An expert panel on lipids and cardiovascular health in the Nigerian Population has alerted to the increase in prevalence of Non Communicable Diseases (NCDs), especially Cardiovascular Disease (CD) in Nigeria, and the documented evidence of deleterious effects of lipids (fats and oil). The experts from a range of relevant disciplines in a report published in July 2017 edition of the European Journal of Nutrition & Food Safety called for an urgent need to advocate for the general public and health professionals to make heart-friendly choices in food consumption even as they declared palm oil healthful. They said red palm oil should be used within the limits of allowed total daily calorie intake from fats, as there is as yet no scientific evidence that shows that consumption of red palm oil, as part of a healthy balanced diet is harmful.
The verdict is out: More Nigerians are dying today of heart-related diseases due to the deleterious effects of cooking oils. Recent studies have shown that more people die annually from Cardiovascular Diseases (CVDs) than from any other cause and more than 80 per cent of the global burden of CVD occur in low- and middle-income countries.
CVD is a class of diseases that involve the heart or blood vessels. CVD includes coronary artery diseases (CAD) such as angina and myocardial infarction (commonly known as a heart attack). Other CVDs include stroke, heart failure, hypertensive heart disease, rheumatic heart disease, cardiomyopathy, heart arrhythmia, congenital heart disease, valvular heart disease, carditis, aortic aneurysms, peripheral artery disease, thromboembolic disease, and venous thrombosis.
A new study by team of medical experts shows that coronary heart disease (CHD) deaths in Nigeria reached 53,836 or 2.82 per cent of total deaths, and are responsible for the greatest proportion of the total mortality due from non-communicable diseases (NCD). While in economically stable countries, death from cardiovascular and cerebrovascular diseases come from long and productive life, in developing countries almost half of such deaths occur among people in the prime of their age.
According to the study titled “Consensus Summit: Lipids and Cardiovascular Health in the Nigerian Population,” the upsurge of these diseases in the developing countries is as a result of increasing behavioral risk factors such as unhealthy nutrition, physical inactivity, tobacco use and alcohol which are modified by social determinants like poverty, urbanization and globalization.
The study conducted by team of researchers from various health and medical institutions in Nigeria and The Netherlands noted that other factors that can modulate predisposition include ageing and genetics. They, however, said most cardiovascular diseases can be prevented by addressing behavioral risk factors The experts observed that the publication of the Federal Ministry of Health (FMOH), Nigeria – National Nutrition Guidelines on Non-communicable Diseases Prevention, Control and Management address these issues.
According to the study, dietary fats and oils provide calories, essential fatty acids and are sources of fat-soluble vitamins A, D, E, and K. However the lipid content of dietary fats and oils have a bearing on serum lipid profile, as dyslipidemia is associated with CVD risk.
They, however, noted that the effects of both the amount and quality of dietary fat have yielded conflicting results. Saturated fatty acids are associated with large less dense Low Density Lipo-protein (LDL) also known as ‘bad’ cholesterol while carbohydrates are associated with the denser small LDL particles that predispose to CVD. Positive relationship between CVD mortality and raised total cholesterol and raised total triglycerides at younger ages is reversed in seniors.
In current times, low High Density Lipo-protein (HDL)/ ‘good’ cholesterol of about 1 mmol/L and high total cholesterol: HDL cholesterol ratio or total triglyceride: HDL cholesterol ratio are the best-known indicators of CVD risk. Plasma concentration of apolipoprotein B the major protein carrier of LDL, Intermediate Density lipoprotein (IDL) and very low-density lipoprotein (VLDL), indicates the total number of potentially atherogenic particles, correlating with the non- HDL cholesterol levels. The ratio of apo B with apolipoprotein A-1 the major protein in HDL is best below 0.9 for men and 0.8 for women. Foods rich in saturated fatty acids (SFA), trans fatty acids, foods with high glycemic index or load, have been considered unhealthy, whereas, monounsaturated fatty acids (MUF A) and polyunsaturated fatty acids (PUFA) are considered beneficial.
