SUMMARY AND
CONCLUSION
E
5. SUMMARY AND CONCLUSION
Developing countries like India are undergoing rapid nutrition and lifestyle
transition. Owing to the hectic schedules and busy lifestyle there is a clear shift
from a traditionally healthy high fibre, low fat diet coupled with active lifestyle to
a mechanized lifestyle with calorie dense, high fat diet which is specifically high
in trans fatty acids, mainly coming from vanaspati. There is a significant and
growing body of evidence linking trans fatty acids (TFA) to obesity, insulin
resistance, type 2 diabetes mellitus, coronary heart disease, infertility,
complications during pregnancy, cognitive decline, certain types of cancers,
asthma and allergies as well as adverse effects on foetal/ infant development,
indicating that the TFA may harm even more than saturated fats. Due to their
deleterious health effects, TFA are being removed from the food supply by the
developed nations. However, in the developing world, including India, not much
work has been done in this regard. Further, due to the lack of awareness regarding
the formation of TFA in foods and their adverse effects on human health, the TFA
containing fats/ oils still continue to rule the palate, by being an integral part of
many of the mouthwatering foods.
In view of paucity of data relating to trans fatty acids in Indian scenario, the
present study has been carried out to estimate the TFA content of fats/ oils, study
the formation of TFA in heated/ re-heated oils as well as analyzing the TFA
content of some fried/ baked/ dairy food items commonly consumed in Indian
households. Using the laboratory analyzed values of TFA, the study further aimed
to assess the dietary intake of TFA by women belonging to middle/ upper-middle
income group (MIG/ UMIG) families from Delhi and study the effect of TFA
intake on their anthropometric measurements, body composition, clinical and
biochemical parameters. The present study has two components, field work
andlaboratory analysis
The field work comprised of gathering the preliminary data on commonly
consumed fats/ oils, deep fat frying practices and knowledge regarding TFA as
well as assessing the TFA intake by women belonging to MIG/ UMIG families.
For this, 402 female school teachers were enrolled from six schools located in
298
different parts of Delhi and the necessary permissions were obtained from the
school authorities. After obtaining written informed consent, data were gathered
on
their
socio
demographic
profile,
medical
history,
dietary
intake,
anthropometry, body composition, clinical and biochemical parameters. An
attempt has been made to study the effect of TFA intake on the cardio-metabolic
risk factors (anthropometry, body composition, clinical and biochemical
parameters).
In addition, a preliminary survey was also carried out among a small number of
chefs/ cooks of select food outlets from Delhi/ NCR, where the necessary data
pertaining to their frying practices/ type of oil used and awareness regarding TFA
were gathered.
The laboratory analysis involved estimating the TFA content of fats/ oils, as well
as studying the formation of TFA in fats/ oils subjected to varying temperatures
with or without frying the food items. Further it also included analysis of the TFA
content of select fried/ baked/ dairy and other food items. For the purpose of
heating edible fats/ oils, due permission was obtained from the Institute of Home
Economics (University of Delhi), HauzKhas New Delhi for availing of facilities at
the Food Science laboratory. Further, after obtaining the necessary permission
from the Indian Institute of Technology (IIT-Delhi), the quantitative analysis of
Trans Fatty Acid (TFA) content of select fats/ oils/ food items was carried out at
the Department of Chemical Engineering, Indian Institute of Technology (IITDelhi).
The result of the preliminary data from field work served as the basis for initiating
and carrying out the laboratory analysis, while the result outcomes of laboratory
analysis helped in understanding the adverse effects of TFA on health status of the
population under study. Thus, both these components of the study,complemented
each other and helped in arriving at the study results. The study has been approved
by human ethics committees of Institute of Home Economics and Fortis hospital
VasantKunj, New Delhi.
For the preliminary Survey six schools located in different parts of Delhi were
approached; 417 teachers were found to be eligible for participation in the
299
study.Out of these only 406 provided their consent, while the dietary data could be
gathered from 402 female school teachers, who formed the study sample. Once
the teacher expressed her interest in participating in the study and provided
consent, the preliminary survey questionnaire cum interview schedule was
administered. For the estimation of biochemical parameters, 7 mL of fasting blood
sample was drawn from a sub sample of the population (n=162 subjects).
Age, Marital Status and Religion: Of the total 402 subjects enrolled, nearly half
(52%) were in the age range of 35-45 years (mean age 41.6 ± 8.6 yrs.). A little
more than one-fourth of the total subjects (26.7%) were aged between 27 to 35
years and 21.3 per cent aged between 45 to 60 years. Further, majority of the
subjects were married (85.6%) while remaining were either unmarried (11.2%),
separated (2.2%) or widowed (1 %).
Since all the subjects under study were female school teachers, their educational
status was quite high. All the subjects were at least graduates with bachelors in
education (B. Ed) with 7 per cent of themhaving double post-graduationand
around 4 per cent possessed Ph D degree.
Nearly three-fourth of the subjects (78.6%) were from nuclear families while
remaining were from joint families (19.9%) with very fewbelonging to extended
families (n=6; 1.5). The total number of family members ranged between 2 - 10
members, average family size being 4.1 ± 1.8.
Income and Socioeconomic Status: The average monthly income of the subjects
was ` 39,838 ranging between ` 28,000 to ` 55,000, with majority of the subjects
(73.1%) earning between ` 35,000 - ` 44,000. While the average monthly income
of the family was ` 94, 4450 (` 60, 000 to ` 1,65,000).
Data relating to cooking practices included type and amount of fat used, fried
food items prepared, consumption of fried/ baked and dairy foods and deep fat
frying practices adopted (amount of fat/ oil taken for frying, duration of heating
fat/ oil before frying/ its re-use and storage of oil after frying etc.).
300
Commonly Consumed Fats/ Oils: It was noted that in general three or more fats/
oils were being used by most of the subjects for the purpose of cooking (sautéing
and baghaar), frying, shortening, baking and as sandwich spread. Subjects
reported the use of a variety of fats/ oils, with the use of mustard oil (for
preparation of specific vegetables) and Desi ghee(for the purpose of baghaar)
almost universal. Other majorly used oils were Groundnut, soybean, sunflower,
refined blended oils, Olive and Canola. Surprisingly, Vanaspati was also being
consumed by 7.2 per cent of the subjects mainly for the purpose of frying;
however, some even used it for cooking purposes (1.5%).
Of the total subjects, 53.1 per cent were vegetarians, 24.1per cent were nonvegetarians and the rest 22.9 per cent were eggetarians. Majority of the subjects
were consuming three main meals. The data on pattern of consumption of midmeals/ snacks revealed that nearly 50 per cent of the subjects were having two
mid-meals/ snacks per day (early morning tea and evening tea). Frequency of
consuming outside food varied from daily to once a month. Approximately onefourth of the subjects reported the consumption of outside food to be thrice a
week, while one-third of them consuming the outside food at least once a week.
Among the eating facilities commonly visited both Indian fast food joints/
halwai’s and the western fast food joints were the most favoured ones, but still the
nearby roadside vendors were preferred (12.2%) for day to day eating out/
snacking specifically for golgappa and paprichaat.
Hectic work schedules, working couples, modernization of the lifestyle have all
contributed towards the concept of “eating out”. The data on commonly
consumed fried/ baked and dairy foods indicated that the subjects were
consuming a wide range of fried foods either purchased from the market or
prepared at home. The data further depict that the subjects were consuming a wide
variety of fried food items ( Potato Chips, Pakora/ Gulabjamun, Jalebi, Fried
AlooChaat, Tikki, PapriChaat Bread Pakora, Dosa/ Cheela, Golgappe, Samosa,
