COUNTDOWN TO 2023
WHO REPORT ON GLOBAL TRANS FAT ELIMINATION 2020
2023
2019
2022
2021
2020
COUNTDOWN TO 2023
WHO REPORT ON GLOBAL TRANS FAT ELIMINATION 2020
Countdown to 2023: WHO report on global trans-fat elimination 2020
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CONTENTS
ACKNOWLEDGEMENTS	III
ACRONYMS	IV
FOREWORD	V
EXECUTIVE SUMMARY	 VII
I. INTRODUCTION	 1
II. GLOBAL PROGRESS	 3
1. Country policies	 3
Current situation	 3
New in the past year	 7
2. Support for reformulation	 8
Current situation	 8
New in the past year	 8
3. Global resources and support for
policy action	 9
Current situation	 9
New in the past year	 9
III. PROGRESS BY REGION	 11
1. Africa	 11
Current situation	 11
New in the past year	 11
2. Americas	 13
Current situation	 13
New in the past year	 13
3. Eastern Mediterranean	 17
Current situation	 17
New in the past year	 17
4. Europe	 19
Current situation	 19
New in the past year	 20
5. South-East Asia 	 22
Current situation	 22
New in the past year	 22
6. Western Pacific	 24
Current situation	 24
New in the past year	 24
IV. GLOBAL CHALLENGES, OPPORTUNITIES
AND PRIORITIES 	 27
V. CONCLUSION AND RECOMMENDATIONS
FOR ACTION	 28
REFERENCES	30
ANNEX 1	
TFA burden and status of TFA policies by
country, ranked by proportion of coronary
heart disease deaths due to TFA intake	 32
ANNEX 2	
Updated methodologies used to estimate
TFA burden by country for this report	 44
ACKNOWLEDGEMENTS
This progress report was prepared by the World Health Organization (WHO) Department of Nutrition and Food Safety, in close
collaboration with Resolve to Save Lives (an initiative of Vital Strategies). WHO acknowledges the great support and valuable
contributions of colleagues at Resolve to Save Lives. WHO also recognizes the valuable contributions made by other collaborators
and partners working together to eliminate industrially produced trans-fatty acids (TFA) from the global food supply.
WHO wishes to acknowledge Dr Ashkan Afshin and his team at the Institute for Health Metrics and Evaluation for providing data
and technical expertise.
Acknowledgement is also made of WHO regional and country office colleagues, including those from the WHO European Office
for the Prevention and Control of Noncommunicable Diseases in Moscow, and their national counterparts, in making tremendous
efforts to validate country data and information on the status of TFA-related policies.
Special thanks are due to Member States, which are committed and are taking concrete actions to achieve the global target of
TFA elimination by 2023.
iii
ACRONYMS
ANVISA	 Agência Nacional de Vigilância Sanitária (Brazil’s
National Agency of Sanitary Surveillance)
CHD	 coronary heart disease
EAEU	 Eurasian Economic Union
EEA	 European Economic Area
EU	 European Union
GBD	 Global Burden of Disease
GCC	 Gulf Cooperation Council
GSO	 GCC Standardization Organization
IFBA	 International Food and Beverage Alliance
IHME	 Institute for Health Metrics and Evaluation
NAFDAC	 Nigerian National Agency for Food and Drug
Administration and Control
NCD	 noncommunicable disease
PAHO	 Pan-American Health Organization
PHO	 partially hydrogenated oils
SFDA	 Saudi Arabian Food and Drug Administration
SFA	 saturated fatty acids
TFA	 trans-fatty acids
WHO	 World Health Organization
iv
Noncommunicable diseases (NCDs) – including heart disease, stroke, cancer and diabetes – kill 41 million people worldwide
every year. Cardiovascular disease is the main killer, accounting for nearly half of all NCD deaths. Many of these deaths are in
people under 70 years of age, and most occur in low- and middle-income countries. The World Health Organization (WHO) is
committed to supporting countries to achieve the Sustainable Development Goal objective of reducing premature deaths from
NCDs by one third by 2030.
Diet-related risk factors are a major driver of preventable deaths due to cardiovascular disease. Industrially produced trans-fatty
acids (TFA), which are still used in some countries as an ingredient in fried food, deep-fried food, baked goods and spreads, are
linked with heart disease and death. But they can be completely eliminated and replaced with healthier oils and fats without
changing the taste or cost of food.
Elimination of industrially produced TFA from food is feasible, cost-effective and life-saving. A number of countries have already
taken action to ban industrially produced TFA and protect their citizens. The 12 largest multinational food companies have
also committed to eliminate industrially produced TFA from all their products by the year 2023. Yet action has been largely
concentrated in wealthier countries, and countries with fewer resources continue to be disproportionately at risk of preventable
deaths from TFA. This is unacceptable and unnecessary.
Global elimination of industrially produced TFA is a WHO priority and a target in the 13th General Programme of Work, which
guides our work through to 2023. WHO will support Member States to replace these harmful substances with healthier oils and
fats. The WHO REPLACE action framework was launched in May 2018 and its accompanying six modules in May 2019 to guide
governments to achieve this goal. Since then, Member States have made encouraging progress in eliminating TFA from their food
supplies. But most countries remain unprotected from the harms of TFA. There is much more to be done to meet the goal of
global elimination of industrially produced TFA from the entire global food supply in the next three years, by 2023.
FOREWORD
COUNTDOWN TO 2023:
WHO REPORT ON GLOBAL TRANS FAT
ELIMINATION 2020
Dr Tedros Adhanom Ghebreyesus
Director-General
World Health Organization
v
vi
EXECUTIVE SUMMARY
Intake of trans-fatty acids (TFA) is associated with increased risk of heart attacks and death from coronary heart disease.
Replacing industrially produced TFA with healthier oils and fats is cost-effective and feasible, and can be done without changing
the taste of food or its cost to the consumer.
In May 2018, the World Health Organization (WHO) called for the global elimination of industrially produced TFA by 2023 and
released the REPLACE action framework. The framework is a roadmap for countries to implement the prompt, complete and
sustained elimination of industrially produced TFA from the food supply. In May 2019, WHO released six REPLACE modules,
which provide practical, step-by-step implementation guidance to support governments. WHO recommends that countries adopt
and implement one of two best-practice policy options for eliminating industrially produced TFA from the food supply.
Countries are responding to this call to action, and the number of countries passing and implementing best-practice policies
is growing. As of May 2020, best-practice TFA policies that either virtually eliminate industrially produced TFA or ban partially
hydrogenated oils (PHO) are in effect for 589 million people in 14 countries (8% global population coverage). The number of
countries with some form of mandatory TFA limits – either best-practice TFA policies or less restrictive TFA limits – has risen to 32
(32% global population coverage).
Since the publication of the first progress report in May 2019, more than 40 countries have taken action to initiate or advance
TFA policy discussions. Best-practice policies came into effect in Lithuania and Saudi Arabia, and were passed in Brazil and
Turkey. India and Nigeria notified draft best-practice TFA policies for public comment. In October 2019, the 35 Member States of
the WHO Regional Office for the Americas/Pan-American Health Organization unanimously approved a regional plan of action to
eliminate industrially produced TFA by 2025. As well, civil society organizations have increased advocacy to support regulations
and product reformulation.
In its first two years, the global initiative to eliminate industrially produced TFA has produced encouraging results in some
countries, but most still do not have policies in place to protect their citizens from the harmful effects of TFA. To meet the 2023
target, WHO recommends that countries take the following actions in the coming year.
	› Develop and implement best-practice policies to set TFA limits or to ban PHO.
	› Invest in monitoring mechanisms, such as laboratory capacity to measure TFA content in foods.
	› Advocate for regional or subregional regulations to expand the benefits of TFA policies.
WHO will strengthen its support to countries working to eliminate TFA by the following activities:
	› Continue to provide technical support for building regulatory capacities to accelerate best-practice policy
development, implementation and enforcement in countries. This includes strengthening laboratory capacity to
assess TFA content in foods.
	› Disseminate country experiences, success stories and good practices, and recognize achievements by countries.
	› Undertake global advocacy through existing and newly developed frameworks and initiatives, such as the World Health
Assembly, the United Nations Decade of Action on Nutrition, and the United Nations Food System Summit.
WHO expects food and beverage industry groups to implement the commitments they have made to eliminate industrially
produced TFA from product lines. WHO also expects major suppliers of oils and fats to step up to remove industrially produced
TFA from the products that are sold to food manufacturers globally.
vii
viii
I. INTRODUCTION
Cardiovascular disease is the leading killer globally, causing an estimated 17.9 million deaths every year (Wang H et al., 2016).
Based on the most recent global systematic evaluation of diet-related disease burden, dietary risks were responsible for 10
million deaths from cardiovascular disease among adults (Afshin et al., 2019). Intake of trans-fatty acids (TFA) is associated with
increased risk of heart attacks and death from coronary heart disease (CHD) (WHO, 2019a). Although limited data are available
on TFA intake globally, a recent report estimated that the 2017 global market volume of partially hydrogenated oils (PHO) – the
main source of industrially produced TFA in food – was approximately 13.6 million tonnes (Persistence Market Research, 2018).
Among various measures to tackle dietary risks, elimination of industrially produced TFA is a relatively straightforward, low-cost,
one-time policy measure that is within reach and has significant long-term health benefits. Replacing industrially produced TFA
with healthier oils and fats is feasible and cost-effective, and will save lives.
TFA elimination has gained momentum as a global priority. As of May 2020, 32 countries have implemented mandatory TFA
limits, covering 2.4 billion people (32% of the global population) (UN DESA, 2019). Of these, 14 countries – covering 589 million
people (8% of the global population) – have implemented a best-practice TFA policy that either virtually eliminates industrially
produced TFA or bans PHO. An additional 26 countries, with approximately 815 million people, have passed a best-practice TFA
policy that will come into effect in the next two years.
Regional regulations are an increasingly popular approach to the elimination of industrially produced TFA. In 2015, the Eurasian
Economic Union (EAEU) became the first regional body to put into effect a TFA elimination policy. This was followed by the Gulf
Cooperation Council (GCC) and the European Union (EU), which passed TFA limits in 2015 and 2019, respectively. In October
2019, countries in the Americas unanimously passed the Action Plan to Eliminate Trans-Fatty Acids from Industrial Production
2020–2025. Together, these four regional initiatives have the potential to protect more than 1.7 billion people in 73 countries.
In many countries, civil society organizations are advocating for mandatory TFA limits and supporting governments to set these
limits. The food industry is also becoming more receptive to replacing industrially produced TFA in their products with healthier
oils and fats.
In 2018, TFA elimination was identified as one of the priority targets in the World Health Organization (WHO) 13th General
Programme of Work, which guides the five-year work of WHO in 2019–2023. Also in 2018, the REPLACE action package was
launched to help countries eliminate industrially produced TFA from their food supplies. WHO released additional resources in
2019 to support country actions, including six implementation modules and a live policy tracking map – the TFA Country Score
Card 1
– to monitor global progress towards the 2023 target. In 2020, WHO established a TFA indicator that records whether
countries have adopted WHO best-practice policies for eliminating industrially produced TFA (WHO, 2020a). The TFA indicator is
discussed in section II.
Terms used in this report are described in Table 1.
TABLE 1. DEFINITIONS OF POLICY CATEGORIES
"Best-practice TFA policy"
Legislative or regulatory measures that limit industrially produced TFA in foods
in all settings and are in line with the recommended approach. The two bestpractice
policies for TFA elimination are:
1	 Mandatory national limit of 2 g of industrially produced TFA per 100 g of
total fat in all foods; and
2	 Mandatory national ban on the production or use of PHO as an ingredient
in all foods.
"Best-practice TFA policy
passed but not in effect"
Best-practice policies have been passed but have not yet come into effect.
"Less restrictive TFA limits"
Legislative or regulatory measures that limit industrially produced TFA in foods
in all settings, but are less restrictive than the recommended approach (e.g. 2%
limit for industrially produced TFA in oils and fats only; 2% limit for industrially
produced TFA in oils and fats, and 5% limit in other foods; 5% limit for
industrially produced TFA in oils and fats).
"Mandatory TFA limits"
A broader term that refers to both “best-practice TFA policy” and “less restrictive
TFA limits”.
"Other complementary measures"
Legislative or other measures that encourage consumers to make healthier
choices about industrially produced TFA (e.g. mandatory declaration of TFA on
nutrition labels; front-of-pack labelling system that includes TFA; reformulation)
or mandatory limits on industrially produced TFA in foods in specific settings
(e.g. public institutions).
"National policy commitment
to eliminate TFA"
National policies, strategies or action plans that express a commitment to reduce
industrially produced TFA in the food supply.
"Monitoring mechanism
for mandatory TFA limits"
A mechanism that monitors the legislative or regulatory measures for mandatory
TFA limits.
This progress report, the second since the 2018 launch of the REPLACE action package, aims to track and accelerate progress
towards the goal of global elimination by 2023. The report:
	› Describes the current global, regional and national situations and changes during the past year (since May 2019);
	› Tracks progress of key policy outcomes and milestones;
	› Discusses challenges and opportunities for future action;
	› Highlights enablers and blockers of TFA elimination at the country level; and
	› Recommends strategic priorities for the next 12 months to achieve the 2023 target.
