World COPD Day: Chronic cough, a novel phenotype of COPD

A new study has suggested that chronic cough is not just a symptom of COPD; instead, it should be considered as an important phenotype during the determination of high-risk groups of patients with COPD, particularly with regard to future acute exacerbation of COPD (AECOPD). 

The study published in the International Journal of Chronic Obstructive Pulmonary Disease included 1,613 COPD patients, patients with chronic cough only, those with sputum only, those with chronic bronchitis and those without cough and sputum were compared with regard to dyspnea, lung function, quality of life (QoL) and risk of AECOPD.a

Compared with patients without chronic cough, those with chronic cough had a lower forced expiratory volume in 1 second (FEV1) (% predicted) and diffusing capacity of the lungs for carbon monoxide (DL_CO) (% predicted), more severe dyspnea and worse QoL.

Chronic cough, and not chronic sputum, was also found to be an independent risk factor for future acute exacerbation of COPD (AECOPD). Hence, it is important to identify patients with chronic cough irrespective of sputum to identify the high-risk patients and evaluate the severity of disease to establish the prognosis.

(Source: Koo HK, Park SW, Park JW, et al. Int J Chron Obstruct Pulmon Dis. 2018 May 30;13:1793-1801)

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA

World COPD Day: Indoor air pollution is a major risk factor for COPD

COPD or chronic obstructive pulmonary disease is an often overlooked but serious global health threat. It is often underdiagnosed in India because spirometry, which can confirm the presence of COPD, is often not conducted during preliminary examination.

COPD is a gradually progressive disease characterized by airflow limitation. Cigarette smoking is the major etiologic factor; however, exposure to other chemical irritants also plays a role in the pathogenesis.

Indoor pollution is also one of the risk factors for COPD. Indoor air quality can be determined by outdoor or ambient air pollution, fuels for heating and cooking, tobacco smoke, second hand tobacco smoke, poorly ventilated and overcrowded living conditions.

When outdoor levels of pollutants are high, their levels also increase indoors. Poor ventilation and structural designs can trap volatile organic compounds, bioaerosols and particulate matter so, the indoor air quality can be up to 10 times worse than outdoor air pollution. In a country like India, it becomes increasingly important to address challenges associated with indoor cooking, especially in rural areas.

Lung is a major site of interaction with environmental particulates. Pollutants such as particulate matter can affect the lung in numerous ways causing inflammation, oxidative stress, and cell cycle death. Therefore, air pollution is strongly associated with the risk of COPD or aggravating pre-existing COPD triggering “exacerbation” episodes. Exposure to second-hand smoke may sometimes cause never-smokers to develop COPD.

Individuals, who have COPD should consult their doctors about need for increasing the dose of their medications. They must use a mask when they step out of the house.

Air quality in Delhi is “very poor” and this has been the case not only since the last few days, but also the past few years. It is becoming a recurring public health problem that needs urgent attention. However, air pollution is mainly man-made and since it harms human health, it is of immediate concern to all. It is not just the responsibility of the government, it is a collective responsibility.

We too can make a difference by adopting measures - at an individual level - to prevent or at least help control the air pollution levels and keep the environment healthy.

Here is what each one of us can do to make a difference and we can start right away.

• Walk or cycle for short distance commutes or to the neighborhood market.
•  Plan and combine all your errands (in one area or close by areas) for one trip.
• Limit driving and carpool.
• Use public transport, as much as possible, for longer distances.
• If you have to use your vehicle, keep it well-maintained for efficient functioning with regular servicing to reduce harmful exhaust emissions and get pollution check done as required. Follow speed limits. Avoid buying diesel vehicle.
• Avoid burning candles, dhoop or incense sticks at home or workplace.
•  Quitting smoking.
• Plant more trees.
•  Limit the areas of bare soil by growing grass to reduce the amount of dust.
• Sprinkle water on exposed soil or construction sites regularly to reduce generation of dust.
• Wet mopping the floors at home or workplace.
• Avoid organizing outdoor parties or any other events when AQI crosses 200.
• Be a strong advocate for measures to control emission of air pollutants. Be active participants in activities to fight air pollution such as odd/even vehicle rule.
• Follow all rules and laws as enforced by the state.

