ELIMINATING THE CONSUMPTION OF TRANS FATS IN SOUTH-EAST ASIA

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Ralf Barnett
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1 ELIMINATING THE CONSUMPTION OF TRANS FATS IN SOUTH-EAST ASIA AN IMPLEMENTATION BRIEF

2 1 What are trans fats? Trans fats are unsaturated fatty acids having at least one unsaturated, non-conjugated double bond in the trans, (rather than the typical cis) configuration. 1 They naturally occur through anaerobic fermentation in the gut of ruminant animals. Industrially produced trans fats are formed by modification of unsaturated fat during industrial processing methods, mainly through partial hydrogenation in the presence of a metal catalyst and high heat. 2 Partial hydrogenation is the key mechanism where oil is hardened for commercial purposes to change its texture, prevent rancidity and tolerance to repeated high temperatures. The proportion of industrially produced trans fats in diets are usually much greater than ruminant trans fat. 1 Trans fats are present in - Oils and fats Vanaspati oil, margarine/spreads, vanaspati ghee, bakery and frying fats and vegetable shortenings How do trans fats enter the food chain? Use of partially hydrogenated vegetable oil (PHVO), the commonest source of trans fat, is popular in the manufacture of bakery products. They are low cost, and semisolid at room temperature, thus easy to use in baked products. PHVO also reduce rancidity and impart greater stability during high temperature commercial deep-frying. 1 The quantity of trans fat formed in commercial baking and deep-fat frying of vegetable oils is usually %, 3 little impact on the dietary intake of trans fats. 4 Domestic frying processes have Consumption of trans fats in South-East Asian countries There was a dearth of country data on trans fats intake, with information from only a few small studies in India, Thailand and Indonesia. 8 9 However, Thailand has recent nationwide data (unpublished observation). An estimation and quantification of global consumption of key dietary fats and oils by country, age, and sex in 1990 and 2010 provides an approximate indication of consumption levels. 10 Trans fats may amount to a daily average consumption for adults 20 years of between % energy/day in most South- Food products Baked foods biscuits, pastries, cake, donuts Fried foods: chips, samosas, sweets (e.g. burfi, jalebi), fried pastry such as potato kachori, patties, rolls. Animal products Small amounts in dairy products and meat from cattle and sheep

2 East Asian countries, indicating that trans fat intakes maybe somewhat lower than in many high income countries. 10 Source: BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.

11 12 The removal of PHVO containing industrially produced trans fats from the food supply is recommended by WHO as a public health intervention (best buy) for reducing the risk of noncommunicable

3 2 East Asian countries, indicating that trans fat intakes maybe somewhat lower than in many high income countries. 10 Source: BMJ 2014; 348 doi: Why restrict trans fat from diets? Consumption of trans fats are associated with an increased risk of cardiovascular disease The removal of PHVO containing industrially produced trans fats from the food supply is recommended by WHO as a public health intervention (best buy) for reducing the risk of noncommunicable disease. 13 The FAO WHO Population Nutrient Intake Goals provide the following recommendations regarding trans and saturated. 14 Energy from trans fat should be less than 1% of total energy. (average energy intake of 2000 kcal x 0.01)/9 = 2.2 g/day. Energy from saturated fat should be less than 10% of total energy (average energy intake of 2000 kcal x 0.1)/9 = 22 g/day.

4 3 Policy options for reducing trans fats from human diets Eliminating trans fats from the food supply of countries through development of legislation to ban their use in the food chain is mandated in the Global Action Plan for the Prevention and Control of NCDs , endorsed by the Sixty Sixth World Health Assembly (WHA66.10) in 2013 and in its updated Appendix The adoption of national policies that eliminate industrial trans fats is also recommended in the Action plan for the prevention and control of noncommunicable diseases in South-East Asia, The following actions have been practiced by countries to limit trans fat intake. Legislation Set legislative limits on trans fat content in consumable fat, including oils and food products. Reformulation Promote and negotiate voluntary reductions in trans fat use by food industry. Labelling Enact mandatory labelling of trans fat in pre packaged food labels Effectiveness of policy options A review of policies to reduce trans fats (mostly from high income countries) indicate that the above policy measures, implemented singly or in combination have been in reducing trans fat usage and even translated into reduced CVDs in some instances. 16 National and local legislative actions proved to be more than labelling policies. National bans virtually eliminated trans fats from the food supply and local level bans were very successful in their removal from fried foods. The effects of mandatory trans fats labelling of pre- packaged foods and voluntary limits were more variable and depended largely on the food category. The review concluded that a voluntary ban or labelling may not be in countries where awareness of trans fats is low, and also that the higher cost of products with voluntary trans fats limits would deter their consumption by lower socio economic groups thus causing social equity issues.

