xx.12. Trans Fat: Why is it harmful?

According to a recent WHO report, five billion people globally remain unprotected from harmful trans fat, increasing their risk of heart disease and death. Global Trans fat elimination was called for in 2018 with the target set in 2023.

WHO first called for the global elimination of industrially produced trans fat in 2018 – with an elimination target set for 2023 – population coverage of best-practice policies has increased almost six-fold.

Forty-three countries have now implemented best-practice policies for tackling trans fat in food, with 2.8 billion people protected globally.

Despite substantial progress, however, this still leaves 5 billion worldwide at risk from trans fat’s devastating health impacts with the global goal for its total elimination in 2023 remaining unattainable at this time.

What is trans fat?	Trans fat is a form of unsaturated fat that is present in food and is sometimes referred to as trans-unsaturated fatty acids or trans fatty acids. Trans fats are present in trace levels in certain naturally occurring foods, but they are abundant in other processed meals. Trans fatty acids occur in meat and dairy products from ruminants. For example, butter contains about 3% trans fatty acid. Artificial trans fats are heavily controlled or outlawed in many countries due to the harmful effects of trans fat intake. The industrially-produced trans fatty acid is formed in an industrial process that adds hydrogen to vegetable oil converting the liquid into a solid, resulting in “partially hydrogenated” oil (PHO). Partially hydrogenated oils (PHO) are solid at room temperature and prolong the shelf life of products. They are primarily used for deep frying and as an ingredient in baked goods. PHOs were first introduced into the food supply in the early 20th century as a replacement for butter and lard; they are not a natural part of the human diet and are fully replaceable Industrially produced trans-fatty acids are commonly found in packaged foods, baked goods, cooking oils, and spreads. PHO is an ingredient in many foods, including margarine, vegetable shortening, and Vanaspati ghee; fried foods and doughnuts; baked goods such as crackers, biscuits, and pies; and pre-mixed products such as the pancake and hot chocolate mix. Baked and fried street and restaurant foods often contain industrially-produced trans fat. All of these products can be made without industrially produced trans fatty acid.
Types and components of fats in food	Saturated fat Unsaturated fat- Monounsaturated fat, Polyunsaturated fat Components of fat Fatty acid- Omega-3, Omega-6, Omega-7, Omega-9 Triglyceride Cholesterol Manufactured fats Fat hydrogenation- Trans fat Fat interesterification
Health impact of trans fat	Trans fatty acid intake is responsible for up to 500 000 premature deaths from coronary heart disease each year around the world. High trans fatty acid intake increases the risk of death from any cause by 34%, coronary heart disease deaths by 28%, and coronary heart disease by 21%. This is likely due to the effect on lipid levels: trans fatty acid increases LDL (“bad”) cholesterol levels while lowering HDL (“good”) cholesterol levels. Trans fatty acid has no known health benefits. It is also associated with a higher risk of developing obesity, type 2 diabetes, metabolic syndrome, insulin resistance, infertility, and certain types of cancers and can also lead to compromised fetal development. Currently, 9 of the 16 countries with the highest estimated proportion of coronary heart disease deaths caused by trans fatty acid intake do not have a best-practice policy. They are Australia, Azerbaijan, Bhutan, Ecuador, Egypt, Iran (Islamic Republic), Nepal, Pakistan, and the Republic of Korea.
Global trans fat Elimination	WHO launched a REPLACE campaign in 2018 for the global-level elimination of trans-fats in industrially produced edible oils by 2023. REPLACE is an action package developed by the WHO that supports governments to ensure the prompt, complete, and sustained elimination of industrially-produced trans fatty acids from the food supply. The practical, 6-step package calls for the promotion of the use and consumption of healthier fats and oils, and the elimination of industrially-produced trans fatty acids, to be achieved through regulatory actions while establishing solid monitoring systems and creating awareness among policy-makers, producers, suppliers, and the public. Forty-three countries have now implemented best-practice policies for tackling trans fatty acids in food, with 2.8 billion people protected globally. Best practices in trans fat elimination policies follow specific criteria established by WHO and limit industrially produced trans fatty acid in all settings. There are two best-practice policy alternatives: mandatory national limit of 2 grams of industrially produced trans fat per 100 grams of total fat in all foods; mandatory national ban on the production or use of partially hydrogenated oils (a major source of trans fat) as an ingredient in all foods. While most trans fatty acid elimination policies to date have been implemented in higher-income countries (largely in the Americas and in Europe). An increasing number of middle-income countries are implementing or adopting these policies, including Argentina, Bangladesh, India, Paraguay, the Philippines, and Ukraine. In 2023, WHO recommends that countries focus on these four areas: adopting best-practice policy monitoring and surveillance healthy oil replacements advocacy WHO guidance has been developed to help countries make rapid advances in these areas. WHO also encourages food manufacturers to eliminate industrially produced trans fatty acids from their products, aligning with the commitment made by the International Food and Beverage Alliance (IFBA). Major suppliers of oils and fats are asked to remove industrially produced trans fatty acids from the products sold to food manufacturers globally.
Indian efforts for trans fat elimination	Recognizing the health hazards associated with the consumption of industrial trans fats, FSSAI intended to eliminate trans fatty acids from the diet in a phased manner by 2022. Therefore, FSSAI employed two-pronged strategies to achieve its goal of “Freedom from Trans Fat @75.” On the supply side, FSSAI has notified several crucial regulations to regulate trans fat in industrial products, and encouraged the edible oil industry and food business operators to eliminate trans fatty acids from their products. On the demand side, FSSAI has launched a mass media campaign “Heart Attack Rewind”- a 30-second Public Service Announcement (PSA) with the aim to create awareness about the harmful effects of trans fatty acid. FSSAI capped the amount of trans fatty acids (TFA) in oils and fats to 3% for 2021 and 2% by 2022 from the current permissible limit of 5% through an amendment to the Food Safety and Standards (Prohibition and Restriction on Sales) Regulations. As part of the ‘Eat Right India’ movement’, edible oil associations, bakery associations, individual bakeries, and chefs have voluntarily committed to eliminating/reducing industrial TFA from their products by signing pledges.
Way forward	Change can be initiated by increasing knowledge about the negative effects of trans fatty acids and the necessity of lowering their use among the general public and the food industry. Governments can set up monitoring and enforcement mechanisms to make sure food producers follow laws and labeling specifications. Including saturated fatty acid (SFA) and trans fat content on packaged food nutrition labels allows monitoring of compliance with mandatory trans fat limits and concomitant changes in SFA. Labelling provides a foundation for either voluntary programs to limit trans fat or local/national laws or regulation. Replacing trans fatty acids with healthier oils/fats in the food supply is a low-cost way for governments to save the lives of their citizens. Experiences in several countries demonstrate that industrially-produced trans fatty acids can be replaced by healthier oils. Costs to implement best practice interventions (i.e. regulatory limits on trans fat) are likely well under the commonly accepted thresholds of cost-effectiveness. WHO recommends trans fatty acid elimination as a cost-effective intervention for low- and middle-income countries. Governments can eliminate the cause of 7% of cardiovascular diseases globally with a low-cost investment. Investing in the study and creation of fresh methods and components that can take the place of trans fats in food by the R&D sector will be another way forward toward the elimination of trans fats.