It’s “Never Too Early, Never Too Late”, as is the theme of the World COPD Day, falling on Wednesday, this year,

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA

HCFI Representation for formulation of law on OTC drugs accepted as PIL and Govt. given time for reply

Dr KK Aggarwal & Advocate Ira Gupta

On 24.08.2018, Hon’ble Chief Justice of Delhi High Court had accepted and converted the representation filed by Dr KK Aggarwal, Padma Shree Awardee and National President of Heart

Care Foundation of India (HCFI) into a Public Interest Litigation (PIL) on the issue of formulation

of law on Over-the-Counter (OTC) drugs in India. Notices were issued to Union Government,

Government of NCT of Delhi, Drug Controller General of India(DCGI), National Pharmaceutical

Pricing Authority etc. in the said PIL.

On Wednesday i.e. 14.11.2018, the said PIL was listed for hearing and all the respondents have

been granted 4 weeks’ time to file their counter affidavits / replies.

The Drugs and Cosmetics Act, 1940 (hereinafter referred to as “DCA 1940”) was passed and modified by the Central Government with main object to regulate the import, manufacture distribution and sale of drugs (and cosmetics) vide amendment made in Section 2 of DCA 1940 in

the year 1962 w.e.f. 27.07.1964. They came into effect from 21.12.1945.  Later, Drugs and Cosmetics Rules, 1945 (hereinafter referred to as “DCR 1945”) were notified by the Central Government under powers given in Section 6(2), 12, 33 and 33(N) of DCA 1940. They came into effect from 10.04.1940.

In the above DCA 1940 read with DCR 1945, there are various schedules i.e. Schedule G, H, H1 and X, which contain details and particulars of modern/allopathic medicines which cannot be sold without prescription by doctor i.e. registered medical practitioners as defined in Rule 2(ee) of DCR 1945. Similarly, in Schedule E1 of DCR 1945, some Ayurvedic medicines/drugs are mentioned which can be sold only with the prescription of registered medical practitioners as defined in Rule 2(ee) of DCR 1945.

However, the said DCA and DCR does not recognize OTC drugs, which can be sold and purchased by any person without any prescription from the registered medical practitioner.

The term OTC drugs is being recognized in the world at large as these OTC drugs are a critical component in advancing consumer health because they allow people to treat or manage many health conditions conveniently and successfully. Because they enable people to self-treat, OTC medicines save health systems valuable resources and can save consumers time and money.

In this regard, HCFI had filed one RTI Application with National Pharmaceutical Pricing Authority (NPPA), Dept. of Pharmaceuticals and also with DCGI, Ministry of Health and Family Welfare.

In response to the said RTI application, the Directorate General of Health Services (DGHS) had stated that there is no terminology or list of OTC drugs in Drugs and Cosmetics Act, 1940 and Rules, 1945.

Thereafter, HCFI had sent representation to Hon’ble Prime Minister, Ministry of Health and Ministry of Law thereby requesting them to formulate a law thereby recognising OTC drugs in India and also to prepare a list of OTC drugs in India. However, till date the said representations have remained unanswered.

As the request of the HCFI was unanswered, HCFI filed a representation before the Hon’ble Chief Justice of Delhi High Court requesting the Hon’ble Court to treat the said representation as PIL as the same pertains to formulation of law relating to OTC drugs and preparation of list of OTC Drugs in India which is relevant in advancing consumer health because they allow people to treat or manage many health conditions conveniently and successfully.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA

New ACC/AHA/HRS clinical practice guidelines on bradycardia and cardiac conduction delay: Top 10 Take-Home Messages

Dr KK Aggarwal

Recently, the American College of Cardiology (ACC), the American Heart Association (AHA) and the Heart Rhythm Society (HRS) have jointly released a guideline for the evaluation and treatment of patients with bradycardia and cardiac conduction disorders. 

Bradycardia has been defined in the guideline as a heart rate of less than 50 beats per minute, compared to a normal heart rate of 50-100 beats per minute. Bradycardia is generally classified into three categories—sinus node dysfunction, atrioventricular (AV) block, and conduction disorders. Here are the top 10 take home messages, reproduced from the guidelines as published in the journal Circulation.

