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Change in Trans Fatty Acid Content of Fast-Food Purchases Associated With New York City's Restaurant Regulation: A Pre–Post Study

Sonia Y. Angell, MD, MPH; Laura K. Cobb, MS; Christine J. Curtis, MBA; Kevin J. Konty, MS; and Lynn D. Silver, MD, MPH
[+] Article and Author Information

From the New York City Department of Health and Mental Hygiene, New York, New York.

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:cjohnso8@health.nyc.gov.

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.


Ann Intern Med. 2012;157(2):81-86. doi:10.7326/0003-4819-157-2-201207170-00004
Text Size: A A A

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.

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 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.

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.

Figures

Grahic Jump Location
Figure.

Distribution of trans fat content per purchase.

Trans fat content may be underestimated because companies can report trans fat values less than 0.5 g as zero grams of trans fat. In 2007, only 32% of customer purchases had zero grams of trans fat vs. 59% of customer purchases in 2009. Similarly, the maximum amount of trans fat in an individual purchase was 28 g in 2007 vs. 5 g in 2009.

Grahic Jump Location

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Comments

Submit a Comment
What is the net public health effect of a reduction of trans fat intake and an increase in total caloric intake?
Posted on August 9, 2012
Paul R. Marantz, MD, MPH,
Albert Einstein College of Medicine, Bronx, NY
Conflict of Interest: None Declared

To the Editor:The article by Angell et al (1) seeks to explore the impact of New York City’s trans fat ban. This kind of analysis of empirical evidence is critically important, and insufficiently conducted, to evaluate the net outcomes of well-meaning public health policy, and the authors (and the New York City Department of Health and Mental Hygiene) should be credited for conducting this important work. There is, however, an important issue that was inadequately addressed in this study.The study’s main finding, that trans fat intake declined after the trans fat ban, is statistically significant but unsurprising: indeed, if this were not found, it would indicate that the ban had not occurred. The authors, and the editorialist (2), rightly point out that one must consider the totality of effects. In this paper, they note a small but statistically significant increase in saturated fat intake, which they say was outweighed by the trans fat reduction. They do not, however, address changes in total calorie consumption; they only consider calorie intake as follows: “We included calories in the model to control for changes in the size of menu items between the 2 study periods.” Given our national obesity epidemic, and the previously demonstrated propensity for dietary guidelines or regulations to yield unintended adverse consequences, (3) this issue deserves special highlighting.While changes in calorie intake were not provided directly in the paper, they can be inferred from the data provided in Table 1, which provides pre and post data on both total trans fat intake and trans fat intake per 1,000 kcal. Based on these data, the average lunch in 2007 contained 921 calories, compared with 1,000 calories in 2009. This represents a nearly 9% increase in calories consumed (or at least, purchased) in just 2 years. The significance, both statistical and population-wide, of such an increase should have been considered in this paper.The question must be asked: what is the net public health effect of a reduction of trans fat intake and an increase in total caloric intake?

Sincerely,Paul R. Marantz, MD, MPH

References

1. Angell SY, Cobb LK, Curtis CJ, Konty KJ, Silver LD. Change in trans fatty acid content in fast-food purchases associated with New York City’s restaurant regulation. A pre-post study. Ann Intern Med 2012; 157: 81-6.

2 Lichtenstein AH. New York City trans fat ban: improving the default option when purchasing foods prepared outside the home. Ann Intern Med 2012: 157: 144-5.

3 Marantz PR, Bird E, Alderman MH. A call for higher standards of evidence for dietary guidelines. Am J Prev Med 2008; 34: 234-40.

 

Author's Response
Posted on September 24, 2012
Sonia Y. Angell, MD, MPH, (Centers for Disease Control), Laura K Cobb, MS, Christine J Curtis, MBA , Kevin J Konty, MS, Lynn D Silver, MD, MPH
New York City Department of Health and Mental Hygiene
Conflict of Interest: None Declared

Dr. Marantz suggests an analysis that considers concomitantly the change in calories and trans fat. While the focus of our article was the change in trans and saturated fat content of noontime purchases, the trans fat regulation was introduced simultaneously with New York City's calorie labeling requirement. The change in caloric content of purchases over the same period was examined in depth by the NYC Department of Health in a previously published study of this same dataset [1]. That study did not find a significant increase in calories purchased. Differences in changes in the amount of calories purchased between the two papers are explained by differing exclusion criteria. In the case of the trans fat article, purchases comprised only of drinks were excluded because they are not a relevant source of partially hydrogenated vegetable oil, the target of the policy. While both papers excluded receipts with missing calorie information, the trans fat paper also excluded receipts with missing trans or saturated fat information [2].

References

1. Dumanovsk T, Huang CY, Nonas CA, Matte TD, Bassett MT, Silver LD, “Changes in energy content of lunchtime purchases from fast food restaurants after introduction of calorie.” BMJ 2011; 343:d4464

2. Angell SY, Cobb LK, Curtis CJ, Konty KJ, Silver LD. Change in trans fatty acid content in fast-food purchases associated with New York City’s restaurant regulation. A pre-post study. Ann Intern Med 2012; 157: 81-6.

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