Why are trans fats harmful

Why are trans fats harmful?

Pawel Malczewski
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Short summary

Industrially produced trans fats (but not ruminant trans fats) are some of the most harmful components in foods. Find out what impact trans fats have on your health. For a quick answer click here.

Explanation

There are two types of trans fats: the naturally occurring trans fats, found in milk and other dairy products and meats of ruminant animals (rTFA) and the industrially created trans fats (iTFA). The two differ structurally and have different functions in the body.

Studies show that rTFAs are safe to consume in the naturally occurring amounts (read more..). By contrast, there is strong evidence indicating that iTFAs cause many negative health problems.

The World Health Organization (WHO) recommends that TFAs in our diet should not exceed 1% of the total daily energy intake. Since one gram of fat is equivalent to nine calories, for an average 2000 calorie diet no more than 2.2 grams should come from trans fats.

Naturally occurring TFAs (rTFAs) are excluded from these recommendations. The recommendations refer to iTFAs, which are unnaturally produced fats, mainly through a process called partial hydrogenation. This process damages the fats during processing at high temperature and pressure.

In 2006, a large meta-analysis study showed that the risk of suffering from coronary artery disease jumped by 23% with an average daily intake of 5g of iTFAs. (1)Steen Stender. Industrially Produced Trans Fats and the New Nordic Diet, by Steen Stender. Coursera. Lecture 23 – 7.3 Available here.

Many customers in countries with no iTFA restrictions consume, on average, 3-6g daily, including Vaccenic acid which is still not proven to be safe in large quantities. These amounts may be much higher depending on the foods consumed.

So why trans fat are bad for you?

The following is a list of the known negative health effects of consuming iTFAs in amounts above the daily recommendation (1% of total energy intake):

  • Coronary heart disease (CHD)

    One of the most studied effects of a diet high in trans fats is the increased risk of developing coronary heart diseases (CHD). There are various risk factors of CHD and many of them are enhanced by the consumption of trans fats. (2)Pietinen P, Ascherio A, Korhonen P, Hartman AM, Willett WC, Albanes D, Virtamo J. Intake of fatty acids and risk of coronary heart disease in a cohort of Finnish men. The Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. Am J Epidemiol. 1997 May 15;145(10):876-87. Available here. (3)Uauy R, Aro A, Ghafoorunissa, L’Abbe MR, Mozaffarian D, Skeaff CM, Stender S, Tavella M. WHO Scientific Update on trans fatty acids: summary and conclusions. European Journal of Clinical Nutrition (2009) 63, S68–S75. Available here. (4)de Souza RJ, Mente A, Maroleanu A, Cozma AI, Ha V, Kishibe T, et al. 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 2015;351:h3978. Available here.

    – Cholesterol levels

    iTFAs cause an increase of the total cholesterol, and a decrease of HDL (good) cholesterol. Therefore, the ratio of total cholesterol to HDL cholesterol increases. (5)Mozaffarian D, Clarke R. Quantitative effects on cardiovascular risk factors and coronary heart disease risk of replacing partially hydrogenated vegetable oils with other fats and oils. European Journal of Clinical Nutrition (2009) 63, S22–S33. Available here. (6)Mensink RP, Katan MB. Effect of Dietary trans Fatty Acids on High-Density and Low-Density Lipoprotein Cholesterol Levels in Healthy Subjects. N Engl J Med 1990; 323:439-445August 16, 1990. Available here.

    iTFAs also increase the levels of Apolipoprotein B and the ratio of ApoB/ApoA1 (a risk factor of CHD). (read more..) (7)Ascherio A, Stampfer MJ, Willett WC. Trans fatty acids and coronary heart disease. Available here. (8)Mozaffarian D, Clarke R. Quantitative effects on cardiovascular risk factors and coronary heart disease risk of replacing partially hydrogenated vegetable oils with other fats and oils. European Journal of Clinical Nutrition (2009) 63, S22–S33. Available here.

    – Inflammation

    Inflammation is a risk factor for many diseases, including atherosclerosis, cardiovascular disease, diabetes and cancer.