Parantha, French Fries, Bhujiya, Bhatura/ Poori and Namkeen). However, the
frequency of consumption of fried foods by the subjects varied with food items
301
like bhujiya, namkeen and parantha were being consumed almost daily by a
majority of them.
Frying practices: For the purpose of deep fat frying, most of the subjects were
using different types of refined vegetable oils, while around one-fourth of the total
subjects were using blended refined vegetable oils and desi ghee. Vanaspati was
also being used by 7.2 per cent of the subjects.
For gathering the information on amount of fat being used for frying,
approximate responses were obtained since measuring the oil prior to putting it
in the frying vessel was not practised by the subjects. Majority of the subjects
were using approximately 350-500ml of edible fat/ oil for frying at a time. Most
of the subjects were not able to provide exact responses regarding the duration of
heating of oil prior to frying. Maximum number of them reportedly allowed the
oil to heat for approximately 10-15 minutes before initiating frying, while others
reportedly heated the oil for 15 -20 minutes prior to frying. It was found that
nearly half of the subjects initiated frying “when the test food article added to hot
fat/ oil quickly rises to the surface” while for another 45.3 per cent subjects the
correct stage was when the oil started smoking, however, few subjects (4.2%)
reportedly initiated the frying when the oil started smoking as well as smelling.
Regarding reutilisation of the oil used for frying, majority reportedly used it in
some form or the other, while 4.2 per cent either discard the oil or gave it to their
domestic help. The used oil was mostly re-utilised for the purpose of re-frying.
Nearly one-fourth of the subjects reportedly did not reheat the fats/ oils because
they either utilised the remaining fats/ oils for cooking purposes or did not use it
themselves, another one-fourth of the subjects reportedly reheated the oils once
again to be later used for cooking, while nearly half of them reportedly reused it at
least 2-3 times (frying cycles). Further, a small percentage (4.7%) of the subjects
mentioned that they would keep using it till the quantity is reduced to be used for
sautéing vegetables in the same vessel.
302
It was observed that a variety of baked food items were being consumed by the
subjects, with food items like bread and biscuits reportedly being consumed by all
the subjects. The consumption of rusks as their favourite morning tea
accompaniment was reported by almost 40 per cent of the subjects, while food
items like cake/ pastry were although being consumed by all, the frequency was
rather occasional. However, foods like pizza were being consumed by nearly onethird of the subjects as part of eating out on weekends.The data depicted that
dairy products were consumed by all the subjects in one form or the other, with
the consumption of milk either full cream/ single/ double toned milk, curds and
cottage cheese almost being universal. Among the other food items being
consumed, majority of the subjects reported the consumption of packet soups,
noodles and chocolates, with 52 per cent subjects reporting the consumption of
vegetarian mayonnaise, while mayonnaise with egg was being consumed by 23.9
per cent subjects.
Knowledge Regarding Trans Fatty Acids: In addition to the knowledge
regarding trans fatty acid some preliminary data were also gathered about their
practices relating to re-heating of fats/ oils used for frying as well as the awareness
and practices relating to nutrition labelling. Since the subjects under study were
teachers who are aneducated and cognisant section of the society, it was rather
disheartening to know thatonly one-third of the subjects were well aware of the
fact that fats/ oils used for frying should not he re-heated or repeatedly used.
When the subjects were asked which fat out of the two Desi ghee and Vanaspati is
better for our health, 65.4 per cent believed Desi ghee to be the obvious choice,
however surprisingly 4.2 per cent considered vanaspatias a better choice, thinking
that since it is made from vegetable oil it is less harmful. Of all the subjects
although 28.1 per cent subjects had heard of the term trans fats/ trans fatty acids/
TFA, but only 19.7 per cent could actually describe it as a “Bad fat” while nearly
5 per cent ended up describing it as a “Good fat”, the remaining were simply
ignorant about it. On being asked whether TFA is good for health or not, 19.4 per
cent answered in negative while remaining 80.6 per cent could not reply. Only
14.6 per cent subjects remembered to check the TFA content on the “Nutrition
Label”. The result of this small yet effective survey clearly shows the lack of
303
knowledge regarding trans fatty acids and their adverse effects even among the
educated class.
The preliminary survey among cooks/ chefs had beenconducted on 42 food
service outlets in various parts of Delhi and National Capital Region (NCR)
covering north, south and central Delhi as well as NCR (Gurgaon-Haryana) using
the pre-designed interview schedule. The food establishments surveyed included
Restaurants, Indian Fast Food Joints/ Halwais, Western Fast Food Joints, Bakery
shops and Road side vendors. To maintain the confidentiality all the outlets
surveyed were allotted appropriate codes.
Fat/ Oils used for Frying, Shortening and Baking: It was noted that nearly onefourth of the eating joints reportedly used vanaspati, (either alone or in a blend
with other fat/ oils) for frying. Other fat/ oils which were reportedly being used
predominantly included Groundnut oil and Soybean oil, Palm oil, Olive Oil,
Sunflower oil and refined vegetable oil. Desi ghee was also reportedly being used
for frying purpose in combination with other fats/ oils. Interestingly, some eating
outlets reported the use of “Ghee” without specifying the type (Desi Ghee or
Vanaspati). The data revealed that for the purpose of baking, most of the chefs/
cooks reportedly used either butter or baker’s shortening, while, margarine was
used by 16.7 per cent cooks/ chefs. However, the information on fats/ oils being
used could not be obtained from 11.9 per cent of the outlets where baking and
frying was commonly being employed. Further, when asked regarding duration of
heating the fats/ oils before frying, most of the cooks/ chefs were not able to give
definite answer, therefore approximate responses were obtained. The study
revealed that nearly one-fourth of the outlets reportedly heated fat/ oil for 30 to <
45 minutes prior to frying. Interestingly a whopping 31 per cent reportedly heated
the fat/ oil for approximately 1 hour or more before frying. Since, these were only
the reported responses; the actual duration of heating may differ.The quality of
frying medium is dependent on its duration of usage. In the outlets surveyed, the
total duration of use of fat/ oil for frying varied between 5-18 hours with an
average of 10.6 ± 2.4 hours depending on the type of eating outlet and the demand
of fried foods. Form the responses obtained from the cooks/ chefs it was found
that re-heating largely depended on the amount of fat/ oil left after frying and the
304
number of frying cycles it has completed. However, majority of the respondents
reportedly reheated the fats/ oils approximately 5-9 times (frying cycles). This
could lead to great deterioration in the fat/ oil.
It is well documented that straining of oils used for frying helps in reducing the
degradation (oxidation and formation of free radicals) of oils. In nearly 43 per cent
of the food outlets, the re-used oil was stored in canisters/ some other vessel,
while in ~38 per cent outlets it was still being stored without any filtration/
straining and was allowed to remain in the same karahi in which frying was done.
The criteria for judging deterioration of the oil was rather subjective and depended
on visible changes like darkening or thickening of oil and accumulation of food
deposits. This shows that most of the food service outlets are still not serious
regarding the quality of oil for frying food items and have adopted a rather casual
approach towards this issue. Utilizing the re-heated oil can further deteriorate the
quality of fat/ oil. In the present study it was observed that one-third of the cooks/
chefs reportedly utilized the re-used fat/ oil either for the purpose of cooking
(sautéing/ as shortening) and frying or for cooking alone. Interestingly 7 per cent
cooks/ chefs reported that the used oil was further sold to road side vendors; such
exploitation is a matter or serious concern because it would lead to further
deterioration of the used fat/ oil.
