**1. Introduction**

The intake of Industrially-produced-Trans fatty acids (IP-TFAs) is associated with an increased risk of heart attacks and death from coronary heart disease (CHD) [1]. A 2% absolute increase in energy intake from IP-TFAs has been associated with a 23% increase in cardiovascular risk [2]. In 2018, IP-TFAs 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 [3]. Also, in 2018, the REPLACE action package was launched to help countries removing IP-TFAs from their food supplies [4]. In addition, WHO released additional resources in 2019 to support country actions, including six implementation modules and a live policy tracking map—the TFAs Country Score Card 1—to monitor global progress towards the 2023 target [3]. In 2020, WHO established an indicator that records whether countries have adopted WHO best-practice policies for eliminating IP-TFAs [5]. Around fifty-eight countries have introduced laws to date that will protect more than 3 billion people from TFAs by the end of 2021 [3]. However, more than 100 countries have yet to act to eliminate TFAs from their national food supply and make the world TFAs free by 2023 [3]. The European Region 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 effort (2004), Austria (2009), Iceland (2011), Hungary (2014), Norway (2014), Latvia (2018), Slovenia (2018) [6], and New Zealand (2008) have passed similar bestpractice regulations [7]. Switzerland, one of the first countries in Europe to take legal action

**Citation:** Hoteit, M.; Zoghbi, E.; Rady, A.; Shankiti, I.; Ibrahim, C.; Al-Jawaldeh, A. Non-Conjugated-Industrially-Produced-Trans Fatty in Lebanese Foods: The Case of Elaidic and Linolelaidic Acids. *Nutrients* **2021**, *13*, 3664. https://doi.org/ 10.3390/nu13103664

Academic Editors: Alessandra Durazzo, Massimo Lucarini and Laura den Hartigh

Received: 11 August 2021 Accepted: 13 October 2021 Published: 19 October 2021

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**Copyright:** © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

to restrict TFA, has a TFA limit in oils and fats (2008) [6]. The Eastern Mediterranean Region (EMR), as well as Lebanon, have witnessed rapid modernization in the last thirty years that has led to a dramatic transformation affecting people's lifestyles and diets. The average intake of saturated fatty acids (SFAs) and IP-TFAs in EMR exceeded the WHO upper limits and was estimated to be 10.3% and 1.9% of total energy intake (EI), respectively [8]. The highest SFAs intake was reported in Djibouti, Kuwait, Saudi Arabia, Lebanon, and Yemen, while the highest intake of IP-TFAs was reported in Egypt and Pakistan [8]. According to recent national data, the proportion of coronary heart diseases (CHD) death due to IP-TFA intake is 9.4% (>0.5% energy) [5] and a high burden of NCDs, accounting for 91% of total annual deaths with CVDs responsible for 47% of total deaths [9] was observed in Lebanon. As a result, the urgent need for policy measures to protect cardiovascular health is more apparent than ever and presents a historic imperative to prioritize and invest in public health by adopting health-promoting policy measures, including industrially produced Trans fatty acids (IP-TFAs) elimination. Although limited data are available on IP-TFAs intake globally, a recent report estimated that the 2017 global market volume of partially hydrogenated vegetable oils (PHVO)—the main source of IP-TFAs in food—was approximately 13.6 million tones [10]. PHVO constitutes 25% to 45% of total fat [6]. Their removal from the global food supply could prevent up to 17 million deaths by 2040 and would be the first time an NCDs risk factor has been eliminated [11]. The most common non-conjugated IP-TFA in the human's daily diet are 18-carbon fatty acids with one double bond in the 9-carbon transposition or two double bonds in the 9 and 12 carbon, called Elaidic acid (EA; 9t18:1) and Linolelaidic acid (LEA; 9t12t18:2) respectively [12]. EA and LEA were associated with various health problems [13]. EA, which is the *trans* form of oleic acid (OA, C18:1 *cis*), is the principal IP-TFA found in PHVO and margarine. EA intake resulted in significant hyperlipidemia, inflammation, and fatty liver alterations [14]. LEA is an omega-6 TFA (9E,12E-9t12t18:2), principally discovered in foods with fried or high-heat cooking or PHVO [15]. It was suspected to enhance the adipogenic differentiation favoring obesity [15]. Moreover, LEA appeared to be potentially more detrimental than EA and LEA contributed to higher risks of sudden cardiac death compared with other TFAs [16]. Because IP-TFAs increases the risk of heart disease and are estimated to cause more than 500,000 deaths per year [3] and based on the WHO recommendation that IP-TFAs intake should not exceed 1% of total daily energy intake (equivalent to less than 2.2 g/day in a 2000-calorie diet), providing baseline information on dietary sources of IP-TFAs in Lebanon is a crucial stepstone to reduce the risk of death and hospitalization by CVDs and is one of the strategic interventions under the area of prevention and reduction of risk factors in the Regional Framework for Action on NCDs [17]. To our knowledge, this is the first national study that assesses the content of EA and LEA in food. The main objectives of this article are to:

Assess IP-TFAs levels, mainly EA and LEA in frequently consumed traditional dishes, Arabic sweets, processed foods, butter, and margarines in Lebanon.

Review of the findings retrieved from online databases on dietary sources of IP-TFAs in Lebanon and compare them with other countries.

Establish a steppingstone for required policies and regulations to mandate limits of IP-TFAs levels in foods imported or produced locally.
