iii

Abstract

This review investigates trans fats, specifically industrial Trans fatty acids (TFA), in this review
we examined their formation, impact on human health, and global responses, and also we
focused on the strategies employed in African countries to address this public health concern.
Our methodology involved a comprehensive analysis of a minimum of 20 journal articles and
online reports for relevant data. This review has established that TFA is primarily formed during
the hydrogenation process, contributing to various health issues such as cardiovascular diseases,
diabetes, coronary heart disease, inflammation, and obesity, Mitigation strategies encompass
legislative actions, compliance enforcement with relevant laws and regulations, awareness
campaigns emphasizing the adverse effects of trans fats, and the implementation of regulations
governing food product labelling it is also observed that, due to the severe health risks associated
with trans fats, especially industrial trans fats, countries must implement strategic measures to
eliminate their production and consumption.

Keywords

Trans fatty acids (TFA), hydrogenation, healthy effects, elimination, stakeholders

Table of Contents

Abstract iii

List of Figures v

Abbreviation and symbols vi

2. Introduction 1

3. Chemistry of Trans Fats (TFAs) 3

3.1. Figure 1. Chemical Structure of some major Trans Fatty Acids (Gashaw & Getasetegn,
2018) 3

3.2. Figure 2: Chemical structures of common Trans fatty acids (Hirata, et al., 2023) 3

4. Health Implications of Trans Fats 3

4.1. Trans fats adversely affect lipid profile & and lipoproteins 4

5. Responses to mitigate the effects of Trans fats 4

5.1. Global Strategies 5

5.1.1. Review Dietary Sources 5

5.1.2. Promote Replacement: 5

5.1.3. Enact Regulatory Actions 5

5.1.4. Assess and Monitor 6

5.1.5. Create Awareness 6

5.1.6. Additional efforts by several countries to reduce or eliminate Trans fats 6

6. Conclusion 9

7. References 10
List of Figures

Figure 1. Chemical Structure of some major Trans Fatty Acids (Gashaw & Getasetegn, 2018) 2

Figure 2: Chemical structures of common Trans fatty acids (Hirata, et al., 2023) 3

Abbreviation and symbols

TFAs

Trans fatty acids

TFA

Industrial Trans fatty acids

CVD

Cardiovascular diseases

MONO /MUTFA

monounsaturated Trans Fatty Acids

PUFTA

Polyunsaturated Trans Fatty Acids

CHD

Coronary heart disease

LDL

Low-density lipoprotein

HDL

High-density lipoprotein

UFA

Unsaturated Fatty Acids

SAFA

Saturated Fatty Acids

WHO

World Health Organization

MOHME

Ministry of Health and Medical Education

UAE
United Arab Emirates

NAFDAC

National Agency for Food and Drug Administration and Control

KSA

Republic of Saudi Arabia

FDA

Food and Drug Administration

>

Greater than

<

Less than

per

Introduction

Trans fatty acids (TFAs) constitute a collective term encompassing all unsaturated fatty acids
characterized by the presence of one or more isolated, non-conjugated double bonds in a trans-
geometric configuration. Specifically, those TFAs featuring only one unsaturated bond are
referred to as monounsaturated Trans Fatty Acids (MUTFA), while those with two or more
unsaturated bonds are denoted as polyunsaturated Trans Fatty Acids (PUTFA) (Dhaka et al.,
2011; Gashaw & Getasetegn, 2018).