5 4 Implementation of trans fats policies in South- East Asia India has gazetted that trans fat in vegetable fats, vanaspati oil, bakery and industrial margarine and bakery shortening should be restricted to 10 % (2011) and reduced to 5 % in The Food Safety and Standards Authority of India has also implemented mandatory labeling of trans fats and saturated fats on vanaspati packs, edible oils and food products containing vanaspati. (Gazette Notification No 4/15015/30/2011) In Thailand, the Thai Food and Drug Administration have recently proposed a new requirement where partially hydrogenated oils would be banned for foods that are produced or imported for sale in Thailand. 18 Policy options to reduce trans fats and their possible ness In South East Asia, majority of urban consumer purchase foods from vendors and informal outlets, and would not benefit from food labelling alone. Policy measure Targets most foods with industrial trans fats Consumer reach and equity Effect on informal sector foods Cost Potential for substitutio n to saturated fats Monitoring and follow up Setting legislative limits on transfat content in consumable oils and foods Highly Highly Effective Low at national level Potential for substitution exists. Cost and resources lower than for other measures Negotiating voluntary reductions in trans fat usage by food industry Less Not Not High due to need for public education Potential for substitution exists. Product and populationintake analyses needed. Mandatory labelling of trans fat Less Not Not High due to need for public education Potential for substitution and claims exists. Similar to voluntary reductions

6 5 Considerations for countries planning to implement policies on trans fat Situational analysis Data on trans fat Generate in-country evidence of trans fat content of food fats and oils, including fats used in bakery and other food industries. Generate information on trans fat content of commonly consumed bakery and fried foods to identify foods high in trans fats ( pre-packaged and other foods) Assess average population intake of trans fats through dietary surveys or blood analysis. Technical information Consult with food technology experts and industry to a) gain understanding of the country s technological capacity on methods to reduce trans fats. 19 b) promote unsaturated fats as the preferred alternative, including n-3 polyunsaturated fats, given their cardiovascular protective effect. c) identify technical assistance needed by industry. Assess the country capacity to monitor the legislation, including the availability of accredited food testing facilities. Existing regulations Examine existing food legislation to see existing regulations on fats and oils. Examine current regulations on health claims to assess guidance on trans fats.(claims should state both trans and saturated fats to prevent misunderstanding by consumers, who may otherwise be misled by trans fat free products, which may have a high saturated fat content). Current trade policies around imports/exports of oil. Stakeholder engagement Awareness and capacity Improve awareness and co-ordination among the food safety and commerce sectors, legislators and food industry including restaurant chains, state institutions and other stakeholders.

7 6 Plan to educate consumers regarding the negative health effects of trans fats and the effects of potential replacement oils and their effects. Decide on the scope of new restrictions on trans fats (see table below) and timeline. Develop and implement regulations Develop regulations Develop regulations based on information gathered during the situational analysis and in alignment with international standards and best practices. Establish measures for non- compliance. Decide if labelling should also be implemented. Monitor compliance Develop or modify available surveillance systems to incorporate verification of implementation of the potential regulation. e.g. require food importers to have all imported oils and fats and foods certified as not containing trans fats over the set threshold. Legislative restrictions on trans fats; scope of restriction Option Country examples Advantages/ disadvantage Restrict trans fat in the ingredient Limit trans fat to a threshold (e.g. no more than 2g per 100g product) for fats and oils supplied to food service establishments and food manufacturers, as well as fats and oils sold in retail outlets. Rationale: Leads to lower trans fat levels in the final product. Additional labelling Require mandatory labelling of trans-fat levels on packaging of retail fats and oils (Singapore and India). Singapore (< 2g trans fat in 100g product) India (< 5 g trans fat in 100g product) Denmark (Limits the use in fats and oils > 2 %, industrially produced trans fats in foods for human consumption experience suggests this would lead to average level of 1 % trans fats in final food Simpler monitoring process Shifts the responsibility for compliance up the food chain and reduces the number of actors targeted by the regulation