    There is strong evidence that iTFAs cause an increase in the production of the inflammatory cytokines, C-reactive protein, Interleukin-6, soluble tumor necrosis factor 2, E-selectin and soluble cell adhesion molecules. (9)Lopez-Garcia E, Schulze MB, Meigs JB, Manson JE, Rifai N, Stampfer MJ, et al. Consumption of Trans Fatty Acids Is Related to Plasma Biomarkers of Inflammation and Endothelial Dysfunction. J. Nutr. March 1, 2005. vol. 135 no. 3 562-566 . Available here. (10)O’Neil A, Shivappa N, Jacka FN, Kotowicz MA, Kibbey K, Hebert JR, Pasco JA. Pro-inflammatory dietary intake as a risk factor for CVD in men: a 5-year longitudinal study. British Journal of Nutrition (2015), 114, 2074–2082. Available here. (11)Hadzhieva B, Dimitrov M, Obreshkova D, Petkova V, Atanasov P, Kasnakova P. Omega-3 polyunsaturated fatty acids metabolism and prevention of some socially significant diseases. WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES. Volume 5, Issue 7, 304-316. Available here. (12)Han SN, Leka LS, Lichtenstein AH, Ausman LM, Schaefer EJ, Meydani SN. Effect of hydrogenated and saturated, relative to polyunsaturated, fat on immune and inflammatory responses of adults with moderate hypercholesterolemia. J Lipid Res. 2002 Mar;43(3):445-52. Available here. (13)Mozaffarian D, Pischon T, Hankinson SE, Rifai N, Joshipura K, Willett WC, Rimm EB. Dietary intake of trans fatty acids and systemic inflammation in women. Am J Clin Nutr. 2004 Apr;79(4):606-12. Available here.

    – Endothelial dysfunction

    Trans fats damage the inner lining of the blood vessels. Since trans fats get incorporated into the cell membranes of the blood vessels, they can alter the other cellular components that interact with the cell membrane wall. This can affect vascular tone/vasodilation, increase the adhesiveness of white blood cells and increase cytokine and growth factor production. (14)Ganguly R, Pierce GN. The toxicity of dietary trans fats. Food and Chemical Toxiciology. Volume 78, April 2015, Pages 170–176. Available here. (15)Lopez-Garcia E, Schulze MB, Meigs JB, Manson JE, Rifai N, Stampfer MJ, et al. Consumption of Trans Fatty Acids Is Related to Plasma Biomarkers of Inflammation and Endothelial Dysfunction. J. Nutr. March 1, 2005. vol. 135 no. 3 562-566 . Available here.

    – Triglycerides

    iTFAs cause an increase in blood triglycerides and triglyceride to HDL ratio – an important factor in atherosclerosis. (16)Kabagambe EK, Ordovas JM, Hopkins PN, Tsai MY, Arnett DK. The Relation between Erythrocyte Trans Fat and Triglyceride, VLDL- and HDL-Cholesterol Concentrations Depends on Polyunsaturated Fat. PLOS One. 2012. Available here. (17)Ascherio A, Stampfer MJ, Willett WC. Trans fatty acids and coronary heart disease. Available here.

    – Omega-3

    Trans fats interfere with the metabolism of omega-3 fatty acids and, therefore, contribute to inflammation and atherosclerosis. They also cause the displacement of essential fatty acids from cell (18)Simopoulos AP. Essential fatty acids in health and chronic disease. Am J Clin Nutr September 1999. vol. 70 no. 3 560s-569s. Available here.

    – Insulin resistance

    Trans fats may increase insulin resistance, which affects heart health and type 2 diabetes. However, more studies are needed. See below under type 2 diabetes.

    – Prostacyclin

    Trans fats suppress the production of prostacyclin – a substance that prevents thrombosis and, therefore, is protective against heart disease. (19)Kummerow FA, Mahfouz M, Zhou Q, Masterjohn C. Effects of trans fats on prostacyclin production. Scandinavian Cardiovascular Journal. Volume 47, 2013 – Issue 6. Available here.