The dietary sources of TFAs predominantly emanate from two origins: naturally occurring TFAs
synthesized by bacteria within the rumens of ruminant animals and artificial or industrial TFAs,
which are commercially manufactured through the hydrogenation or partial hydrogenation of
liquid vegetable oils to confer solidity or semi-solidity at ambient temperatures (Remig et al.,
2010; Laaninen, 2016). Over time, the consumption of TFAs has been linked to an escalated
susceptibility to cardiovascular diseases, obesity, insulin resistance, cancer, and inflammation,
among other health concerns (Pipoyan et al., 2021).
However, by acknowledging the adverse health implications associated with TFAs, global
initiatives have been instituted to curtail their consumption and bolster public health., to achieve
these several interventions were initiated such as the eradication of industrially produced trans
fats from the food supply chain which is achieved by the substitution with healthier oils and fats,
the introduced initiatives and interventions are underpinned by comprehensive policy
frameworks, regulations, effective monitoring systems, and the dissemination of awareness
among pertinent stakeholders, including policymakers, the food industry, and consumers (WHO,
2018; WHO, 2019) one good example is an action taken by the e World Health Organization
(WHO), it introduced the REPLACE action package in 2018, also advocating heightened
awareness of TFAs and their health ramifications, coupled with the promotion of healthier fats
and oils.

As of today, several nations have proactively implemented regulations to eliminate industrial

TFAs. A good example worth acknowledgement is South Africa, where regulations mandate the
disclosure of trans-fat content on food labels and restrictions on industrial TFAs. Similarly, also
here in Malawi, the government instituted nutritional guidelines aimed at mitigating the burden
of non-communicable diseases, including limitations on the consumption of TFAs (Trijsburg,
Ulimwengu, & Domgho, 2021; Republic of South Africa, 2007). Another nation that is also
striding is Nigeria, it has imposed restrictions on the TFA content in foods intended for human
consumption, which is a huge success in limiting it to approximately 2 grams per 100 grams. The
other country is Kenya, this country has set a target to replace TFA intake to less than 1% of
energy consumption, substituting it with unsaturated fatty acids (GAIN, 2020; WHO, 2017).

Based on this background, therefore this review article will delve into the chemistry
underpinning the formation of TFAs, their implications for human health, global responses
aimed at eradicating their consumption, and the specific measures undertaken or underway in
African nations to mitigate their adverse effects.
Chemistry of Trans Fats (TFAs)

Trans fats encompass all the geometrical isomers of monounsaturated and polyunsaturated fatty
acids characterized by nonconjugated carbon-carbon double bonds, interspersed by at least one
methylene group, arranged in a trans configuration. This configuration is typically induced
through the hydrogenation process, wherein hydrogen atoms are added to unsaturated fats
(Chopra et al., 2021). This chemical transformation impacts the spatial orientation of hydrogen
atoms surrounding the double bonds within the fatty acid molecules. Consequently, in the trans
configuration, the two hydrogen atoms flanking the double bond assume opposite directions,
diverging from the cis configuration where these hydrogen atoms align in the same direction
(Oteng & Kersten, 2019).

The Food and Drug Administration (FDA) defines Trans fats as unsaturated fatty acids
containing one or more double bonds with a trans configuration of hydrogen atoms attached to
sp2 carbons. Prominent examples of major or common Trans fatty acids encompass elaidic acid,
palmitelaidic acid, vaccenic acid, oleic acid, linoleic acid, and linoelaidic acid, among others
(Gashaw & Getasetegn, 2018) and (Hirata et al., 2023), as illustrated in Figures 1 and 2.

HO

elaidic acid

HO

palmitelaidic acid

HO

vaccenic acid
O

HO

trans linoleic acid

Figure 1. Chemical Structure of some major Trans Fatty Acids (Gashaw & Getasetegn, 2018)

Figure 2: Chemical structures of common Trans fatty acids (Hirata, et al., 2023)

Health Implications of Trans Fats

The negative impact of trans fat consumption on human health is a cause for genuine concern, as
illuminated by recent research. Suárez et al. (2023) underscored the plain association between
heightened trans fat intake and cardiovascular diseases (CVD), a cluster of afflictions ranging
from hypertension to vein diseases. Unhealthy dietary habits, particularly the irresistible allure of
red and processed meats, significantly contribute to elevated trans fat levels, thereby fostering an
environment ripe for cardiovascular system failure.

