery disease are fairly well understood. The mechanism for their effects on diabetes is still under investigation. They may impair the metabolism of long-chain polyunsaturated fatty acids (LCPUFAs).[77] However, maternal pregnancy trans fatty acid intake has been inversely associated with LCPUFAs levels in infants at birth thought to underlie the positive association between breastfeeding and intelligence.[78]

Trans fats are processed by the liver differently than other fats. They may cause liver dysfunction by interfering with delta 6 desaturase, an enzyme involved in converting essential fatty acids to arachidonic acid and prostaglandins, both of which are important to the functioning of cells.[79]

Intake of dietary trans fat disrupts the body's ability to metabolize essential fatty acids (EFAs, including Omega-3) leading to changes in the phospholipid fatty acid composition of the arterial walls, thereby raising risk of coronary artery disease.[75]

The major evidence for the effect of trans fat on CAD comes from the Nurses' Health Study – a cohort study that has been following 120,000 female nurses since its inception in 1976. In this study, Hu and colleagues analyzed data from 900 coronary events from the study's population during 14 years of followup. He determined that a nurse's CAD risk roughly doubled (relative risk of 1.93, CI: 1.43 to 2.61) for each 2% increase in trans fat calories consumed (instead of carbohydrate calories). By contrast, for each 5% increase in saturated fat calories (instead of carbohydrate calories) there was a 17% increase in risk (relative risk of 1.17, CI: 0.97 to 1.41). "The replacement of saturated fat or trans unsaturated fat by cis (unhydrogenated) unsaturated fats was associated with larger reductions in risk than an isocaloric replacement by carbohydrates."[80] Hu also reports on the benefits of reducing trans fat consumption. Replacing 2% of food energy from trans fat with non-trans unsaturated fats more than halves the risk of CAD (53%). By comparison, replacing a larger 5% of food energy from saturated fat with non-trans unsaturated fats reduces the risk of CAD by 43%.[80]

Another study considered deaths due to CAD, with consumption of trans fats being linked to an increase in mortality, and consumption of polyunsaturated fats being linked to a decrease in mortality.[68]

Other health risks

Scientific studies have examined other negative effects of industrial trans fat beyond cardiovascular disease, with the next most studied area being type-2 diabetes.

Food industry response

Manufacturer response

Palm oil, a natural oil extracted from the fruit of oil palm trees that is semi-solid at room temperature (15–25 degrees Celsius), can potentially serve as a substitute for partially hydrogenated fats in baking and processed food applications, although there is disagreement about whether replacing partially hydrogenated fats with palm oil confers any health benefits. A 2006 study supported by the National Institutes of Health and the USDA Agricultural Research Service concluded that palm oil is not a safe substitute for partially hydrogenated fats (trans fats) in the food industry, because palm oil results in adverse changes in the blood concentrations of LDL and apolipoprotein B just as trans fat does.[102] [103]

In May 2003, BanTransFats.com Inc., a U.S. non-profit corporation, filed a lawsuit against the food manufacturer Kraft Foods in an attempt to force Kraft to remove trans fats from the Oreo cookie. The lawsuit was withdrawn when Kraft agreed to work on ways to find a substitute for the trans fat in the Oreo.

The J.M. Smucker Company, then the American manufacturer of Crisco (the original partially hydrogenated vegetable shortening), in 2004 released a new formulation made from solid saturated palm oil cut with soybean oil and sunflower oil. This blend yielded an equivalent shortening much like the prior partially hydrogenated Crisco, and was labelled zero grams of trans fat per 1 tablespoon serving (as compared with 1.5 grams per tablespoon of original Crisco).[104] As of 24 January 2007, Smucker said that all Crisco shortening products in the US had been reformulated to contain less than one gram of trans fat per serving while keeping saturated fat content less than butter.[105] The separately marketed trans fat free version introduced in 2004 was discontinued.

