Progress toward replacing trans-fats with healthy edible oil

Globally, noncommunicable diseases (NCDs) constitute a significant public health problem, and cardiovascular diseases (CVDs) are the leading cause of morbidity and mortality among NCDs. Major risk factors for CVDs include unhealthy diets, physical inactivity, tobacco, and alcohol use. Among dietary risks, high trans-fat intake increases the risk of all-cause mortality by 34%, coronary heart disease (CHD) deaths by 28%, and CHD incidence by 21%.[1] In 2016, India reported that NCDs accounted for 63% of total deaths, with CVDs contributing to 27% of these fatalities. Among individuals aged 40–69 years, CVDs were responsible for 45% of deaths. Those at risk of CVD often exhibit elevated blood pressure, blood glucose, and lipid levels, along with overweight and obesity.[2] Edible oil is a staple in every household cuisine, playing a crucial role in maintaining overall health by supporting essential bodily functions and meeting the body’s essential fatty acid requirements. Over the past decades, per capita consumption of edible oil in many LMICs including India where it has risen significantly, reaching 19.7 kg/year. This rapid increase has exceeded the country’s domestic production capacity, leading to a heavy reliance on imports to meet both household and industrial demand. As a result, edible oil imports reached 16.5 million tonnes in 2022–2023, reflecting a 67% increase, with a substantial portion consisting of palm oil.[3] Unsaturated fatty acids with a double bond in a trans conformation are known as trans fatty acids (TFAs). It can be found naturally in meat and dairy products, as well as through industrial procedures such as the partial hydrogenation of vegetable oil, which results in the production of solid fats.[4] High-temperature frying of oil also increases the concentration of trans-fats. In recent years, its use in processed food products has expanded because of its capacity to extend shelf life and its solid physical properties at room temperature.[1] Partial hydrogenation of vegetable fats (vanaspati, margarine, and bread shortenings) contains significant amounts of artificial or industrial trans-fat. Trans-fats can be found in fried dishes, bakery goods, and reheated oils, among other prepared items.[5] Trans-fatty acids increase the plasma low-density lipoprotein cholesterol concentrations similar to saturated fatty acids. However, it does not increase the high-density lipoprotein cholesterol concentrations and increase triglyceride concentrations; these lead to dyslipidemia and increased risk of CVDs. According to some researchers, trans fatty acids may increase lipoprotein(a), C-reactive protein, visceral adiposity, insulin resistance, metabolic syndrome, inflammatory markers, and the risk of diabetes.[6] The WHO set a goal to eliminate trans-fats from the food supply system by 2023 due to mounting health concerns. Significant progress has been made, despite the fact that this goal has not yet been entirely accomplished. In addition, the WHO introduced the REPLACE action package, which offers a road map to help nations eliminate trans-fats. It consists of six doable steps: raising awareness among the public, producers, suppliers, and legislators; putting legislation into effect; and making sure that they are monitored and enforced. Trans-fat substitution with healthy oils is a cost-effective, evidence-based approach, particularly for low- and middle-income nations. A mandatory national limit of 2 g of industrially produced trans-fat per 100 g of total fat in all foods is one of the two best practice alternatives recommended by the WHO. The other is a mandatory national ban on the production or use of partially hydrogenated oils, a major source of trans-fat, as an ingredient in all foods.[1] WHO has released its fifth report on progress toward trans-fat elimination, showing significant improvement in tackling industrial trans-fat from 2018 to 2013. By 2023, 53 nations had implemented best practices and demonstrated significant progress in improving the food environment for 46% of the world’s population, saving 183,000 lives annually compared to 6% coverage in 2018. Thailand, Saudi Arabia, Denmark, Lithuania, and Poland have received the first-ever certificates from the WHO for their efforts in becoming industrial trans fatty acid (iTFA) free nations through effective monitoring and enforcement systems.[7] India, Bangladesh, Paraguay, the Philippines, and Ukraine also passed policies for trans-fat elimination in May 2020 to support the global goal of eliminating trans-fats. They became the first lower-middle-income countries to implement such policies.[8] In India at the request of the Food Safety and Standard Authority of India (FSSAI), the National Institute of Nutrition in India started a nationwide consultation in 2010. In 2013, it was formally announced that the trans fatty acid restriction should not surpass 10% by weight. This maximum was later cut to 5%, then further dropped to no more than 3% in all fats and oils by January 2021, and to no more than 2% by January 2022, declared in the Gazette notification in December 2020. All food products in which edible oils and fats are used as an ingredient shall not contain industrial trans fatty acids more than 2% by mass of the total oils/fats present in the product, on and from January 1, 2022, as per the regulation, Food Safety and Standards (Prohibition and Restrictions on Sales) Second Amendment Regulations, 2021 gazetted in February 2021.[9] To meet the current demand–supply gap of edible oil, there is reliance on cheaper alternatives such as palm oil, which is extensively used in the unorganized sector. Research has shown that vendors often reuse oil through repeated heating, the use of vanaspati is still prevalent, and labeling issues in packaged food products persist. In addition, oil samples collected, and preparations made by vendors were found to be high in trans-fat.[10] FSSAI initiated the Repurpose Used Cooking Oil (RUCO) scheme on July 1, 2018 to divert used cooking oil from the food value chain to soap and biodiesel manufacturing, thereby curbing illegal practices. Total Polar Compounds, formed during repeated frying, are associated with several diseases such as hypertension, atherosclerosis, Alzheimer’s disease, and liver disorders. The key strategy of RUCO is based on education, enforcement, and ecosystem. The scheme is currently implemented in 16 States/UTs with 79 aggregators.[11] However, it still has a long way to go, as there are a lot of challenges in the unorganized sector and research shows there is a lack of awareness among Food Business Operators regarding trans-fat and the RUCO scheme. Despite all these challenges, it is important to move forward on replacing trans-fats with healthy edible oils by enforcement of policies, consumer awareness, and active participation of the industry. Ethical approval statement The Institutional Ethics Committee of PGIMER, Chandigarh reviewed and approved the RTSL funded project “Roadmap for replacing trans-fat with healthy oils in India”. The reference Id is PGI/IEC/2023/EIC001392.