In a compelling review, Salemi et al. (2023) revealed a moving connection between trans fats
and cancer development. The literature eloquently substantiates the notion that trans fats act as
catalysts for inflammation and oxidative stress, key elements in the intricate ballet of cancer
progression. The study notably exposed an augmented risk of colorectal cancer intricately
entwined with dietary trans fatty acids.

Turning to the internal workings of the human body, Inaishi and Saisho (2020) brought forth a
disconcerting perspective on the potential repercussions of heightened trans fat consumption on
pancreatic beta cells. Their findings, laden with concern, unveiled a disconcerting correlation
between an increase in pancreatic fat accumulation and a perilous escalation in the risk of type 2
diabetes.

Ge et al. (2018) delved into the esoteric realms of the underlying mechanisms linking trans fatty
acids to chronic diseases. Their study unearthed the imbalance induced by trans fatty acids in gut
microbiota composition. The despicable consequence is an amplification in the abundance of
'harmful' bacteria, including Proteobacteria and Desulfovibrionaceae, coupled with a diminution
in 'beneficial' bacteria like Bacteroidetes, Lachnospiraceae, and Bacteroidales – a symphony of
imbalance precipitating chronic diseases.
Also, Islam et al. (2019) painted a vivid portrait of trans fats wreaking havoc. Their study,
heightened LDL: HDL ratios, Apolipoprotein B: Apolipoprotein A (apoB:apoA) ratios, and
elevated cholesterol content in both LDL and HDL particles, dwarfing the comparative impact of
saturated fats. These harmful outcomes paint a bleak canvas, weaving a narrative of heightened
risks for atherosclerosis and coronary heart disease (CHD). Notably, trans fats are architects of
change in the size and composition of apoB 100-containing lipoproteins, adding an ominous
layer to their detrimental profile.

Trans fats adversely affect lipid profile & and lipoproteins

Trans fatty acids (TFAs) exhibit a correlative relationship with augmented low-density
lipoprotein (LDL) to high-density lipoprotein (HDL) ratios, an elevated Apolipoprotein B to
Apolipoprotein A (apoB:apoA) ratio and increased cholesterol content within both LDL and
HDL particles when juxtaposed with saturated fats. These observed lipid profile alterations
consistently align with an elevated susceptibility to atherosclerosis and coronary heart disease
(CHD). Furthermore, TFAs are implicated in the perturbation of the size and composition of
apoB 100-containing lipoproteins, as delineated in the study conducted by Islam et al. (2019).

Responses to mitigate the effects of Trans fats

The successful eradication of industrially-produced trans fats in high-income countries has been
attributed to a multifaceted approach involving various policies. These encompass mandated
trans-fat labelling, public education campaigns, collaborative efforts with the industry to
reformulate products, as well as national and local regulations and bans on elevated levels of
trans fats (Euromonitor International, 2015; Mozaffarian & Stampfer, 2010). These regulatory
measures extend globally, with particular emphasis on addressing the trans-fat issue in African
countries.

Global Strategies

In 2018, the collaborative initiative between the World Health Organization (WHO) and
Chatham House culminated in a pivotal meeting involving major multinational food
corporations, as well as manufacturers of edible oils and fats. The primary objective was to
establish a framework of expectations for industry commitments towards the elimination of
industrially-produced trans fats. This resulted in the formulation of an extensive action package
termed REPLACE, which articulates a multifaceted approach to address the complex challenges
associated with trans fat reduction. The salient features of the REPLACE action package are
expounded below:

Review Dietary Sources

Stakeholders were charged with the responsibility of conducting a comprehensive mapping and
assessment of dietary sources of industrially-produced trans fats. This entailed identifying major
sources within the broader food sector (e.g., packaged food, street food) and specific food
categories (e.g., confectioneries, fried snacks).

