Sonia Y. Angell, MD, MPH; Laura K. Cobb, MS; Christine J. Curtis, MBA; Kevin J. Konty, MS; Lynn D. Silver, MD, MPH
Note: All authors were employed by the New York City Department of Health and Mental Hygiene at the time that this analysis was conducted. For contact purposes only, Dr. Angell is currently employed by the Centers for Disease Control and Prevention.
Disclaimer: All authors had full access to the data and can take responsibility for the integrity of the data and the accuracy of the data analysis.
Acknowledgment: The authors thank Christina Huang, MPH, doctoral fellow at Pardee RAND Graduate School, and Tamara Dumanovsky, PhD, independent consultant, for their contributions to the design and implementation of the original study; Gail Goldstein, MPH, New York City Department of Health, for her leadership in implementing the New York City trans fat restriction and for her review of this article; Sarah Niederman, MPH, New York City Department of Health, for her assistance with data analysis and coordination; and Stephen E. Schachterle, PhD, MPH, New York City Department of Health, for his assistance with data analysis.
Grant Support: The initial study to evaluate calorie labeling was funded by the City of New York and the Robert Wood Johnson Foundation Healthy Eating Research program (grant 65839). The secondary analysis on trans fat reported here was funded solely by the City of New York.
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-2949.
Reproducible Research Statement:Study protocol, statistical code, and data set: Not available.
Requests for Single Reprints: Christine J. Curtis, MBA, New York City Department of Health and Mental Hygiene, Gotham Center, CN24, 42-09 28th Street, 9th Floor, Long Island City, NY 11101-4132; e-mail, mailto:email@example.com.
Current Author Addresses: Dr. Angell: Centers for Disease Control and Prevention, 1600 Clifton Road, MS D-69, Atlanta, GA 30333.
Ms. Cobb: Johns Hopkins Bloomberg School of Public Health, Welch Center, 2024 Monument Street, Suite 2-600, Baltimore, MD 21205.
Ms. Curtis: New York City Department of Health and Mental Hygiene, Gotham Center, CN24, 42-09 28th Street, 9th Floor, Long Island City, NY 11101-4132.
Mr. Konty: New York City Department of Health and Mental Hygiene, 125 Worth Street, Room 315, Box CN15, New York, NY 10013.
Dr. Silver: Sonoma County Department of Health Services, 3313 Chanate Road, Santa Rosa, CA 95404.
Author Contributions: Conception and design: S.Y. Angell, L.D. Silver.
Analysis and interpretation of the data: S.Y. Angell, L.K. Cobb, K.J. Konty, L.D. Silver.
Drafting of the article: S.Y. Angell, L.K. Cobb, C.J. Curtis, K.J. Konty, L.D. Silver.
Critical revision of the article for important intellectual content: S.Y. Angell, L.K. Cobb, C.J. Curtis, K.J. Konty, L.D. Silver.
Final approval of the article: S.Y. Angell, L.K. Cobb, C.J. Curtis, K.J. Konty, L.D. Silver.
Statistical expertise: S.Y. Angell, L.K. Cobb, K.J. Konty.
Obtaining of funding: L.D. Silver.
Administrative, technical, or logistic support: L.K. Cobb, L.D. Silver.
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;157:81-86. doi: 10.7326/0003-4819-157-2-201207170-00004
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Published: Ann Intern Med. 2012;157(2):81-86.
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.
To assess the effect of the NYC regulation on the trans and saturated fat content of fast-food purchases.
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.
168 randomly selected NYC restaurant locations of 11 fast-food chains.
Adult restaurant customers interviewed in 2007 and 2009.
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.
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 gper 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.
Fast-food restaurants that were included may not be representative of all NYC restaurants.
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.
City of New York and the Robert Wood Johnson Foundation Healthy Eating Research program.
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Cardiology, Coronary Heart Disease, Prevention/Screening.
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