Trans-fats: a silent killer

Cardiovascular diseases are considered a major health concern primarily for developing nations. Approximately 17 million people die due to heart disease worldwide every year. According to the recent WHO report on heart attack ratio in Pakistan, 240,720 people died from coronary heart disease in Pakistan in 2020, accounting for 16.49% of all fatalities. Unfortunately, Pakistan is ranked 30 in the world with a death rate of 193.56 per 100,000 people.

Among the multiple factors influencing heart health, the high intake of industrially produced trans fatty acids (iTFAs) have emerged as a significant cause. iTFAs are the unhealthiest type of fats that are commonly found in processed and industrially produced food items. They are formed through hydrogenation, a process that converts liquid oils into solid fats, prolonging the shelf life and stability of products. The iTFAs are also produced during frying, heating and refinement of edible oils. These are often found in vanaspati ghee, commercially baked goods, fried foods, margarine and numerous convenience foods, making them prevalent in the modern diet.

It is alarming that Pakistan’s trans-fat intake is estimated to be the 2^nd highest in the WHO-EMRO region after Egypt. Multiple research studies have unveiled the detrimental impact of iTFAs on cardiovascular health and have demonstrated a strong association between iTFAs consumption and an increased risk of cardiovascular disorders, obesity, diabetes, hypertension, cancer, infertility, Alzheimer and other chronic diseases. The unbalanced dietary pattern of the Pakistani community has significant implications for their overall health and well-being. The insufficient intake of essential nutrients leads to nutritional deficiencies, which increases the risk of various health issues. The National Nutrition Survey (NNS-2018) revealed that the prevalence of obesity among children under five has almost doubled from 2011 to 2018. Similarly, obesity and overweight increased in women of reproductive age (WRA) from 28% to 38% between 2011 and 2018. According to the non-communicable disease STEPS survey 2014-2015, more than four out of ten adults (41.3%) were overweight, while 37% had hypertension.

The WHO has also taken note of the hazards posed by iTFAs and has urged nations worldwide to take action. Mandatory TFA policies are currently in effect for 3.4 billion people in 60 countries (43% of the world population). In 2003, Denmark was the first country in the world to regulate the iTFAs limitation in their food products, and nearly eliminated industrially produced iTFAs. In the three years following the policy implementation, mortality attributable to cardiovascular disease decreased on average by approximately 14.2 deaths per 100,000 people per year.

Owing to the situation, WHO proposed a comprehensive action package. The action package REPLACE provides a strategic approach for countries to adopt and implement actions to reduce and eliminate iTFA by 2023, which outlines six strategic action areas to support the elimination of iTFA from the food supply. These six areas of action include: 1) Review dietary sources of iTFA and the landscape for required policy change. 2) Promote the replacement of iTFA with healthier fats and oils. 3) Legislate or enact regulatory actions to eliminate iTFAs. 4) Assess and monitor trans-fat content in the food supply and changes in trans-fat consumption in the population. 5) Create awareness of the negative health impact of iTFAs among policymakers, producers, suppliers and the public. 6) Enforce compliance with policies and regulations.

The Pakistan Standards and Quality Control Authority (PSQCA) approved iTFAs limits (not more than 2g per 100g of fats) in vanaspati, shortenings, bakery fats, bakery ware, rusk and breads. To further progress, Pakistan should adopt WHO-recommended policies, like limiting iTFAs to 2g per 100g of total fat in all foods and banning partially hydrogenated oil (PHO) production and use. It is also necessary to ensure that food manufacturers comply with these regulations and replace iTFA with healthier fats and oils. Media can play a crucial role in advocating policy changes to limit iTFAs and educating the masses.

Published in The Express Tribune, October 3^rd, 2023.

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