In addition an attempt was made to assess knowledge of the cooks/ chefs
regarding the adverse effects of re-heating of fats/ oils and trans fatty acids from
the health perspective. Only 7 chefs/ cooks were aware of the adverse effects of
re-heating fats/ oils and reported that prolonged heating was harmful but were
unable to assign any reason. Regarding consumption of vanaspati, nearly 57 per
cent considered it to have a positive impact on health. Some data were also
gathered from cooks/ chefs of food outlets regarding their present knowledge on
Trans fatty acids. On being asked about trans fatty acids approximately 16.6 per
cent were aware of or had heard the term trans fatty acids, but only 11.9 per cent
actually knew what it is. Most of the workers had absolutely no knowledge of
either trans fatty acids or their adverse effects on human health. Those who had
some knowledge were mostly the personnel employed at multi-national food chain
outlets following some standard specifications. The present preliminary survey is
305
an eye opener in highlighting the quality of fat being used and the deep fat frying
practices adopted at commercial establishments. A previous study by Goyal and
Sundararaj (2009) had also indicated similar findings and this issue is a cause of
serious concern.
As part of the Laboratory Analysis, estimation of the fatty acid profile of edible
fats/ oils was carried out in a total of 33 fats/ oils samples. Each fat/ oil was
appropriately coded and where available, the date of manufacturing/ expiry, batch
number, cost per unit, nutritional information, ingredients and health claims were
noted for each fat/ oil. After standardising the protocol and taking all due
precautions, the fats/ oils samples were analysed for their complete fatty acid
profile including TFA using gas chromatography (GC) coupled with flame
ionisation detector (FID). Each oil sample was analyzed in duplicate to ensure the
accuracy of the results.
The fat samples of animal origin (yellow butter; white butter; Desi ghee) were
predominantly high in saturated fatty acid content. These animal fats also had high
levels of cis-MUFA as compared to cis-PUFA. Trans fatty acid was also present
in all the fat samples of animal origin, however, there was a wide variation in their
TFA content (ranging between 0.68 g% to 8.6g % Desi Ghee). Results not only
indicate a significant amount of trans fatty acid in desi ghee, but also a wide
variation in the TFA content within the three samples of desi ghee.
A wide variety of fat/ oil samples of plant origin were shortlisted for the study
which included fats like peanut butter, sandwich spread, vegetable oils (mustard,
groundnut, soybean, sunflower, rice bran, olive and canola), blended refined
vegetable oils and partially hydrogenated vegetable oils (PHVO)/ Vanaspati.
Erucic acid was the predominant fatty acids found in both the samples of mustard
oil under study; however, these contained low levels of SFA (17.8% and 16.8%
respectively). The TFA content of these samples indicated wide variations, with
one sample containing as high as 4.6 per cent of TFA and a fair amount of omega
9 fatty acid (43.07%) while the other sample (ROM) containing 0.95 per cent of
TFA and 18.2 per cent of omega 9 fatty acid.Though there were some individual
306
variations in the fatty acid profile of the groundnut oil samples, both were low in
SFA and had average amount of cis-PUFA (25.03% and 21.5%). However in one
of the samplescis-omega 9 fatty acid was higher (53.8% vs34.1%) and it also
contained small amounts of trans fatty acid (0.68%) which was rather absent in the
second sample. The predominant fatty acid found in both these samples was oleic
acid.
Both the samples of soybean oil showed approximately similar fatty acid profile;
these had low levels of SFA, average cis-MUFA (23.8%, and 26.1%) and high
cis-PUFA (58.2% and 53.9%). TFA content of one sample was 1.78 per cent
while it was negligible in the other. Linoleic was the predominant fatty acid in
both the soybean oil samples; although essential, it is unstable during storage and
frying. Similar to the soybean oil, both the samples of sunflower oil were high in
cis-PUFA (56.5% - 54.5%), low in SFA (9.5% and 12.8%) and had linoleic acid
as the predominant fatty acid. Both the samples were high in cis-omega 6 fatty
acid (55.8% and 53.5%) had average levels of cis-MUFA and had significant
amounts of trans fatty acid content (2.7% and 3.0%).
Oleic acid was the predominant fatty acid present in Olive oil and Canola Oil.
While Rice bran oil and one sample of refined blended oil contained both oleic
acid and linoleic acid as the predominant fatty acids. Further high percentage of
cis-MUFA was found in both the samples of olive oil (83.7% and 73.7%), one
sample of refined blended oil as well as in refined rice bran oil (69.3%). All these
samples had low levels of cis-PUFA. In one sample of refined blended oil cisPUFA constituted around 78 per cent of total fatty acids, which was the highest
level among all the fats/ oil samples (animal/ plant origin) under study. The TFA
content was undetectable in both the samples of olive oil and two samples of
refined blended oil; however, canola oil, rice bran oil and one sample of refined
blended oil contained around 1.7 per cent, 0.35 per cent and 0.5 per cent TFA
respectively.
As compared to the Red palm oil (SFA; 54.8%, cis-PUFA; 3.4% and cis-MUFA;
40.9%), Refined Palmolein oil had a slightly higher level of SFA (56.5%) and
cis-PUFA (8.7%) and lower levels of cis-MUFA (35.3%). No TFA could be
307
detected in refined palmolein oil, however it was present in Red Palm oil (0.68%).
The predominant fatty acids in both these oils were palmitic and oleic acid. Oleic
acid also constituted around 40.9 per cent and 35.3 per cent of total fat in red palm
oil and refined palmolein oil respectively.
One sample each of peanut butter and vegetable oil based sandwich spread
were also analysed for their fatty acid profile (including TFA). The laboratory
analysis revealed that Peanut butter was high in SFA (52.7%) and cis-MUFA
(43.1%) while the TFA content was rather negligible. On the other hand the
sandwich spread although low in SFA (24.5%); high in cis-MUFA as well as cisPUFA (36.8% and 34.1%) had rather high levels of TFA (4.4%). Thus, peanut
butter and the yellow/ white butter turned out to be the healthier choices that can
be used as sandwich spread rather than vegetable oil based sandwich spread.
All the samples of partially hydrogenated vegetable oils (vanaspati) had almost
similar fatty acid profile. These had high levels of SFA (41.05 - 49.1%), low
levels of cis-PUFA (5.2% - 9.8%) and fair amounts of cis-MUFA ranging from
27.2 per cent to 36.6 per cent. These partially hydrogenated vegetable oil samples
were predominantly high in oleic acid and palmitic acid. High levels of TFA were
detected in all the samples of partially hydrogenated vegetable oils (12.9% to
14.6%).
Amongst all the categories of fats/ oils under study, partially hydrogenated
vegetable oils (vanaspati) had the highest amount of TFAs. It is a matter of
serious concern since partially hydrogenated vegetable oils are being used rather
liberally and discriminately even in the big urban cities, posing a serious threat to
human health.
Estimation of TFA Content of Heated/ Re-heated Fats/ Oils: Several
researches have been carried out in the western countries to study the effect of
formation of TFA during frying indicating an increase in the concentrations of
trans isomers with increase in temperature and duration of heating. As a result
several European countries have formed stringent rules and have recommended
that the frying oil temperature must not exceed 180ºC. However, in India due to
paucity of knowledge and data, there are no such guidelines or checks on the
temperature of oil. In view of frying being a common method of food preparation
308
in our country, an India specific study is very much required to understand the
effect of formation of TFA when oil is constantly heated at high, varying
temperatures with intermittent episodes of cooling (as practised at both household
and commercial level). Therefore, this part of the present study was designed to
assess the formation of TFA in edible fats/ oils during heating/ frying, with
intermittent cooling and then re-heating wherein experiments were performed in
the laboratory using six different types of fats/ oils samples. Using GC coupled
with FID(AOAC method) the shortlisted fat/ oil samples were analyzed for their
fatty acid profile including TFA content, both before and after subjecting them to
heating/ re-heating at 180ºC and 220ºC, with or without frying the test food item
