Imagine a young mother carefully browsing through the grocery aisles, choosing food items for her household. She picks up a container of margarine, a roll of biscuits, maybe some crisps and a box of infant formula milk for the youngest member of her family. Unbeknown to her, these apparently harmless choices are laced with industrially produced trans fatty acids, invisible killers that lurk in a wide variety of the foods we consume.

These harmful fats, found in partially hydrogenated oils, are everywhere. From margarine and baked goods to fried snacks and street foods, dairy products and packaged products, iTFAs infest the food that we not merely eat ourselves but also offer to our families and loved ones.

Trans-fats are an appealing ingredient to food manufacturers because they improve texture, shelf life and flavour stability. However, their health costs far outweigh these benefits. Unlike naturally occurring trans fats found in small amounts in dairy and meat, iTFAs have no known health benefits and are among the leading culprits contributing to an increase in low-density lipoprotein (‘bad’ cholesterol) and a decrease in high-density lipoprotein ( ‘good’ cholesterol).

These silent killers have been quietly contributing to a growing health crisis in Pakistan. According to the World Health Organisation, non-communicable diseases account for more than 58 per cent of deaths in our country. Cardiovascular diseases alone claim more than 200,000 lives each year. The link between iTFAs and these alarming health concerns is well-researched and sufficiently documented. Research has shown that even a small amount of iTFA intake—a two per cent increase in the energy intake from trans fatty acids is associated with a 23 per cent increase in the incidence of coronary heart disease.

Alarmingly iTFAs have been found in infant formula milk, endangering the youngest and most vulnerable population. Many babies rely on formula milk for nutrition. The exposure to harmful trans fats during this critical period can have long-lasting negative effects on their health.

Pakistan is on WHO's "less restrictive list" of countries vis-à-vis the consumption of iTFAs. This essentially means that while some food products (namely, cooking oils, banaspati ghee, bakery wares and bakery items) are regulated, several food categories remain unregulated. These include ultra-processed and many types of packaged and unpaged foods, dairy products such as chocolates and ice-creams and a variety of street foods and snacks.

Adopting WHO's best practice policy in regulating iTFAs is a clear actionable path forward. By limiting iTFAs to 2 grams per 100 grams of total fat in all foods and/ or banning the production and distribution of PHOs, we can significantly reduce the prevalence of these harmful fats in our diet.

Trans-fats are an appealing ingredient to food manufacturers because they improve texture, shelf life and flavour stability. However, their health costs far outweigh these benefits. Unlike naturally occurring trans-fats found in small amounts in dairy and meat, iTFAs have no known health benefits and are among the leading culprits contributing to an increase in low-density lipoprotein

Some countries have adopted a two-pronged approach of limiting iTFA to two per cent of the total fats in all foods and banning PHOs. This ensures comprehensive coverage by addressing the direct addition of iTFAs in food production and restricting its use as an ingredient.

The implementation of these regulations is likely to have several positive health outcomes. To begin with, such measures can directly reduce the incidence of cardiovascular and other non-communicable diseases, saving thousands of lives every year. The regulation of iTFAs across all dietary sources and a ban on the production and distribution of PHOs will significantly alleviate the economic burden on our healthcare system. NCDs are expensive, both in terms of direct medical expenses and lost productivity. By preventing these diseases, resources can be reallocated to other critical areas of public health and development.

The countries that have implemented similar regulations are already recording positive changes in their public health outcomes. Denmark, the first country to introduce a ban in 2003, has witnessed a significant decline in heart disease-related mortality rates. Countries like India and Egypt (once among the highest consumers of iTFAs in the world) have also introduced regulations limiting industrially produced trans-fatty acids to less than two per cent of the total fats in all food items. This sets an important precedent for Pakistan, showing that regulatory action is not a luxury only the Global North enjoys, but a necessity that the Global South has also embraced.

The Ministry of National Health Services, Coordination and Regulation is committed to working collaboratively with various stakeholders to offer technical support and guidance.

Public education and awareness campaigns will play a crucial role. Consumers need to be informed about the dangers of iTFAs and empowered to make healthy food choices. Clear front-of-pack labelling, public service announcements and partnerships with public service campaigns such as TRANSFORM Pakistan can help disseminate this vital information. The collective power of the government and civil society can enable an environment of health and wellness through schools, workplaces and media to amplify the need for and potential impact of regulatory measures.

The battle against iTFAs is inherent to Pakistan's broad strategy of combating NCDs and promoting public health. It aligns well with its national health goals and international commitments, including the sustainable development goals. By taking bold and proactive steps to regulate iTFAs, we can create a healthier future.

The elimination of industrial trans-fats from our food supply is, not just a health issue. It is a moral imperative too. The evidence is strong, and the benefits are profound. The sooner we ensure the reduction and eventual elimination of iTFAs from our dietary sources, the sooner we will be able to start our journey towards a healthier Pakistan.

The writer is the director for nutrition at the Ministry of National Health Services, Coordination and Regulation