Concerns over rising cases of cardiovascular diseases

•NHF, medical experts advocate review of national guidelines for food production
•Bow to pressure from WHO, FAO, EFSA, FDA on safety of palm oil derivatives for cooking
•Adopt new safety limit for palm oil derivatives, trans fat in food products, industries
•Set June 2024 deadline for certification, recertification of cooking oils as heart friendly
•Explain how to detect homemade, packaged foods with high level of salt before consumption
•Decry association of extra salt with hypertension, heart failure, stroke, heart attack

Worried by the rising cases of cardiovascular diseases in the country, especially hypertension, the Nigerian Heart Foundation (NHF), cardiologists and nutritionists have advocated review of national guidelines for food production.

They expressed concerns over a World Health Organisations (WHO) report that 76.2 million Nigerians are living with hypertension, which poses the highest cardiovascular disease burden.

Cardiovascular diseases are the leading cause of deaths globally. An estimated 17.9 million people died from cardiovascular diseases in 2019, of which 85 per cent were due to heart attacks and strokes. Eliminating trans fat is seen as an easy way to reduce the numbers.

The experts led by the NHF have also bowed to pressure by the WHO, European Food Safety Authority (EFSA) and United States Food and Drugs Administration (FDA) to readjust safety limit for foods containing palm oil derivatives/ Saturated Fatty Acids (SAFAs).

Consequently, the NHF has adopted new safety limit for palm oil derivatives in food products and set June 30, 2024 deadline for recertification of cooking oils as heart friendly. They also insist on zero limits for trans fat in foods.

They also decried association of added salt with hypertension, heart failure, stroke and heart attack, even as they explained how to detect cooked and packaged foods with high level of salt.

Cardiovascular diseases (CVDs) are a group of disorders of the heart and blood vessels. They include: coronary heart disease – a disease of the blood vessels supplying the heart muscle; cerebrovascular disease – a disease of the blood vessels supplying the brain; peripheral arterial disease – a disease of blood vessels supplying the arms and legs; rheumatic heart disease – damage to the heart muscle and heart valves from rheumatic fever, caused by streptococcal bacteria; congenital heart disease – birth defects that affect the normal development and functioning of the heart caused by malformations of the heart structure from birth; and deep vein thrombosis and pulmonary embolism – blood clots in the leg veins, which can dislodge and move to the heart and lungs.

According to WHO, heart attacks and strokes are usually acute events and are mainly caused by a blockage that prevents blood from flowing to the heart or brain. The most common reason for this is a build-up of fatty deposits on the inner walls of the blood vessels that supply the heart or brain. Bleeding from a blood vessel in the brain or from blood clots can cause strokes.

Trans fat, also called trans-unsaturated fatty acids, or trans fatty acids, is a type of unsaturated fat that occurs in foods. Trace concentrations of trans fats occur naturally, but large amounts are found in some processed foods.

A consultant cardiologist and Executive Director, NHF, Dr. Kingsley Akinroye, while speaking at a stakeholders meeting in Lagos, last week, with the theme, ‘Lipids and Cardiovascular Health,’ said: “We want Nigerians to live long, we wants Nigerians to live healthy and we want a productive population. In few years, quite a lot of our young executives have been dying suddenly.

“The commonest cause of sudden death is heart. We want everybody to be healthy. Right from the family to the policy makers, everybody has got responsibility.

“We know that the number one factor in heart disease is diet and commonest culprit in the diet is fat. Although salt is also there but fat is key.”

The participants at the stakeholders meeting were drawn from all the relevant agencies, academia, food industry, research scientists, university, government, regulatory agencies, organisations, and consumers among others.

According to Akinroye, in the last 15 years, the NHF has been working in Nigeria and has labelled some oils, which were heart friendly.

He said that even though NHF was an international organisation, it ensures some flexibility in the contents to fit Nigeria content.

The cardiologist said: “We review what we do every four years, the last time we did this was 2016 and so, now this is high time we fall into global standard.

“Most people here agreed they needed to live healthy and longer. To live longer, there are certain things we must do as individual and other things government and industry must do.

“Individuals should go take care of themselves and ensure that they check contents of foods and beverages they buy. Is it friendly, does it carry the logo of Nigerian Heart Foundation.

“Government must invest in this cause, in. what we are doing and ensure more partnership with us.”

Akinroye said Codex has the acceptable maximum limit for SAFA as 30g/100g of total fat in food products.

The Codex Alimentarius is a collection of internationally recognised standards, codes of practice, guidelines, and other recommendations published by the Food and Agriculture Organisation (FAO) and WHO of the United Nations relating to food, food production, food labeling, and food safety.

He, however, said American Heart Association, 50 years ago recommended the criteria of 30g/100g of total fat as acceptable in food products. This was recently reviewed.