In addition, this report highlights countries in each WHO region that have made significant policy advances in the past year.
2
II. GLOBAL PROGRESS
1. COUNTRY POLICIES
CURRENT SITUATION
2
	 http://www.who.int/nutrition/gina/en/; GINA is an online database of validated information on countries’ policies and programme
interventions relating to fortification, food labelling, marketing of breast-milk substitutes and nutrition (including TFA).
3
	 https://www.who.int/nutrition/topics/replace-transfat
4
	 https://apps.who.int/iris/bitstream/handle/10665/331300/9789241516440-eng.pdf
Mandatory TFA policies are currently in effect for 2.4 billion people in 32 countries (32% of the global population in 2020). Of
these, 14 countries (covering 589 million people – 8% of the global population) have best-practice policies, and two countries
(Peru and Uruguay, covering 36 million people), which have less restrictive limits in place, have passed best-practice policies that
will come into effect in the next two years. Another 26 countries, covering 779 million people, have also passed best-practice
TFA policies that will come into effect within the next two years. Currently, 27 countries have other complementary measures in
place, and 62 countries have a national policy, strategy or action plan in place that expresses a commitment to reduce TFA in the
food supply. For the remaining 64 countries, there has either been no action to eliminate TFA or the status is unknown.
Fig. 1 shows the status of TFA policy implementation around the world. The map is based on a country performance score card
developed by WHO and data from the WHO Global database on the Implementation of Nutrition Action (GINA)2
. The live map is
constantly updated and accessible on the GINA and REPLACE webpages3
.
Annex 1 provides country-by-country information on the CHD burden attributable to TFA intake, and the status of TFA policies –
both those that in effect and those that will shortly come into effect. The estimates on CHD burden in Annex 1 are provided by
the Institute for Health Metrics and Evaluation (IHME) and are based on data from the Global Burden of Disease (GBD) study
2019, whereas the estimates in the 2019 progress report4
were based on data from GBD 2010. Several differences can be
seen when the estimates in the current report are compared with those in the 2019 report. For example, the distribution of
the TFA-attributable burden of CHD death appears to have become significantly narrower, and many countries appear to have
substantially reduced the portion of CHD attributable to TFA. The rankings of countries have also shifted. These differences are
mostly due to technical and methodological advances in estimating the burden of disease attributable to TFA intake. Changes
made in methodologies used for the analysis in GBD 2019 are described in detail in Annex 2. Because of these advances in
methodologies, it is considered that the estimates in Annex 1 more accurately reflect the reality of the worldwide CHD burden
attributable to TFA. The changes in methodologies mean that estimates from the 2019 report and the current report cannot be
directly compared.
Although these estimates are currently the best available, there are some limitations. For example, the CHD burdens attributable
to TFA in this report and the 2019 report are estimates based on modelling rather than actual measurements. Although an
increasing number of countries now have data on TFA sales and consumption, there is still a data gap that needs to be filled by
assumptions and extrapolations.
Despite these issues, part of the change between GBD 2010 and GBD 2019 could also reflect actual changes as a result of
policy achievements in countries that have introduced a TFA best-practice policy to virtually eliminate industrially produced TFA or
ban PHO. TFA consumption has decreased in countries where the oil composition has changed as a result of reformulation after
introduction of a best-practice policy. This reinforces the importance of countries pursuing regulations for TFA elimination.
.
3
FIG. 1. TFA POLICY IMPLEMENTATION: MAP OF COUNTRY PERFORMANCE
Note: The map is based on the data available in GINA (as of May 2020). A live and clickable
version of the map is available on GINA: https://extranet.who.int/nutrition/gina/en/scorecard/TFA
Best-practice TFA policies
Best-practice TFA policy passed
but not yet in effect
Less restrictive TFA limits
Other complementary measures
National policy commitment to eliminate TFA
Monitoring mechanism for mandatory TFA limits
Missing data
As of May 2020, 14 countries have best-practice TFA policies in effect, and this number is projected to increase to at least 40
in 2022 (Fig. 2). Although good progress has been made, important disparities persist in policy coverage by region and country
income level. Most policy actions to date, including those passed in 2019 and 2020, have been in higher-income countries and
in the WHO regions of the Americas and Europe: best-practice TFA policies have been adopted by seven upper-middle-income
countries5
and 33 high-income countries6
(Fig. 3). No low-income or lower-middle-income countries have adopted best-practice
TFA policies. Supporting low- and middle-income countries to implement best-practice policies is critical to ensure that people in
all countries benefit equally from protection from TFA in foods.
FIG. 2. NUMBER OF COUNTRIES WITH BEST-PRACTICE TFA POLICY IMPLEMENTED, BY YEAR
1 1 1 1 1 2 2
5 5 5
7 7 7 7
11
13 14
39 40
0
5
10
15
20
25
30
35
40
45
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022
NumberofCountries
FIG. 3. NUMBER OF COUNTRIES WITH BEST-PRACTICE TFA POLICY PASSED OR IN EFFECT, BY INCOME STATUS
0
5
7
10
15
20
25
30
35 33
HIC UMIC LMIC LIC
HIC: high-income countries; LIC: low-income countries; LMIC: lower-middle-income countries; UMIC: upper-middle-income countries
5
	 Brazil, Bulgaria, Peru, Romania, South Africa, Thailand, Turkey
6
	 Austria, Belgium, Canada, Chile, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland,
Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Saudi Arabia, Slovakia, Slovenia, Spain,
Sweden, United Kingdom, United States of America, Uruguay
6
In 2020, within the 13th General Programme of Work Results Framework, WHO developed an indicator that records whether
countries have adopted WHO best-practice policies for eliminating industrially produced TFA. The indicator was based on
estimated global averages (from IHME data) and represents the proportion of the population who are expected to reduce TFA
intake to the level recommended by the WHO guideline (i.e. less than 1% of total energy intake) during the five years following
policy implementation (WHO, 2020b).
Table 2 shows the number of people with TFA intake exceeding the WHO recommended level of less than 1% of total energy
intake, according to the year when countries’ best-practice policies took (or will take) effect. In the 40 countries with a bestpractice
TFA policy taking effect by 2022, nearly 280 million people are estimated to have an excessive TFA intake before or
at the beginning of policy implementation and have the potential to benefit from the protection provided by the best-practice
policy. It is estimated that currently 886 million people living in 143 countries without a best-practice TFA policy have TFA intake
levels that exceed the WHO recommended level. These 886 million people could potentially be protected if these 143 countries
introduced a best-practice policy.
TABLE 2. NUMBER OF PEOPLE WITH TFA INTAKE EXCEEDING THE WHO RECOMMENDED LEVEL
Year of effect
of best-practice
TFA policy
Countries
Number of people with
TFA intake exceeding
WHO guideline at time
of implementation
Before 2017 Denmark (2004); Austria (2009); Chile, Iceland,
South Africa (2011); Hungary, Norway (2014)
2.0 million
2018 Canada, Latvia, Slovenia, United States of America 214 million
2019 Lithuania, Thailand 0.8 million
2020 Saudi Arabia 26,000
2021 (planned) Belgium, Brazil, Bulgaria, Croatia, Cyprus, Czech Republic,
Estonia, Finland, France, Germany, Greece, Ireland, Italy,
Luxembourg, Malta, Netherlands, Peru, Poland, Portugal,
Romania, Slovakia, Spain, Sweden, Turkey, United Kingdom
61.7 million
2022 (planned) Uruguay 1,500
No best-practice
policy passed or in
effect (not imminent)
Remaining 143 WHO Member States 886 million
Note: 11 countries were not included due to missing data.
NEW IN THE PAST YEAR
Since the first annual progress report in May 2019, there has been significant progress in TFA elimination around the world
(Table 3). Best-practice policies came into effect in Lithuania and Saudi Arabia, and a less restrictive TFA limit came into effect
in Uruguay. In December 2019, a best-practice policy was passed in Brazil and will come into effect in July 2021. In May 2020,
Turkey passed a best-practice TFA limit, which will take effect in 2021.
Two countries notified draft best-practice TFA policies for public comment: India in August 2019, and Nigeria in January 2020. In
October 2019, the 35 Member States of the Pan-American Health Organization (PAHO) unanimously approved the Plan of Action
for the Elimination of Industrially Produced Trans-Fatty Acids 2020–2025 (PAHO, 2019).
In the past year, there has been an encouraging trend towards countries adopting best-practice TFA policies rather than less
restrictive limits. New policy measures passed and introduced have overwhelmingly followed best practice (passed in Brazil
and Turkey; drafts introduced in India and Nigeria); and countries that previously had less restrictive measures are updating
7
policies to align with best practice (passed in Saudi Arabia; draft introduced in India). As well, Singapore officially announced
plans to strengthen its existing less restrictive TFA limit (which applies to oils and fats only) to align with global best practice by
implementing a ban on PHO (following Canada, Thailand and the United States as models) (Singapore Ministry of Health, 2019).
In the next 12 months, WHO will continue supporting country adoption and implementation of best-practice TFA policies. WHO
will also provide support to countries in strengthening their regulatory capacities to help accelerate implementation, compliance
monitoring and enforcement of TFA policy actions.
TABLE 3. PROGRESS IN MANDATORY TFA LIMITS SINCE MAY 2019
Best-practice TFA policy Less restrictive limits
Came into effect Passed Draft policy proposed and
notified for public comment
Came into effect
Lithuania
Saudi Arabia
Brazil
Turkey
Indiaa
Nigeria
Uruguayb
a
	 In 2011, India passed regulations that set a TFA limit of 10% in oils and fats, which was further reduced to 5% in 2015. In December
2018, the Food Safety and Standards Authority of India (FSSAI) proposed reducing this limit to 2% and eliminating industrially produced
TFA in the food supply by 2022, a year ahead of the global target. In August 2019, the FSSAI proposed aligning India’s regulations with
global best practice and notified for public comment draft regulations that apply the 2% TFA limit to all food products by January 2022.
b
	 Uruguay’s policy limits industrially produced TFA to 2% of the total fat content in oils and fats, and to 5% of the total fat in other foods. The
policy took effect in November 2019. In a second implementation phase, by May 2022, the 2% limit will apply to all fats, oils and foods
(best practice).
2. SUPPORT FOR REFORMULATION
CURRENT SITUATION
Elimination of industrially produced TFA requires the involvement of manufacturers of foods, edible oils and fats. In April 2019,
Dr Tedros Adhanom Ghebreyesus, Director-General of WHO, issued a statement calling on fats, oils, and food and food service
industries to reformulate foods to eliminate industrially produced TFA and increase replacement with alternatives low in saturated
fatty acids (SFA) (WHO, 2019b). In May 2019, member companies of the International Food and Beverage Alliance (IFBA)
committed to not exceeding 2 g of industrially produced TFA per 100 g of oils and fats in their products worldwide by 2023 (IFBA,
2019). IFBA companies account for approximately 13% of global packaged food sales (Alexander, Yach & Mensah, 2011). This
means that manufacturers of almost 90% of packaged foods globally are not committed to eliminating industrially produced TFA.
Suppliers of edible oils and fats may be even more instrumental than food manufacturers in eliminating industrially produced TFA
from the global food supply. Relatively few suppliers of edible oils and fats serve all food manufacturing and service companies
– from large multinationals to small and medium-sized enterprises. If industrially produced TFA are removed from oils and fats
supplied to food manufacturing and service companies, they will be eliminated from all food products sold to consumers. To date,
however, no suppliers have committed to eliminating industrially produced TFA from product lines.
NEW IN THE PAST YEAR
With funding from Resolve to Save Lives, the Global Alliance for Improved Nutrition (GAIN) and the Scaling Up Nutrition (SUN)
Business Network initiated a project to provide technical support to small and medium-sized enterprises to reformulate product
lines to remove industrially produced TFA (SUN Business Network, 2019). In 2019 and 2020, 25 small and medium-sized
enterprises in Nigeria, and 15 in Pakistan received training from IFBA company experts, based on the needs and resources
available in each country (GAIN, 2020).
In 2019 and early 2020, a coalition of nongovernmental organizations (American Heart Association, NCD Alliance, Resolve to
Save Lives, and World Heart Federation) sent letters to major food companies urging them to take action to protect the health of
their consumers by removing industrially produced TFA from global product lines.
In early 2020, discussions began on organizing a meeting for countries of the EAEU to create dialogue between the oils and fats
industry and governments; the objectives were to use industry’s technical expertise to identify hurdles to achieving a food supply
free from industrially produced TFA, and to build a technology roadmap for countries. However, the COVID-19 pandemic has
resulted in postponement of this planned meeting. However, given the importance of this dialogue to move towards the target of
8
eliminating TFA by 2023, the potential to hold a virtual meeting before the end of 2020 is currently being considered.
A priority for the next year will be to engage edible oils and fats suppliers to support a global supply chain that is free from
industrially produced TFA, and to ensure that an appropriate accountability mechanism is in place.
