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How trans fat fuels rise in chronic diseases, premature deaths in Nigeria, by experts

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Fries, Photo: PEXELS

Fifty-three-year-old Femi Okoya slumped and died while climbing up the stairs. The story was not different for 44- year-old Njideka Osondu who ‘fainted’ and died while dancing during an end-of-year party for graduating students of her school. 
    
“He was not sick. He did not complain of anything. I don’t understand. What do I do now? We have four children. How am I going to take care of the children without him?” Okoya’s wife lamented. 
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“She was physically fit. She exercised every day. What went wrong? How is the husband going to cope with their three children?” Amina, Njideka Osondu’s friend retorted.
     
Okoya and Osondu represent the estimated 110,000 Nigerians and 500,000 people globally that die yearly due to heart failure and 64.3 million patients with the condition worldwide.
      
According to 2018 World Health Organisation (WHO) data, published Coronary Heart Disease, heart failure in Nigeria reached 108,578, which is 5.60 per cent of total deaths for that year.
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According to a study published in February 2021 in the European Journal of Preventive Cardiology, the number of patients with heart failure worldwide nearly doubled from 33.5 million in 1990 to 64.3 million in 2017. 
     
The authors said the rising rate of heart failure in the low, low middle, and middle countries such as Nigeria “is driven by a surge of risk factors such as hypertension, diabetes mellitus, obesity, smoking, and other unhealthy lifestyles.”
   
They said symptoms of heart failure could be debilitating. Shortness of breath, fatigue and fluid retention may limit patients’ ability to walk, stand, work or care for themselves. 
 
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Also, the rising cases of heart attacks and sudden deaths in Nigeria and indeed the world have been associated with an increase in intake of industrially produced Trans Fatty Acids (iTFA), which are replete in vegetable oils, fried and baked foods, popcorn, chin-chin, bean cake, noodles, plantain chips. 
    
In Nigeria, a significant number of deaths linked to cardiovascular diseases is as a result of poor dietary choices including the intake of foods containing trans fat in an amount higher than the recommended 2.2 grams per day in a 2,000 calorie diet.
    
However, studies indicate that treating high blood pressure, cutting down on salt, and getting rid of trans fats ‘could prevent nearly 100 million premature deaths globally. It is also recommended to avoid foods made with partially hydrogenated oils (such as hard butter and margarine), as they contain high levels of industrial trans fat.
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The Guardian investigation revealed local foods with high iTFA/ unhealthy fat content include biscuits, fried foods (French fries, pizza, puff puff), deep-fried fast food (akara, fried chicken), plantain chips, crackers, sauces and seasonings, ice cream, doughnuts, pastries, cakes, chin-chin, pastries and pre-packaged snacks, microwave popcorn, margarine, and other confectionery. 
   
Industrial trans fat is unhealthy fats that are produced when vegetable oils are heated or when they are “hydrogenated”.
   
Hydrogenation is the process of bubbling hydrogen gas through the oil to harden/make solid the oil. Stopping the hydrogenation part of the way through the process results in partially hydrogenated oil, a product with a butter-like consistency but much cheaper to produce than butter.
    
Food manufacturers have used partially hydrogenated oils (PHOs) to improve food texture, food flavour stability, and keep some foods fresh for a long time. It is sold as ‘margarine’, ‘oleo’ or ‘vegetable shortening’. PHOs are the main source of industrial trans fat.
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Director-General, National Agency for Food and Drug Administration and Control (NAFDAC), Prof. Mojisola Adeyeye, told The Guardian that iTFA is now known for increasing risks of health problems such as coronary heart disease, cancer, diabetes, obesity, liver dysfunction, and infertility.
     
Adeyeye said WHO estimates that diets high in trans-fat increase the risk of heart disease by 21 per cent and deaths by 28 per cent. 
    
A consultant cardiologist and Executive Director, Nigerian Heart Foundation (NHF), Dr. Kingsley Akinroye, said foods rich in iTFAs raise Low-Density Lipo-protein (LDL) or ‘bad cholesterol, and triglycerides levels and reduces High-Density Lipo-protein (HDL) or ‘good cholesterol. He said raised LDL is associated with heart disease.
    
Has the association between trans fat and heart attack been established? “Yes, globally, high risks of heart disease are associated with iTFA consumption,” Akinroye said. 
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He said the reasons for the popularity are simple: “The oils were relatively inexpensive to produce when compared to solid animal fats. They increase the shelf life of food, they tasted good, and — at a time when saturated fats in butter were vilified — they were billed as a healthy alternative. (Think margarine versus butter.)”
    
But for decades, evidence has been mounting that even a small amount of trans fat increases bad (LDL) cholesterol in the blood and decreases the amount of good (HDL) cholesterol — raising the risk of coronary heart disease and heart attacks.
   