The cardiologist said the World Heart Federation (WHF), the parent international body of NHF, recently released the criteria on SAFA in line with Codex and recommended SAFA maximum limit of 30mg/100 of total fat in foods.

Akinroye said all country members of WHF, including Nigeria are expected to comply with the recommendations. Akinroye said NHF, since inception of the NHF Front of Pack Labelling in 2003, in collaboration with the National Agency for Food and Drug Administration and Control (NAFDAC), adopted the upper limit of SAFA as 36g/100g of total fat acceptable to all products permitted to carry NHF Heart Mark Logo.

Akinroye, however, said there has not been clinical trials and supportive scientific evidence to back up the position of NHF over the last decade. “Unfortunately, research institutes, universities, oil manufacturing industries in Sub- Saharan Africa, where palm oil is majorly consumed daily have consequently not responded to scientific research to support the need to review the acceptable criteria,” he said.

The cardiologist said NHF has now made a position statement to adopt the acceptable level of SAFA of 30g/100g of total fat from June 30, 2024 for all food products to carry the NHF Heart Mark Logo, and total trans fat of zero (0.00) limit for certification or recertification.

On the implication of added salt in cardiovascular diseases, Akinroye said there are few studies in Nigeria that have shown high levels of salt consumption in homemade foods but not on fast foods.

The cardiologist said the implications of excess salt consumption is high level of mean blood pressure in individuals consuming high sodium content, and also leading to increased association with hypertension, heart failure, stroke and heart attack.

On how to check the level of salt in foods, Akinroye said: “For consumers it is advisable to check the content of sodium in all food items purchased. To promote easy identification of food with high contents of sodium; Nigerian Heart Foundation has been promoting the front- of – pack labelling programme in partnership with NAFDAC since 2003 in Nigeria. Products that participates in the programme and that fulfill the criteria carry NHF Heart – Check logo indicating the products fulfill the acceptable criteria.”

Akinroye said there are healthier alternatives like using herbs, and natural food products that could give the food a friendly taste.

Chairman Executive Council, NHF, Dr. Femi Mobolaji-Lawal, while speaking at a stakeholders meeting in Lagos, last week, said studies have shown that since the onset of COVID-19 in the country, people living with cardiovascular diseases, amongst other Non-Communicable Diseases (NCDs) were significantly affected and died from COVID-19.

Mobolaji-Lawal said statistics has shown that cardiovascular diseases pose a high burden on health systems; an increasing trend that can be controlled by making healthy food choices, among others.

Specifically, he disclosed that the Nigerian Policy and Strategic Plan of Action on NCDs, a Federal Ministry of Health document, proposes to look at different ways to manage NCDs, a rising cause of morbidly and mortality in the country.

To this end, he disclosed that in recognition of the rising prevalence of cardiovascular diseases in the country and the importance of prevention strategies is co-organising with World Heart Federation in March this year a “National Roundtable Discussion” on cardiovascular diseases, which is to focus on hypertension.

In her speech, Director General, NAFDAC, Prof. Christianah Mojisola Adeyeye, disclosed that coronary heart disease deaths in Nigeria reached 53,836 or 2.82 per cent of total deaths, and are responsible for the greatest proportion of the total mortality due to NCDs.

Represented by her Special Assistant, Dr. Gbenga Fajemirokun, Adeyeye said there is critical need to pay more attention to meeting global standards with a view to promoting cardiovascular health in the country.

According to her, “the development of socio-economic space and increasing disposable income of Nigerians giving them freedom to fund their healthier food choices is expected to influence the regulatory bodies in the long run. This would avoid adverse impact on widening of the socio-economic gaps and ensure closing of such gaps and lessening of diseases of public health concerns.”

Also, the experts expressed worry over the increasing cardiovascular diseases and related death in Nigeria.

The experts called for national guidelines on production and consumption of foods and beverages.

The scientists agreed that diet remained the commonest risk factor in the cardiovascular diseases.

Chairman of occasion and a former two-term Head of Department, Human Nutrition, University of Ibadan, Prof. Rasak Sanusi, stressed the importance of controlled and regulated diet to enhance cardiovascular health.

“There is a need for the development of a national guidelines for production and consumption of healthy foods with acceptable lipid concentration based on global standard and best practices.

“The quality of life cannot be described to what it was 10 or 15 years ago.

“There is a difference between feeding and eating. Eating is what human beings do and feeding is what animals do.

“The difference between them is choice. When we have choices of what we eat then we are eating.

“On the other hand, when choices are removed, we are only feeding. With this definition today, I wonder how many of us in Nigeria are actually eating,” Sanusi said.

Calling for the re-examining of the role of each of the stakeholders, Sanusi said that Nigerians should be informed about their cardiovascular health.