3. GLOBAL RESOURCES AND SUPPORT FOR POLICY ACTION
CURRENT SITUATION
WHO is committed to supporting countries to implement the actions of the REPLACE action package. The complete
REPLACE action package, including a technical framework and comprehensive implementation resources, is available on the
REPLACE webpage.7
Ensuring capacity to monitor compliance and enforce TFA regulations is critical to maximizing public health benefits. Some
countries (generally higher-income countries) have mandatory labelling – that is, a TFA declaration on nutrient facts panels and/
or PHO on the ingredients list – that should ensure compliance with regulations. However, even when labelling requirements are
in place, it is important for countries to be able to confirm, through laboratory testing, that companies are complying with the
information on the labels.
Many other (generally lower-resourced countries) do not have labelling requirements in place and will need to rely on some
laboratory testing of TFA levels to monitor compliance. Further, labelling is not a viable compliance monitoring mechanism in
countries where sources of TFA include unpackaged foods. A lack of in-country laboratory capacity for measurement of TFA in
foods, especially in lower-resourced countries, can be a barrier to enforcement.
To support country assessments of TFA in foods, WHO convened an expert consultation in October 2018 and released global
surveillance protocols in May 2019. These protocols (available on the REPLACE webpage8
) can be adapted for measuring TFA
levels in national food supplies in a range of settings.
NEW IN THE PAST YEAR
To support countries in designing and implementing best-practice TFA policies, a regulatory and legal capacity-building course
was developed. The interactive training was delivered in June 2019 for countries in the Eastern Mediterranean Region, and in
July 2019 for countries in the Americas Region.
To better understand the laboratory needs in countries, an interlaboratory study (“ring trial”) on measurement of TFA and other
fatty acids in selected foods by gas chromatography was undertaken. Fourteen laboratories, representing all WHO regions, are
participating in the study, which aimed to assess the level of agreement of results among laboratories. Full analysis of results is
under way. The global laboratory protocol for measuring TFA in food have been revised, based on the preliminary findings from
this study, to make them more usable for countries.
In many countries, civil society organizations and other nongovernmental organizations have become active around TFA
elimination. Groups have developed resources to support REPLACE implementation and policy action in countries, including
advocacy briefs, food sampling protocols for measuring TFA, and country case studies (available in the LINKS cardiovascular
health toolkit section).9
A Knowledge Exchange Network was established in 2019 by NCD Alliance, providing a virtual platform for
civil society organizations working on TFA elimination to share experiences, successes and challenges.
In the next year, WHO will accelerate efforts in providing Member States with technical support to strengthen their regulatory
and legal capacities for implementing policies to eliminate TFA from their food supplies. WHO also plans to publish the ring trial
results and will explore the possibility of identifying laboratories that could become regional hubs for TFA testing in foods.
7
	 https://www.who.int/nutrition/topics/replace-transfat
8
	 https://www.who.int/nutrition/topics/replace-transfat
9
	 https://linkscommunity.org/toolkit/trans-fat-elimination; LINKS is a collaborative effort of WHO, the United States Centers for Disease Control
and Prevention through the CDC Foundation, and Resolve to Save Lives (an initiative of Vital Strategies).
9
10
III. PROGRESS BY REGION
1. AFRICA
CURRENT SITUATION
The African Region (see Table 4) continues to have only a small number of countries with mandatory TFA limits or other
complementary measures. South Africa has had best-practice mandatory TFA limits in foods, oils and fats since 2011.
Fourteen countries have adopted national plans on nutrition or noncommunicable diseases (NCDs) that include goals or
strategies to eliminate industrially produced TFA.
TABLE 4. SUMMARY OF THE TFA POLICY SITUATION IN THE AFRICAN REGION
National policy
commitment to
eliminate TFA
Other
complementary
measures
Less
restrictive
TFA limits
Best-
practice
TFA
policy
Best-
practice
TFA policy
passed
but not in
effect
(as of May
2020)
Monitoring
mechanism
for
mandatory
TFA limits
Algeria, Benin,
Botswana, Cabo
Verde, Chad, Côte
d’Ivoire, Eswatini,
Ghana, Kenya,
Mauritius, Namibia,
Nigeria, Seychelles,
Zambia
Ethiopia South
Africa
South Africa
NEW IN THE PAST YEAR
In the past 12 months, TFA policy discussions have begun in several key countries. In Nigeria, a technical working group was
established in 2018 to support the Ministry of Health and the Nigerian National Agency for Food and Drug Administration and
Control (NAFDAC) in developing the evidence and recommendations around the need for TFA limits. In 2020, NAFDAC notified
a draft best-practice TFA policy that limits TFA to 2% of oils and fats in all oils, fats and foods. The policy experience in Nigeria is
described in Box 1.
In Ethiopia, in March 2020, parliament passed an excise tax on food products that are known to increase the risk of diabetes
and heart disease, including sugar-sweetened beverages, and oils and fats with high levels of SFA or TFA. Under the new tax
law, margarine with more than 40% SFA, or more than 0.5% TFA, will be taxed at 50%; and partially or wholly hydrogenated oils
and fats with more than 40% SFA, or more than 0.5% TFA, will be taxed at 40%, as will oils and fats whose SFA content is not
labelled or is unable to be determined from the label.
In Uganda, the Ministry of Health began developing the Uganda National Food Control Strategic Plan; the situation analysis
included a label review to assess TFA levels in popular food products.
Civil society groups in Africa are activating around TFA elimination. LINKS awardees in Tanzania (Muhimbili University of Health
and Allied Sciences) and Kenya (International Institute for Legislative Affairs) have begun projects to assess the amount of TFA in
the national food supplies, so that they can promote best-practice policies, and replacement with healthier oils and fats.
Because many countries in the African Region have limited resources and regulatory capacities, and the political priority to
support TFA elimination is also limited, working at the level of regional trading blocs as entry points may help to accelerate
progress in the region. This will be further explored in the next 12 months. Meanwhile, interested countries will continue to be
supported in implementing actions to eliminate TFA, including through development of TFA elimination policies.
A regional capacity-building workshop was planned for 2020 to strengthen regulatory capacities of national policy-makers in the
region. However, as a result of the COVID-19 pandemic, it has been postponed, perhaps to 2021. Some parts of the planned
capacity-building training may be conducted virtually while waiting for the more detailed face-to-face training workshop.
11
Box 1. Policy experience in Nigeria
Just a year and half after first taking on TFA elimination, the Nigerian Government drafted, announced and notified
for public comment a best-practice TFA policy in January 2020; this is an encouraging timeline that underscores the
feasibility of the WHO goal of global elimination by 2023. Passage of the best-practice policy is expected by the end
of 2020. The success in Nigeria was due to political will within the government – including at NAFDAC, the Federal
Ministry of Health and other key agencies – and the central role of civil society in advocating, convening stakeholders and
providing legal support on policy provisions throughout the policy process.
POLICY DEVELOPMENT:
In June 2018, NAFDAC proposed fats and oils regulations without any mention of TFA or PHO. Through media monitoring,
civil society groups identified this as an opportunity to include TFA limits. In August 2018, the Nigerian Medical
Association (NMA) successfully appealed to NAFDAC to extend the deadline for public comment on the proposed fats and
oils regulations.
In September 2018, the NMA discussed the importance of TFA elimination with the Minister of Health. At the minister’s
request, the NMA convened a technical working group on TFA elimination. Participants included representatives of key
government agencies, including the Federal Ministry of Health, the Ministry of Budget and National Planning, NAFDAC,
the Standards Organization of Nigeria, the Consumer Protection Council and the Nigerian Bureau of Statistics. It also
included representatives from WHO and from civil society organizations, including the Nigerian Heart Foundation, the
Nutrition Society of Nigeria, the Nigerian Cardiac Society and the Nigerian Council for Women.
With guidance from the technical working group on international best practices for TFA elimination, NAFDAC, in April
2019, published revised fats and oils regulations that would limit TFA content to 2% of oils and fats. The agency also
released regulations on pre-packaged food labelling that address TFA and other food components. Civil society proposed
areas for improvement to ensure that the policy would meet global best practices and maximize health benefits.
At a strategic meeting with the Acting Minister of Health and civil society advocates in June 2019, the permanent
secretary of the Federal Ministry of Health agreed to champion TFA elimination. Understanding the current burden of TFA
in the food supply and establishing a baseline for ongoing monitoring were identified as priorities. The following month,
research experts from the Global Health Advocacy Incubator trained Nigerian researchers in collecting food samples for
TFA testing. NAFDAC also invested in laboratory equipment and staff training to analyse TFA in foods.
In August 2019, NAFDAC’s Director General met with WHO and civil society advocates to discuss further improvements to
the agency’s fats and oils regulations. This led to the reopening of the regulations for public evaluation.
After a period of intense campaigning by civil society advocates to raise public awareness of TFA health harms and build
support for TFA regulations, NAFDAC released the revised regulations on fats and oils, as well as on pre-packaged foods,
for a 60-day public comment period in January 2020. The updated regulations on fats and oils include a best-practice
limit on TFA.
As the Nigerian Government, WHO and civil society worked to advance the regulations, industry also activated around
the issue of TFA elimination. In October 2019, an orientation workshop on reformulation of products high in TFA was
conducted for small and medium-sized companies. The show of support from local industry reinforced NAFDAC’s
commitment to implementing the REPLACE action package.
POLICY IMPLEMENTATION:
When regulations are finalized and come into effect (expected to occur in 2021), NAFDAC will design an implementation
and enforcement strategy.
12
2. AMERICAS
CURRENT SITUATION
The Americas Region (see Table 5) continues to make swift progress towards eliminating industrially produced TFA. Before the
release of the REPLACE action framework in 2018, mandatory TFA limits were already in place in four countries in the region.
Chile has had a best-practice 2% limit for industrially produced TFA in oils and fats that has applied to all foods since 2011;
Argentina (2014), Colombia (2013) and Ecuador (2014) all have limits of 2% in oils and fats, and 5% of total fat in all foods.
In 2018, complete bans on PHO came into effect in Canada and the United States, and Peru established a TFA limit of 2% in
vegetable oils and margarines, and 5% of total fat in all foods. In 2021, Peru will implement a second phase of the regulations,
banning PHO completely. The policy experience in Peru is described in Box 2.
TABLE 5. SUMMARY OF THE TFA POLICY SITUATION IN THE AMERICAS REGION
National policy
commitment to
eliminate TFA
Other
complementary
measures
Less
restrictive
TFA limits
Best-
practice
TFA
policy
Best-
practice
TFA policy
passed
but not in
effect
(as of May
2020)
Monitoring
mechanism
for
mandatory
TFA limits
Antigua and Barbuda,
Bahamas, Barbados,
Belize, Costa Rica,
Dominican Republic,
Grenada, Guatemala,
Guyana, Jamaica,
Saint Kitts and Nevis,
Saint Lucia, Saint
Vincent and the
Grenadines, Suriname,
Trinidad and Tobago,
Venezuela
Bolivia (Plurinational
State of), Brazil, El
Salvador, Mexico,
Paraguay
Argentina,
Colombia,
Ecuador,
Peru,
Uruguaya
 
Canada,
Chile,
United
States
Brazila
, Peru,
Uruguay 
Argentina,
Canada,
Chile,
Colombia,
Ecuador,
Peru,
United States,
Uruguay
a
	 New since May 2019.
NEW IN THE PAST YEAR
In 2019, Uruguay implemented regulations limiting TFA to 2% in vegetable oils and margarines, and 5% in all other foods; in
2022, the 2% limit will be extended to apply to all foods.
In December 2019, Brazil became the sixth country in the Americas Region to pass a best-practice policy (following Canada,
Chile, Peru, the United States and Uruguay). Brazil’s National Agency of Sanitary Surveillance (ANVISA) adopted regulations
setting a 2% limit for industrially produced TFA in all oils and foods (effective July 2021), and banning all PHO (effective January
2023). The policy experience in Brazil is described in Box 3.
In October 2019, Member States in the Americas Region unanimously approved a new plan to reduce cardiovascular disease
by eliminating industrially produced TFA from foods by 2025. The Action Plan to Eliminate Trans-Fatty Acids from Industrial
Production 2020–2025, approved by the 57th Directing Council of PAHO, promotes best-practice TFA policies (PAHO, 2019).
In the next 12 months, country-level implementation of the action plan will be a priority in the region.
13
Box 2. Policy experience in Peru
Since 2018, mandatory limits in Peru have capped TFA content at 2% in vegetable oils and fats, and 5% in other
processed foods. A best-practice PHO ban is scheduled to take effect in 2021. PAHO’s and WHO’s recommendations
on TFA, Chile’s policy implementation and enforcement success, and a PHO ban implemented in the United States and
Canada have inspired the adoption of a best-practice TFA elimination policy in Peru.
