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Calorie for Calorie, We're Eating Better

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Calorie for Calorie, We're Eating Better

By Sid Kirchheimer WebMD Medical News

Sept. 10, 2003 -- Despite the country's current obesity epidemic, calorie for calorie, Americans have been eating healthier in recent decades. In particular, we've significantly cut back on the most deadly of all dietary factors in the risk of heart disease -- trans-fatty acids.

A new study surveying the dietary habits of residents in the state with the longest life span -- Minnesota -- finds that between 1980 and 1997, men ate 24% less trans fatty acids while women ate 13% less.

What about the rest of us?

"In the past, many of the other trends we have seen in our ongoing survey, such as blood pressure levels, have paralleled with what's seen in national surveys," says lead investigator Lisa Harnack, DrPH, MPH, of the University of Minnesota School of Public Health. "So we think it reflects what's happening nationally."

Minnesotans Doing Best

Her latest findings are part of the ongoing Minnesota Heart Survey, which analyzes various factors in the development of heart disease of 40,000 households in a seven-county, 2 million-person area of Minnesota between 1980 and 1997. Her research is published in this month's issue of the Journal of the American Dietetic Association.

In addition to lowering trans fatty acid intake, Harnack finds that in that time, male Minnesotans reduced their total fat and saturated fat grams by 19% and women had a 7% drop. Dietary cholesterol fell by 28% in men and 24% in women.

This may explain, at least in part, why the nation's rate of heart disease has steadily declined since 1960, she says. Since 1980, the rate of heart disease in the U.S. has dropped 21%, and improvements in diet may account for two-thirds of that decrease, according to other research.

However, Harnack's study also shows a less positive and all-too-familiar trend: There's more on the plate -- even in Minnesota, often considered the country's "healthiest" state because, statistically, its residents live longer than in any other. While men there eat only 37 more calories per day than in 1980, women are taking in more than 200 additional calories -- a 13% increase.

"That's the one move in the wrong direction in terms of nutritional changes: Body weight has gone up," she tells WebMD. "Overall, we've been moving in the right direction, but we're still not there yet. And maybe we're now starting to go in the wrong direction."

Limit Trans Fatty Acids

In a preliminary review of even newer data not yet published -- tracking eating patterns from 2000 to 2002 -- Harnack tells WebMD that she's finding the dietary improvements made have leveled off and may be reversing. "I think it reflects confusion about the 'good' and 'bad' of dietary fats, the whole Atkins diet phenomenon," she says.

But the drop noted in trans fatty acid consumption is especially important -- and timely. In July, the FDA and Department of Health and Human Services announced that food manufacturers have until Jan. 1, 2006, to list the amounts of trans fatty acids on food labels.

"There is no safe threshold for trans fats," says Frank Hu, MD, PhD, MPH, of Harvard School of Public Health, an expert on trans fatty acids and longtime researcher on how diet affects heart disease. "Of course, the more you eat, the worse the risk. The best strategy is to avoid trans fats altogether; if not, significantly limit them."

He tells WebMD that foods rich in trans fatty acids -- anything that's made with oils that have been "hydrogenated" or "partially hydrogenated" to give them a longer shelf life -- plays the biggest role in raising heart disease risk than any other dietary measure.

"It's not as bad as smoking or obesity. But gram for gram, the risk from trans fats is more than double that from eating saturated fat or cholesterol."

Hu was not involved in Harnack's study, but he says the trends she noted "sound reasonable" for the rest of the country.

Stick Margarine Not So Popular

"The consumption of trans fats across the entire U.S. has declined in recent decades, primarily due to decreased consumption of stick margarines," says Hu, who published a study three years ago noting that diet improvements alone -- including eating less trans fatty acids -- could claim most credit for the nation's declining rate of heart disease.

"Primarily, we're eating less trans fats because there's a drop in the use of stick margarines," says Hu. "More people are using soft margarines, which have less trans fatty acids than sticks, and even trans fat-free products such as Smart Balance. People are more conscious now about the dangers."

Besides margarine, other foods rich in trans fatty acids include baked goods, shortenings, fried foods, salad dressings, and other processed foods listed to contain "partially hydrogenated" vegetable oils.