Transcript 20120726TransFat - 埼玉医科大学総合医療センター 内分泌

Journal Club
Angell SY, Cobb LK, Curtis CJ, Konty KJ, Silver LD.
Change in Trans Fatty Acid Content of Fast-Food Purchases
Associated With New York City's Restaurant Regulation: A Pre-Post
Study.
Ann Intern Med. 2012 Jul 17;157(2):81-6.
2012年7月26日 8:30-8:55
８階 医局
埼玉医科大学 総合医療センター 内分泌・糖尿病内科
Department of Endocrinology and Diabetes,
Saitama Medical Center, Saitama Medical University
松田 昌文
Matsuda, Masafumi
GPR120 is a member of
the rhodopsin family of G
protein-coupled receptors
(GPRs) (Fredriksson et al.,
2003).
GPR120 has also been
shown to mediate the antiinflammatory and insulinsensitizing effects of
omega 3 fatty acids.
GPR120、GPR40 は α-リノレン酸(α-LA)な
どの長鎖不飽和脂肪酸をリガンド. とする G
タンパク質共役型受容体であり、類似する薬
理特性を持っている。
朝日新聞（2月20日 39面）、京都新聞（2月20日 24面）、産経新聞（2月20日 22面）、日
本経済新聞（2月20日 34面）、毎日新聞（2月20日 31面）および読売新聞（2月20日 35
面）に掲載。フジテレビにても放映あり。
http://www.kyoto-u.ac.jp/ja/news_data/h/h1/news6/2011/120220_1.htm
日本の食品成分表示
Cis double bonds produce a bend in the molecule that
impairs crystallization and keeps the oil liquid. To convert
vegetable and marine oils into fats of various degrees of
plasticity, manufacturers of edible fat straighten out cis
unsaturated fatty acids by converting them to trans isomers
or saturated fatty acids in a process called hydrogenation.
油脂の加工・精製でできるもの
http://www.cspinet.org/transfat/
http://www.cspinet.org/transfat/
the New York City Department of Health and
Mental Hygiene, New York, New York
Ann Intern Med. 2012;157:81-86.
The U.S. Food and Drug Administration mandated in 2003
that trans fat content be listed on the Nutrient Facts panel of
packaged foods by 2006.
http://www.fda.gov/food/labelingnutrition/labelclaims/nutrientcontentclaims/ucm110179.htm
In 2005, the New York City (NYC) Department of Health and
Mental Hygiene (DOHMH) took the bold step of calling for a
voluntary reduction in the use of partially hydrogenated fat
by commercial food establishments.
The first phase required elimination of partially hydrogenated
fat from spreads and products used in frying, pan-frying
(saute´ing), and grilling unless the product contained less
than 0.5 g of trans fat per serving. The second phase required
that no food contain partially hydrogenated vegetable oil,
shortening, or margarine with more than 0.5 g of trans fat per
serving. After several unsuccessful legal challenges, the first
phase went into effect in July 2007 and the second phase in
July 2008.
Background: Dietary trans fat
increases risk for coronary heart
disease. In 2006, New York City
(NYC) passed the first regulation in
the United States restricting trans
fat use in restaurants.
Objective: To assess the effect of
the NYC regulation on the trans and
saturated fat content of fast-food
purchases.
Design: Cross-sectional study that included
purchase receipts matched to available nutritional
information and brief surveys of adult lunchtime
restaurant customers conducted in 2007 and
2009, before and after implementation of the
regulation.
Setting: 168 randomly selected NYC restaurant
locations of 11 fast-food chains.
Participants: Adult restaurant customers
interviewed in 2007 and 2009.
Measurements: Change in mean grams of trans
fat, saturated fat, trans plus saturated fat, and
trans fat per 1000 kcal per purchase, overall and
by chain type.
Study Design
In 2007, we randomly sampled 300 locations from all 1625 NYC
licensed restaurant locations of 13 chains. These 13 chains
represented almost 90% of all eligible restaurants, defined as
chain restaurants that have more than 15 locations nationally,
have available nutritional information, and are not ice cream
chains.
Of the 300 identified restaurant locations, 25 were excluded because they had closed or
were in an airport or a shopping mall.
For 9 weeks from March through June 2007, we recruited patrons
exiting the 275 sampled fast-food locations for participation in the
study. They were asked to provide their receipts after exiting and
to take a brief survey to describe their purchase, confirm that it
was for only 1 person, and answer a few additional questions.
During the same time frame in 2009, we approached the same
restaurant locations for a repeated survey of patrons.
Of the original 275 locations, 22 had either closed or would not allow data collection and
were therefore replaced in our sample by outlets of the same chain in the same
neighborhood or a neighboring ZIP code.
Results: The final sample included 6969 purchases in
2007 and 7885 purchases in 2009. Overall, mean trans
fat per purchase decreased by 2.4 g (95% CI, －2.8 to
－2.0 g; P ＜ 0.001), whereas saturated fat showed a
slight increase of 0.55 g (CI, 0.1 to 1.0 g; P ＜ 0.011).
Mean trans plus saturated fat content decreased by 1.9
g overall (CI, －2.5 to －1.2 g; P ＜ 0.001). Mean trans
fat per 1000 kcal decreased by 2.7 g per 1000 kcal (CI,
－3.1 to －2.3 g per 1000 kcal; P ＜ 0.001). Purchases
with zero grams of trans fat increased from 32% to 59%.
In a multivariate analysis, the poverty rate of the
neighborhood in which the restaurant was located was
not associated with changes.
Limitation: Fast-food restaurants that were included
may not be representative of all NYC restaurants.
Conclusion: The introduction of a local
restaurant regulation was associated with a
substantial and statistically significant decrease in
the trans fat content of purchases at fast-food
chains, without a commensurate increase in
saturated fat. Restaurant patrons from high- and
low-poverty neighborhoods benefited equally.
However, federal regulation will be necessary to
fully eliminate population exposure to industrial
trans fat sources.
Primary Funding Source: City of New York and
the Robert Wood Johnson Foundation Healthy
Eating Research program.
Editorial
Ann Intern Med. 2012;157:144-5.
New York City Trans Fat Ban: Improving the Default Option When
Purchasing Foods Prepared Outside of the Home
What have we learned from NYC’s trans fat ban? Public health
measures work and, when well-planned and well implemented, do not
result in adverse consequences. The benefit seems to be widespread
and not limited to subsets of the population. Nevertheless, these new
data represent a sliver of the commercially prepared foods available
from a narrow segment of food outlets. Caution must be used when
interpreting the data.
What have we not learned from NYC’s trans fat ban? The major
public health challenge in the United States is excess energy intake,
and the question remains about whether the trans fat–free designation
confers an undeserved “health halo” for foods that are high in energy
and low in nutrient density. Vigilance in this area is essential. What
NYC’s trans fat ban has done is make the default option for foods
prepared outside of the home a bit healthier. The final assessment of
this public health effort awaits additional evaluation; however, the data
so far suggest that the mission has been accomplished.
Alice H. Lichtenstein, DSc Tufts University Boston, MA 02111
Message
ニューヨーク市内のファストフードチェーン168
店を利用した成人へのインタビューから、2006
年のトランス脂肪酸使用規制の効果を横断的研
究で評価。規制後、購入1回当たりのトランス脂
肪酸の平均量は2.4g低下し（P＜0.001）、飽和
脂肪は0.55g増加した。飽和脂肪を増やさずトラ
ンス脂肪酸が統計的有意に低下と示唆された。
米国全体での規制強化になれば
議論になると思われる。
日本でも必ず