(pre-frozen French fries PFFF) were selected as the test food for frying). Prior to
initiating the frying protocol, the fatty acid profile including TFA of the frozen
French fries prior to frying was analysed using gas chromatography method
coupled with flame ionization detectors. The results indicated that no detectable
level of TFA(0.0g) was present in the pre-fried frozen French fries.
Though the unheated fats/ oils samples varied in their TFA content, with refined
soybean oil, refined groundnut oil and refined olive oil having undetectable
amounts of TFA, while desi ghee and refined canola oil had 0.68g/ 100g and
1.60g/ 100g of TFA respectively, however the TFA levels in partially
hydrogenated vegetable oil were recorded to be as high as 13.90g/ 100g. When
these fats/ oils were subjected to heating at 180ºC, all the three oils which had
undetectable amounts of TFA had increased levels of TFA, clearly depicting that
heating leads to generation of TFA. The fats/ oil which already had TFA also
showed increased amounts after being subjected to heat treatment. When these
fats/ oils were heated to a higher temperature, there was further increase in their
TFA levels, with refined soybean oil and refined olive oil depicting more than 100
per cent increase in their TFA levels while refined groundnut oil, refined canola
oil and desi ghee registered an increase of 20 - 30 per cent. However, on reheating these fats/ oils to 180ºC (after cooling down to room temperature), slight
increase in the TFA levels was observed. While on further re-heating (to 220ºC)
these fats/ oils had drastically increased TFA. The overall trend, however,
indicates towards an increasing amount of TFA on subsequent heating and from
309
this it can be inferred that during heating process formation of TFA takes place
and cis-TUFA gets converted to SFA and TFA.
Trans fatty acid in the fats/ oils used for frying after subjecting to heating/ reheating under the study: In the present study when frying was carried out in the
select fat/ oil samples at 180ºC and 220ºC, the trend was quite similar to that of
heated fat/ oil samples i.e. the SFA and TFA increased with subsequent frying
cycles while the concentration of cis-TUFA decreased. However, it was noted that
the increase in the concentration of TFA and SFA was not as high as that in the
case of heated/ re-heated fats/ oils samples. Though this difference in the
concentrations of SFA, TFA and cis-TUFA is not clearly understood, it could
perhaps be attributed to the test food being fried and the possibly due to the
selective absorption/ retention of SFA and TFA by the food sample being fried.
Estimation of TFA in the fried test food could have given a clearer picture of the
entire mechanism however; this could not be undertaken since it was out of the
purview of the study moreover the time and resource constraints did not allow this
component to be aligned in the present study. This segment can definitely be taken
up as independent study in the future.
Overall the study results were able to demonstrate the effect of high temperature
heating/ re-heating of fats/ oil with or without frying on formation of TFA, which
is a common practice at commercial level. The results not only highlighted an
increase in the overall percentage of TFA but also in SFA. This indicates that the
fats/ oils though initially have low levels of TFA and SFA, after subjecting to high
temperature heating/ re-heating end up having higher concentrations of both (TFA
and SFA), which is least desired nutritionally.
Estimation of TFA Content in Select Food Items (Fried/ Baked Food Items
and Dairy Products): In view of the scarcity of data on the TFA content of
Indian food items, an attempt was made to estimate the complete fatty acid profile
including TFA of select fried, baked and dairy food items. On the basis of the
preferences of commonly consumed fried/ baked/ dairy food items indicated by
the subjects in the preliminary questionnaire, a total of 48 food items were
identified, however due to resource constraint only 23 food items could be
310
analysed for their fatty acid profile including TFA content which included 10 fried
foods, 6 baked foods, 5 dairy products and other food items. Prepared foods
purchased from restaurants were analyzed either on the same day or next day
(after storing at 4ºC-6ºC) while the packaged food items were analyzed within
three days of the purchase.
The fatty acid profile including TFA for all the 23 shortlisted food samples have
been analysed using GC coupled with FID. For the assessment of TFA content in
food items, fat was extracted from the food samples using soxhlet method. These
extracts of fats were then converted into their fatty acid methyl esters (FAMEs)
which were run in a chromatogram to identify the fatty acid (FA) peaks against
those of fatty acid standards.The fatty acid profile of fried, baked, dairy and
miscellaneous food items has been expressed as g/ 100g of the fat extract. Further,
the total amounts of fat/ fatty acid per 100g of the food item have also been
estimated from where the TFA content per serving of food item have been
computedto have a clearer understanding and to see the actual amount of fat, in
particular the trans fatty acid being consumed.
The total fat content of the select fried food items (Potato chips, Bhujiya, Samosa,
Tikki, Bread pakora, Fried Aloochaat, Parantha, Bhatura, Gulabjamun, French
Fries, Frozen French Fries) ranged between 10.5g/ 100g of food item
(GulabJamun) to 41.0g/ 100g food item (Potato chips), while the SFA content of
these food items ranged between 6.4g/ 100g of food (Parantha) to 21.0g/ 100g of
food (Potato Chips); cis-MUFA ranged between 2.2g (Gulabjamun) to 14.0g
(Bhujia); cis-PUFA ranged between 1.1g (Gulabjamun) to 6.9g (Bhujiya). With
respect to the total TFA, Bhujiya had the highest content (1.48g/ 100 food item)
while bread pakora had the lowest levels of TFA (0.34g/ 100g of food item).
Baked foods require pliable/ semi-solid fat which can provide some texture to the
food items, to curtail the cost, cheaper fat substitute like bakers shortening/
margarine are commonly being used. These substitutes are hydrogenated fats and
thus, have high TFA content, leading to high levels of TFA in bakery products. In
all 6 bakery food samples (Biscuits, Rusks, Patties, Pastry, Pizza, Burger) were
shortlisted for analysis for the complete fatty acid profile (SFA, cis-MUFA, cis-
311
PUFA, cis-TUFA and TFA). The total fat content in g/ 100 g of food item ranged
between 11.3g (Rusk) and 23.8g (Bakery Biscuits), while the SFA content ranged
between 5.2g/ 100g of food item (Rusk) and 11.1g/ 100g of food item (Bakery
Biscuit). The cis-MUFA and cis-PUFA content ranged between 3.3g/ 100g of
food item (Rusk and Pizza) to 8.6g/ 100g of food item (Bakery Biscuits) and 1.3g/
100g of food item (Pastry) to 6.5g/ 100g of food item (Burger) respectively. As far
as total TFA content is concerned, it ranged between 0.22g/ 100g of food item
(Pizza) to 1.58g/ 100g of food item (Patties).
In all 5 samples of dairy products (Milk, Curds, Cottage cheese, Cream, Cheese
Slice) and 2 samples of mayonnaise-vegetarian and mayonnaise-with egg were
shortlisted for analysis. The SFA content (g/ 100 g) of the these dairy products
ranged between 2.3g (Curds) and 21.0g (Cream), while the cis-MUFA and cisPUFA ranged between 1.5g (Curds) to 8.5g (Cheese Slice) and 0.6g (Curds) to
8.0g (Cream) respectively. The total TFA content ranged between 0.04g (Curds)
to 0.40g (Cheese Slice). The Fatty acid profile of miscellaneous food items (g/
100g of food) was quite similar; mayonnaise with egg had a higher value of SFA
(30.6g/ 100 g of food item) than vegetarian mayonnaise (26.3g/ 100 g of food
item). The levels for cis-MUFA (20.8g/ 100 g of food item and 19.8g/ 100g of
food item) and cis-PUFA (9.9g/ 100g of food item and 10.0g/ 100g of food item)
were almost similar for vegetarian mayonnaise and mayonnaise with egg
respectively. However the TFA content varied with mayonnaise-vegetarian having
a lower level (1.95g/ 100 g of the food item) as compared to mayonnaise with egg
(2.98g/ 100 g of food item).
The present study, thus, demonstrated that a substantial number of products
(mainly fried and baked food items) contained a total amount of trans fatty acid
that was much higher than the tolerable limit of 2% of total fats enforced in
Denmark, the only country in the world that has a legal limit for trans fatty acids.
Hence, the public health authorities in India should initiate the legal process to
introduce a trans fatty acid limit for Indian foods in order to reduce the incidence
of non-communicable disease.
312