POLICY DEVELOPMENT:
During the past 10 years, Peru has passed several policies in support of a food supply free from industrially produced
TFA. These were motivated by the obligation of the state to promote and protect public health, and by the increasing
prevalence of diet-related NCDs, including TFA-related NCDs, and deaths caused by such diseases. The Peruvian
Government took its first step towards protecting the people of Peru from TFA in 2010, when the Consumer Defense and
Protection Code began requiring declaration of TFA content on food nutrient labels. In 2013, a new law on the promotion
of healthy foods for children and adolescents was passed, requiring both front-of-pack warning labels (including on TFA)
and issuance of regulations for a gradual reduction of industrially produced TFA in all packaged foods, whether nationally
produced or imported, until complete elimination. In July 2016, a follow-up regulation specified a five-year, two-phase
process and time frame for elimination of industrially produced TFA.
The first phase came into effect in mid-2018, mandating that TFA in all fats, vegetable oils and margarines oils could
no longer exceed 2% of total fat. For all other processed foods and non-alcoholic beverages, the TFA limit was 5%. Five
years after signing of the regulation (2021), a complete ban on PHO will become effective, and the limit of industrially
produced TFA from non-PHO sources, such as oil refining and processing, will be 2% of fats for all products.
In early 2018, another follow-up regulation stipulated the precise requirements for the prominent front-of-pack warning
labels and for their use in advertising of affected products.
Although industry and related actors opposed these sets of regulations and tried to delay their implementation, civil
society helped move the process forward by advancing arguments about the proven feasibility of these approaches, the
need to protect public health, and the absolute priority of public health over trade and commerce.
Since mid-2019, all products containing any amount of TFA must present a front-of-pack label indicating “CONTAINS
TFA”; all related advertisements for products must also feature the warning. Peru was the first country to implement
such a policy.
POLICY IMPLEMENTATION:
Compliance with the regulations is monitored through verification of ingredients lists. For imported foods, compliance is
enforced through mandatory pre-importation registration, certificates of analysis and importer certification. The burden is
on the food industry to demonstrate that the nutrition content of products being imported is in line with the standards in
Peru. The National Institute for the Defence of Competition and the Protection of Intellectual Property (Instituto Nacional
de Defensa de la Competencia y de la Protección de la Propiedad Intelectual) monitors compliance with the front-of-pack
labelling requirement, and reviews labels in supermarkets and at other points of sale; compliance with the regulations is
monitored by the General Directorate of Environmental Health (Dirección General de Salud Ambiental).
Penalties for noncompliance with the policy include a ban on sale of the noncompliant product, a fine, closure of the
establishment and withdrawal of the health certificate.
Consumers and civil society also contribute to monitoring via a mechanism for filing complaints about violations. To
support this monitoring activity, civil society, together with academia, PAHO and WHO, the Ministry of Health and other
government entities have formed a standing working group, which meets periodically to evaluate and ensure proper
implementation of the healthy food law.
Pre-regulation studies were carried out using a combination of review of ingredients lists for products on the market, and
laboratory analyses to verify accuracy of ingredients lists and amounts of TFA. Early post-regulation market studies have
shown that front-of-pack signs have resulted in a reduction in sales of products containing TFA and/or excessive amounts
of sugars, SFA and/or sodium (Kantar World Panel, 2019).
14
15
Box 3. Policy experience in Brazil
Serious efforts to address the negative consequences of industrially produced TFA in foods began in Brazil in the early
2000s. Participation in the South American trade bloc Mercosur (Mercado Común del Sur) spurred Brazil’s initial policy
action, when Mercosur made labelling for TFA on packaged foods mandatory in 2003. During the past 15 years, Brazil
has participated in regional working groups, made pledges and conducted assessments, culminating in the passage
of best-practice TFA regulations in December 2019. The regulations will limit TFA to 2% of total fat in all foods by July
2021 and ban PHO by January 2023. Political will to assess and act on the burden of TFA in Brazil, and an activated civil
society were key influencers of Brazil’s policy success towards TFA elimination.
POLICY DEVELOPMENT:
Brazil was one of the first countries to take policy action against the well-documented harms of TFA. In 2003, the
Brazilian National Agency of Sanitary Surveillance (Agência Nacional de Vigilância Sanitária – ANVISA) adopted a
Mercosur resolution requiring food manufacturers to report TFA content per serving on the nutrition facts label, unless the
amount is 0.2 g per portion or less; in these cases, companies may make claims of “zero trans” or “trans free” on the
packaging (ANVISA, 2003).
In 2007, Brazil’s Ministry of Health signed a cooperation agreement with the Brazilian Association of Food Industries to
promote healthy lifestyles and nutritional diets, including reducing TFA in processed foods (Brasil Ministério da Saúde,
2008). In June 2008, the Ministry of Health and several food and cooking oil industry representatives signed the Trans
Fat Free Americas declaration of Rio de Janeiro, pledging to limit industrially produced TFA to 2% of total fat in oils and
margarines, and to 5% in processed foods (PAHO, 2008).
Despite these efforts, consumption of TFA in Brazil exceeded the limit recommended by WHO (maximum of 1% of total
energy intake). In 2008–2009, the first Brazilian National Dietary Survey assessed the burden of TFA consumption
in Brazil. Results revealed that average daily TFA intake was 1.4% of total energy, and that a diet consisting of ultraprocessed
foods contained eight times more TFA than one made up of fresh and minimally processed foods (Louzada et
al., 2015). There was a clear need to take further action.
In 2009, the Ministry of Education approved a resolution to limit TFA in school meal programmes to 1% of total energy.
In May 2017, legislation was introduced to ban the use of PHO in the manufacturing of food. ANVISA was allowed to
grant exceptions based on technical justifications. The legislation was approved by the Senate and referred to the House
of Deputies (Câmara dos Deputados, 2017).
In March 2018, ANVISA announced its intention to examine regulatory options on TFA (ANVISA, 2018). In May 2018,
ANVISA hosted a stakeholder meeting to review available TFA research, following the call by WHO to eliminate industrially
produced TFA from the global food supply.
ANVISA took several actions over the following months, including releasing a technical report summarizing information
on TFA in Brazil, hosting a stakeholder meeting on TFA elimination with civil society and industry representatives, and
releasing a timetable for addressing TFA in foods. In July 2019, ANVISA’s board of directors released its justification for
regulating TFA in foods and approved the launch of a public consultation process on the policy proposal, from 7 August to
7 October 2019.
In parallel, civil society advocates had begun to activate around TFA elimination in early 2019. Advocates assessed ways
to support the adoption of TFA policies and strengthen ANVISA’s role in regulating TFA in foods, and met with ANVISA
representatives advocating for TFA policies. The Brazilian Association of Nutrition (Associação Brasileira de Nutrição –
ASBRAN) was the face of civil society advocates working for a TFA policy in Brazil, and coordinated public engagement
around ANVISA’s consultation process.
ANVISA’s public consultation received more than 1200 comments, of which 90% supported the agency’s proposal to
regulate TFA in foods.
Following a stakeholder meeting in November 2020, ANVISA’s board of directors approved a plan to limit TFA to 2% of
total fat in all foods by July 2021, and ban PHO from January 2023. On 26 December 2019, ANVISA’s TFA regulation
(RDC 332/2019) was published in the Official Gazette.
POLICY IMPLEMENTATION:
ANVISA is now developing a strategy for policy monitoring and enforcement. Civil society continues to provide technical
support in designing this strategy.
16
3. EASTERN MEDITERRANEAN
CURRENT SITUATION
The Eastern Mediterranean Region has had some of the highest TFA intake globally (Wang Q et al., 2016). Iran was the
first country in the region to regulate TFA, with a 2% limit in oils and fats that became effective in 2016. In 2015, the Gulf
Cooperation Council (GCC) approved TFA limits of 2% of total fat in vegetable oils and soft spreadable margarines, and 5% of
total fat in other foods. GCC Member States (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and United Arab Emirates) must each
approve implementation of the regulation before it can come into effect in the country.
Of the GCC countries, Bahrain, Kuwait and Saudi Arabia have implemented the regulation, which took effect in 2016, 2017
and 2017, respectively; the implementation process has been initiated in Oman and Qatar. Table 6 summarizes the TFA policy
situation in the Eastern Mediterranean Region.
TABLE 6. SUMMARY OF THE TFA POLICY SITUATION IN THE EASTERN MEDITERRANEAN REGION
National
policy
commitment
to eliminate
TFA
Other
complementary
measures
Less
restrictive
TFA limits
Best-
practice
TFA policy
Best-
practice
TFA policy
passed
but not in
effect
(as of May
2020)
Monitoring
mechanism
for
mandatory
TFA limits
Afghanistan,
Egypt, Lebanon,
Morocco, Qatar,
United Arab
Emirates
Jordan, Oman,
Pakistan, Tunisia
Bahrain,
Iran (Islamic
Republic of),
Kuwait
Saudi Arabiaa
Saudi Arabia
a
	 New since May 2019.
NEW IN THE PAST YEAR
During the past year, interest in TFA elimination in the region has increased. In January 2020, Saudi Arabia implemented a
second phase of its TFA policy, banning PHO and becoming the first country in the region with a best-practice policy. The policy
experience in Saudi Arabia is described in Box 4. In early 2019, WHO collaborated with the governments of Egypt and Pakistan
to assess TFA sources and the levels of TFA in foods (WHO, 2019c). In Pakistan, the Ministry of Health established a Technical
Working Group on TFA in September 2019. The group is co-led by the Ministry of Health and WHO, and is working to build
support for, and draft, a best-practice policy.
In June 2019, the WHO Regional Office for the Eastern Mediterranean hosted key government representatives from 15 countries
(Bahrain, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Palestine, Pakistan, Qatar, Saudi Arabia, Sudan, Syria, Tunisia)
for a legal and regulatory capacity-building workshop. At the workshop, countries learned about best-practice approaches for
TFA elimination and began identifying key elements of a regulation for effective elimination in their countries. A key challenge
raised during the workshop is the lack of laboratory capacity in the region to conduct TFA testing in foods, which is necessary for
monitoring compliance with TFA limits.
In the next 12 months, WHO will continue to support the development of best-practice policies in countries and laboratory
capacity-building for TFA analysis in the region.
17
Box 4. Policy experience in Saudi Arabia
In January 2020, Saudi Arabia became the first country in the Eastern Mediterranean Region and the 14th country in the
world to implement a best-practice TFA policy. Saudi Arabia’s policy will protect 35 million people from the harms of TFA
and will facilitate similar policies in the other GCC countries, covering an additional 24 million people.
Key factors that influenced the successful policy process in Saudi Arabia included positioning the TFA regulations as part
of a broader Healthy Food Strategy that was driven by leadership within the Saudi Government, engaging food companies
throughout the process to ensure that the policy was implementable and that companies of all sizes were prepared to
comply, and engaging WHO and civil society to ensure that the policy approach was based on evidence and successful
experiences in other countries (NCD Alliance, 2019).
POLICY DEVELOPMENT:
The Saudi Arabian Food and Drug Administration (SFDA) acted to eliminate TFA from the national food supply to reduce
Saudi Arabia’s high burden of heart disease. In 2016, 73% of all deaths were from NCDs, of which more than half
were cardiovascular diseases (WHO, 2018). Saudis were, on average, consuming TFA in quantities above the WHO
recommended limit, and TFA intake was estimated to cause 10% of all heart disease deaths in the country (Wang Q et
al., 2016).
In 2017, the SFDA launched a strategic plan for healthy food focused on sugar reduction, fat reduction, salt reduction
and calorie display. The strategies in the plan were based on international best practices, scientific literature and WHO
recommendations. There was a clear need to reduce TFA in the food supply, and the SFDA sought scientific guidance
from the WHO Regional Office for the Eastern Mediterranean on how to achieve this.
No data were available on TFA sources in the Saudi food supply. Because 80% of food in Saudi Arabia is imported, the
SFDA looked to data from the United States on sources of TFA, which showed that 79% of TFA comes from industrial
sources. Of the TFA from industrial sources, 50% comes from a small selection of food categories (e.g. cakes, cookies,
biscuits) (US FDA, 2003).
To gain critical inputs on how to structure regulations, the SFDA held meetings with key stakeholders, including industry,
and a committee with members from civil society organizations, academia and WHO. Civil society advocates and
academics also provided support through advocacy, communications and evidence generation.
The SFDA started with a regulation for mandatory labelling of TFA, which was passed in June 2015 and came into
effect in 2016. In November 2015, a regulation was passed for a TFA limit of 2% in oils and fats, and 5% in other food
products. These TFA limits were approved by the GCC Standardization Organization (GSO) and became available for other
GCC Member States to adopt in 2015.10
The limit took effect in Saudi Arabia in November 2017.
To ensure that companies were prepared to comply with the regulations, the SFDA held workshops to facilitate exchange
of knowledge and expertise between larger food companies (that have experience in complying with TFA regulations in
other countries) and smaller companies. The SFDA also worked with food companies on a voluntary agreement to reduce
PHO to 1% by weight in products by 2018 as part of the Healthy Food Strategy.
POLICY IMPLEMENTATION:
In February 2018, the SFDA undertook an inspection campaign and tested TFA levels in samples of 400 foods. Of
these, 5% were noncompliant with the TFA limits (NCD Alliance, 2019). To ensure that all industrially produced TFA is
removed from the food supply, the SFDA decided to follow global best practices – in particular, the Canadian model – and
completely banned the use of PHO in all products. In November 2018, the SDFA replaced the TFA limit with a PHO ban,
which became effective in January 2020.
The SFDA plans to undertake another inspection campaign in early 2020 to monitor compliance with the PHO ban. There
are no laboratory methods for measuring PHO in foods, so the SFDA is working with Health Canada and the private sector
to develop its compliance monitoring approach. Saudi Arabia also intends to develop a plan for evaluating the health
impacts of the policy.
Pending GSO approval, Saudi Arabia’s PHO ban will be available for other GCC Member States to adopt, extending the
benefits of the years of policy development by the SFDA and other stakeholders.
10
	 The GSO has the role of unifying standards across the region. Whenever a GCC Member State drafts a regulation, it must go to GSO
members for review and approval. Upon GSO approval, Member States must individually adopt the GSO regulation.
18
4. EUROPE
CURRENT SITUATION
The European Region (see Table 7) has the largest number of mandatory TFA limits in place and has had the most policy progress
of all WHO regions since 2019. Since Denmark’s pioneering effort (2004), Austria (2009), Iceland (2011), Hungary (2014),
Norway (2014), Latvia (2018) and Slovenia (2018) have passed similar best-practice regulations. Switzerland, one of the first
countries in Europe to take legal action to restrict TFA, has a TFA limit in oils and fats (2008).
Regional regulations, covering 34 countries, will contribute immensely to Europe’s success in TFA elimination. From January
2018, a regulation that limits TFA to 2% in oils and fats came into effect in EAEU countries, including Armenia, Belarus,
Kazakhstan, Kyrgyzstan and the Russian Federation; this regulation strengthened the less restrictive limits that had been in place
since 2015. Currently, there are still challenges for implementation of the EAEU regulations in these five countries; the major
reason cited for this during a meeting hosted by the WHO Regional Office for Europe in February 2019 is the lack of laboratory
capacity for TFA testing.
In April 2019, the EU passed regulations, which will be effective from 2021, to limit industrially produced TFA to 2 g of TFA per
100 g of total fat in all food products; this will be directly applicable in all the Member States of the EU, as well as the European
Economic Area (EEA).
TABLE 7. SUMMARY OF THE TFA POLICY SITUATION IN THE EUROPEAN REGION
National
policy
commitment
to eliminate
TFA
Other
complementary
measures
Less
restrictive
TFA limits
Best-
practice
TFA policy
Best-
practice
TFA policy
passed
but not in
effect
(as of May
2020)
Monitoring
mechanism
for
mandatory
TFA limits
Albania,
Bosnia and
Herzegovina,
Czech Republic,
Finland, Malta,
Portugal,
Republic of
Moldova, The
former Yugoslav
Republic of
Macedonia,
Turkmenistan,
Ukraine
Azerbaijan, Belgium,
Bulgaria, France,
Germany, Greece,
Israel, Italy, Spain,
Sweden, Tajikistan,
Turkey,
United Kingdom
Armenia,
Belarus,
Georgia,
Kazakhstan,
Kyrgyzstan,
Russian
Federation,
Switzerlanda
,
Uzbekistan
Austria,
Denmark,
Hungary,
Iceland, Latvia,
Lithuania,
Norway,
Slovenia
EU and EEA
(21 countriesb
),
Turkey, United
Kingdom
Armenia,
Austria,
Belarus,
Denmark,
Georgia,
Hungary,
Iceland,
Kazakhstan,
Kyrgyzstan,
Latvia,
Lithuania,
Norway,
Russian
Federation,
Switzerland
a
	 Switzerland was one of the first countries in Europe to take legal action to restrict TFA.
b
	 Member States of the EU adopted a best-practice policy, but food that does not comply with the policy may continue to be placed on the
market until 1 April 2021. Austria, Denmark, Hungary, Latvia, Lithuania and Slovenia in the EU, and Iceland and Norway in the EEA already
have a best-practice policy in effect, and therefore they are not included in the 21 countries.
A few countries have managed to achieve substantial reduction of TFA through voluntary regulations (Box 5). These successes
were in countries that were able to hold stakeholders accountable through strong government leadership, a strong monitoring
system and data. Experiences in several other countries have demonstrated that mandatory approaches are generally much
more effective than voluntary approaches, and therefore regulatory measures and enforcement of mandatory TFA limits are
recommended.
19
Box 5. Policy experience in the United Kingdom and the Netherlands
The official United Kingdom (UK) recommendation for overall consumption of total fats is that they should comprise no
more than 35% of daily calorie intake. Within this, SFA should form no more than 11%, and TFA no more than 2%, of
total energy intake (Public Health England, 2015).
The latest National Diet and Nutrition Survey (2018) indicated that average intakes of TFA (natural and industrially
produced) in the UK were below the WHO recommendation of less than 1% of total energy intake, ranging between
0.4% and 0.6% of total energy intake (Public Health England, 2018).
In the UK, there is no legal ban on industrially produced TFA, but in 2012 most supermarkets, many manufacturers and
the bigger fast food chains agreed to sign up to the voluntary Public Health Responsibility Deal agreement to remove and
not use industrially produced TFA (UK Department of Health, 2014). Through the combined efforts of the food industry,
industrially produced TFA have been largely removed from food products.
Similarly, the Netherlands has achieved substantial reduction in industrially produced TFA in the food supply chain
since 2003 via the Dutch Task Force for the Improvement of the Fatty Acid Composition (TFIFAC). TFIFAC members
include major buyers and suppliers of vegetable oils and fats in a range of product categories. The initiative prompted
manufacturers to reformulate and lower the industrially produced TFA content of products (Rippin et al., 2017).
NEW IN THE PAST YEAR
In May 2020, Turkey published in its official gazette new best-practice regulations to limit industrially produced TFA to 2 g per
100 g of the total oil in the foods supplied to retail outlets and consumers. The regulations will take effect from 2021. Because
of the trade relations between Turkey and the EU, Turkey’s policy is well aligned with that of the EU.
To address challenges with implementing the existing EAEU TFA policy, the WHO Regional Office for Europe organized a laboratory
capacity-building workshop in November 2019 in which Member States were trained in fatty acids analysis of foods. In early
2020, the Regional Office for Europe also initiated a programme of work to bring together major suppliers of edible oils and fats,
and government and regulatory representatives in EAEU countries to develop technology roadmaps for discontinuing the use of
industrially produced TFA in the food supply. The policy experience in the EAEU is described in Box 6.
In the next 12 months, WHO will continue supporting implementation of existing regulations in EAEU countries, including building
laboratory capacity, and engaging oils and fats suppliers on technical solutions. WHO will leverage the recently passed EU
regulations to encourage additional countries in the region to pass policies.
20
Box 6. Policy experience in the Eurasian Economic Union
Removing TFA from the food supply in the EAEU is potentially one of the most effective public health interventions for
reducing NCD risks for the region’s population of 176 million. The EAEU works in collaboration with the WHO European
Office for the Prevention and Control of NCDs in Moscow on this topic, and several activities take place in the EAEU
member countries (Armenia, Belarus, Kazakhstan, Kyrgyzstan and the Russian Federation). The EAEU was the first trade
bloc globally to restrict TFA, with a 20% TFA limit in specific fat products that came into effect in January 2015. A stricter
2% TFA limit in oils and fats came into effect in January 2018.
POLICY DEVELOPMENT:
In January 2018, technical regulations of the EAEU Customs Union, Technical regulations for oil and fat products, came
into full force after a seven-year transition period. The regulations state that TFA in a fixed list of vegetable oil and animal
fat products should comprise no more than 2% of the fat content in the product. Previously, permissible levels were
8–20% of fat content.11
The regulations establish requirements for packaging, labelling, production, storage, transportation and sale of oil and fat
products released into circulation in the territory of all Member States. They contain legal requirements for permissible
levels of safety indicators in oil and fat products.
Since the regulations came into effect, the permissible levels have been reduced to coincide with the WHO
recommendations. The previous regulations, from January 2015, allowed industrially produced TFA to comprise 20%
of the fat content of solid margarines and specialty fats. With the amendments in January 2018, permissible levels
of industrially produced TFA for these products were reduced to 2% of the fat content. A similar reduction for milk
fat replacers, soft and liquid margarines, specialty fats, vegetable oil–cream spreads, and other vegetable oil and fat
products, from 8% to 2% of fat content, became effective in January 2018.
POLICY IMPLEMENTATION:
The less restrictive TFA limits in effect in EAEU countries are not currently being implemented. If the interventions were
fully implemented, a decrease in the TFA content of all foods and a decrease in disease burden caused by the intake of
TFA in EAEU Member States would be expected.
Awareness about the burden of disease caused by TFA intake among policy-makers, producers, suppliers and the public
needs to increase, to increase support for development and implementation of legislative and regulatory actions, and
enforcement of compliance with legal provisions on TFA.
The need to replace TFA with healthier oils and fats requires further discussion among professionals, public institutions,
producers and other stakeholders in EAEU Member States. The priorities are to emphasize the need to replace TFA with
healthier oils and fats in EAEU Member States, and to ensure full implementation of existing EAEU regulations. This
includes harmonizing with the WHO recommendations and best practice to implement a permissible industrially produced
TFA limit of 2% in all processed oils and fats, dairy products and other foods, including imported products. Regulations
need to be comprehensive and consistent across the region. There is also a need to build capacity for monitoring and
enforcement for both fieldwork methods and laboratory protocols.
The WHO European Office for the Prevention and Control of NCDs in Moscow and the Eurasian Economic Commission
organized a training workshop for laboratory staff of Member States to harmonize the methods for TFA analysis in
national-level laboratories. The first workshop was conducted in November 2019, and capacity-building programmes will
continue in this area.
Evaluation of the impact of this policy is crucial. Most of the Member States in this region did not have any published
data on the TFA levels in food. The FeedCities project12
conducted by the WHO European Office for the Prevention and
Control of NCDs has provided baseline data to describe the problem and allow monitoring of progress.
Collaboration between governments, public health professionals and the private sector is key to ensuring
implementation success.
11
	 http://www.eurasiancommission.org/ru/nae/news/Pages/15-03-18-1.aspx
12
	 https://www.euro.who.int/en/countries/kyrgyzstan/publications/feedcities-project.-the-food-environment-description-in-cities-in-eastern-
europe-and-central-asia-kyrgyzstan-2017
21
5. SOUTH-EAST ASIA
CURRENT SITUATION
The South-East Asia Region (see Table 8) has seen relatively slow but growing interest in regulating TFA. India has had less
restrictive limits in effect since 2013. In January 2019, Thailand took an important step by putting in place a ban on PHO,
becoming the third country in the world to do so, following the PHO ban introduced in Canada and the United States (Thailand
Ministry of Public Health, 2018). The policy experience in Thailand is described in Box 7.
TABLE 8. SUMMARY OF THE TFA POLICY SITUATION IN SOUTH-EAST ASIA
National
policy
commitment
to eliminate
TFA
Other
complementary
measures
Less
restrictive
TFA limits
Best-
practice
TFA policy
Best-
practice
TFA policy
passed
but not in
effect
(as of May
2020)
Monitoring
mechanism
for
mandatory
TFA limits
Bangladesh,
Bhutan,
Indonesia,
Maldives,
Myanmar,
Nepal,
Sri Lanka,
Timor-Leste
India Thailand India, Thailand
NEW IN THE PAST YEAR
In 2019, India notified draft best-practice regulations that would reduce the current regulatory limit for industrially produced TFA
from 5% in oils and fats to 2%, and expand the limit to apply to all fats, oils and foods.
Several countries in the region have also begun implementing strategies outlined in the REPLACE action package and bestpractice
policies. In Bangladesh, the Bangladesh Standards and Testing Institute is in the process of developing a TFA standard.
In Sri Lanka and Maldives, the Regional Office for South-East Asia has engaged with policy-makers and completed policy
landscapes; assessments of TFA in foods are under way. In 2020, programmes were initiated in Bhutan and Nepal to assess the
dietary sources and consumption of TFA, and evaluate the policy landscape on edible oils and fats to inform the policy process to
eliminate TFA from the food supply.
A regional capacity-building workshop was planned for 2020 to strengthen regulatory capacities of national policy-makers in the
region. However, as a result of the COVID-19 pandemic, it has been postponed, perhaps to 2021. Some parts of the planned
capacity-building training may be conducted virtually while waiting for the more detailed face-to-face training workshop.
In the next 12 months, WHO will support strengthening of regulatory capacities, including laboratory capacities, in countries.
WHO will also continue to provide technical support to interested countries for their assessments, and advocate for
implementation of best-practice regulations.
22
Box 7. Policy experience in Thailand
Thailand implemented a ban on PHO in January 2019, largely as a preventive measure. The Thai Government worked
with the small number of PHO producers in the country to change their manufacturing processes and ensure that
replacements were available. Effective collaboration between academia, the Thai Food and Drug Administration (FDA),
civil society and industry was instrumental in banning PHO in Thailand (NCD Alliance, 2019).