On 22 May 2004, Unilever, the corporate descendant of Joseph Crosfield & Sons (the original producer of Wilhelm Normann's hydrogenation hardened oils) announced that they had eliminated trans fats from all their margarine products in Canada, including their flagship Becel brand.[106]

Agribusiness giant Bunge Limited, through their Bunge Oils division, produce an NT product line of non-hydrogenated oils, margarines and shortenings, made from corn, canola, and soy oils.[107]

Major users' response

Beginning around 2000, as the scientific evidence and public concern about trans fat increased, major American users of trans fat began to switch to safer alternatives. The process received a large boost in 2003 when the FDA announced it would require trans fat labeling on packaged food starting in 2006. Packaged food companies then faced the choice of either eliminating trans fat from their products, or having to declare the trans fat on their nutrition label. Lawsuits in the U.S. against trans fat users also encouraged its removal.

Major American fast food chains including McDonald's, Burger King, KFC and Wendy's reduced and then removed partially hydrogenated oils (containing artificial trans fats) by 2009. This was a major step toward trans fat removal, as french fries were one of the largest sources of trans fat in the American diet, with a large serving of fries typically having about 6 grams of trans fat until around 2007.[108] [109] [110] [111] [112] [113] [114] [115]

Two other events were important in the removal of trans fat. First, in 2013 the FDA announced it planned to completely ban artificial trans fat in the form of partially hydrogenated oil. Second, soon after this, Walmart informed its suppliers they needed to remove trans fat by 2015 if they wanted to continue to sell their products at its stores. As Walmart is the largest brick-and-mortar retailer in the U.S., mainstream food brands had little choice but to comply.[116]

These reformulations can be partly attributed to 2006 Center for Science in the Public Interest class action complaints, and to New York's restaurant trans fat ban, a massive effort led by Minal Amlani under the guidance of Michael Bloomberg, with companies such as McDonald's stating they would not be selling a unique product just for New York customers but would implement a nationwide or worldwide change.[117] [118] [119]