A consultant physician and medical director, Optimal Specialist Hospital Surulere, Lagos, Dr. Celestine Ugochukwu Chukwunenye, said most cases of sudden deaths in Nigeria are related to unhealthy diets. Chukwunenye said eating healthy diets could have prevented Okoya, Osondu, and many other causes of heart failure. 
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A professor of Community Nutrition at the Department of Nutrition and Dietetics, Federal University of Agriculture, Abeokuta, Ogun State, Prof. Wasiu Afolabi, told journalists that many Nigerians consume imported vegetable oils that have high levels of iTFAs. 
     
Afolabi said: “There are quite a number of vegetable oils that are imported into the country that have a high levels of trans fat. Trans fat and ‘bad’ cholesterol put people at risk of cardiovascular diseases.
    
“Most people do not know the danger in consuming these oils and that is why they have to be careful about the vegetable oil that they buy and consume. There are some confectioneries which are produced using hydrogenated oils and most of them are not produced in the country.”
    
The nutritionist added: “Nigerians must realise that diet laden with trans fat increases their risk of heart attacks and all diseases that are associated with the heart; including narrowing of the arterial wall such that limits pumping of blood into the heart.
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“All these can lead to stoppage of the heart suddenly, which is usually referred to as heart attack. That is the major risk that we have in consumption of high trans fat.”
    
According to “MAPPING OF INDUSTRIALLY-PRODUCED TRANS-FATTY ACIDS (iTFA) IN NIGERIA: A report on sources and replacement solutions for iTFA in Nigeria”, published in March 2020, there are limited data on the burden of TFA in Nigeria. 
   
It noted: “The risks associated with iTFA consumption are, however, largely known and recognised. In 2010, an estimated 1,300 Nigerians were reported to have died as a result of high TFA intake, and the mean TFA intake was 0.9 per cent of total energy intake. 
    
“The negative effects of TFA on the health of humans far outweigh the benefit it offers in terms of increasing the shelf life of processed foods and other associated sensory properties. Evidence exists that TFA raises LDL ‘bad cholesterol, triglycerides and insulin levels and reduces HDL/ ‘good’ cholesterol.” 
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According to another document titled “Trans Fat-Free by 2023: CASE STUDIES in Trans Fat Elimination”, “TFAs were once touted as a healthier replacement for Saturated Acids (SFAs) when the health harms of SFAs, including increased blood cholesterol and CVD risk, became known. However, evidence has become clear that TFAs provide no nutritional benefits and are even more harmful than SFAs in increasing CVD risk. TFAs increase CVD risk by increasing the ratio of ‘bad’ LDL cholesterol to ‘good’ HDL cholesterol, promoting inflammation, and causing dysfunction in the lining of the heart and blood vessels. In fact, consumption of 5 grams of TFAs per day has been shown to increase the risk of CVD by 29 per cent. Globally, more than 500,000 deaths each year are due to the consumption of TFAs. TFAs have shown to cause health harms even when they comprise only one-three per cent of total calories.”
    
According to another document titled “COUNTDOWN TO 2023: WHO REPORT ON GLOBAL TRANS FAT ELIMINATION 2020”, NCDs – including heart disease, stroke, cancer, and diabetes – kill 41 million people worldwide every year.    
    
It noted: “Diet-related risk factors are major drivers of preventable deaths due to cardiovascular disease. TFA, which is still used in some countries as an ingredient in fried food, deep-fried food, baked goods, and spreads, are linked with heart disease and death. But they can be completely eliminated and replaced with healthier oils and fats without changing the taste or cost of food.”
      
Has the association between trans-fat and cardiovascular diseases been established?
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Adeyeye said there were accounts from Denmark, which was the first country to make restrictions on industrially-produced trans fats mandatory that there was a dramatic decline in the trans-fatty acid content of their food products and cardiovascular disease deaths declined more quickly than in comparable developed countries. She said WHO also reported that an increased trans-fatty acid intake (greater than one per cent of total energy intake) is associated with coronary heart disease events as well as with mortality. The NAFDAC DG said when trans-fats are replaced with unsaturated fatty acids it decreases the risk of heart disease, partly, by ameliorating the negative effects that trans fats have on blood lipids.
   
On what NAFDAC is doing to curtail the use of trans fat in Nigeria, Adeyeye said: “With NAFDAC it begins with having the necessary regulatory framework and tools. In this case there has been a revision of the fats and oils regulations, which has set limits for trans-fat with the intention of ultimately eliminating trans-fat from the Nigerian food supply. This revised regulation which is currently going through the process of approval states that fats, oils, and other foods intended for human consumption which the content of trans-fat exceeds 2g per 100g of fat or oil are prohibited. 
     