1.                  “Sinus node dysfunction is most often related to age-dependent progressive fibrosis of the sinus nodal tissue and surrounding atrial myocardium leading to abnormalities of sinus node and atrial impulse formation and propagation and will therefore result in various bradycardic or pause-related syndromes.

2.                  Both sleep disorders of breathing and nocturnal bradycardias are relatively common, and treatment of sleep apnea not only reduces the frequency of these arrhythmias but also may offer cardiovascular benefits. The presence of nocturnal bradycardias should prompt consideration for screening for sleep apnea, beginning with solicitation of suspicious symptoms. However, nocturnal bradycardia is not in itself an indication for permanent pacing.

3.                  The presence of left bundle branch block on electrocardiogram markedly increases the likelihood of underlying structural heart disease and of diagnosing left ventricular systolic dysfunction. Echocardiography is usually the most appropriate initial screening test for structural heart disease, including left ventricular systolic dysfunction.

4.                  In sinus node dysfunction, there is no established minimum heart rate or pause duration where permanent pacing is recommended. Establishing temporal correlation between symptoms and bradycardia is important when determining whether permanent pacing is needed.

5.                  In patients with acquired second-degree Mobitz type II atrioventricular block, high-grade atrioventricular block, or third-degree atrioventricular block not caused by reversible or physiologic causes, permanent pacing is recommended regardless of symptoms. For all other types of atrioventricular block, in the absence of conditions associated with progressive atrioventricular conduction abnormalities, permanent pacing should generally be considered only in the presence of symptoms that correlate with atrioventricular block.

6.                  In patients with a left ventricular ejection fraction between 36% to 50% and atrioventricular block, who have an indication for permanent pacing and are expected to require ventricular pacing >40% of the time, techniques that provide more physiologic ventricular activation (e.g., cardiac resynchronization therapy, His bundle pacing) are preferred to right ventricular pacing to prevent heart failure.

7.                  Because conduction system abnormalities are common after transcatheter aortic valve replacement, recommendations on postprocedure surveillance and pacemaker implantation are made in this guideline.

8.                  In patients with bradycardia who have indications for pacemaker implantation, shared decisionmaking and patient-centered care are endorsed and emphasized in this guideline. Treatment decisions are based on the best available evidence and on the patient’s goals of care and preferences.

9.                  Using the principles of shared decision-making and informed consent/refusal, patients with decisionmaking capacity or his/her legally defined surrogate has the right to refuse or request withdrawal of pacemaker therapy, even if the patient is pacemaker dependent, which should be considered palliative, end-of-life care, and not physician-assisted suicide. However, any decision is complex, should involve all stakeholders, and will always be patient specific

10.              Identifying patient populations that will benefit the most from emerging pacing technologies (e.g., His bundle pacing, transcatheter leadless pacing systems) will require further investigation as these modalities are incorporated into clinical practice.”

(Source: Kusumoto FM, Schoenfeld MH, Barrett C, et al. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation. 2018; DOI: 10.1161/CIR.0000000000000628)

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA

HCFI representation for installation of AED machines and CPR training in public places converted into PIL and government given time for reply

Dr KK Aggarwal & Advocate Ira Gupta

Earlier on 24.08.2018, Hon’ble Chief Justice of Delhi High Court had accepted and had converted the representation filed by Dr. KK Aggarwal, Padma Shree Awardee and National President of Heart Care Foundation of India (HCFI) into Public Interest Litigation (PIL) on the issue of Cardiopulmonary Resuscitation (CPR) and automated external defibrillator ((hereinafter “AED”) machine in public places like courts, railways and metro. Notices were issued to Union Government, Government of NCT of Delhi, Supreme Court Registrar, etc. in the said PIL.

On Wednesday i.e. 14.11.2018, the said PIL was listed for hearing and all the respondents have been granted 4 weeks’ time to file their counter affidavits / replies.

HCFI has been working on the subject of heart care since its inception and regularly conducts program to train people in essential life saving techniques like hands-only CPR for revival of patients after sudden cardiac arrest.