See also

Further reading

External links

Notes and References

  1. Web site: Trans fats in foods: A new regulation for EU consumers . European Commission . 24 January 2025 . 2019.
  2. Web site: Trans fat . https://web.archive.org/web/20190618002821/https://www.fda.gov/food/food-additives-petitions/trans-fat . 18 June 2019 . US Food and Drug Administration . 24 January 2025 . 30 April 2024.
  3. Encyclopedia: Gormley . James J. . Juturu . Vijaya . Partially Hydrogenated Fats in the US Diet and Their Role in Disease . Modern Dietary Fat Intakes in Disease Promotion . 2010 . Humana Press . De Meester F, Zibadi S, Watson RR . Totowa, NJ. 978-1-60327-571-2 . Nutrition and Health . 85–94 . en . 10.1007/978-1-60327-571-2_5 .
  4. EFSA Panel on Dietetic Products, Nutrition, and Allergies. Scientific opinion on dietary reference values for fats. 10.2903/j.efsa.2010.1461. EFSA Journal. 2010. 8. 3. 1461. free.
  5. Web site: Fat: the facts. UK National Health Service. 14 April 2023. 24 January 2025.
  6. Brouwer IA, Wanders AJ, Katan MB . Effect of animal and industrial trans fatty acids on HDL and LDL cholesterol levels in humans - a quantitative review . PLOS ONE . 5 . 3 . e9434 . March 2010 . 20209147 . 2830458 . 10.1371/journal.pone.0009434 . 2010PLoSO...5.9434B . free .
  7. de Souza. Russell J.. Mente. Andrew. Maroleanu. Adriana. Cozma. Adrian I.. Ha. Vanessa. Kishibe. Teruko. Uleryk. Elizabeth. Budylowski. Patrick. Schünemann. Holger. Beyene. Joseph. Anand. Sonia S.. 2015-08-11. Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies. BMJ (Clinical Research Ed.). 351. h3978. 10.1136/bmj.h3978. 1756-1833. 4532752. 26268692.
  8. Web site: Trans fatty acids . Food Standards Australia-New Zealand . 24 January 2025 . May 2017.
  9. Web site: Eliminating trans fat from foods will save lives without changing the taste: Only our hearts will know the difference . Ghebreyesus TA, Frieden T . World Health Organization. 2021. 22 July 2023.
  10. Web site: REPLACE Trans fat-free. Sergey Volkov. World Health Organization. 1 February 2024. 11 April 2024.
  11. Web site: 2019-04-01 . Butter, salted . 2024-10-11 . FoodData Central.
  12. 10.1002/lipd.12324. Trans-10 18:1 in ruminant meats: A review . 2021 . Alves . Susana P. . Vahmani . Payam . Mapiye . Cletos . McAllister . Tim A. . Bessa . Rui J. B. . Dugan . Michael E. R. . Lipids . 32 . 6 . 539–562 . 34608647 . 238356805 .
  13. Teresa Tarrago-Trani . Maria . Phillips . Katherine M. . Lemar . Linda E. . Holden . Joanne M. . 2006 . New and Existing Oils and Fats Used in Products with Reduced Trans-Fatty Acid Content . Journal of the American Dietetic Association . 106 . 6. 867–880 . 10.1016/j.jada.2006.03.010 . 16720128 .
  14. Web site: About Trans Fat and Partially Hydrogenated Oils . Center for Science in the Public Interest.
  15. Web site: Tentative Determination Regarding Partially Hydrogenated Oils . . 8 November 2013 . 8 November 2013 . 2013-26854, Vol. 78, No. 217 . https://web.archive.org/web/20140406185048/https://www.federalregister.gov/articles/2013/11/08/2013-26854/tentative-determination-regarding-partially-hydrogenated-oils-request-for-comments-and-for . 6 April 2014 . live .
  16. Ascherio A, Stampfer MJ, Willett WC . Trans fatty acids and coronary heart disease. The New England Journal of Medicine. 1999. 340. 25. 1994–1998. 10.1056/NEJM199906243402511. 10379026. 14 September 2006. https://web.archive.org/web/20060903061226/http://www.hsph.harvard.edu/reviews/transfats.html. 3 September 2006. subscription.
  17. Willett WC, Ascherio A . Trans fatty acids: are the effects only marginal? . American Journal of Public Health . 84 . 5 . 722–4 . May 1994 . 8179036 . 1615057 . 10.2105/AJPH.84.5.722 .
  18. News: Lawsuit dropped as Oreo looks to drop the fat. CNN. 14 May 2003. 14 July 2011.
  19. Web site: CSPI withdraws from lawsuit after KFC cuts trans fat. Centre for Science in the Public Interest. 2006. 22 July 2023.
  20. Approaches to removing trans fats from the food supply in industrialized and developing countries. European Journal of Clinical Nutrition. 63. S50–7. 2009. 10.1038/ejcn.2009.14. Suppl 1. L'Abbé MR, Stender S, Skeaff CM, Tavella M . free. 19190645 . 2830089.
  21. Web site: Information Sheet: REPLACE trans fat: an action package to eliminate industrially produced trans-fatty acids . World Health Organization. 2021. 22 July 2023.
  22. Regulation: 21 CFR 101.9 (c)(2)(ii). Web site: Food and Drug Administration. 21 CFR Part 101. Food labeling; trans fatty acids in nutrition labeling; consumer research to consider nutrient content and health claims and possible footnote or disclosure statements; final rule and proposed rule. National Archives and Records Administration. 11 July 2003. 18 January 2007. https://web.archive.org/web/20070103035701/http://www.cfsan.fda.gov/~acrobat/fr03711a.pdf. 3 January 2007.
  23. Web site: FDA acts to provide better information to consumers on trans fats. Food and Drug Administration. 26 July 2005. https://web.archive.org/web/20050625032556/https://www.fda.gov/oc/initiatives/transfat/. 25 June 2005.
  24. Web site: Newswise: most consumers misinterpret meaning of trans fat information on Nutrition Facts panel. 19 June 2008.
  25. News: Shockman . Luke . Trans fat: 'Zero' foods add up . Toledo Blade . 5 December 2005 . 18 January 2007 . https://web.archive.org/web/20090621150507/http://toledoblade.com/apps/pbcs.dll/article?AID=%2F20051205%2FNEWS32%2F512030320 . 21 June 2009 .
  26. Book: Food lipids: chemistry, nutrition, and biotechnology. 1–2. 978-0-8247-0749-1. Casimir C. Akoh . David B. Min.. 2002. M. Dekker. New York.
  27. Book: https://goldbook.iupac.org/F02330.html. "fatty acid". IUPAC Gold book. 2014 . International Union of Pure and Applied Chemistry. 10.1351/goldbook.F02330 .
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