title: The need for multisectoral food chain approaches to reduce trans fat consumption in India.
abstract: BACKGROUND
  The World Health Organization (WHO) recommends virtually eliminating trans fat from the global food supply. Although several high-income countries have successfully reduced trans fat levels in foods, low- and middle-income countries such as India face additional challenges to its removal from the food supply. This study provides a systems analysis of the Indian food chain to assess intervention options for reducing trans fat intake in low-income consumers.
  
  
  METHODS
  Data were collected at the manufacturer, retailer and consumer levels. Qualitative interviews were conducted with vanaspati manufacturers (n = 13) and local food vendors (n = 44). Laboratory analyses (n = 39) of street foods/snacks sold by the vendors were also conducted. Trans fat and snack intakes were also examined in low-income consumers in two rural villages (n = 260) and an urban slum (n = 261).
  
  
  RESULTS
  Manufacturers of vanaspati described reducing trans fat levels as feasible but identified challenges in using healthier oils. The fat content of sampled oils from street vendors contained high levels of saturated fat (24.7-69.3 % of total fat) and trans fat (0.1-29.9 % of total fat). Households were consuming snacks high in trans fat as part of daily diets (31 % village and 84.3 % of slum households) and 4 % of rural and 13 % of urban households exceeded WHO recommendations for trans fat intakes.
  
  
  CONCLUSIONS
  A multisectoral food chain approach to reducing trans fat is needed in India and likely in other low- and middle-income countries worldwide. This will require investment in development of competitively priced bakery shortenings and economic incentives for manufacturing foods using healthier oils. Increased production of healthier oils will also be required alongside these investments, which will become increasingly important as more and more countries begin investing in palm oil production.
authors.affiliation: Menzies Centre for Health Policy, University of Sydney, Sydney, Australia. Shauna.downs@sydney.edu.au.
authors.forename: Shauna M
authors.initials: SM
authors.lastname: Downs
authors.affiliation: Indian Institute for Public Health, Public Health Foundation of India and All India Institute of Medical Sciences, Delhi, India. arch_singh@ymail.com.
authors.forename: Archna
authors.initials: A
authors.lastname: Singh
authors.affiliation: Indian Institute for Public Health, Public Health Foundation of India, Haryana, India. vidhu.gupta@iiphd.org.
authors.forename: Vidhu
authors.initials: V
authors.lastname: Gupta
authors.affiliation: London School of Hygiene and Tropical Medicine and Leverhulme Centre for Integrative Research on Agriculture and Health, London, UK. Karen.Lock@lshtm.ac.uk.
authors.forename: Karen
authors.initials: K
authors.lastname: Lock
authors.affiliation: Indian Institute for Public Health, Public Health Foundation of India, Plot No.34, Sector - 44, Institutional Area, Gurgaon, 122002, Haryana, India. suparna.ghoshj@iiphd.org.
authors.forename: Suparna
authors.initials: S
authors.lastname: Ghosh-Jerath
mesh_terms: D003132:Commerce / Q000706:statistics & numerical data*; D003258:Consumer Behavior; D004041:Dietary Fats / Q000008:administration & dosage* / Q000009:adverse effects; D005227:Fatty Acids; D005231:Fatty Acids, Unsaturated / Q000008:administration & dosage; D005523:Food Supply / Q000706:statistics & numerical data*; D015438:Health Behavior; D006801:Humans; D007194:India / Q000453:epidemiology; D044242:Trans Fatty Acids / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D004041:Dietary Fats; D005227:Fatty Acids; D005231:Fatty Acids, Unsaturated; D044242:Trans Fatty Acids