POLICY DEVELOPMENT:
Assessments of TFA levels in foods in Thailand, conducted by research and government agencies in 2006, 2007
and 2014, showed that TFA consumption in the Thai population was relatively low; foods such as fried doughnuts,
margarines, puffs and pastries, had the highest TFA content (Chavasit et al., 2019). With the increase in consumption
of these types of foods, TFA in Thailand were becoming a greater problem. Thai FDA officials were alarmed to learn that
multinational food companies that sold products with a TFA-free claim in countries with TFA policies in place were selling
products containing TFA in Thailand (NCD Alliance, 2019). The Thai FDA decided that it was critical to restrict TFA as a
preventive measure.
TFA policy action in the United States, where the US Food and Drug Administration announced its PHO ban in 2015,
served as a model for Thai officials.
The Thai FDA held stakeholder meetings, including with researchers, food manufacturers and importers, to determine the
best policy approach. The food industry could use oil blending techniques to develop PHO replacements by mixing highly
saturated and/or fully hydrogenated oils with less saturated oils.
Information from the food industry, collected in a survey administered in 2017 by the Thai FDA in collaboration with
Mahidol University, indicated that most PHO used in the country were produced in only three oil manufacturing plants
where hydrogenation facilities were available. This led Thai officials to focus on PHO as the target of their policy, rather
than TFA more broadly.
After making tentative policy decisions and notifying member countries at the World Trade Organization, the Thai FDA held
a public hearing. At the public hearing, consumers, food producers, importers, academia and other government agencies
demonstrated broad support for the PHO ban, citing the uncontested health harms of TFA and the availability of healthier
replacements in Thailand.
In July 2018, Thailand’s Minister of Public Health issued the final notification prohibiting the production, import or sale of
PHO and foods containing PHO in Thailand. The policy took effect in January 2019.
POLICY IMPLEMENTATION:
Between July 2018 and January 2019, the Thai FDA educated consumers, manufacturers and importers on the new
regulation to ensure that these key stakeholders were prepared to comply.
The Thai FDA enforces the regulation via laboratory testing of food products. There is no laboratory method for testing for
the presence of PHO, so researchers from Mahidol University have proposed the criteria shown in the table for the Thai
FDA to use for monitoring (Chavasit et al., 2019).
FOOD CATEGORY TRANS FAT LIMIT TRANS FAT-FREE CLAIM
Food products other than
mentioned below
All Kinds
Not more than
0.5 g/serving
TFA ≤0.5 g/serving
and SFA ≤5 g/serving
Ruminant products Butter/butter oil <6%
Blended fat/oil product
(e.g. butter blend)
<2%
Others
Not more than
0.5 g/serving
Fat and oils other
than ruminant products
Refined cooking oils <2%
Margarine/shortening <2%
Given budget constraints, the Thai FDA is collaborating with civil society on monitoring and enforcement. Civil society
organizations are helping by identifying products that are not in compliance and educating stakeholders about
the regulation.
23
6. WESTERN PACIFIC
CURRENT SITUATION
The Western Pacific Region (see Table 9) has seen relatively little action on TFA elimination. However, some key countries have
begun regulatory processes, which may spur broader interest in the region. Singapore is currently the only country in the region
with TFA limits, which have been in place since 2012 and apply to oils and fats only.
TABLE 9. SUMMARY OF THE TFA POLICY SITUATION IN THE WESTERN PACIFIC REGION
National
policy
commitment
to eliminate
TFA
Other
complementary
measures
Less
restrictive
TFA limits
Best-
practice
TFA policy
Best-
practice
TFA policy
passed
but not in
effect
(as of May
2020)
Monitoring
mechanism
for
mandatory
TFA limits
Cambodia, Fiji,
Lao People’s
Democratic
Republic,
Mongolia,
Nauru, Papua
New Guinea,
Samoa, Vanuatu
Brunei Darussalam,
China, Philippines,
Republic of Korea
Singapore Singapore
NEW IN THE PAST YEAR
Since May 2019, TFA has become an important part of public health debates in Singapore and the Philippines. In the
Philippines, the Department of Health (DOH) is finalizing the Administrative Order to accelerate actions in eliminating TFA,
and a Bill on TFA elimination was filed in Congress in July 2020. The DOH administrative issuance specifies the roles and
responsibilities of DOH and its attached agencies. In Singapore, the Ministry of Health announced in June 2019 that PHO will be
banned in all foods sold in Singapore, including fats, oils and pre-packaged foods, from June 2021 (Singapore Ministry of Health,
2019). This is an amendment to the existing TFA limit in oils and fats only. The policy experience in Singapore is described in
Box 8.
In the next 12 months, WHO is planning to provide technical support to interested countries in implementing actions to eliminate
TFA, including developing policies for TFA elimination.
24
25
Box 8. Policy experience in Singapore
Excessive TFA intake is a public health concern in Singapore, especially among young working adults. In 2004, a national
nutrition survey found that 3 in 10 Singapore residents aged 18–69 years old exceeded the WHO limit for TFA intake of
no more than 2.2 g a day (assuming a 2000 calorie diet). Two thirds of these people were young adults aged 18–39
years, of whom 10% had levels of TFA intake more than double the recommended limit.
Unlike many countries where the main source of TFA is from PHO used for deep-frying of fast food, local analysis showed
that the key source of TFA is shortening used for making commercial baked items such as cakes, pastries, doughnuts,
biscuits and snacks.13
These products contribute to 60% of the TFA intake in Singapore.
In response to the WHO advice, Singapore has taken a two-phase approach to limit TFA in the food supply: limits on the
TFA levels in oils and fats sold in Singapore, followed by ban on the use of PHO as an ingredient in food products.
In 2013, Singapore introduced legislation to limit TFA to no more than 2 g per 100 g for all oils and fats (including
shortening) sold in the retail setting, and supplied to local food manufacturers and food and beverage retailers. This
legislation also mandated labelling of TFA levels on the packaging on these products. The legislation has led to a
significant reduction in TFA consumption, from an average daily intake of 2.1 g in 2010 to 1.0 g in 2018.
However, TFA remain a cause for concern among certain population segments, especially young adults and the ethnic
minority, whose diet is seeing growing prevalence of pre-packaged snacks and baked goods, a key source of PHO. In
2019, in line with WHO’s call for countries to eliminate industrially produced TFA in diets, Singapore announced that
PHO would be prohibited as an ingredient across all product categories after June 2021. Before the decision was made,
intensive consultations were held with a diverse range of stakeholders, including importers, distributors, manufacturers
and retailers of products to evaluate the impact such a ban would have on the industry. The stakeholders consulted
understood the rationale for the proposed ban in terms of positive health outcomes, and committed their support. Given
the readily available PHO-free alternatives such as sunflower and canola oil, they also recognized that reformulation could
be readily achieved at minimal cost.
To accelerate reformulation efforts and to ensure a smooth transition before the ban takes effect, Singapore successfully
worked with six companies, which together represent 50% of the market share across the four high-risk food categories
(snacks, baked goods, prepared meals and fat spreads), to pledge that their products would be PHO-free by June 2020,
one year ahead of the ban. This aims to produce positive competition, which encourages other companies to accelerate
their reformulation.
As part of monitoring and surveillance, Singapore will carry out periodic checks on high-risk and imported pre-packaged
foods (e.g. snacks, baked goods). Singapore will also conduct laboratory testing to monitor changes in TFA in the
food supply.
With the ban coming into effect from June 2021, Singapore will be the first country in the Western Pacific Region to
eliminate industrially produced TFA in foods.
13
	 Commercially prepared meals in food outlets such as hawker centres in Singapore usually do not contain significant amounts of TFA
because they are prepared using palm oil, which has good stability and does not need to be hydrogenated.
26
IV. GLOBAL CHALLENGES, OPPORTUNITIES
AND PRIORITIES
14
	 www.who.int/nutrition/topics/replace-transfat/
Despite growing country action and interest to act on TFA elimination, there is still a long way to go to meet the WHO goal of
global elimination by 2023. Common challenges identified in eliminating TFA are described below, as well as opportunities and
priority areas for overcoming the challenges and accelerating action in TFA elimination. Many of these challenges were first
identified in the 2019 global progress report.
Lack of regulatory capacities
Policies that effectively remove TFA from food supplies must be enforceable and sustainable. In countries with limited
human and financial resources, this can be challenging. Many countries have sizeable informal food sectors that are largely
unregulated and for which there may be no existing enforcement infrastructure to build on. In collaboration with partners and
technical experts, WHO developed a training curriculum to strengthen countries’ regulatory capacities to develop effective
policy measures for TFA elimination. Ongoing technical support to countries will provide clear guidance on enforcement
options that are accessible at different resource levels.
Lack of laboratory capacities
Initiating policy dialogue and action often relies on an understanding of the in-country burden due to TFA, and gaining this
understanding requires food sampling and laboratory testing. In 2019, WHO released guidance materials and draft protocols
to support countries and national laboratories in assessing TFA in foods (available on the WHO REPLACE webpage14
).
These materials were revised in 2020, as laboratories often require additional financial and technical support to accurately
measure TFA.
Identifying laboratories in each region that have demonstrated capacities for analysing fatty acids in foods is critical. Using
these laboratories and their expertise to support laboratory testing in neighbouring countries is an area to explore.
Lack of accurate and reliable TFA data
Many countries do not have data on TFA levels in foods or population TFA intake. Without data, TFA elimination is often not
a priority issue for investment of time and resources. Designing and conducting studies also requires investment. To address
this issue, WHO will continue to advocate for TFA elimination with policy-makers. This will include framing TFA elimination as
a preventive measure to avoid vulnerability to the harms of TFA, as a priority action to promote healthy diets, and as part of
a broader NCD prevention initiative. WHO will also provide technical support to countries in conducting studies to help spur
policy discussions.
Civil society, academics, and advocates for nutrition and cardiovascular health also have an important role in building public
debate and political will.
27
V. CONCLUSION AND RECOMMENDATIONS
FOR ACTION
The momentum for TFA elimination has continued to build as more countries have taken action and advanced policies to
eliminate TFA. However, most countries do not have policies in place to protect their citizens from the harmful effects of TFA, and
there is much work to be done to meet the WHO goal of global elimination by 2023.
In the coming year, WHO recommends that countries focus on the following action areas.
	› Develop and implement best-practice policies to set TFA limits or to ban PHO.
	› Invest in monitoring mechanisms, such as laboratory capacity to measure TFA content in foods.
	› Advocate for regional or subregional regulations to expand the benefits of TFA policies.
WHO will strengthen its support to countries working to eliminate TFA by the following activities.
	› Continue to provide technical support for building regulatory capacities to accelerate best-practice policy
development, implementation and enforcement in countries. This includes strengthening laboratory capacity to
assess TFA content in foods.
	› Disseminate country experiences, success stories and good practices, and recognize achievements by countries.
	› Undertake global advocacy through existing and newly developed frameworks and initiatives such as the World Health
Assembly, the United Nations Decade of Action on Nutrition, and the United Nations Food System Summit.
WHO expects food and beverage industry groups to implement the commitments they have made to eliminate industrially
produced TFA from product lines. WHO also expects major suppliers of oils and fats to step up to remove industrially produced
TFA from the products that are sold to food manufacturers globally.
28
REFERENCES
Afshin A, Sur PJ, Fay KA, Cornaby L, Ferrara G, Salama JS, et al. (2019). Health effects of dietary risks in 195 countries,
1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 393(10184):1958–72.
Alexander E, Yach D, Mensah GA (2011). Major multinational food and beverage companies and informal sector contributions to
global food consumption: implications for nutrition policy. Global Health. 7(1):26.
ANVISA (Agência Nacional de Vigilância Sanitária – Brazil’s National Agency of Sanitary Surveillance) (2003). Resolução RDC no.
360 de dezembro de 2003. Dispõe regulamento técnico sobre rotulagem nutricional de alimentos embalados. Diário oficial [da]
República Federativa do Brasil, 23 dezembro. Brasília: Poder Executivo.
ANVISA (Agência Nacional de Vigilância Sanitária – Brazil’s National Agency of Sanitary Surveillance) (2018). Food general
management: trans fatty acids. Basic document for regulatory discussion. Brasilia: ANVISA.
Brasil Ministério da Saúde (2008). Nota técnica. Ações do Governo Brasileiro sobre as gorduras trans. Rio de Janeiro: Ministério
da Saúde (http://189.28.128.100/dab/docs/portaldab/documentos/nota_imprensa_gorduras_trans.pdf, accessed 27 July 2020).
Câmara dos Deputados (2017). PL 7681/2017 – Projeto de Lei. Brasília: Câmara dos Deputados (https://www.camara.leg.br/
proposicoesWeb/fichadetramitacao?idProposicao=2138672, accessed 27 July 2020).
Chavasit V, Photi J, Kriengsinyos W, Ditmetharoj M, Preecha S, Tontisirin K (2019). Overcoming the trans fat problem in Thailand.
Curr Dev Nutr. 3(6):nzz045.
GAIN (Global Alliance for Improved Nutrition) (2020). Mapping of industrially-produced trans-fatty acids (iTFA) in Nigeria: a report
on sources and replacement solutions for iTFA in Nigeria. Geneva: GAIN (https://sunbusinessnetwork.org/mapping-industriallyproduced-trans-fatty-acids-in-nigeria/,
accessed 27 July 2020).