Composite use of the data obtained from Laboratory Analysis and Field
Work: In the present study a combination of two day 24 hour dietary recall, one
working (school day) and one non-working day (non-school day/ holiday) and a
qualitative food frequency questionnaire was employed to obtain the dietary
intake data of the subjects. In addition the per cent energy derived from protein,
carbohydrates, total fat and fatty acids were also calculated for all the subjects and
the mean energy per cent values are reported.
Data indicate that the average energy intake of the study population was 2135 ±
254 kcal/ d; the mean intake on the non-school day (2219 ± 391 kcal/ d) was
significantly higher (p <0.001) than that on the school day (2052 ± 281 kcal/ d).
Elaborate meals, specifically breakfasts (commonly including parantha/ poori/
pakoras) coupled with frequently eating out on weekends could perhaps be the
most probable reason for the increased calorie consumption on the non-school
day.
The average protein intake by the subjects was 61.9 ± 8.9 g/ d. Just like energy,
protein intake was also significantly higher (p <0.001) on non-working day (65.3
± 13.1 g/d) as compared to the working day (58.4 ± 11.5 g/d). However, the per
cent energy derived from protein was almost similar for both working and nonworking days with the average being 11.6 ± 0.8.
The average carbohydrate intake among the subjects was 304.2 ± 40.0 g/d. It was
significantly higher on non-working day (p <0.001). The average per cent energy
derived from carbohydrates was found to be ~ 57 per cent and was similar for both
working and non-working days. In the present study the average intake of total
dietary fibre was 41.5 ± 7.0g/d. The intake was lower on working day (39.4 ± 10.9
g/ d) as compared to the non-working day (43.5 ± 9.0 g/d; p <0.001).
The mean total fat intake was 75.7 ± 13.1 g/d. The consumption was more on the
non-working day (80.9 ± 17.2 g/d) as compared to the working day (72.1 ± 17.4 g/
d; p <0.001). Similarly, the per cent energy derived from fats was lower on
working day (31.6 ± 6.7) as compared to non-working days (32.8 ± 3.7; p <0.001),
with the average being 32.8 ± 4.2 per cent, which is higher than the recommended
30 per cent energy derived from fats.The mean saturated fatty Acid (SFA)intake
313
was 27.4 ± 6.8 g/ d. The consumption was more on the non-working day (29.6 ±
8.7g/ d) as compared to the working day (25.2 ± 8.9g/ d; p <0.001). Similarly, the
per cent energy derived from saturated fats was lower on working day (11.1 ± 3.5)
as compared to non-working days (12.0 ± 2.2; p <0.05), with the average being
11.5 ± 2.1per cent, which is higher than the recommended 10 per cent energy
derived from saturated fats.The mean mono unsaturated fatty acid (MUFA)
intake was 20.2 ± 4.6g/ d. As in case of other total fat and SFA the consumption
was more on the non-working day (21.3 ± 5.5g/ d) as compared to the working
day (19.1 ± 6.9g/ d; p <0.05). However, the per cent energy derived from fats was
almost similar for working day (8.4 ± 2.8) as well as non-working days (8.7 ±
1.5), with the average being 8.5 ± 1.6 per cent, which is lower than the
recommended 10 - 15 per cent energy derived from monounsaturated fats.The
mean poly unsaturated fatty acid (PUFA) intake was 22.3 ± 3.0 g/ d. The
consumption was higher on the non-working day (23.4 ± 3.3g/ d Vs 21.2 ± 4.5g/
d; p<0.05). However, the per cent energy derived from polyunsaturated fats was
almost similar for working (9.3 ± 2.0) as compared to non-working days (9.5 ±
1.1), with the average being 9.4 ± 1.1 per cent.
The mean total trans fatty acid(TFA) intake was 4.91 ± 1.5g/ d. The
consumption was significantly higher (p <0.001) on the non-working day (5.93 ±
1.9g/ d) as compared to the working day (3.89 ± 1.1g/ d). Similarly, the per cent
energy derived from total trans fatty acids was also significantly higher (p <0.001)
on non-working day (2.40 ± 1.51) as compared to working days (1.71 ± 0.64),
with the average being 2.06 ± 0.58 per cent, which is much higher than the limits
proposed by WHO (<1en% derived from total trans fatty acids).
The mean ω-3 fatty acid intake was 2.3 ± 0.9 g/ d. The consumption was almost
similar on working and non-working day. The average per cent energy derived
from ω-3 fatty acid was 0.94 ± 0.4 per cent, which is much less than the
recommended 1-2 per cent energy derived from ω- 3 fatty acid.The mean ω-6
fatty acid intake was 19.3 ± 2.7g/ d. The consumption was slightly higher on nonworking (20.1 ± 4.2g/d) than the working day (18.4 ± 2.6g/d; p<0.05). However
the per cent energy derived from ω- 6 fatty acid was similar for working (8.1 ±
314
1.9) and on non-working day (8.15 ± 0.8), with the average being 8.4 ± 1.0 per
cent, which is higher than the recommended range of 5-8 per cent energy derived
from ω- 6 fatty acid. The mean ω-6/ ω-3 ratio was 8.6 ± 1.7, which was almost
similar for both working (8.8 ± 1.9) and the non-working day (8.4 ± 2.6), which is
within the recommended range of 5-10.
High dietary cholesterol intake has been associated with cardio-metabolic risk
factors. In the present study the mean cholesterol consumption was 106.0 ± 26.0
mg/ d. The consumption was significantly much higher on non-working day as
compared to the working day (p<0.01). The present study depicted higher
consumption of most of the nutrients on non-working days as compared to
working days which possibly resulted due to the increase in eating out trend in the
urban population.
Anthropometry data indicate that mean height of the subjects was 156.6 ± 6.2
cm and mean weight of the subjects was 64.6 ± 9.4 kg, ranging between 41 to
101.5 kg. The mean BMI value of the subjects was 26.4 ± 4.1 kg/m 2 ranging from
15.8 to 44.5 kg/m2. The mean value for waist circumference, hip circumference
and waist hip ratio was 89.0 ± 11.6 cm, 97.4 ± 10.0 cm and 0.92 ± 0.08
respectively. The mean fat percentage was noted to be 35.7 ± 9.84 % and the
mean fat mass was 28.1 ± 11.2 kg. The mean for fat free mass, muscle mass and
bone mass were 37.6 ± 9.0 kg, 37.8 ± 5.9 kg and 2.6 ± 1.9 kg respectively. The
prevalence of overweight and obesity in the present study was noted to be quite
high; on the basis of BMI alone it was 21.9 per cent and 56.0 per cent
respectively. According to waist circumference the prevalence of obesity in the
present study was 75.6 per cent which was higher to the obesity prevalence
calculated by BMI, while on the basis of waist hip ratio and per cent body it was
recorded as 71.9 per cent and 70.7 per cent respectively.
The mean systolic and diastolic blood pressure was 127.7 ± 20.4 and 77.9 ± 17.9
ranging between 93 to 185 mmHg and 52 to 145 mmHg respectively. The
prevalence of hypertension was 36.1 per cent according to the JNC VII criteria,
while it was 37.8 per cent according to the NCEP ATP III guidelines respectively.
The mean fasting blood glucose was 99.8 ± 24.1 mg/ dL, ranging from 52 to 181
mg/ dL. The mean fasting serum insulin level was 11.1 ± 6.6 μU/ mL, while the
315
mean HOMA- IR level was 3.4 ± 2.2. The mean levels for total cholesterol and
serum triglycerides were 198.8 ± 46.5 and 147.5 ± 47.4 respectively. Subjects’
mean levels for LDL-c, HDL-c and VLDL-c were 98.7 ± 38.4 mg/dL, 46.6 ± 9.8
and 29.8 ± 10.5 respectively. The cardio-metabolic risk profile in the subjects
(n=162) was quite alarming. Around one-fourth of the subjects had impaired
fasting glucose while almost 18.5 per cent of the subjects were suffering from
diabetes. The prevalence of hyperinsulinimia was reported in as high as 45.7 per
cent subjects, while insulin resistance as detected by HOMA-IR was present in
51.9 per cent subjects. The prevalence of hypercholesterolemia was seen in 43.8
per cent subjects while that of hypertriglyceridemia was 44.4 per cent. Nearly
59.9 per cent of the subjects had high levels of LDL-c. Of specific concern was
the presence of low levels of HDL-c in nearly 63.6 per cent subjects. The
metabolic syndrome which is a clustering of risk factors was in 43.8 per cent in
the present study. It is understandable that with such high prevalence of obesity
and abdominal adiposity, co-morbid risk factors, dysglycemia and dyslipidemia
would be high.
The effect of dietary intake of total TFA vis cardio-metabolic risk factors:
There is an increased prevalence of lifestyle related non communicable diseases
among Indians. These have been linked with many factors including high intake
of trans fatty acids. In the present study an attempt has been made to study the
effect of trans fatty acids intake on the anthropometry, body composition, clinical
and biochemical parameters. Based on the dietary intake of total TFA (expressed