He pointed out the expectations for the meeting include examination of the increase in the cardiovascular diseases in Nigeria, the main risk factor, and to identify guidelines and focus on research agenda.

Mobolaji-Lawal added: “Ultimately, what we consume affect out health. What we consume has direct relationship with our cardiovascular system, especially our heart.

“We know that what we consume, especially the Lipid affect our heart.”

Mobolaji-Lawa said that the multi sectorial meeting had become necessary to review evidence of what was happening globally and experience Nigeria, to guide policy markets and activities.

He emphasised the need to disseminate information to the people especially consumers.

Also speaking, President of Non-Communicable Diseases (NCD) Committee, Dr. Olorogun Sonny Kuku, decried low life expectancy in Nigeria, saying cardiovascular diseases accounted for a lot of deaths in the country.

Describing the meeting as appropriate, Kuku said: “In this part of the country, we love lipids. Lipids need to be controlled and when controlled, life expectancy can be raised to 80 year.”

Doing an overview, Director, Scientific Affairs, NHF, Prof. Isaac Adeyemi, said that the objective was for update on the current global and national status lipid concentration and profile in foods and beverages as well as the potential impacts of food on cardiovascular health.

Adeyemi said that the goal was to ensure that Nigerians live a healthy live, “that will ensure or reduce the increasing rate of cardiovascular diseases in this country.”

Urging the consumers to select heart health options, the professor stressed the need to invest in monitoring and surveillance mechanism such as laboratory capacity to measure Trans Fatty Acids (TFA) content in foods.

On challenges, he said that foods and beverages being consumed must align with global health standards, saying, “It is important that food industry strives as much as possible to meet national, regional and global standards.

Adeyemi also stressed the need for early warning system that would involve scientist, academia, and government agencies in curbing the rising incidence.

He added: “Consumers must read the nutrition facts on food products. Industry should replace trans fats in processed food as soon as possible and where feasible with healthy alternatives.

“The consumers must be stimulated should consume fish as part of healthy diet.”

Adeyemi emphasised the need for the experts to sensitise not only the public but also the government and industries about the important of having healthy foods devoid of trans fats and unhealthy fatty acids.

“Also, we must sensitise the public on the issue of point of package labeling.

“This is very important. As an individual and a country, consumers should be aware of the importance of point of package labeling.

“This will make them to identify the nutritional value of any food materials being purchased,” he added.

Meanwhile, a professor of chemical engineering at the Tan Sri Omar Centre for Science, Technology and Innovation Policy Studies, UCSI University, Kuala Lumpur, Malaysia, Dr. Ahmad Ibrahim, said: “It was in the early 1990s when it became clear that trans fat was the real culprit behind the rise in cardiovascular diseases around the world. Prior to that, saturated fats were always the bad boy.

“When scientists found out that trans fat was more deleterious, the news shocked the world’s oils and fats trade.

“The United States Food and Drug Administration took some time before it came out with the necessary labelling rulings to warn consumers. There was hesitation in some countries, which fear the repercussions on the local edible fats business.

“The best practice on eliminating trans fat means either a mandatory national limit of 2g of industrially produced trans fat per 100g of total fat in all foods, or a national ban on the production or use of partially hydrogenated oils, which are a major source of trans fat.

“This is where palm oil offers clear benefits. Palm oil can be used in all such applications without undergoing partial hydrogenation. That piece of evidence alone sent world palm oil demand up beyond expectations.

“That also accounts for palm oil remaining as the leading edible oil in world trade. The WHO said nine of the 16 countries with the highest estimated proportion of coronary heart disease deaths caused by trans fat intake were not implementing best-practice policies.

“It was reported that 60 nations now have trans fat elimination policies, covering 3.4 billion people, or 43 per cent of the world’s population. The majority is largely in Europe and the Americas.

“Recently, WHO warned that five billion people are exposed to higher heart disease risks through trans fats. Back in 2018, WHO appealed for the unhealthy fats to be eliminated worldwide by 2023, amid evidence that it caused 500,000 premature deaths every year.”

Resolve to Save Lives president and former director of the United States Centers for Disease Control and Prevention (CDC), Tom Frieden, said: “There’s simply no excuse for any country not taking action to protect their people from this artificial toxic chemical. Only your heart will know the difference. You can eliminate artificial trans fat without changing the cost, taste or the availability of great food.”

Taking into account present developments, global elimination of trans fat is within reach, pointing to big countries like Nigeria and Mexico moving towards eliminating the use of trans fat. Experts are optimistic that the world can make trans fat history.

“And palm oil can play that saviour role. Who would have guessed that palm oil, which was heavily demonised before, is now a darling among consumers who want to avoid taking trans fat.

“Nature does work in mysterious ways, turning the table around in palm oil’s favour,” Ibrahim said.