A Systematic Review of Trans Fat Reduction Initiatives in the Eastern Mediterranean Region

Abstract

High intakes of trans fatty acids (TFA), particularly industrially-produced TFA, are implicated in the etiology of cardiovascular diseases, which represent the leading cause of mortality in the Eastern Mediterranean Region (EMR). This systematic review aims to document existing national TFA reduction strategies in the EMR, providing an overview of initiatives that are implemented by countries of the region, and tracking progress toward the elimination of industrially-produced TFA. A systematic review of published and gray literature was conducted using a predefined search strategy. A total of 136 peer-reviewed articles, gray literature documents, websites and references from country contacts were obtained, up until 2 August 2021. Randomized-control trials, case-control studies, and studies targeting unhealthy population groups were excluded. Only articles published after 1995, in English, Arabic or French, were included. Key characteristics of strategies were extracted and classified according to a pre-developed framework, which includes TFA intake assessment; determination of TFA levels in foods; strategic approach; implementation strategies (TFA bans/limits; consumer education, labeling, interventions in public institution settings, taxation), as well as monitoring and evaluation of program impact. Thirteen out of the 22 countries of the EMR (59%) have estimated TFA intake levels, 9 have determined TFA levels in foods (41%), and 14 (63.6%) have national TFA reduction initiatives. These initiatives were mainly led by governments, or by national multi-sectoral committees. The most common TFA reduction initiatives were based on TFA limits or bans (14/14 countries), with a mandatory approach being adopted by 8 countries (Bahrain, Iran, Jordan, KSA, Kuwait, Morocco, Oman and Palestine). Complementary approaches were implemented in several countries, including consumer education (10/14), food labeling (9/14) and interventions in specific settings (7/14). Monitoring activities were conducted by few countries (5/14), and impact evaluations were identified in only Iran and the UAE. The robustness of the studies, in terms of methodology and quality of assessment, as well as the lack of sufficient data in the EMR, remain a limitation that needs to be highlighted. Further action is needed to initiate TFA reduction programs in countries that are lagging behind, and to ensure rigorous implementation and evaluation of ongoing programs.

Unhealthy Dietary Habits and Obesity: The Major Risk Factors Beyond Non-Communicable Diseases in the Eastern Mediterranean Region

“…Data have been extracted from various sources. These include the WHO's global ( 6 ) and regional health observatories ( 14 ), data collected for the second WHO Global Nutrition Policy Review 2016–2017 ( 15 ), the WHO Global Database on the Implementation of Nutrition Action (GINA) ( 16 ), communication about country-level action from WHO country offices and national government nutrition focal points, and other relevant academic papers ( 17 – 20 ). Specifically, data were collected on the policy areas related to a healthy diet that features in the new regional nutrition strategy ( 21 ).…”

“…They also include actions connected to managing metabolic risk factors, such as hypertension and diabetes, to prevent more severe disease or complications ( 145 ) (see text footnote 1 ). Table 6 reveals the key policies and action plans available and implemented among EMR countries ( 6 , 17 – 20 ).…”

“…Among EMR countries that are on track to meet SDG target 3.4 are Iran, Kuwait, and Bahrain ( 29 ). These three countries have policies to reduce salt/sodium consumption, tax on sugar sweetened beverages, policy to eliminate industrially produced trans-fatty acids, policy to limit saturated/ trans-fatty acids intake, policy to reduce the impact of marketing of food to children, and policy on salt iodization ( 6 , 17 – 20 ) (see Table 6 ).…”

Oleogels and bigels as alternatives to saturated fats: A review on their application by the food industry

“…The World Health Organization (WHO) has the goal of eliminating industrially produced trans‐fat by 2025, with several countries committing themselves to this cause, such as Brazil, United Kingdom, United States of America and the European Union (WHO, 2021a, 2021b, 2021c). Overall, strategies from different countries include trans fatty acids (TFA) bans or limitations; consumer education, labeling, interventions in public institution settings and taxation, among others (Al‐Jawaldeh et al, 2021). Nevertheless, recent studies still indicate that several countries still exceed the upper limit set by WHO of 1%, namely from the Mediterranean region (Al‐Jawaldeh et al, 2021).…”

“…Overall, strategies from different countries include trans fatty acids (TFA) bans or limitations; consumer education, labeling, interventions in public institution settings and taxation, among others (Al‐Jawaldeh et al, 2021). Nevertheless, recent studies still indicate that several countries still exceed the upper limit set by WHO of 1%, namely from the Mediterranean region (Al‐Jawaldeh et al, 2021).…”