as en %) the study subjects were divided in three groups; TFA intake less than 1
en% (group 1), between 1 - 2 en% (group 2) and more than 2 en% (group 3). A
one-way ANOVA followed by Scheffe’s test was conducted to compare the
association of TFA intake on the mean values of anthropometric measurements,
body composition, clinical and biochemical parameters for each of these groups.
The results indicated that the mean values of weight, (p<0.01), BMI (p<0.05) and
body fat per cent (p<0.05) were significantly higher in group 2 (TFA intake
between 1-2 en%) and group 3 (TFA intake >2 en%) as compared to group 1
(TFA intake <1 en%), indicative of a positive association between total TFA
intake and these parameters. When intergroup comparison was made using
316
Scheffe’s test it was noted that the mean value for weight was significantly higher
(p<0.05) in group 3 as compared to group 1, while mean value for BMI was
higher in both group 2 (p<0.05) and group 3 (p<0.01) as compared to group 1.
Further, the mean values of these parameters although were more in group 3 as
compared to group 2 but the difference was not statistically significant. Similarly,
the mean values of other anthropometric and clinical parameters like waist
circumference (p=1.129), hip circumference (p=0.277) and diastolic blood
pressure (p=0.411) although were higher in group 3 and group 2 as compared to
group 1, these were not found to be statistically significant. However, with respect
to pulse rate and systolic blood pressure, the mean values between the three
groups did not show any significant difference.
Similar to weight, BMI and body fat per cent, the mean values of almost all the
biochemical parameters including fasting blood glucose (p <0.001), fasting serum
insulin (p <0.001), HOMA-IR (p <0.001), total cholesterol (p < 0.001), serum
triglyceride (p <0.001), LDL-c (p <0.001) and VLDL-c (p <0.05) were higher in
both, group 2 and 3 as compared to group 1. When intergroup comparison was
made using Scheffe’s test it was noted that the mean value for fasting blood
glucose (p <0.001), fasting serum insulin (p <0.001), HOMA-IR (p < 0.001), total
cholesterol (p < 0.001), serum triglyceride (p < 0.001), LDL-c (p < 0.001) and
VLDL-c (p < 0.05) were significantly higher in group 3 as compared to group 1.
Even compared to group 2 the mean values of fasting blood glucose (p<0.001),
fasting serum insulin (p<0.001), HOMA IR (p<0.001), and total cholesterol
(p<0.05) were significantly higher in group 3, indicating that even a slight
increase in the total TFA intake could possibly have a negative effect on these
parameters. However, role of confounding factors cannot be ruled out.
The test of association between the prevalence of cardio-metabolic risk factors
among the three groups based on the dietary intake of total TFA indicated that
there were statistical differences between various levels of TFA intake. Further,
the prevalence of overweight, obesity (BMI ≥ 25 kg/m2; waistcircumference > 80
cm; WHR > 0.8), impaired fasting glucose, diabetes mellitus, insulin resistance,
hyperinsulinemia, hypertriglyceridemia, hypercholesterolemia, high levels of
LDL-c and VLDL-c increased with the level of TFA intake. However, statistically
317
significant difference were present only for the prevalence of overweight (p<
0.01), Obesity (BMI > 25 kg/m2; p<0.01 and WC > 80cm: p <0.05), impaired
fasting glucose (p <0.001), diabetes mellitus (p <0.001), insulin resistance
(p<0.001),
hyperinsulinemia
(p<0.001),
hypertriglyceridemia
(p<0.001),
hypercholesterolemia (p<0.001), high levels of LDL-c (p<0.001) and the
metabolic syndrome (p< 0.001). Further, no such trend was visible in the case
hypertension and HDL-c levels, indicating the role of other confounding factors.
Although it is a cross-sectional study, an attempt has been made to find out the
effect of total TFA intake on cardio-metabolic risk factors viz anthropometry,
body composition, clinical and biochemical parameters. Multiple linear regression
analysis indicated that subjects with TFA intake more than 2 en% had
significantly higher body weight (p<0.05), BMI (p=0.001), fasting blood glucose
(p<0.001), fasting serum insulin (p<0.001), levels of HOMA-IR (p<0.001), total
cholesterol (p<0.01) and levels of LDL-c (p<0.01) as compared to subjects with
TFA intake less than 1 en %, when adjusted for confounding factors. Further, no
significant effect was visible among subjects with TFA intake between 1-2 en%
with respect to these parameters as compared to subjects with TFA intake less
than 1 en%.Indicating, that TFA intake more than 2 en% can have a rather
deleterious effect on these parameters.
However, in the present study no significant association could be noted between
intake of TFA with systolic and diastolic blood pressure, serum triglycerides and
HDL-c levels which point towards the role of other confounding factors.
Despite being a cross-sectional study, it is still able to show some association
between TFA intake and cardio-metabolic risk factors, highlighting the need for
detailed intervention study. The physical activity profile, which could also have
thrown light on the relationship between TFA intake and cardio-metabolic
parameters, could not be included in the present study due to time and resource
constraints. However, in the present study, this fact can be said to have lesser
relevance since all the subjects were female school teachers representing the urban
female population belonging to middle and upper middle income group families,
having a hectic and mechanised lifestyle.
318
However, being a cross section study it has its own limitations and thus, no
concrete conclusion can be drawn regarding effect of TFA intake on cardiometabolic risk profile. Nevertheless, in the light of the evidence available from the
developed countries on adverse effects of TFA intake on human health and limited
work done in India in this regard, the results of the present study can be of great
help and can further be used for initiating an interventional study for exploring the
affects of TFA consumption on health status in Indian scenario, given the genetic
makeup and increased prevalence of lifestyle related non communicable diseases
among the Indians.
The present study is one of the few reporting the TFA content of fat/ oil samples
as well as its formation with respect to heating/ re-heating the oil or during frying
process. In addition the study also reported the TFA content of select fried/ baked/
dairy food items, and using these data it has further assessed the dietary intake of
TFAs in urban, north-Indian female population belonging to MIG/ UMIG
families. The results of the present study highlights that apart from hydrogenated
fats, TFA is also present in some edible oils which otherwise are considered “free
from trans fatty acids”. Further, the study also indicates that the commonly
consumed fried/ baked food items have substantial amounts of TFA, with most of
them having TFA content that was much higher than the tolerable limit of 2 per
cent of total fats enforced in Denmark, the only country in the world that has a
legal limit for trans fatty acids. In addition, the study demonstrated that although
the oils as such do not contain TFA, when subjected to heat, their TFA content
increases on heating/ re-heating or when they are used for frying in heated/ reheated oils depending on the temperature. Similarly, in the case of edible fats
(Desi ghee/ vanaspati), which already contain TFA, when subjected to heat, their
TFA content increased further.
The study also highlights that despite the study population being highly educated,
their knowledge regarding TFA was negligible; and the cooking and frying
practices were rather poor. Further, their frequency of consumption of outside
foods, which are high in energy, total fat and TFA was quite high. The data also
depicted that in the population under study the consumption of fats, TFA in
319
particular, was higher than the recommendation by ICMR/ NIN/ WHO guidelines
for prevention of non-transmittable chronic diseases, which are a leading cause of
death worldwide. Although being a cross-sectional study, still it is able to show
some relation between TFA intake and cardio-metabolic risk factors, highlighting
the need for detailed intervention study. The results of the present study can be
used to showcase the current scenario regarding TFA consumption in India, and
can later be used in studies showing the secular trends.
Based on the findings of the study, following are some of the suggestions which
can help in gradually eliminating TFA from the food supply in India, as has been
done in many of the developed countries.