  • Obesity

    Animal studies found a possible link between trans fatty acids and central obesity, although more studies are needed on humans. (20)Kavanagh K, Jones KL, Kelley K, Carr JJ, Wagner JD, Rudel LL. Trans Fat Diet Induces Abdominal Obesity and Changes in Insulin Sensitivity in Monkeys. Obesity. A Research Journal. Volume 15, Issue 7. July 2007. Pages 1675–1684. Available here.

  • Type 2 Diabetes

    While ruminant trans fats (rTFAs) are associated with the risk reduction of developing type 2 diabetes, studies on this association with iTFAs are mixed. Studies on animals show clear links between iTFAs and insulin resistance, (21)Kavanagh K, Jones KL, Kelley K, Carr JJ, Wagner JD, Rudel LL. Trans Fat Diet Induces Abdominal Obesity and Changes in Insulin Sensitivity in Monkeys. Obesity. A Research Journal. Volume 15, Issue 7. July 2007. Pages 1675–1684. Available here. (22)Ibrahim A, Natrajan S, Ghafoorunissa R. Dietary trans-fatty acids alter adipocyte plasma membrane fatty acid composition and insulin sensitivity in rats. Metabolism. 2005 Feb;54(2):240-6. Available here. while studies on humans are contradictory. Some studies show that iTFAs may increase insulin resistance, associated with obese people. It is thought that insulin resistance may occur due to iTFAs’ interference with the insulin receptors located on the cells’ membranes.Insulin resistance may lead to type 2 diabetes. However, more studies are needed. (23)Meyer KA, Kushi LH, Jacobs DR, Folsom AR. Dietary fat intake and risk of type 2 diabetes in women. Diabetes Care 2001 Sep; 24(9): 1528-1535. Available here. (24)de Souza RJ, Mente A, Maroleanu A, Cozma AI, Ha V, Kishibe T, et al. 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 2015;351:h3978. Available here. (25)Kavanagh K, Jones KL, Kelley K, Carr JJ, Wagner JD, Rudel LL. Trans Fat Diet Induces Abdominal Obesity and Changes in Insulin Sensitivity in Monkeys. Obesity. A Research Journal. Volume 15, Issue 7. July 2007. Pages 1675–1684. Available here. (26)Lefevre M, Lovejoy JC, Smith SR, Delany JP, Champagne C, Most MM, et al. Comparison of the acute response to meals enriched with cis- or trans-fatty acids on glucose and lipids in overweight individuals with differing FABP2 genotypes. Diabetes Care. 1997 May;20(5):881-7. Available here. (27)Louheranta AM, Turpeinen AK, Vidgren HM, Schwab US, Uusitupa MI. A high-trans fatty acid diet and insulin sensitivity in young healthy women. Metabolism. 1999 Jul;48(7):870-5. Available here.

    Inflammation, also a risk factor of developing type 2 diabetes, has a strong association with trans-fat intake. (28)Han SN, Leka LS, Lichtenstein AH, Ausman LM, Schaefer EJ, Meydani SN. Effect of hydrogenated and saturated, relative to polyunsaturated, fat on immune and inflammatory responses of adults with moderate hypercholesterolemia. J Lipid Res. 2002 Mar;43(3):445-52. Available here. (29)Mozaffarian D, Pischon T, Hankinson SE, Rifai N, Joshipura K, Willett WC, Rimm EB. Dietary intake of trans fatty acids and systemic inflammation in women. Am J Clin Nutr. 2004 Apr;79(4):606-12. Available here.

  • Pregnancy

    Trans fats may have a few pregnancy-related effects:

    May shorten the pregnancy period (30)Elias SL, Innis SM. Infant plasma trans, n−6, and n−3 fatty acids and conjugated linoleic acids are related to maternal plasma fatty acids, length of gestation, and birth weight and length. Am J Clin Nutr April 2001. vol. 73 no. 4 807-814. Available here.
    May increase the risk of preeclampsia (31)Williams MA, King IB, Sorensen TK, Zingheim RW, Troyer BL, Zebelman AM, Luthy DA. Risk of Preeclampsia in Relation to Elaidic Acid (Trans Fatty Acid) in Maternal Erythrocytes. Gynecol Obstet Invest 1998;46:84–87. Available here.
    May affect fetal development – observational studies that show that iTFAs may have harmful effects on the development of the fetus. (32)Stender S, Astrup A, Dyerberg J. Ruminant and industrially produced trans fatty acids: health aspects. Food Nutr Res. 2008; 52: 10.3402/fnr.v52i0.1651. Available here.

