The Introduction:
WHO estimates that every year, trans fats intake leads to more than 500,000 deaths of people from cardiovascular disease. Realizing the graveness of the situation WHO Director-General, Dr Tedros Adhanom Ghebreyesus calls on governments around the world to use the REPLACE action package to eliminate industrially-produced trans-fatty acids from the food supply1. After reading this statistics and serious word of concern by the head of World Health organisation our first response is “What are this Trans fats and how it leads to so many deaths? And why the whole world is talking about it? And what is the REPLACE package that the WHO is trying to promulgate.
Here we try to give you a basic understanding of trans fats and history of policy of banning Trans fats in many countries. So now straight to the question one i.e. What are trans fats? The full form of trans fats is Trans-fatty acids (TFA) and they are fatty acids with at least one double carbon–carbon bond in the trans configuration. TFA can be produced industrially by the partial hydrogenation of vegetable and fish oils, but also occur at lower levels naturally in meat and dairy products from ruminant animals, such as cattle, sheep, goats, and camels. Industrially-produced TFA have become the predominant source of dietary TFA in many populations around the world. Trans fats also permeated into the food habits of every Indians, they can be found in various bakery products, fried foods, packed food and snacks, fast moving consumer products, ice creams, artificial oils etc. The cheapness of production Trans fats has also contributed to the ominous presence in the eating culture of urban India and the world.
Health impact of Trans- fats:
A study “Impact of nonoptimal intakes of saturated, polyunsaturated, and trans-fats on global burdens of coronary heart disease” nails the impact of trans fats, that approximately 540,000 deaths each year can be attributed to intake of industrially produced trans-fatty acids. Another study a systematic review “Intake of saturated and trans unsaturated fatty acids and risk of all-cause mortality, cardiovascular disease, and type 2 diabetes” confirms consumption of trans unsaturated fatty acids is associated with a 34% increase in all-cause mortality, a 28% increased risk of CHD mortality, and a 21% increase in the risk of CHD2.
The History of Banning Trans fats
- Curious case of the Danish Popcorn3
Denmark was the first country to regulate the level of trans- Fats at 2 gm per 100 gm, after a series of academic corroboration that there exists a strong relationship between the Trans- fats and cardiovascular disease. Though journey was not smooth but satisfying as the Denmark banned trans- fats completely in 2003. The story in Denmark started with startling study published by the Lancet in 1993 titled “Intake of trans fatty acids and risk of coronary heart disease among women.” This study shook up the Danish government and send tremors in the public conscience, the government commissioned a study on Trans fats to the Danish nutrition council. The council in 2001 estimated that about 50,000 Danes were at high risk for cardiovascular disease from their intake of trans fats, and suggested the Government legislate to limit trans-fats content in foods. The report got the media attention and public’s support. In the report innocuous microwave popcorn was found to be the most damning, about 40 % of the popcorn was trans-fats and among Danes microwave popcorn was most popular.
There were many roadblocks to 2003 TFA ban, as Danes have to fight the European union as there were conflict of free trade in the European union. But the Danish government stood by the report and eventually the European commission accepted the argument which based on solid science and public support.
- Protracted Case of Argentina4
Argentina fight for the trans- fats started in 1990, but it took them 24 years to ban Trans fats completely in 2014. Dr Fabio Gomes, Regional Nutrition Advisor at the Pan American Health Organization (PAHO), the Regional Office of the Americas for WHO, says “Eliminating trans-fats is a priority for the entire region” and adds “Reducing trans-fats consumption by just 2% to 4% of total calories could prevent an estimated 30 0000 to 225 000 heart attacks in Latin America and the Caribbean.”
The story starts in 1990, a group of researchers from the prestigious Argentinian institute La Plata National University, the Buenos Aires Scientific Investigations Commission, and the Buenos Aires Health Ministry began studying the high incidence of coronary death, the group concluded deaths attributing to TFAs. In 2008, the PAHO-backed Trans Fats Free Americas Declaration called for limiting industrially- produced trans-fats to less than 2% of total fats in oils and margarines, and less than 5% of total fats in other foods. The declaration recommended mandatory labelling of trans fats content in foods, standardized across the Americas, and when possible, replacement with unsaturated fats.
Global Phenomena: Ban spreads like wild fire1
Recently Canada has also banned Trans-fats in 2018, and most countries that have passed regulations or legislation followed the Denmark model, including Austria, Chile, Ecuador, Hungary, Iceland, Norway, Singapore, and South Africa. Latvia, Slovenia, and Sweden have passed similar limits that have not yet gone into effect. Argentina, Colombia, Iran and Switzerland have similar restrictions in effect, with 2% trans-fats limits in fats and oils plus, in the case of Argentina and Colombia, 5% trans-fats limits in fats and oils for other foods. India has limits of 5% trans-fats content in some fats and oils.
The Indian Scene
The World Health organisation with support from Food safety and standard authority of India (FSSAI) launched a mass media campaign against the use of trans fats called Heart attack rewind in 17 Indian languages in 20185, FSSAI is targeting to reduce the trans-fats below 2% in all product. From 2015 and currently India is having trans-fats admissible level of 5% in all food which high but it is good improvement comparing the 2011 trans-fats limit of 10% in all food. India has been incrementally progressing towards less than 2% TFA ban. India is aiming total TFA ban in all product by year 2022, it is marginally ambitious considering WHO target TFA ban is year 2023. But given the poor history enforcement and accountability of the government, there is a very high scepticism about the effectiveness of the TFA Ban.
The REPLACE package:
The REPLACE acronym stands for Review, Promote, Legislate, Asses, Create and Enforce. Every country should review industry produced dietary sources for trans fats and landscape required for the policy changes, promote healthier oils and fats, legislate to eliminate trans fats in all products, assess the level of trans fats in food supply, create awareness about the health effects of trans fats and enforce compliance with policies and regulations6.
What can government do?
Replacing trans-fats with healthier oils/fats in the food supply is one of the governments can save the lives. Accountability of the FSSAI towards the civil society to reduce the level of trans-fats to 2% by inviting them in their data dissemination meeting can be one of the steps. The academic society could contribute by developing cost effective modelling study or social return on investment studies on ban of trans fats in India. Raising public awareness specifically targeting the middle class I n phased manner can be done. Enforcing “Sin taxes” on the products high on TFAs can be some of the intervention that government can try.
References
- WHO plan to eliminate industrially-produced trans-fatty acids from global food supply. who/news. https://www.who.int/news-room/detail/14-05-2018-who-plan-to-eliminate-industrially-produced-trans-fatty-acids-from-global-food-supply. Published 2018. Accessed April 5, 2019.
- De Souza RJ, Mente A, Maroleanu A, 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;351:1-31. doi:10.1136/bmj.h3978
- Office WHOE, Diseases N, States U, Council DN. Denmark , trans fat ban pioneer : lessons for other countries. 2019;(December 2003):3-4.
- Nutrition R. Argentina regulating trans fats and monitoring heart health. 2019:1-3.
- TRANS FAT FROM THE GLOBAL FOOD SUPPLY. 2018;(May):2023.
- WHO/NHM/NHD/18.4. Re p l a c e.