More recent systematic research and meta-analysis however reveal that substituting SFA and MUFA calories in nutrition with PUFA did not reduce CVD events, although substituting five per cent of energy from either MUFAs or SFAs with the same amount of energy from carbohydrate was associated with 62–68 per cent higher CHD mortality.
Caloric restriction (CR) has proved to be the most effective and reproducible dietary intervention to increase healthy lifespan and aging, and strong evidence supports a valid reversed association of vegetables, nuts, the “Mediterranean” and high- quality dietary pattern with CHD.
The summit held in April 2016 at NIMR Yaba, Lagos, set out to evaluate information available on the relationship between dietary fats and CVD in the Nigerian context. The stakeholders reviewed the current situation and the best practices to adopt in the Nigerian population. The Summit deliberated on policy documents that are available and those that are yet to be put in place.
The Summit invited partners from the FMoH, Federal Ministry of Agriculture, NIMR, NCDC, National Agency for Food Drug Administration and Control (NAFDAC), Standard Organization of Nigeria (SON), Research Institutes, 110 universities, Civil Society Organizations (CSOs), consumers, food manufacturers and other relevant stakeholders to deliberate on this important issue.
At a plenary session the following presentations were made: “The Nigerian Heart Foundation Heart Check Food Labelling Programme”; “Current Status of Cardiovascular Diseases and Operational Policies in Nigeria”; “Dietary Lipids and Cardiovascular Disease in Nigeria”; “Palm oil and Heart health in Nigeria” and “Choices International healthy food programme”.
The NHF Heart Check Food Labelling Programme
NHF in its effort to reduce NCDs-related morbidity and mortality in Nigeria recognized that healthy diets play a major role in the prevention and control of NCDs. The initiative, “Nigerian Heart Foundation Heart Check Food Labelling Programme” was developed in 1998 in collaboration with the Federal Government of Nigeria parastatal – NAFDAC that regulates and controls the manufacture, importation, exportation, distribution, advertisement, sale and use of food, drugs, cosmetics, chemicals, medical devices and packaged water in Nigeria.
The NHF Heart Check Food Labelling Programme is voluntary. Companies that are interested subject their products to standardized nutrition profile evaluations, guided by a set of scientific criteria. The criteria was developed by the Nigerian Heart Foundation, and approved by NAFDAC. The criteria include approved levels of sodium, sugar, cholesterol and trans-fat. The Nigerian Heart Foundation grants permission to use the Logo on all packaged food items that fulfill the criteria. The Nigerian Heart Foundation Heart Check logo is used in all the geographic regions of Nigeria, and in a few countries in West Africa.
Current status of CDs and operational policies in Nigeria
According to the study, policies, plans and services for the prevention and control of NCDs need to take account of health and socio-economic changes throughout the life course.
Government policies aimed at tackling the challenge of NCDs include the mandatory fortification of wheat flour and vegetable oil with Vitamin A. The NAFDAC food fortification with Vitamin A regulations of 2005, addresses the prohibition of sales of the specified food vehicles, without adequate fortification with Vitamin A and labelling of Vitamin A fortified foods among others. The “National Nutrition Guideline on NCDs Prevention, Control and Management” and the “National Strategic Plan of Action for Nutrition” are policy documents that addresses Nutrition as priority areas for non-communicable diseases in Nigeria.
Palm oil and heart health in Nigeria
Raw red palm oil is a rich source of phytonutrients, carotenoids, tocopherols, tocotrienols, sterol, phospholipids and polyphenols. Refined palm oil is in mainly heat stable, largely tasteless and trans- fat free.
The argument against the use of palm oil is because it contains palmitic acid (44 per cent), a saturated fatty acid, which by extrapolation increases risk of cardiovascular disease. However, palm oil also contains oleic acid (40 per cent), which are monounsaturated and the major constituent of olive oil. Palm oil is also a very rich source of vitamins A and E as well as other anti- oxidants.