Given the dietary patterns of Indians, including the amount of food
consumed outside home due to dietary transition, it is important to find a
solution that would encompass both manufactured foods and foods
prepared in retail and food service establishments (e.g. in restaurants, food
service operations/, bakeries and food outlets/ kiosks). The policy makers
can make and enforce laws to limit the TFA content of manufactured food
on a finished product basis; and the TFA content of foods prepared on site
in retail; and food service establishments on an ingredient basis.
Healthcare policy implementation requires partnerships between multiple
stakeholders. To make it effective a multi-level approach involving the
policy makers, industry, health care professionals, media and consumers is
imperative.
The proposed suggestions/ approaches which can help in limiting dietary
TFA can be grouped under the following heads; Governmental levels,
Industrial level, Role of health care providers/ researchers, role of media
and at consumer level.
I Governmental level; The authorities can play a key role towards the
management of TFA menace in India and needs to actively work towards
designing a strong policy and implementing it through different channels.

The key recommended regulatory measure may be to adopt, a threshold
limit of TFA (as < 2% of total fat) in vegetable oils and for all other foods
320
at present, and efforts can be made towards eliminating it from the diet
within a period of 2 years.

It may be made mandatory for the industry to disclose the
recommendations pertaining to TFA and disclose its compliance on the
food label giving the TFA content per serving/ per 100g and per packet of
the food item.

