Eliminate trans fats: WHO’s REPLACE package

WHO’s new guidelines provide the opportunity and incentive to replace oils high in trans fats region-wide with locally made, healthy alternatives. That opportunity should be grasped, and a return to better known, traditional alternatives embraced

The use of artificial “trans fat” in edible oils imperils health. New World Health Organisation (WHO) guidelines advocate for a return to better-known, traditionally used alternatives.

On May 14, the WHO called on all countries to make the world free of trans fats by 2023. A number of countries have already accomplished this, including a range of middle-and lower-income countries worldwide that have heavily restricted or eliminated trans fats altogether.

They do so with good reason.

There are two main sources for trans fats: natural sources (in the dairy products and meat of ruminants such as cows and sheep) and industrially-produced sources (partially hydrogenated oils).

Industrially produced  trans fats are artificial compounds formed  by “partial hydrogenation of edible oils’ that are harmful when consumed, even at low levels. In the South-East Asia Region, partially hydrogenated vegetable oils (PHVOs) are the primary source of trans fats in food items.

Commercial food production, particularly with regard to bakery products such as biscuits and pastries, use high amounts of PHVOs, thus increasing the risk of trans fat consumption. Changing food patterns and  the popularity of processed  foods is likely to increase trans fat intake. Likewise, high levels of trans fat have also been found elsewhere, especially in food produced by informal vendors. Trans fats dramatically increase the risk of heart attack.

Replacing  oils containing high trans fats with healthier options will have no impact on the taste or availability of food, and will dramatically advance health and wellbeing. It will also help achieve WHO South-East Asia’s regional target and Flagship Priority of reducing noncommunicable diseases by one-fourth by 2025, and then by one-third by 2030, as per the Sustainable Development Goal targets.

Mustard, sunflower, rapeseed (canola), ground nut, and soya-based oils are all healthier alternatives. These crops are valuable, efficient and in high demand. Importantly, the increased growth, production and use of these crops will enhance the health and wellbeing of people and align the region with the global drive to restrict trans fats and save millions of lives at virtually no cost to government or consumers.

To that end, WHO’s six-step REPLACE action package – launched last week in Geneva – provides all countries with proven tools to completely eliminate trans fats from their national food supply and counter increasingly changing food patterns.

At present, 90 per cent of people around the world – about 6.5 billion – are exposed to these artery-clogging substances, with little to no government support or alternatives offered. WHO’s REPLACE package aims to accelerate restrictions on trans fat products via an easy six-step process. Each of these steps can be readily embraced, implemented and enforced, with game-changing effect.

First is “Reviewing” dietary sources of trans fats and the landscape required for policy change. Second is “Promoting” the replacement of trans fats with healthier fats and oils. Third is “Legislating” or enacting regulatory actions to eliminate trans fats. Fourth is “Assessing” and monitoring trans fat content in the food supply and changes in trans fat consumption in the population. Fifth is “Creating” awareness of the negative health impact of trans fats among policymakers, producers, suppliers and the public. And sixth is “Enforcing” compliance with policies and regulations. All these together make WHO’s REPLACE package.

If implemented effectively, the WHO REPLACE package will ensure prompt, complete and sustained elimination of trans fats from the world’s food supply, thereby driving down demand. That is a good that will give many times over, saving billions of dollars in both developed and developing economies, and slashing the rate of premature deaths worldwide.

But making that happen requires more than goodwill; it requires a willingness to act, and to do so decisively.

WHO recommends that the total trans fat intake be limited to less than 1 per cent of total energy intake, which translates to less than 2.2 g/day with a 2,000-calorie diet. Trans fats increases levels of LDL-cholesterol, a well-accepted biomarker for cardiovascular disease risk, and decreases levels of HDL-cholesterol, which carry away cholesterol from arteries and transport it to the liver, that secretes it into the bile.

Diets high in trans fat increase heart disease risk by 21 per cent and deaths by 28 per cent. Replacing trans fats with unsaturated fatty acids decreases the risk of heart disease, in part, by ameliorating the negative effects of trans fats on blood lipids. In addition, there are indications that trans fat may increase inflammation and endothelial dysfunction.

WHO’s new guidelines provide the opportunity and incentive to replace  oils high in trans fats region-wide with locally made, healthy alternatives. That opportunity should be grasped, and a return to better known, traditional alternatives embraced.

Singh is Regional Director, WHO South-East Asia Region