The expert panel recommends that red palm oil should be used within the limits of allowed total daily calorie intake from fats, as there is as yet no scientific evidence that shows that consumption of red palm oil, as part of a healthy balanced diet is harmful.
According to the study, many fats and oils manufacturing industries are found in Nigeria and many manufactured foods also contain quantities of fats and oils. Discussions in this group revolved round issues bothering on heart health in the Nigerian population as well as good manufacturing practices in the production of fats and oils.
There has been sub-optimal emphasis on heart healthy foods, which contribute to the low awareness of healthy foods in relation to heart health. Knowledge for healthy eating is however gradually building up as evidenced by fruit and vegetable salads sold by vendors on streets, fast-food outlets and supermarkets. Inability to afford these healthy foods classes limits the options by social class, contributing to making unhealthy food choices.
Some advertisements of calorie dense, low nutrient food products, target children and trigger poor snaking habits for unhealthy food type.
The Summit observed that there is abundance of local sources of heart-friendly lipid products, which are yet to be fully tapped in Nigeria. Research and development to process local raw foods for storage and preserve them optimally will not only cater for the malnourished by preventing destruction of nutrients, but also reduce hunger by avoiding spoilage.
The expert panel said funding for industrial innovation should be sourced not only from the private sector but the government as well, so that we can develop technology specific to the local foods, taste, and in healthy forms. Heart-health benefits of many plant products such as ginger, garlic, garden eggs, bitter leaf, walnuts, and pears are profuse in literature and should be taken advantage of.
According to the study, food processing methods that are discouraged include smoking of food products as encountered in barbecues, open air roasting of corn and yams, repeated frying of oils in home use, including manufacturing and handling processes that change the integrity and composition of vegetable oils. Overheating, bleaching, hydrogenations are extreme treatment of food and food products, which usually degrade the nutritive value of the processed food and of oils in particular.
Therefore recycling of frying oils that hydrogenate and oxidize oils, are some deleterious effects conferred on fats and oils that should be discouraged. On the other hand, to preserve the antioxidants and vitamins in food and food products, boiling extraction methods of red palm oil preserves the B carotene and antioxidants better than refining process that produces tasteless white palm oil obtainable in the food manufacturing industries.
Although most oils in the market claim to have no or low cholesterol, it is not certain that they meet the cholesterol free standards by the CODEX criteria of less than, 0.005 g per 100 g solids, 0.005 g per 100 ml liquids with less than 1.5 g saturated fat per 100g solids or 0.75 g saturated fat per 100 ml liquids and 10% energy from saturated fats.
Compliance with local fortification regulations also needs to be verified for integrity of such oils to be acceptable.
There are various dietary lipids available in the Nigerian markets, both of plant and animal origins, including groundnut oil, palm kernel oil, coconut oil, soybean oil, sunflower seed oil, cotton seed oil, maize oil, palm oil and so on. Over 40 vegetable oils were published under different trade names as being available on the Nigerian market, but only four have been endorsed by NHF. These are established as cholesterol-free oil in the Nigerian market and their production promoted by the NHF heart friendly endorsement.
The Summit on cardiovascular health in the Nigerian population reached a consensus on all the points summarized in the different groups. The Summit agrees that there is a gap of scientific knowledge to be filled on lipids and cardiovascular health in Nigerian population. Translating the research into effective population interventions will go a long way in exchange for relevant information in cardiovascular health, empowering us with tools for effective strategic planning and finding solutions to the burden of NCDs in Nigeria.
The Summit’s conclusions and recommendations are already published. The expert panel said the Federal Government of Nigeria needs to continue to play a coordinating role in convening stakeholders meeting consisting of philanthropic foundations, nongovernmental organizations, research institutions, private companies, industries and international institutions; on addressing NCDs periodically. This, they said, will help to develop a strategic and sustainable plan for collective actions on NCDs in Nigeria.
Source: The Guardian Newspaper