The establishment of standards for “health claims” can be brought into
practice and Usage of “Trans fat free”,” heart healthy” or “cholesterol
free” logo’s should be prohibited, when the food product contains even 0.1
gram of TFA per serving or when the food item is free from TFA but
contains high amount of total/ saturated fat per serving or per packet.

There can be enough of food inspectors appointed so as to
comprehensively control the quality of food provided by restaurants,
halwais, road side vendors, multi-chain outlets etc..

The food testing laboratories may be developed all over the country so as
to effectively help the food administration ensure the quality food for the
consumers, allowing TFA testing in food items at nominal/ affordable
charges for purpose of research.

Research organizations should be promoted to work with industry leaders
to identify common ground for action and to expedite the process of
phasing-out TFA and promote the adoption of healthier oils and dietary
fats in the food supply of the country.

Generating awareness among the general population on dietary fats with
special focus on good and bad fats as well as the correct ways of using
them and dissemination of information on healthy cooking practices
among general population can be planned through advertisements
(print/electronic media) and incorporating it in education curriculum.
II. Industrial level; In issue of public interest, the food industry can work
towards voluntary elimination of TFA from the food supply.Industrial TFA in the
food supply should be eliminated and unsaturated fats should be the preferred
alternative, including the n-3 polyunsaturated fatty acids, given their cardio-
321
protective effect. As a substitute, saturated fats should only be used when
indispensable to the specific applications; this should be uncommon considering
advances in food technology.

Industry should comply to the TFA guidelines set up by the
government and accordingly highlight its compliance on the label of
the food item and should clearly highlight the TFA content (if any) on
all the packaged food items along with SFA, PUFA and MUFA
content on the nutrition labels on the foods products.

Development of alternative supplies of more healthful options to TFA
should be promoted and initiatives for developing newer technologies
(e.g. interesterification) for making the food healthy and reducing TFA
content in India should be undertaken.

The agro-industry can work towards development of a suitable oil
combination which can meet the requirements of food industry as well
as take care of consumer’s health.

Preference should be laid on the use of cold pressing technique for
extraction of oil from oil seeds and blending at low & controlled
temperature to avoid formation of TFA.
III. Medical level: Health Care Providers and Researchers: Health care
providers (doctors, public health practitioners, nutritionist, researchers, diabetes
educators, dieticians, nurses etc.) play a crucial role in providing correct medical/
dietary/ health related advice to population at large by educating patients
regarding adverse effects of TFA and ways to limit them. Further, dietary intakes
for all patients can be recorded for calculation of dietary TFA intake as an integral
part of diet counseling and aspecialised counseling can be imparted particularly to
those with high consumption of TFA.
New research protocols should be
developed for conducting quality research on harmful effects of TFA specifically
for Indian population given their genetic makeup.
IV. Consumer level: It is the responsibility of the consumers to stay aware and
safeguard their own health. Adopting the following suggestions can help in
possible reduction of TFA intake:
322

Substitution of liquid oils for "hard fats" like “vanaspati” (those that are
more solid at room temperature) to reduce both saturated fatty acids and
TFA should be brought into practice and use of vanaspatior margarine in
food preparation should be avoided.

The Nutrition Facts label on packaged food items should be checked for
TFA content, if it is present then the product should be avoided and
healthier option should be selected.

The ingredient list for type of fats should be checked for “partially
hydrogenated vegetable oil” and if found, the product should be replaced
with a healthier option.

Avoid re-heating of oil/ re-using used oil for food preparation.

When eating out/ ordering food from outside the owner/ server should be
asked regarding the type of fat/ oil being used for food preparation and
foods prepared/ fried in vanaspati or margarine should be avoided.
V. Role of Media: Taking a cue from the developed countries, Indian media can
play a very important role and can act as change agents in eliminating trans fatty
acids from Indian market. By passing the right information to the consumers
regarding the adverse effects of TFA on health, progress being made on the food
policies regarding TFA etc, they can create mass awareness and at the same time
help in reducing the demand for TFA containing fats/ oils/ food items, putting
further pressure on the food industry to come with healthier alternatives.
These strategies are likely to:

Contribute in decreasing the risk factors associated with TFA.

Reduce daily intake of trans fatty acids between 1% and 2%
of energy
intake consistent with current dietary recommendations.

Those at the highest consumption level will benefit from the mandatory
reduction of industrially produced trans fatty acids. Even those with low
consumption will benefit. Even if small amounts of fat is consumed,
if it is devoid of TFA and contains unsaturated fatty acids, the population
will stand to benefit.
323

Promote the development of alternative supplies of more healthful
alternatives of trans fatty acids.
The study strongly advocates for the need of reducing trans fatty acid containing
fats/ oils and replacing them with healthier alternatives in the food chain.
However, this process is a complex multi-sectoral issue that requires action and
collaboration by government, public health, science, media and the industry.
Successful elements required for implementing TFA policy appear to include a
consistent evidence based message not only on health effects, but also on
successful policy options, media coverage and consumer awareness. In addition,
champion organizations such as consumer groups who can lead the stakeholder
partnerships along with government involvement maintaining pressure on large
multinational and national food companies (such as voluntary or statutory action
on food labelling or content). The results of this study provide ample evidence for
the Indian government to formulate a policy on TFA, and this message is quite
clear and consistent. However, the challenge also lies in convincing the policy
makers that the issue is feasible, cost effective; and being a public health concern
is worth tackling on a war footing.
324