Promote Replacement:
The mandate included providing informed recommendations for the replacement of commonly
used fats and oils containing trans fatty acids with healthier alternatives. This necessitated a
thorough assessment of the opportunities and barriers associated with trans fatty acid
elimination. Stakeholders were also expected to offer technical assistance to small- and medium-
sized enterprises, engage existing government structures supporting agricultural businesses,
eliminate subsidies, enforce nutrition labelling, ensure the procurement and use of products
containing healthy fats in public institutions, and elevate consumer awareness on discerning
products with healthier oils and fats.

Enact Regulatory Actions

Stakeholders were enjoined to enact legislative and regulatory measures aimed at the elimination
of industrially-produced trans fats. This involved the imposition of mandatory limits on trans fats
as a percentage of total fats, exemplified by thresholds such as less than 2 g/100g of total fat or
oil in all foods. Additionally, the action package called for a categorical ban on partially
hydrogenated oils within the existing regulatory framework, necessitating amendments to
classify such oils as inherently unsafe.

Assess and Monitor

Expectations encompassed the identification of principal dietary sources of trans fats, the
development of a meticulous monitoring system for trans fatty acids (TFA) and saturated fatty
acids (SAFA) in key food categories, and the establishment of a publicly accessible database
housing TFA and SAFA nutrient label data alongside laboratory-analyzed TFA and SAFA acid
content.

Create Awareness

Stakeholders were tasked with intensifying awareness initiatives targeting policy-makers,

producers, suppliers, and the general public regarding the deleterious health impacts of trans
fatty acids. This entailed a commitment to and active advocacy for trans fatty acid elimination.
Strategies included public education on how to discern trans fatty acids in product labels,
supporting and showcasing research elucidating the health and economic benefits of eliminating
trans fatty acids, and disseminating information on trans fatty acid levels in food, as well as trans
fatty acid intake.

Enforce Compliance

The final expectation emphasized the imperative of clearly defining and enforcing penalties for
products that contravene established regulations. Stakeholders were encouraged to develop a
robust compliance monitoring system to support the legislative framework and assessment
mechanisms.

This comprehensive strategy, epitomized by the REPLACE action package, reflects a concerted
global effort to combat the pervasive health hazards associated with trans fats. A notable real-
world manifestation of this commitment is observed in the actions of the Food and Drug
Administration (FDA). On June 18, 2018, the FDA officially banned the use of trans fats, or
partially hydrogenated oils, in all foods sold in American restaurants and grocery stores, marking
a significant milestone in the pursuit of public health and safety (Thakar, 2018).

Additional efforts by several countries to reduce or eliminate Trans fats

Efforts to abate the health risks posed by industrially-produced trans fats (TFAs) have
engendered a plethora of regulatory and strategic interventions on a global scale. In North
America, Canada, and South Korea, the implementation of TFA labelling, as detailed by Downs
et al. (2017), has evidenced a discernible reduction in Trans fatty Acid levels in consumable
goods. Canada, for instance, fortified its regulatory arsenal by introducing mandatory TFA
labelling in 2002. Stringent stipulations mandated foods to exhibit low saturated fatty acids
(SAFA) and TFAs, with thresholds set at <2g of SAFA and TFAs combined per reference
amount and serving size and <0.2g of TFAs (Heartfile Organization, 2019).

India's endeavours are epitomized by government initiatives, employing a multifaceted approach

encompassing stringent regulations to ensure the availability of TFAs-free or low-TFA products.
This comprehensive strategy is orchestrated through policy frameworks, stakeholder
engagement, awareness campaigns, and the dissemination of information elucidating the adverse
effects of TFAs (Singhal, 2021). Denmark, in tandem with its commitment to TFA reduction,
enacted legislation in 2003, imposing limitations on artificial TFAs to 2g/100g of fat or oil in all
food products. This legislative framework further mandated that products claiming to be 'free
TFA's must contain less than 1g/100g of the individual oil or fat (Heartfile Organization, 2019).