“It also states that where a ‘trans-fat free’ claim is made on the label or in an advertisement, the content of trans-fat shall be less than 1g of the total fat or oil in the final product. The regulation further provides that for a food product that contains 2g of fat or more per 100g of the final product, the nutritional label shall indicate the types and levels of each of the fat components in the product as saturated fatty acids, trans-fatty acids, and cholesterol.”
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Adeyeye said the pre-packaged food labeling regulations have also been revised (awaiting approval) and has made nutrient declaration mandatory for all pre-packaged foods. This means that there will be a declaration on food labels regarding the amount or type of fatty acids contained in the food, this includes the amount of trans fatty acid in gramme. 
    
She said both regulations: Pre-Packaged Food (Labelling) Regulations 2020 and Fats and Oils Regulations 2020 are awaiting approval and gazetting. 
“Our food laboratory is also gearing up in terms of capacity to carry out the necessary analysis to identify the presence of trans-fat in food products,” Adeyeye said.  
   
Is there any legislation against trans-fat in Nigeria? If no, do you recommend one? If yes, how far? Adeyeye said the NAFDAC Act Cap N1 LFN 2004 places the mandate of regulating and controlling the manufacture, importation, exportation, distribution, advertisement, sale and use of food on NAFDAC and so this covers issues such as ensuring that only safe, good quality, wholesome and nutritious food is sold. “Regulations are subsidiary legislation and we have carried out a revision of the relevant regulations pertaining to trans-fatty acids,” she said.
      
Are there healthy local alternatives to trans-fat in Nigeria? Adeyeye said: “I think what we are speaking of here is reformulating to achieve products with healthier oils and fats which are free of industrially-produced trans-fat. There are indeed possibilities for assisting industry through technology transfer to know how to replace partially hydrogenated oils (PHO) with non-PHO solutions using different methods and locally available starting materials like palm oil, palm kernel, coconut, and shea nut.”
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On what the NHF is doing to curtail the use of trans fat in Nigeria, Akinroye said, “Yes, Nigerian Heart Foundation is collaborating with NAFDAC towards the regulation of iTFA in Nigeria through the Nigeria Heart Foundation Heart Mark Food Labelling Programme.” 
     
He said the NHF is also engaging with other Organisations like Network for Health Equity and Development (NHED), Corporate Accountability and Public Participation Africa (CAPPA), Standard Organisation of Nigeria (SON), Nutrition Society of Nigeria (NSN), Nigerian Institute for Medical Research (NIMR) Yaba, Nigerian Institute of Food Science and Technology (NIFST), SUN Business Network (SBN)/Global Alliance for Improved Nutrition (GAIN) and Nigerian Medical Association (NMA) towards regulation/elimination of iTFA in the Nigerian Food Supply Chain.
    
The cardiologist said: “There is no legislation against trans fat in Nigeria.”
    
Are there healthy local alternatives to trans fat in the country? Akinroye said: “Yes there are, these alternatives include naturally stable oils such as corn, palm, peanut, sunflower, canola, and soybean oils.”
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Meanwhile, experts are optimistic that the review of the 2005 Fats and Oils Regulation by NAFDAC is a step by the government towards eliminating trans fat in Nigeria. The recently reviewed and published Regulation – the Fats and Oils Regulation, 2019 covers all foods containing fats and oils which are manufactured, exported, imported, advertised, sold, distributed and used in Nigeria. It clearly prohibits anyone from performing these actions where a product or food containing fats and oils is concerned unless such has been duly registered as prescribed in the Regulation.
    
The Guardian investigation revealed a high level of ignorance on trans fat and its association with heart failure and other chronic diseases. Over 95 per cent of people interviewed do not have any knowledge of trans fat. Visits to local markets and supermarkets showed that even the branded vegetable oils do not have any information pertaining to trans fat on their labels.
   
Also, hospitals visited do not have specific programmes on trans fat. Except for cardiologists, general practitioners do not have adequate knowledge of trans fat.
    
The Guardian investigation revealed that a major challenge to the elimination of trans fat in Nigeria that ought to be clearly addressed in the Regulation is the sale of unbranded cooking oils. The Regulation lays emphasis on packaged products or food containing fat and oils but it does not clearly address unpackaged/unbranded-cooking oils, which are easily accessible to so many Nigerians. 
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Stakeholders recommend nationwide mass education on trans fat and the health implications. They insist that specific provisions addressing this, strict implementation procedure and appropriate penalties for erring vendors must be in place to achieve the goal of eliminating trans fat in Nigeria.
    
Meanwhile, Adeyeye, Akinroye, Afolabi, and other stakeholders are optimistic that the deaths of Okoya, Osondu, and many others, which are part of the estimated 110,000 Nigerians and 500,000 people who die every year globally due to heart failure and 64.3 million patients with the condition worldwide, be prevented and averted with proper regulation and legislation against iTFAs. 
   
It is hoped that the success in Denmark, which was the first country to make restrictions on industrially-produced trans fats mandatory, could be replicated in Nigeria starting with the approval and implementation of NAFDAC’s Pre-Packaged Food (Labelling) Regulations 2020 and Fats and Oils Regulations 2020. 

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