  • Infant health

    iTFAs causes disorders on the nervous system and vision in infants. (33)Elias SL, Innis SM. Infant plasma trans, n−6, and n−3 fatty acids and conjugated linoleic acids are related to maternal plasma fatty acids, length of gestation, and birth weight and length. Am J Clin Nutr April 2001. vol. 73 no. 4 807-814. Available here.

  • Men’s fertility

    Trans fats affect men’s fertility, since they interfere with the enzymes involved during sex hormone production. This results in a decreased testosterone, abnormal sperm production, motility and prostate disease. (34)Chavarro JE, Minquez-Alarcon L, Mendiola J, Cutillas-Tolin A, Lopez-Espin JJ, Torres-Cantero AM. Trans fatty acid intake is inversely related to total sperm count in young healthy men. Hum Reprod. 2014 Mar; 29(3): 429–440. Available here.

  • Cancers

    Studies on the trans fat effects on cancers are weak or inconsistent. The association is currently being researched on breast, colorectal, pancreatic and prostate cancers.

    Trans fats have an impact on cancer promoting factors in the body, primarily those related to inflammation and oxidative stress.

    They interfere with enzymes that fight cancer, damage the endothelium of blood vessels, have an impact on the C-reactive protein, Interleukin-6, Soluble tumor necrosis factor 2, E-selectin and soluble cell adhesion molecules.Although trans fats have not been clearly linked to cancer, there are some studies that suggest this possibility. (35)Ohmori Hitoshi, Fujii Kiyomu, Kuniyasu Hiroki. Significance of Trans Fatty Acids in Cancer. Journal of Nara Medical Association. Vol.66 No.3,4,5,6. Available here. (36)Lopez-Garcia E, Schulze MB, Meigs JB, Manson JE, Rifai N, Stampfer MJ, et al. Consumption of Trans Fatty Acids Is Related to Plasma Biomarkers of Inflammation and Endothelial Dysfunction. J. Nutr. March 1, 2005. vol. 135 no. 3 562-566 . Available here. (37)Thompson AK, Shaw DI, Minihane AM, Williams CM. Trans-fatty acids and cancer: the evidence reviewed. Nutr Res Rev. 2008 Dec;21(2):174-88. Available here. (38)Kohlmeier L, Simonsen N, van t Veer P, Strain JJ, Martin-Moreno JM, Margolin B, et al. Adipose tissue trans fatty acids and breast cancer in the European Community Multicenter Study on Antioxidants, Myocardial Infarction, and Breast Cancer. Cancer Epidemiology, Biomarkers and Prevention. September 1997. Volume 6, Issue 9. Available here. (39)O’Sullivan A, Wilson C, Hafekost K, Mitrou F, Lawrence D. Narrative review: The relationship between dietary trans-fatty acids and adverse health outcomes. Food Standards Australia New Zealand. Available here. (40)Slattery ML, Benson J, Ma KN, Schaffer D, Potter JD. Trans-Fatty Acids and Colon Cancer. Nutrition and Cancer. Pages 170-175 ” Published online: 18 Nov 2009. Available here.

  • Allergy

    Trans fats have possible links to allergy reactions. There is evidence that consuming margarine increases the risk for eczema and allergic sensitization in children. However, it is not clear if these reactions are specific to trans fats. (41)Sausenthaler S, Kompauer I, Borte M, Herbarth O, Schaaf B, Berg A. Margarine and butter consumption, eczema and allergic sensitization in children. The LISA birth cohort study. Pediatr Allergy Immunol. 2006 Mar;17(2):85-93. Available here. (42)O’Sullivan A, Wilson C, Hafekost K, Mitrou F, Lawrence D. Narrative review: The relationship between dietary trans-fatty acids and adverse health outcomes. Food Standards Australia New Zealand. Available here.

