Nutrition | Strategy/policy | Policy statement and recommended actions for reducing fat intake and lowering heart attack rates in the Eastern Mediterranean Region

Policy statement and recommended actions for reducing fat intake and lowering heart attack rates in the Eastern Mediterranean Region

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Policy goals

  1. Eliminate all industrially produced trans-fats from the food supply;
  2. Reduce markedly the saturated fat content of the food supply.

Rationale

Trans-fat (TFA) from industrial refining is toxic to the heart and may increase the risk of diabetes: it needs to be eliminated. Saturated fat (SFA), together with smoking, is the major risk factor for heart disease and stroke. WHO recommends that populations should not exceed the consumption of 10% of energy from SFA, and 1% from naturally occurring TFA. In addition, WHO notes that intakes from total fat range between 10% and 35% of total energy intake. Evidence shows an association between fat intake and the increased likelihood of weight gain and obesity and therefore of diabetes. Traditional Middle East diets are very low in fat content. As fat content has risen so has the prevalence of obesity/diabetes, resulting in an epidemic which is more serious than in any other region in the world.

An overview of national policies has concluded that the most effective way of ensuring a significant fall in TFA intakes is by legally prohibiting the sale of food products containing industrially produced TFA. In practice, highly effective legislation (such as that in Austria, Denmark, Iceland and Switzerland) indicates a limit of 2 g/100 g of oils or fats[1].  The voluntary reduction approach taken by some countries requires a solid and sustainable monitoring system and has not been proven to be as effective. It is evident that in countries of the Region there are local oil refining companies which could rapidly be required to eliminate the production of TFA, e.g. when producing local ghee or margarine. If a sales ban is implemented, import of products that do not comply with it may also be prohibited without infringing international trade agreements. This is important in a region where food imports often comprise a substantial proportion of the national food supply. It is also important to advise oil producers and traders to increase the content of polyunsaturated fatty acids (PUFA) and not to increase the content of SFA in the process of TFA elimination. Experience in this direction has been gained in Singapore.

The reduction of the dietary intake of SFA has been remarkably successful in bringing down deaths from coronary heart disease and stroke, by as much as 85%, in Finland. Reducing SFA requires a good understanding of the food chain within a country. For example, in Finland 19 government initiatives involved all sectors of the food chain, from local production to government purchase of food and import policies. It did not rely on health education alone.

In countries of the Eastern Mediterranean Region, there is a substantial opportunity to reduce SFA intake by introducing policies that discourage the use of products containing palm oil and coconut oil and that encourage the sale and consumption of products containing other vegetable oils with less SFA and more unsaturated fats. Current international trade prices are lower for palm oil so financial adjustments would be needed. The current oil subsidy policy should be revised to promote the sales of oil products containing less SFA.

If cow’s milk and its products are widely used in a country, policies to establish the routine use of semi-skimmed or low fat milk (with fat content of 1–1.8%) are highly effective measures for reducing national SFA intakes. Animal producers should be encouraged to use feeds containing more unsaturated fat (e.g. canola oil), which is then reflected in the fat content of meats such as chicken. Actions to encourage such changes include pricing policies, the establishment of food quality standards to guide purchases in public institutions, and labelling (including front-of-the-pack labels, easily understandable traffic light systems, and healthy option symbols). Government procurement policies should move progressively to the purchase of only exclusively healthy, low fat, low SFA, low salt and low sugar products, together with training of all caterers and food producers.

Suggested actions to reduce trans-fats

Phase 1: January 2014

  1. Establish a national taskforce on fats representing key stakeholders and partners.
  2. Introduce legislation to ban the sale, and therefore local production and importation, of products containing artificially produced TFA (in oils and fats alone or part of processed food products) in shops and catering outlets. Legislation would need to establish the maximum content of all TFA in products (max. 2 g/100 g of oils).
  3. Identify processed foods rich in artificial TFA and determine the average population intake of these foods.
  4. Recommend that replacement fats used do not increase the saturated and total fat content of the foods; mechanisms will need to be established to monitor compliance with the recommendations.

Phase 2: June 2014

  1. Require food importers to have all imported foods certified as free of artificially produced TFA.
  2. Monitor compliance with national food standards and establish measures for non-compliance; i.e. consider sanctions for non-compliers. Certification of compliance with the TFA legislation for procurement of foods in government establishments will have a major beneficial impact.

Phase 3:  January 2015

  1. Adequately inform consumers of the importance of elimination of TFA in diets and of the measures taken to support these goals, and engage civil society organizations in supporting the measures taken.
  2. Provide incentives in the form of public support for product reformulation and information to the public about compliers and non-compliers.

Suggested actions to reduce saturated fats

Phase 1: January 2014

  1. Develop national standards to limit the use of palm and coconut oil in the food industry.
  2. Develop national standards to ensure lower SFA content of dairy products.
  3. Require government establishments to provide only semi-skimmed (1.0–1.8% fat) milk and ensure such milk is sold to consumers at a lower price than full cream milk.
  4. The Ministry of Agriculture/Food may help local dairy businesses to develop milk skimming facilities.
  5. Negotiate and review standards for livestock to reduce SFA content of meats through changes in feed and husbandry systems[2].
  6. Negotiate and review standards for vegetable oils and ghee such that total SFA content is less than 10%.

Phase 2:  June 2014

  1. Ensure that all foods purchased by government establishments comply with the new standards for SFA content of 
  2. Study measures to favour import of fats, oils and processed foods containing less SFA over import of such items with higher SFA content.
  3. Reconsider policies to assist the production of fats and oils so that varieties with lower SFA content are made more economically viable.
  4. Reconsider social support policies (e.g. subsidies to food purchases) to favour oils and fats with low SFA.

Phase 3: January 2015

  1. Consider establishing a differential taxation system so that the consumer price of products with a reduced SFA content is lower than the same products with a higher SFA content.
  2. Establish mandatory labelling schemes for SFA content that are easily understandable for most consumers (e.g. traffic light system) and/or consider the establishment of a “low SFA” label.
  3. Adequately inform consumers of the importance of reduction of SFA in diets and of the measures taken to support these goals, and engage civil society organizations in supporting the measures taken.
  4. Develop or enhance policies to encourage replacement of palm and coconut oils with a high SFA content with better oils, e.g. corn, soya, olive or sunflower oils, by:

a) replacing palm/coconut oils with more suitable oils in all government subsidy schemes;

b) markedly limiting imports of palm oil by changing import policies/duties on health grounds, based on national financial analyses of best options.


[1] Downs SM, Thow AM, Leeder SR. The effectiveness of policies for reducing dietary trans fat: a systematic review of the evidence. Bulletin of the World Health Organization. 2013;91:262–9H.

[2] Negotiations need to be with the livestock industry, private sector, Ministry of Trade and Ministry of Agriculture.

Statistics and figures

WHO has several nutrition-related global databases. They include data for countries in the Region. Please click on the links to access them.

Vitamin and Mineral Nutrition Information System

WHO Global Database on Body Mass Index

WHO Global Database on Child Growth and Malnutrition

WHO Global Data Bank on Infant and Young Child Feeding

Some nutrition-related data from the Regional Health Observatory:

Estimates of anaemia in non-pregnant women of reproductive age

Anaemia in preschool-age children

Trend estimates for under 5 child malnutrition: