title: Impact of WHO recommendations to eliminate industrial trans-fatty acids from the food supply in Latin America and the Caribbean.
abstract: BACKGROUND
  The World Health Organization (WHO) has deemed that there is enough evidence to recommend the elimination of industrially produced trans-fatty acids (TFA) from the food supply. This article evaluates government-led public health strategies in countries in Latin America and the Caribbean (LAC), and factors perceived to affect following WHO's recommendation to eliminate industrially produced TFA.
  
  
  METHODS
  Descriptive, prospective multiple case studies integrated data from open-ended questionnaires to representatives of ministries of health, and systematic review of internal and publicly available documents in 13 LAC countries.
  
  
  RESULTS
  Overall, government efforts to follow WHO recommendations have not been well co-ordinated throughout the region. Evidence for this includes the lack of standardization of TFA definitions. For example, some countries exclude naturally occurring TFA from the definitions, whereas others leave the option open to their inclusion. As a consequence, the criteria for trans-free nutrient claims and labelling requirements are inconsistent across the region. Government-led strategies varied from banning or limiting TFA content in the food supply to voluntary labelling of TFA. The identified challenges to the implementation of policies to reduce TFA include the shortage of information on TFA content of diets and foods, consumer unawareness of TFA and lack of monitoring and surveillance. The identified enabling factors were intersectoral collaboration with industry, mandatory labelling regulation and international and national visibility of the topic, which facilitated reduction of TFA content.
  
  
  CONCLUSIONS
  A co-ordinated effort is required to achieve virtual elimination of all TFA in the region, as recommended by WHO. Standardization of the definition of TFA across the region would facilitate regulation, consumer education efforts and monitoring and surveillance efforts. Simultaneously, countries need to determine their level of exposure to TFA through the implementation of small surveys to assess blood TFA levels using blood spots, and the evaluation of TFA in fat sources that are commonly used.
authors.affiliation: Department of Global Health, School of Public Health and Health Services, George Washington University, 2175 K Street, NW, Suite 200, Washington, DC 20037, Department of Health and Nutrition, Costa Rican Institute for Research and Education on Nutrition and Health (INCIENSA), Ministry of Health, 100 Oeste de la Gasolinera Tinoco, Tres Ríos, La Uni򬬠Cartago, Costa Rica and Department of Nutrition, Harvard School of Public Health, Harvard University, 655 Huntington Avenue, Building I Room 201, Boston, MA 02115.
authors.forename: Uriyoán
authors.initials: U
authors.lastname: Colón-Ramos
authors.affiliation: Department of Global Health, School of Public Health and Health Services, George Washington University, 2175 K Street, NW, Suite 200, Washington, DC 20037, Department of Health and Nutrition, Costa Rican Institute for Research and Education on Nutrition and Health (INCIENSA), Ministry of Health, 100 Oeste de la Gasolinera Tinoco, Tres Ríos, La Uni򬬠Cartago, Costa Rica and Department of Nutrition, Harvard School of Public Health, Harvard University, 655 Huntington Avenue, Building I Room 201, Boston, MA 02115 rmonge@inciensa.sa.cr.
authors.forename: Rafael
authors.initials: R
authors.lastname: Monge-Rojas
authors.affiliation: Department of Global Health, School of Public Health and Health Services, George Washington University, 2175 K Street, NW, Suite 200, Washington, DC 20037, Department of Health and Nutrition, Costa Rican Institute for Research and Education on Nutrition and Health (INCIENSA), Ministry of Health, 100 Oeste de la Gasolinera Tinoco, Tres Ríos, La Uni򬬠Cartago, Costa Rica and Department of Nutrition, Harvard School of Public Health, Harvard University, 655 Huntington Avenue, Building I Room 201, Boston, MA 02115.
authors.forename: Hannia
authors.initials: H
authors.lastname: Campos
mesh_terms: D017691:Caribbean Region; D005515:Food Labeling / Q000592:standards; D005523:Food Supply / Q000592:standards*; D007221:Industry; D007843:Latin America; D018673:Nutrition Policy; D011446:Prospective Studies; D011634:Public Health; D044242:Trans Fatty Acids / Q000592:standards*; D014944:World Health Organization
chemical_list: D044242:Trans Fatty Acids
keywords: Latin America and Caribbean; nutrition policy; nutritional labelling; regulation; trans-fatty acids