IFBA (International Food and Beverage Alliance) (2019). International Food and Beverage Alliance (IFBA) enhanced commitment
to phase out industrially produced trans-fatty acids. Geneva: IFBA (https://ifballiance.org/uploads/press/pdf/5ccc4b8061475_
IFBA%20iTFA%20Enhanced%20Commitment%2002.05.2019.pdf, accessed 27 July 2020).
Kantar World Panel (2019). Primeros resultados en autoservicios (https://www.kantarworldpanel.com/pe/Noticias/EtiquetadoPrimeros-resultados-en-autoservicios,
accessed 27 July 2020).
Louzada MLDC, Martins APB, Canella DS, Baraldi LG, Levy RB, Claro RM, et al. (2015). Ultra-processed foods and the nutritional
dietary profile in Brazil. Rev Saúde Pública. 49:38.
NCD Alliance (2019). Trans fat free by 2023: case studies in trans fat elimination. Geneva: NCD Alliance (https://ncdalliance.
org/resources/TransFatFree2023Report, accessed 27 July 2020). (The report of the NCD Alliance’s Side Event (22 May 2019,
Geneva) is also available: https://ncdalliance.org/sites/default/files/Report_WHA%20side%20event%20TFAs_22%20May%20
2019.pdf.)
PAHO (Pan American Health Organization) (2008). Trans fat free Americas: declaration of Rio de Janeiro. Washington, DC: PAHO
(https://www.paho.org/hq/dmdocuments/2009/transfat-declaration-rio%5B1%5D.pdf, accessed 27 July 2020).
PAHO (Pan American Health Organization) (2019). Plan of action for the elimination of industrially produced trans-fatty acids
2020–2025. Provisional agenda item 4.6: 57th Directing Council – 71st Session of the Regional Committee of WHO for the
Americas. Washington, DC: PAHO (https://www.paho.org/hq/index.php?option=com_docman&view=download&alias=49612cd57-8-e-poa-trans-fatty&category_slug=cd57-en&Itemid=270&lang=en,
accessed 27 July 2020).
Persistence Market Research (2018). PHO and non-PHO based oils and fats market: global industry analysis 2013–2017 and
forecast 2018–2026. Persistence Market Research.
Public Health England (2015). Do you know the facts about fats? London: Public Health England (https://publichealthmatters.
blog.gov.uk/2015/10/09/do-you-know-the-facts-about-fats/, accessed 27 July 2020).
Public Health England (2018). National Diet and Nutrition Survey: results from years 7 and 8 (combined) of the rolling
programme (2014/2015 to 2015/2016). London: Public Health England.
Rippin HL, Hutchinson J, Ocke M, Jewell J, Breda JJ, Cade JE (2017). An exploration of socio-economic and food characteristics
of high trans fatty acid consumers in the Dutch and UK national surveys after voluntary product reformulation. Food Nutr Res.
61(1):1412793.
30
SUN (Scaling Up Nutrition) Business Network (2019). SBN awarded grant for elimination of trans fat project
(https://sunbusinessnetwork.org/sbn-awarded-grant-for-elimination-of-trans-fat-project/, accessed 27 July 2020).
Singapore Ministry of Health (2019). Ban on partially hydrogenated oil in all fats, oils, and pre-packaged foods sold in Singapore.
Press release (https://www.moh.gov.sg/news-highlights/details/ban-on-partially-hydrogenated-oil-in-all-fats-oils-and-pre-packaged-
foods-sold-in-singapore#:~:text=As%20part%20of%20the%20Government's,whether%20manufactured%20locally%20or%20
imported%2C, accessed 27 July 2020).
Thailand Ministry of Public Health (2018). Notification of the Ministry of Public Health No. 388 B.E.2561 (unofficial translation)
(http://food.fda.moph.go.th/law/data/announ_moph/V.English/No.388_trans_fat.pdf, accessed 27 July 2020).
UK Department of Health (2014). Public Health Responsibility Deal. F3(a). Non use of artificial trans fat. Information related to
Public Health Responsibility Deal (https://www.gov.uk/government/news/public-health-responsibility-deal, accessed 27 July 2020).
UN DESA (United Nations Population Division, Department of Economic and Social Affairs) (2019). World population prospects
2019. New York: United Nations (https://population.un.org/wpp/Download/Standard/Population/, accessed 1 May 2020).
US FDA (United States Food and Drug Administration) (2003). Consumer magazine, September–October 2003. Washington, DC:
US FDA (Pub. No. FDA04-1329C).
Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, et al. (2016). Global, regional, and national life expectancy, allcause
mortality, and cause-specifi c mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden
of Disease Study 2015. Lancet. 388(10053):1459–1544.
Wang Q, Afshin A, Yakoob MY, Singh GM, Rehm CD, Khatibzadeh S, et al. (2016). Impact of nonoptimal intakes of saturated,
polyunsaturated, and trans fat on global burdens of coronary heart disease. J Am Heart Assoc. 5(1):e002891.
WHO (World Health Organization) (2018). Noncommunicable diseases country profiles 2018. Geneva: WHO (https://www.who.int/
nmh/countries/en, accessed 27 July 2020).
WHO (World Health Organization) (2019a). Draft guidelines on saturated fatty acid and trans-fatty acid intake for adults and
children. Geneva: WHO.
WHO (World Health Organization) (2019b). Fats, oils, food and food service industries should join global effort to eliminate
industrial trans fat from processed food by 2023. Press release. Geneva: WHO (https://www.who.int/news-room/detail/23-04-
2019-fats-oils-food-and-food-service-industries-should-join-global-effort-to-eliminate-industrial-trans-fat-from-processed-foodby-2023,
accessed 27 July 2020).
WHO (World Health Organization) (2019c). Assessment of diet associated noncommunicable diseases’ risk factors in Pakistan
and strategies to reduce their burden. Draft report. Geneva: WHO.
WHO (World Health Organization) (2020a). Thirteenth General Programme of Work (GPW13): Methods for impact measurement.
Geneva: WHO (https://www.who.int/docs/default-source/documents/about-us/gpw13-methods-for-impact-measurement.
pdf?sfvrsn=56cf3c4b_2&download=true, accessed 27 July 2020).
WHO (World Health Organization) (2020b). GPW13 metadata for impact measurement indicators. Geneva: WHO (https://www.
who.int/publications/m/item/thirteenth-general-programme-of-work-(gpw13)-methods-for-impact-measurement, accessed 6
August 2020).
31
ANNEX 1
TFA BURDEN AND STATUS OF TFA POLICIES BY COUNTRY, RANKED BY
PROPORTION OF CORONARY HEART DISEASE DEATHS DUE TO TFA INTAKE
Country
Proportion of CHD deaths
(%) due to TFA intake
(>0.5% energy)a
Scoreb
Details of
implemented policy
Notes
Egypt 8.39 1
National policy
commitment to
eliminate TFA
United States
of America
7.57 4
Mandatory national
ban on PHO
Monitoring mechanism
for mandatory TFA limits
Iran (Islamic
Republic of)
6.96 3
2% industrially
produced TFA limit in
oils and fats only
Latvia 6.14 4
Mandatory national limit
(industrially produced
TFA <2 g/100 g total oils
and fats in all foods)
Monitoring mechanism
for mandatory TFA limits
Mexico 5.82 2
Mandatory limits on
industrially produced
TFA in foods in specific
settings; reformulation
Azerbaijan 5.81 2 Reformulation
Canada 5.65 4
Mandatory national
ban on PHO
Monitoring mechanism
for mandatory TFA limits
Ecuador 4.97 3
2% industrially
produced TFA limit in
oils and fats only
Monitoring mechanism
for mandatory TFA limits
Pakistan 4.94 2
Mandatory limits on
industrially produced
TFA in foods in
specific settings
Republic of Korea 4.76 2 Reformulation
India 4.63 3
5% industrially produced
TFA limit in oils and fats
Monitoring mechanism
for mandatory TFA limits
Slovenia 4.56 4
Mandatory national limit
(industrially produced
TFA <2 g/100 g total oils
and fats in all foods)
Monitoring mechanism
for mandatory TFA limits
Bhutan 4.45 1
National policy
commitment to
eliminate TFA
Bangladesh 4.41 1
National policy
commitment to
eliminate TFA
Nepal 4.38 1
National policy
commitment to
eliminate TFA
32
Country
Proportion of CHD deaths
(%) due to TFA intake
(>0.5% energy)a
Scoreb
Details of
implemented policy
Notes
Australia 4.27 – –
Peru 3.96 3
2% industrially
produced TFA limit in
oils and fats, and 5%
limit in other foods
Monitoring mechanism
for mandatory TFA
limits; best-practice
TFA policy passed but
not yet in effect
Bolivia (Plurinational
State of)
3.95 2
Front-of-pack labelling
system that includes TFA;
reformulation
Netherlands 3.81 – –
Best-practice TFA
policy passed but
not yet in effect
Estonia 3.53 – –
Best-practice TFA
policy passed but
not yet in effect
Costa Rica 3.52 1
National policy
commitment to
eliminate TFA
Venezuela
(Bolivarian
Republic of)
3.51 1
National policy
commitment to
eliminate TFA
Slovakia 3.32 – –
Best-practice TFA
policy passed but
not yet in effect
New Zealand 3.25 – –
El Salvador 3.20 2
Mandatory limits on
industrially produced
TFA in foods in
specific settings
Honduras 3.15 – –
Nicaragua 3.12 – –
Lithuania 3.12 4
Mandatory national limit
(industrially produced
TFA <2 g/100 g total oils
and fats in all foods)
Monitoring mechanism
for mandatory TFA limits
Germany 3.10 2 Reformulation
Best-practice TFA
policy passed but
not yet in effect
Panama 3.09 – –
United Kingdom 3.06 2 Reformulation
Best-practice TFA
policy passed but
not yet in effect
33
Country
Proportion of CHD deaths
(%) due to TFA intake
(>0.5% energy)a
Scoreb
Details of
implemented policy
Notes
Switzerland 2.89 3
2% industrially
produced TFA limit in
oils and fats only
Monitoring mechanism
for mandatory TFA limits
Belgium 2.77 2 Reformulation
Best-practice TFA
policy passed but
not yet in effect
Georgia 2.66 3
2% industrially
produced TFA limit in
oils and fats only
Monitoring mechanism
for mandatory TFA limits
Philippines 2.64 2
Mandatory declaration of
TFA on nutrition labels
Afghanistan 2.64 1
National policy
commitment to
eliminate TFA
United Arab
Emirates
2.60 1
National policy
commitment to
eliminate TFA
Brazil 2.58 2
Mandatory declaration
of TFA on nutrition
labels; reformulation
Best-practice TFA
policy passed but
not yet in effect
Paraguay 2.57 2
Mandatory declaration of
TFA on nutrition labels
Libya 2.55 – –
Kuwait 2.52 3
2% industrially
produced TFA limit in
oils and fats, and 5%
limit in other foods
Sudan 2.51 – –
Yemen 2.51 – –
Hungary 2.50 4
Mandatory national limit
(industrially produced
TFA <2 g/100 g total oils
and fats in all foods)
Monitoring mechanism
for mandatory TFA limits
Qatar 2.47 1
National policy
commitment to
eliminate TFA
Oman 2.46 2 Reformulation
San Marino 2.45 – –
Bahrain 2.43 3
2% industrially
produced TFA limit in
oils and fats, and 5%
limit in other foods
Monaco 2.43 – –
34
Country
Proportion of CHD deaths
(%) due to TFA intake
(>0.5% energy)a
Scoreb
Details of
implemented policy
Notes
Jordan 2.42 2
Mandatory declaration
of TFA on nutrition
labels; reformulation
Iraq 2.42 – –
Syrian Arab
Republic
2.41 – –
Denmark 2.41 4
Mandatory national limit
(industrially produced
TFA <2 g/100 g total oils
and fats in all foods)
Monitoring mechanism
for mandatory TFA limits
Haiti 2.40 – –
Colombia 2.39 3
2% industrially
produced TFA limit in
oils and fats, and 5%
limit in other foods
Monitoring mechanism
for mandatory TFA limits
Morocco 2.38 1
National policy
commitment to
eliminate TFA
Republic of Moldova 2.33 1
National policy
commitment to
eliminate TFA
Guatemala 2.32 1
National policy
commitment to
eliminate TFA
Jamaica 2.31 1
National policy
commitment to
eliminate TFA
Belize 2.30 1
National policy
commitment to
eliminate TFA
Brunei Darussalam 2.29 2
Front-of-pack labelling
system that includes TFA;
reformulation
Guyana 2.29 1
National policy
commitment to
eliminate TFA
Bahamas 2.29 1
National policy
commitment to
eliminate TFA
Suriname 2.27 1
National policy
commitment to
eliminate TFA
Antigua and
Barbuda
2.27 1
National policy
commitment to
eliminate TFA
Trinidad and Tobago 2.26 1
National policy
commitment to
eliminate TFA
35
Country
Proportion of CHD deaths
(%) due to TFA intake
(>0.5% energy)a
Scoreb
Details of
implemented policy