  • Other

    There are mixed results for the following associations: macular degeneration, dementia, asthma and eczema. More studies are needed. (43)O’Sullivan A, Wilson C, Hafekost K, Mitrou F, Lawrence D. Narrative review: The relationship between dietary trans-fatty acids and adverse health outcomes. Food Standards Australia New Zealand. Available here.

Conclusion

Back to Top

While ruminant fats are considered to be safe, there are many ways that industrially produced fats negatively affect our health.

There is a strong evidence proving that ITFAs affect cardiovascular health, which is one of the top killers in the western society. Trans fats are also associated with inflammation, pregnancy and fetal development issues, insulin resistance and type 2 diabetes in obese people, men’s fertility and infant health.

References   [ + ]

1. Steen Stender. Industrially Produced Trans Fats and the New Nordic Diet, by Steen Stender. Coursera. Lecture 23 – 7.3 Available here.
2. Pietinen P, Ascherio A, Korhonen P, Hartman AM, Willett WC, Albanes D, Virtamo J. Intake of fatty acids and risk of coronary heart disease in a cohort of Finnish men. The Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. Am J Epidemiol. 1997 May 15;145(10):876-87. Available here.
3. Uauy R, Aro A, Ghafoorunissa, L’Abbe MR, Mozaffarian D, Skeaff CM, Stender S, Tavella M. WHO Scientific Update on trans fatty acids: summary and conclusions. European Journal of Clinical Nutrition (2009) 63, S68–S75. Available here.
4. de Souza RJ, Mente A, Maroleanu A, Cozma AI, Ha V, Kishibe T, et al. 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 2015;351:h3978. Available here.
5. Mozaffarian D, Clarke R. Quantitative effects on cardiovascular risk factors and coronary heart disease risk of replacing partially hydrogenated vegetable oils with other fats and oils. European Journal of Clinical Nutrition (2009) 63, S22–S33. Available here.
6. Mensink RP, Katan MB. Effect of Dietary trans Fatty Acids on High-Density and Low-Density Lipoprotein Cholesterol Levels in Healthy Subjects. N Engl J Med 1990; 323:439-445August 16, 1990. Available here.
7. Ascherio A, Stampfer MJ, Willett WC. Trans fatty acids and coronary heart disease. Available here.
8. Mozaffarian D, Clarke R. Quantitative effects on cardiovascular risk factors and coronary heart disease risk of replacing partially hydrogenated vegetable oils with other fats and oils. European Journal of Clinical Nutrition (2009) 63, S22–S33. Available here.
9. Lopez-Garcia E, Schulze MB, Meigs JB, Manson JE, Rifai N, Stampfer MJ, et al. Consumption of Trans Fatty Acids Is Related to Plasma Biomarkers of Inflammation and Endothelial Dysfunction. J. Nutr. March 1, 2005. vol. 135 no. 3 562-566 . Available here.
10. O’Neil A, Shivappa N, Jacka FN, Kotowicz MA, Kibbey K, Hebert JR, Pasco JA. Pro-inflammatory dietary intake as a risk factor for CVD in men: a 5-year longitudinal study. British Journal of Nutrition (2015), 114, 2074–2082. Available here.
11. Hadzhieva B, Dimitrov M, Obreshkova D, Petkova V, Atanasov P, Kasnakova P. Omega-3 polyunsaturated fatty acids metabolism and prevention of some socially significant diseases. WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES. Volume 5, Issue 7, 304-316. Available here.
12. Han SN, Leka LS, Lichtenstein AH, Ausman LM, Schaefer EJ, Meydani SN. Effect of hydrogenated and saturated, relative to polyunsaturated, fat on immune and inflammatory responses of adults with moderate hypercholesterolemia. J Lipid Res. 2002 Mar;43(3):445-52. Available here.