8 7 product) Regulate trans fats in final food product Legal limits set for trans fat in food products Rationale: most efficient means of promoting a shift away from trans fats in the food production industry Switzerland South Korea Difficulties in setting limits, and enforcement: analyzing food products

9 8 References 1. Butt MS, Sultan MT. Levels of trans fats in diets consumed in developing economies. JAOAC Int 2009;92(5): de Souza Russell J, Mente Andrew, Maroleanu Adriana, Cozma Adrian I, Ha Vanessa, Kishibe Teruko 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:h Mozaffarian D. Removing industrial trans fat from foods. BMJ 2010;340:c Sartika RAD. Influencing of Deep Frying in Forming of Trans Fatty Acids. Makara Seri Sains 2009;13(1): Ghafoorunissa G. Role of trans fatty acids in health and challenges to their reduction in Indian foods. Asia Pac J Clin Nutr 2008;17 Suppl 1: Goyal N, Sundararaj P. Are We Unknowingly Consuming Trans Fats and Abused Oils? NFI Bull. 2009;31(2):4-7 wingly%20consuming%20trans%20fats%20and%20abused%20oils%20_%20pages%204-7.pdf 7. Agrawal A, Gupta R, Varma K, Mathur B. High trans fatty acid content in common Indian fast foods. Nutr Food Sci 2008;38(6): Narkwichian N, Tongyong L, Patarapanich C. Analysis of Trans Fatty Acids In Soem Foods By Attenuated Total Reflection- Fourier Transform Infrared Spectroscopy. J Health Res 2009;23(4): Sartika RAD.. Effect of Trans Fatty Acid Intake on Blood Lipid Profile of Workers in East Kalimantan, Indonesia. Mal J Nutr 2011;17(1): Global, regional, and national consumption levels of dietary fats and oils in 1990 and 2010: a systematic analysis including 266 country-specific nutrition surveys BMJ 2014; 348 doi: Uauy R, Aro A, Clarke R, L Abbé MR, Mozaffarian D, Skeaff CM,, et al., et al. WHO scientific update on trans fatty acids: summary and conclusions. Eur J Clin Nutr 2009; 63: S

10 9 12. de Souza Russell J, Mente Andrew, Maroleanu Adriana, Cozma Adrian I, Ha Vanessa, Kishibe Teruko 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 :h World Health Organisation.Global Action Plan for the Prevention and Control of NCDs WHO, Chizuru Nishida,*, Ricardo Uauy, Shiriki Kumanyika and Prakash Shetty. The Joint WHO/FAO Expert Consultation on diet, nutrition and the prevention of chronic diseases: process, product and policy implications. Public Health Nutrition (1A), Action plan for the prevention and control of noncommunicable diseases in South-East Asia, Downs SM, Thow AM, Leeder SR. The ness of policies for reducing dietary trans fat: a systematic review of the evidence. Bulletin of the World Health Organization. 2013Apr 1;91(4):262 9H ( articles/pmc /. 17. Food Safety and Standards Authority of India: Regulation of trans fatty acids in partially hydrogenated vegetable oils. Delhi: Ministry of Health and Family Welfare, Food Safety and Standards Authority of India; DP.aspx?language=E&CatalogueIdList=240519&CurrentCatalogueIdIndex=0&FullTextHash=1&HasEnglishRecord=True& HasFrenchRecord=True&HasSpanishRecord=True 19. Dhaka V, Gulia N, Ahlawat KS, Khatkar BS: Trans fats-sources, health risks and alternative approach - a review. Journal of Food Science and Technology-Mysore 2011, 48: Singapore Health Promotion Board 21.Executive Order No. 160 of 11 March 2003 on the Content of Trans Fatty Acids in Oils and Fats. 22. Trans Fatty Acids and Health: A Review of Health Hazards and Existing Legislation. Policy Department. Economic and Scientific Policy. JOIN_ET(2008)408584_EN.pdf Nutrition and Health for Development Unit, Department of Non Communicable Diseases WHO Regional Office for South East Asia February 2018

TEXTS ADOPTED Provisional edition. European Parliament resolution of 26 October 2016 on trans fats (TFAs) (2016/2637(RSP))

European Parliament 04-09 TEXTS ADOPTED Provisional edition P8_TA-PROV(06)047 Trans fats European Parliament resolution of 6 October 06 on trans fats (TFAs) (06/637(RSP)) The European Parliament, having