Notes
Saint Vincent and
the Grenadines
2.26 1
National policy
commitment to
eliminate TFA
Barbados 2.24 1
National policy
commitment to
eliminate TFA
Saint Lucia 2.24 1
National policy
commitment to
eliminate TFA
Grenada 2.24 1
National policy
commitment to
eliminate TFA
Dominica 2.23 – –
Cuba 2.23 – –
Saint Kitts
and Nevis
2.16 1
National policy
commitment to
eliminate TFA
Czech Republic 2.10 1
National policy
commitment to
eliminate TFA
Best-practice TFA
policy passed but
not yet in effect
Portugal 2.08 1
National policy
commitment to
eliminate TFA
Best-practice TFA
policy passed but
not yet in effect
Albania 2.08 1
National policy
commitment to
eliminate TFA
France 2.07 2 Reformulation
Best-practice TFA
policy passed but
not yet in effect
Romania 2.06 – –
Best-practice TFA
policy passed but
not yet in effect
Belarus 2.05 3
2% industrially
produced TFA limit in
oils and fats only
Monitoring mechanism
for mandatory TFA limits
Serbia 2.04 – –
Montenegro 2.04 – –
Russian Federation 2.03 3
2% industrially
produced TFA limit in
oils and fats only
Monitoring mechanism
for mandatory TFA limits
Bulgaria 2.00 2 Reformulation
Best-practice TFA
policy passed but
not yet in effect
36
Country
Proportion of CHD deaths
(%) due to TFA intake
(>0.5% energy)a
Scoreb
Details of
implemented policy
Notes
Greece 1.96 2
Mandatory limits on
industrially produced
TFA in foods in
specific settings
Best-practice TFA
policy passed but
not yet in effect
Mongolia 1.95 1
National policy
commitment to
eliminate TFA
Iceland 1.95 4
Mandatory national limit
(industrially produced
TFA <2 g/100 g total oils
and fats in all foods)
Monitoring mechanism
for mandatory TFA limits
Cyprus 1.92 – –
Best-practice TFA
policy passed but
not yet in effect
Andorra 1.92 – –
Tajikistan 1.90 2 Reformulation
Turkmenistan 1.90 1
National policy
commitment to
eliminate TFA
Luxembourg 1.88 – –
Best-practice TFA
policy passed but
not yet in effect
Ukraine 1.87 1
National policy
commitment to
eliminate TFA
Indonesia 1.86 1
National policy
commitment to
eliminate TFA
Solomon Islands 1.86 – –
Finland 1.86 1
National policy
commitment to
eliminate TFA
Best-practice TFA
policy passed but
not yet in effect
Nauru 1.86 1
National policy
commitment to
eliminate TFA
Kyrgyzstan 1.85 3
2% industrially
produced TFA limit in
oils and fats only
Monitoring mechanism
for mandatory TFA limits
Malta 1.84 1
National policy
commitment to
eliminate TFA
Best-practice TFA
policy passed but
not yet in effect
Algeria 1.83 1
National policy
commitment to
eliminate TFA
Kiribati 1.83 – –
37
Country
Proportion of CHD deaths
(%) due to TFA intake
(>0.5% energy)a
Scoreb
Details of
implemented policy
Notes
Thailand 1.83 4
Mandatory national
ban on PHO
Monitoring mechanism
for mandatory TFA limits
Japan 1.82 – –
Marshall Islands 1.82 – –
The former Yugoslav
Republic of
Macedonia
1.81 1
National policy
commitment to
eliminate TFA
Dominican Republic 1.80 1
National policy
commitment to
eliminate TFA
Zimbabwe 1.80 – –
Armenia 1.80 3
2% industrially
produced TFA limit in
oils and fats only
Monitoring mechanism
for mandatory TFA limits
Vanuatu 1.79 1
National policy
commitment to
eliminate TFA
Samoa 1.79 1
National policy
commitment to
eliminate TFA
Papua New Guinea 1.79 1
National policy
commitment to
eliminate TFA
Micronesia
(Federated States
of)
1.79 – –
Tuvalu 1.78 – –
Botswana 1.77 1
National policy
commitment to
eliminate TFA
Lao People's
Democratic
Republic
1.77 1
National policy
commitment to
eliminate TFA
Eswatini 1.77 1
National policy
commitment to
eliminate TFA
Lesotho 1.77 – –
Democratic People's
Republic of Korea
1.76 – –
Palau 1.75 – –
Cambodia 1.75 1
National policy
commitment to
eliminate TFA
38
Country
Proportion of CHD deaths
(%) due to TFA intake
(>0.5% energy)a
Scoreb
Details of
implemented policy
Notes
Myanmar 1.74 1
National policy
commitment to
eliminate TFA
Fiji 1.74 1
National policy
commitment to
eliminate TFA
Namibia 1.73 1
National policy
commitment to
eliminate TFA
Timor-Leste 1.72 1
National policy
commitment to
eliminate TFA
Norway 1.72 4
Mandatory national limit
(industrially produced
TFA <2 g/100 g total oils
and fats in all foods)
Monitoring mechanism
for mandatory TFA limits
Niue 1.71 – –
Tonga 1.71 – –
Maldives 1.70 1
National policy
commitment to
eliminate TFA
Cook Islands 1.69 – –
Mauritius 1.69 1
National policy
commitment to
eliminate TFA
Seychelles 1.69 1
National policy
commitment to
eliminate TFA
Croatia 1.69 – –
Best-practice TFA
policy passed but
not yet in effect
Sri Lanka 1.68 1
National policy
commitment to
eliminate TFA
Viet Nam 1.67 – –
South Africa 1.62 4
Mandatory national limit
(industrially produced
TFA <2 g/100 g total oils
and fats in all foods)
Monitoring mechanism
for mandatory TFA limits
China 1.54 2
Mandatory declaration of
TFA on nutrition labels
Kenya 1.50 1
National policy
commitment to
eliminate TFA
Poland 1.48 – –
Best-practice TFA
policy passed but
not yet in effect
39
Country
Proportion of CHD deaths
(%) due to TFA intake
(>0.5% energy)a
Scoreb
Details of
implemented policy
Notes
Uzbekistan 1.48 3
4% industrially produced
TFA limit in all foods
Singapore 1.45 3
2% industrially
produced TFA limit in
oils and fats only
Monitoring mechanism
for mandatory TFA limits
Nigeria 1.45 1
National policy
commitment to
eliminate TFA
Chile 1.44 4
Mandatory national limit
(industrially produced
TFA <2 g/100 g total oils
and fats in all foods)
Monitoring mechanism
for mandatory TFA limits
Ethiopia 1.44 2
Excise tax on food
products that contain TFA
Mali 1.40 – –
Liberia 1.39 – –
Guinea-Bissau 1.38 – –
Ghana 1.38 1
National policy
commitment to
eliminate TFA
Congo 1.38 – –
Sierra Leone 1.38 – –
Zambia 1.37 1
National policy
commitment to
eliminate TFA
Somalia 1.37 – –
Equatorial Guinea 1.37 – –
Mauritania 1.37 – –
Madagascar 1.37 – –
Democratic
Republic of the
Congo
1.37 – –
Guinea 1.36 – –
Argentina 1.36 3
2% industrially
produced TFA limit in
oils and fats, and 5%
limit in other foods
Monitoring mechanism
for mandatory TFA limits
Eritrea 1.36 – –
Sao Tome and
Principe
1.36 – –
Niger 1.36 – –
Comoros 1.36 – –
40
Country
Proportion of CHD deaths
(%) due to TFA intake
(>0.5% energy)a
Scoreb
Details of
implemented policy
Notes
Central African
Republic
1.36 – –
Benin 1.36 1
National policy
commitment to
eliminate TFA
Burundi 1.35 – –
Cameroon 1.35 – –
Senegal 1.35 – –
Côte d'Ivoire 1.35 1
National policy
commitment to
eliminate TFA
Togo 1.35 – –
Angola 1.35 – –
Gambia 1.35 – –
Rwanda 1.35 – –
Bosnia and
Herzegovina
1.35 1
National policy
commitment to
eliminate TFA
Chad 1.35 1
National policy
commitment to
eliminate TFA
Uganda 1.34 – –
Burkina Faso 1.34 – –
Malawi 1.34 – –
Djibouti 1.34 – –
South Sudan 1.33 – –
Mozambique 1.32 – –
United Republic
of Tanzania
1.32 – –
Saudi Arabia 1.32 4
Mandatory national
ban on PHO
Monitoring mechanism
for mandatory TFA limits
Gabon 1.31 – –
Cabo Verde 1.31 1
National policy
commitment to
eliminate TFA
Malaysia 1.25 – –
Kazakhstan 1.23 3
2% industrially
produced TFA limit in
oils and fats only
Monitoring mechanism
for mandatory TFA limits
41
Country
Proportion of CHD deaths
(%) due to TFA intake
(>0.5% energy)a
Scoreb
Details of
implemented policy
Notes
Uruguay 1.17 3
2% industrially
produced TFA limit in
oils and fats, and 5%
limit in other foods
Monitoring mechanism
for mandatory TFA
limits; best-practice
TFA policy passed but
not yet in effect
Sweden 1.14 2 Reformulation
Best-practice TFA
policy passed but
not yet in effect
Ireland 1.13 – –
Best-practice TFA
policy passed but
not yet in effect
Lebanon 1.02 1
National policy
commitment to
eliminate TFA
Austria 1.00 4
Mandatory national limit
(industrially produced
TFA <2 g/100 g total oils
and fats in all foods)
Monitoring mechanism
for mandatory TFA limits
Turkey 0.98 2
Mandatory declaration of
TFA on nutrition labels
Best-practice TFA
policy passed but
not yet in effect
Spain 0.96 2 Reformulation
Best-practice TFA
policy passed but
not yet in effect
Israel 0.94 2
Mandatory declaration of
TFA on nutrition labels
Tunisia 0.93 2 Reformulation
Italy 0.88 2
Mandatory limits on
industrially produced
TFA in foods in
specific settings
Best-practice TFA
policy passed but
not yet in effect
–	 missing data
a
	 Based on data from Global Burden of Disease 2019
b
	 Score definition:
1. = “National policy commitment to eliminate TFA”: National policies, strategies or action plans that express a
commitment to reduce industrially produced TFA in the food supply.
2. = “Other complementary measures”: Legislative or other measures that encourage consumers to make healthier choices
about industrially produced TFA (e.g. mandatory declaration of TFA on nutrition labels; front-of-pack labelling system that
includes TFA; reformulation) or mandatory limits on industrially produced TFA in foods in specific settings (e.g. public
institutions).
3. = “Less restrictive TFA limits”: Legislative or regulatory measures that limit industrially produced TFA in foods in all
settings, but are less restrictive than the recommended approach (e.g. 2% limit for industrially produced TFA in oils and fats
only; 2% limit for industrially produced TFA in oils and fats, and 5% limit in other foods; 5% limit for industrially produced
TFA in oils and fats).
4. = “Best-practice TFA policy”: Legislative or regulatory measures that limit industrially produced TFA in foods in all settings
and are in line with the recommended approach. The two best-practice policies for TFA elimination are: 1) mandatory
national limit of 2 g of industrially produced TFA per 100 g of total fat in all foods; and 2) mandatory national ban on the
production or use of PHO as an ingredient in all foods.
42
ANNEX 2
UPDATED METHODOLOGIES USED TO ESTIMATE TFA BURDEN BY
COUNTRY FOR THIS REPORT
The estimates of TFA burden by country, provided by the Institute for Health Metrics and Evaluation, are based on data from
Global Burden of Disease (GBD) study 2019, whereas the estimates in the 2019 progress report were based on data from GBD
2010. Several methodological improvements were made over the past cycles of GBD in the process of estimating the burden of
disease attributable to TFA intake.
	› To improve the quality and coverage of the dietary estimates, literature was searched systematically for nationally or
subnationally representative studies providing information on consumption of TFA.
	› To capture recent trends in TFA consumption, sales data were also used to inform the estimates.
	› To improve the harmonization of data across various sources, a network meta-regression was used and non-goldstandard
data points (e.g. sales data) were adjusted to 24-hour dietary recall data.
	› To better characterize the overall time trend of TFA intake, spatiotemporal Gaussian process regression was used to
estimate the full time series of TFA intake.
	› To more accurately characterize the distribution of TFA intake at the population level, an ensemble model of different
parametric distributions was developed.
	› To address concerns over within-person variation in TFA intake, the standard deviation of intake was used to estimate
usual TFA intake, which was then used to quantify the attributable disease burden.
	› Based on the most recent epidemiological evidence and newly developed methods for characterizing the risk curve in
GBD 2019, the dose–response curve of relative risks for TFA and ischaemic heart disease was updated.
43
FOR MORE INFORMATION, PLEASE CONTACT:
Department of Nutrition and Food Safety
World Health Organization
Avenue Appia 20, CH-1211 Geneva 27, Switzerland
Fax:	 +41 22 791 4156
Email:	nutrition@who.int
www.who.int/nutrition
9789240010178