13. Mozaffarian D, Pischon T, Hankinson SE, Rifai N, Joshipura K, Willett WC, Rimm EB. Dietary intake of trans fatty acids and systemic inflammation in women. Am J Clin Nutr. 2004 Apr;79(4):606-12. Available here.
14. Ganguly R, Pierce GN. The toxicity of dietary trans fats. Food and Chemical Toxiciology. Volume 78, April 2015, Pages 170–176. Available here.
15. Lopez-Garcia E, Schulze MB, Meigs JB, Manson JE, Rifai N, Stampfer MJ, et al. Consumption of Trans Fatty Acids Is Related to Plasma Biomarkers of Inflammation and Endothelial Dysfunction. J. Nutr. March 1, 2005. vol. 135 no. 3 562-566 . Available here.
16. Kabagambe EK, Ordovas JM, Hopkins PN, Tsai MY, Arnett DK. The Relation between Erythrocyte Trans Fat and Triglyceride, VLDL- and HDL-Cholesterol Concentrations Depends on Polyunsaturated Fat. PLOS One. 2012. Available here.
17. Ascherio A, Stampfer MJ, Willett WC. Trans fatty acids and coronary heart disease. Available here.
18. Simopoulos AP. Essential fatty acids in health and chronic disease. Am J Clin Nutr September 1999. vol. 70 no. 3 560s-569s. Available here.
19. Kummerow FA, Mahfouz M, Zhou Q, Masterjohn C. Effects of trans fats on prostacyclin production. Scandinavian Cardiovascular Journal. Volume 47, 2013 – Issue 6. Available here.
20. Kavanagh K, Jones KL, Kelley K, Carr JJ, Wagner JD, Rudel LL. Trans Fat Diet Induces Abdominal Obesity and Changes in Insulin Sensitivity in Monkeys. Obesity. A Research Journal. Volume 15, Issue 7. July 2007. Pages 1675–1684. Available here.
21. Kavanagh K, Jones KL, Kelley K, Carr JJ, Wagner JD, Rudel LL. Trans Fat Diet Induces Abdominal Obesity and Changes in Insulin Sensitivity in Monkeys. Obesity. A Research Journal. Volume 15, Issue 7. July 2007. Pages 1675–1684. Available here.
22. Ibrahim A, Natrajan S, Ghafoorunissa R. Dietary trans-fatty acids alter adipocyte plasma membrane fatty acid composition and insulin sensitivity in rats. Metabolism. 2005 Feb;54(2):240-6. Available here.
23. Meyer KA, Kushi LH, Jacobs DR, Folsom AR. Dietary fat intake and risk of type 2 diabetes in women. Diabetes Care 2001 Sep; 24(9): 1528-1535. Available here.
24. de Souza RJ, Mente A, Maroleanu A, Cozma AI, Ha V, Kishibe T, et al. 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 2015;351:h3978. Available here.
25. Kavanagh K, Jones KL, Kelley K, Carr JJ, Wagner JD, Rudel LL. Trans Fat Diet Induces Abdominal Obesity and Changes in Insulin Sensitivity in Monkeys. Obesity. A Research Journal. Volume 15, Issue 7. July 2007. Pages 1675–1684. Available here.
26. Lefevre M, Lovejoy JC, Smith SR, Delany JP, Champagne C, Most MM, et al. Comparison of the acute response to meals enriched with cis- or trans-fatty acids on glucose and lipids in overweight individuals with differing FABP2 genotypes. Diabetes Care. 1997 May;20(5):881-7. Available here.
27. Louheranta AM, Turpeinen AK, Vidgren HM, Schwab US, Uusitupa MI. A high-trans fatty acid diet and insulin sensitivity in young healthy women. Metabolism. 1999 Jul;48(7):870-5. Available here.
28. Han SN, Leka LS, Lichtenstein AH, Ausman LM, Schaefer EJ, Meydani SN. Effect of hydrogenated and saturated, relative to polyunsaturated, fat on immune and inflammatory responses of adults with moderate hypercholesterolemia. J Lipid Res. 2002 Mar;43(3):445-52. Available here.