Argentina, in 2008, adopted stringent regulations underscoring the limitation of industrially

produced TFAs in food to <2% of total fats in vegetable oils and margarine and <5% of total fats
in other food categories (Heartfile Organization, 2019). Iran, through its Ministry of Health and
Medical Education (MOHME), devised a comprehensive plan incorporating negotiations with
food processing entities to restrict TFA percentages, public education campaigns elucidating the
adverse health effects of TFAs in processed foods and edible oils, and the establishment of a
national committee for TFA reduction (Heartfile Organization, 2019).

Pakistan, acknowledging the imperative of regulatory oversight, introduced the Punjab Pure
Food Rules in 2011, targeting the regulation of the production and import of vanaspati ghee,
margarine, and other oil products. The national plan aspires to curtail the prevalence of TFAs in
edible oils and fats to <2% by the year 2023 (Tarar et al., 2020; Rashid et al., 2020). In Palestine,
a mandatory amendment in 2021 dictated restrictions on TFA content to 2g/100g in prepared
foods. Concurrently, the National Nutrition Policy accentuated awareness campaigns advocating
for the reduction of TFA intake (Ministry of Health, 2016, 2019, and 2021).

Qatar, as part of its National Strategy for the Health Sector (2018–2022), set ambitious targets to
diminish TFA intake to <1% of energy intake. Furthermore, an initiative in 2019 aimed at the
reduction of fat, sugar, and salt consumption included voluntary targets for TFA levels in foods
and snacks (Ministry of Public Health, 2016). The United Arab Emirates (UAE) meticulously
articulated a government initiative in 2017 specifying a maximum TFA level of 2% in vegetable
oils and soft spreadable portions of margarine, and 5% in all other foods, including ingredients
sold to restaurants (WHO, 2015).

Countries such as Bahrain, Kuwait, Oman, Jordan, Iraq, Brazil, Chile, Peru, Mexico, China,
South Korea, Malaysia, Puerto Rico, and Singapore have implemented an array of measures to
address TFAs, ranging from mandatory labelling and bans on specific ingredients to stipulations
on TFA content in foods. This diversity of strategies underscores the global commitment to
mitigating the health ramifications of trans fats.

In Africa, regulatory initiatives to mitigate TFA risks are underway in countries like South
Africa, Nigeria, Malawi, Morocco, and Egypt. South Africa, for instance, introduced Regulation
249 in 2011, restricting artificial TFA to 2g/100g of fat in all food products (Republic of South
Africa, 2007; Ottermann, 2011). Nigeria, in its quest to eliminate industrially-produced TFAs,
revised the Fats and Oils Regulations in 2005, limiting trans fat amounts in foods to
approximately 2g/100g of fat or oil (GAIN, 2020). Malawi, guided by nutritional guidelines, has
taken significant strides in restricting the intake of food groups and nutrients posing health risks,
including TFAs (Trijsburg, Ulimwengu, & Domgho, 2021).

Morocco, cognizant of the adverse health effects of TFAs, restricts TFA intake to 1% of energy
intake, coupled with the Ministry of Agriculture's endeavour to limit TFA content in oils and fats
to 2g/100g in specific products (WHO, 2015). Egypt, through the Ministry of Health, drafted a
roadmap for industrial TFA elimination, aspiring to replace TFAs with unsaturated fatty acids
(UFA) by 2017, aiming to reduce TFA intake to <1% of energy intake (WHO, 2017). These
comprehensive efforts underscore the nuanced and multifaceted approaches both globally and
within Africa to counteract the health risks associated with trans fats.

Conclusion

This review strongly exhumes that trans fats pose a significant threat to human health, and their
adverse effects on cardiovascular health and overall well-being are well-established. Global
efforts, such as the WHO REPLACE action package, emphasize the urgent need to eliminate
Trans fats from the food supply. In African countries, initiatives focusing on policy
implementation and public awareness are crucial steps toward reducing trans-fat consumption
and promoting a healthier population. Collaborative actions at both the global and regional levels
are essential to effectively mitigate the adverse effects of trans fats and improve public health.
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