美国限制反式脂肪有十年了,促进健康吗?
2017/04/15
4月12日的JAMA Cardiology显示在纽约州的几个地区限制了反式脂肪之后,和其它地区相比这些地方的心脏病住院率下降了7.8%之多。该研究结果预示着美国从2018年开始在全国禁止人造反式脂肪,将带来更大规模的公共健康效益。

4月12日的JAMA Cardiology显示在纽约州的几个地区限制了反式脂肪之后,和其它地区相比这些地方的心脏病住院率下降了7.8%之多。该研究结果预示着美国从2018年开始在全国禁止人造反式脂肪,将带来更大规模的公共健康效益。

专家评论研究意义

哈佛公共卫生学院的营养流行病学家Frank Hu评论说:“这是第一个将反式脂肪禁令和大规模人群中心脏病和脑卒中减少链接起来的研究。这项研究的证据表明,在全国范围内实施反式脂肪酸的禁令将减少心脏病,挽救许多美国人的生命。”

限制反式脂肪有10年了

过去的研究发现,吃含有人造反式脂肪的食物会增加冠心病的风险。摄入这些脂肪会导致高水平的低密度脂蛋白胆固醇——“坏”胆固醇。这是导致动脉阻塞斑块的一个组成部分。人造的或工业的反式脂肪来源于氢化的植物油。这些食物通常包括油炸食品、烘焙食品、饼干和人造黄油。从2007年,纽约的餐馆、自助餐厅、烘焙面包坊等地开始限制人工反式脂肪。在接下来的几年中纽约州的很多地方纷纷效仿。

限制的地区心脏病发作或住院率下降

文章的第一作者,耶鲁大学内科医生Eric Brandt说该限制给审核其实施后,心血管健康的变化提供了一个良好的机遇。Brandt和同事将11个限制人造反式脂肪的郡和25个没有进行限制的郡进行相比。研究人员调查了2002至2013年间心脏病发作或中风的住院率。Brandt说,由于药物和治疗的改进,心脏病发作和中风的入院率在第一次限制之前就已经下降了。

在人工反式脂肪限制生效至少三年后,受限制的郡与非限制性郡居民的心脏病发作和中风的入院率相比下降了6.2%。这意味着每100000人中,少于43人会有心脏病发作和中风。Brandt说,这一下降超出了人们对人口趋势的预期。

该小组还分析了每次诊断的住院情况。在受限制的郡,心脏病发作入院率的下降也超过非限制的郡。Brandt说,心脏病发作和中风的入院率降低,以及心脏病发作的几率降低,很可能是由于人工反式脂肪的限制。虽然中风入院率在限制的郡也下降了,但这个结果可能不是和该政策相关的。

2018年FDA将在全美禁止反式脂肪

美国FDA于2015确定部分氢化油不再“一般公认为安全”,已下令食品制造商确保他们的产品在2018年6月前不含这些油。这将有效地消除来自美国的整个食品供应的人工反式脂肪。这项研究的结果被认为非常支持即将到来的FDA行动。

参考资料

Hospital Admissions for Myocardial Infarction and Stroke Before and After the Trans-Fatty Acid Restrictions in NewYork

Rules restricting artificial trans fats are good for heart health

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  • Hospital Admissions for Myocardial Infarction and Stroke Before and After the Trans-Fatty Acid Restrictions in New York

    Importance Trans-fatty acids (TFAs) have deleterious cardiovascular effects. Restrictions on their use were initiated in 11 New York State (NYS) counties between 2007 and 2011. The US Food and Drug Administration plans a nationwide restriction in 2018. Public health implications of TFA restrictions are not well understood. Objective To determine whether TFA restrictions in NYS counties were associated with fewer hospital admissions for myocardial infarction (MI) and stroke compared with NYS counties without restrictions. Design, Setting, and Participants We conducted a retrospective observational pre-post study of residents in counties with TFA restrictions vs counties without restrictions from 2002 to 2013 using NYS Department of Health’s Statewide Planning and Research Cooperative System and census population estimates. In this natural experiment, we included those residents who were hospitalized for MI or stroke. The data analysis was conducted from December 2014 through July 2016. Exposure Residing in a county where TFAs were restricted. Main Outcomes and Measures The primary outcome was a composite of MI and stroke events based on primary discharge diagnostic codes from hospital admissions in NYS. Admission rates were calculated by year, age, sex, and county of residence. A difference-in-differences regression design was used to compare admission rates in populations with and without TFA restrictions. Restrictions were only implemented in highly urban counties, based on US Department of Agriculture Economic Research Service Urban Influence Codes. Nonrestriction counties of similar urbanicity were chosen to make a comparison population. Temporal trends and county characteristics were accounted for using fixed effects by county and year, as well as linear time trends by county. We adjusted for age, sex, and commuting between restriction and nonrestriction counties. Results In 2006, the year before the first restrictions were implemented, there were 8.4 million adults (53.6% female) in highly urban counties with TFA restrictions and 3.3 million adults (52.3% female) in highly urban counties without restrictions. Twenty-five counties were included in the nonrestriction population and 11 in the restriction population. Three or more years after restriction implementation, the population with TFA restrictions experienced significant additional decline beyond temporal trends in MI and stroke events combined (−6.2%; 95% CI, −9.2% to −3.2%; P < .001) and MI (−7.8%; 95% CI, −12.7% to −2.8%; P = .002) and a nonsignificant decline in stroke (−3.6%; 95% CI, −7.6% to 0.4%; P = .08) compared with the nonrestriction populations.

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