29. Mozaffarian D, Pischon T, Hankinson SE, Rifai N, Joshipura K, Willett WC, Rimm EB. Dietary intake of trans fatty acids and systemic inflammation in women. Am J Clin Nutr. 2004 Apr;79(4):606-12. Available here.
30. Elias SL, Innis SM. Infant plasma trans, n−6, and n−3 fatty acids and conjugated linoleic acids are related to maternal plasma fatty acids, length of gestation, and birth weight and length. Am J Clin Nutr April 2001. vol. 73 no. 4 807-814. Available here.
31. Williams MA, King IB, Sorensen TK, Zingheim RW, Troyer BL, Zebelman AM, Luthy DA. Risk of Preeclampsia in Relation to Elaidic Acid (Trans Fatty Acid) in Maternal Erythrocytes. Gynecol Obstet Invest 1998;46:84–87. Available here.
32. Stender S, Astrup A, Dyerberg J. Ruminant and industrially produced trans fatty acids: health aspects. Food Nutr Res. 2008; 52: 10.3402/fnr.v52i0.1651. Available here.
33. Elias SL, Innis SM. Infant plasma trans, n−6, and n−3 fatty acids and conjugated linoleic acids are related to maternal plasma fatty acids, length of gestation, and birth weight and length. Am J Clin Nutr April 2001. vol. 73 no. 4 807-814. Available here.
34. Chavarro JE, Minquez-Alarcon L, Mendiola J, Cutillas-Tolin A, Lopez-Espin JJ, Torres-Cantero AM. Trans fatty acid intake is inversely related to total sperm count in young healthy men. Hum Reprod. 2014 Mar; 29(3): 429–440. Available here.
35. Ohmori Hitoshi, Fujii Kiyomu, Kuniyasu Hiroki. Significance of Trans Fatty Acids in Cancer. Journal of Nara Medical Association. Vol.66 No.3,4,5,6. Available here.
36. Lopez-Garcia E, Schulze MB, Meigs JB, Manson JE, Rifai N, Stampfer MJ, et al. Consumption of Trans Fatty Acids Is Related to Plasma Biomarkers of Inflammation and Endothelial Dysfunction. J. Nutr. March 1, 2005. vol. 135 no. 3 562-566 . Available here.
37. Thompson AK, Shaw DI, Minihane AM, Williams CM. Trans-fatty acids and cancer: the evidence reviewed. Nutr Res Rev. 2008 Dec;21(2):174-88. Available here.
38. Kohlmeier L, Simonsen N, van t Veer P, Strain JJ, Martin-Moreno JM, Margolin B, et al. Adipose tissue trans fatty acids and breast cancer in the European Community Multicenter Study on Antioxidants, Myocardial Infarction, and Breast Cancer. Cancer Epidemiology, Biomarkers and Prevention. September 1997. Volume 6, Issue 9. Available here.
39. O’Sullivan A, Wilson C, Hafekost K, Mitrou F, Lawrence D. Narrative review: The relationship between dietary trans-fatty acids and adverse health outcomes. Food Standards Australia New Zealand. Available here.
40. Slattery ML, Benson J, Ma KN, Schaffer D, Potter JD. Trans-Fatty Acids and Colon Cancer. Nutrition and Cancer. Pages 170-175 ” Published online: 18 Nov 2009. Available here.
41. Sausenthaler S, Kompauer I, Borte M, Herbarth O, Schaaf B, Berg A. Margarine and butter consumption, eczema and allergic sensitization in children. The LISA birth cohort study. Pediatr Allergy Immunol. 2006 Mar;17(2):85-93. Available here.
42. O’Sullivan A, Wilson C, Hafekost K, Mitrou F, Lawrence D. Narrative review: The relationship between dietary trans-fatty acids and adverse health outcomes. Food Standards Australia New Zealand. Available here.
43. O’Sullivan A, Wilson C, Hafekost K, Mitrou F, Lawrence D. Narrative review: The relationship between dietary trans-fatty acids and adverse health outcomes. Food Standards Australia New Zealand. Available here.

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