Scaling Up Obesity and NCD Prevention in the Eastern Mediterranean Region through Fat Reduction Intake Strategies at Population Levels

Abstract

NCDs are the leading cause of mortality globally which estimated 40 million death per year (68% of total death), with cardiovascular diseases, cancers, chronic respiratory diseases and diabetes. In the Eastern Mediterranean Region (EMR), around 60% of all deaths are attributed to NCDs. Two-thirds of NCD premature deaths are linked to 4 shared modifiable behavioural risk factors: tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol. These unhealthy behaviours lead to 4 key metabolic/biological changes that increase the risk of NCDs: raised blood pressure, overweight/obesity, high blood glucose levels/diabetes, and hyperlipidemia (high levels of fat in the blood). Globally, countries are already working towards agreed global goals on maternal and infant nutrition and on the prevention of NCDs, and both these include halting the increase in overweight and obesity and reducing NCD diet-related risk factors including reducing saturated fatty acids (SFA) and Trans fatty acid (TFA) intake. According to values reported for countries of the Eastern Mediterranean Region, average SFA intake is estimated at 10.3% of energy intake (EI), thus exceeding the WHO recommended level of 10% EI. Average TFA intake in EMR countries is estimated at 1.9% EI, which also exceeds the WHO recommended levels of 1% EI. The EMR region was reported amongst the regions with the highest levels of TFA intake. The highest SFA intake was reported from Djibouti, Kuwait, Saudi-Arabia and Yemen, while the highest TFA intakes were reported from Egypt and Pakistan. If countries of the Eastern Mediterranean region receive immediate public health attention, that toll of NCD-related morbidity and mortality can be considerably decreased if evidence-based preventive interventions are implemented effectively. In this context, reductions in saturated fat and trans fat intakes have been highlighted as cost-effective strategies that may hamper the growth of the NCD epidemic.

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

“…In contrast, nine countries (41%), including Egypt, Iran, Jordan, Lebanon, Morocco, Pakistan, Sudan, Tunisia, and the UAE, have estimated population TFA intakes (Supplementary Table 2). Some of the available studies estimated TFA intakes at the national level for specific population groups (e.g., adults) or the entire population (per capita), while others reported the intakes within specific regions of the countries (4,12,14,(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51). Except for Jordan, where TFA intake assessment was based on a household budget survey, all the other countries had evaluated TFA intakes based on dietary assessment methodologies (e.g., 24-h recalls, food frequency questionnaires, diet history questionnaires) (Supplementary Table 2).…”

“…In Oman a Ministerial Decree to prohibit the use of PHOs is in preparation (155,156). Iran implements a restriction of PHO use rather than a ban, while Iraq has removed the subsidy on PHOs, and replaced them by other types of oil (14,50,113,122). In Oman, there has been a proposal to tax PHOs, but this has not been adopted or implemented yet (143).…”

“…In Oman, there has been a proposal to tax PHOs, but this has not been adopted or implemented yet (143). Jordan banned the use of PHOs in dairy products (50,123,124) and Pakistan has prohibited their use in formula milk (146). Initiatives that included TFA limits/bans were mandatory in 8 countries, including Bahrain, Iran, Jordan, KSA, Kuwait, Morocco, Oman and Palestine (8/14 countries; 57%) (Table 1).…”

“…Frontiers in Nutrition | www.frontiersin.org (50,111,112), requiring declaration of TFA as part of nutrition labels for products containing 0.5 g/100 g or more and regulating "trans-fat free" claims (…”

“…Available evidence suggests that the legislations that were implemented in Iran resulted in a significant reduction in the level of TFAs content in edible oil. In fact, initiatives aimed at reducing the level of TFA in edible oils were launched in 2005, when the standards for frying oil and mixed liquid oils were revised to reduce the maximum level of TFA (to <10%, down from over 20%) (120), and when the Ministry of Commerce started the gradual replacement of hydrogenated oils by non-hydrogenated (specifically olive oil) and liquid frying oils (14,50,113). Peymani et al assessed the impact of this policy on the levels of TFA in edible oils.…”