HCFI has been working for the benefit of public at large and to save the lives of thousands of people who die because of sudden cardiac arrest in absence of cardiac first aid including CPR and also in absence of non-availability of AED.  The said persons who are dying because of sudden cardiac arrest are sometimes even not aware that their lives can be saved by cardiac first aid or by taking the assistance of AED.

According to World Health Organization (WHO), nearly 5.8 lakh people are dying due to heart stroke in the world in a year. Nearly 1.15 lakh people die due to cardiac arrest every day in the world.

Sudden Cardiac Arrest (SCA) is the number one killer in India, killing approximately 25 lakhs people every year. As per the data revealed by Delhi Economic Survey about 150 to 250 deaths happen in the city of Delhi every single day and out of these deaths, 25 to 45 deaths occurred due to SCA.

50% of the patients can be saved if proper CPR is given on time. However, about 98% of the country’s population is not trained in CPR. 

Many valuable lives can be saved by giving training to the people in Cardiac First Aid (CFA) including CPR and also by installing of AED at public places and with further training given to the staff / employees stationed at such public places / offices to conduct the CPR and use the facility of Defibrillator in case of any person suffering from SCA.

An AED is a simple to use unit based on computer technology, which is designed to analyze the heart rhythm itself in deciding if electric shock is required to be given to the patient.  They are designed to be used by persons who require little training to operate them correctly. 

An ambulance reaches the patient in much delayed time who suffered a SCA in a public place. There is even an acute shortage of cardiac ambulances, which are to be mandatorily equipped with Defibrillator and because of that several deaths take place.  In the above scenario if public at large is trained in Cardiac First Aid including CPR and AEDs are installed at public places large number of invaluable and precious human lives can be saved.

HCFI had identified 3 main public places, which are being visited by thousands and lakhs of people every day i.e. all courts, metro and railways.

HCFI had noticed that the people who are visiting such places are under great stress and they are prone to cardiac arrest and in such places no AED machine is being installed and in fact the staff of such places are also not well trained in CPR technique.

In this regard, HCFI had sent representations dated 6.9.2016 to the office of Hon’ble Prime Minister of India, Hon’ble Minister for Health & Family Welfare, Hon’ble Lt. Governor of Delhi, Hon’ble Chief Minister of Delhi and also Hon’ble Health Minster of Govt. of NCT of Delhi.  However no concrete steps have been taken till date and the representations submitted by HCFI remained unanswered.

Earlier in the year 2016 and later in 2018, HCFI had filed various applications under Right to Information Act to the various courts including Hon’ble Supreme Court of India, this Hon'ble Court and all the Distt. Courts situated in Delhi and also to the National Consumer Disputes Redressal commission and State Consumer Disputes Redressal Commission. 

HCFI was shocked to learn that no Defibrillator has been installed in any court of law and moreover the staff of the respective Hon'ble Courts has also not been trained in Cardiac First Aid including CPR except the staff of Hon’ble Supreme court of India, which has been trained in the Cardiac First Aid including CPR.

Also, in the month of February, 2018, HCFI had sent one RTI application dated 12.02.2018 to Delhi Metro Rail Corporation (DMRC) and one application to Ministry of Railways.  

DMRC replied that there is no dispensary at any metro station, AED machine is not being installed neither in any metro station nor in any metro train. Only in some metro stations the pharmacy / chemist shop is available.

In response to the RTI application sent to Ministry of Railways, HCFI received various replies from almost all Railway Zones across the country and was shocked to know that 45,160 people have died in last 5 years in 14 zones and 10685 people have died inside the train.

The fourth-largest railway network in the world by size, with 121,407 kilometres (75,439 mi) of total track over a 67,368-kilometre (41,861 mi) route and which runs more than 13,000 passenger trains daily, on both long-distance and suburban routes, from 7,349 stations across India does not even have dispensary and First Aid Medicines. Even trains do not have First Aid medicines.

As almost 8.26 billion passengers travel by Indian Railways across the country, so it is imperative for the Indian Railways to have a proper and updated medical and First Aid facility both inside the trains and also at the railways stations.

On receiving such shocking data and replies from various courts, railways, metro, HCFI submitted one representation before the Hon’ble Chief Justice of Delhi High Court requesting the Hon’ble Court to treat the said representation as Public Interest Litigation as the same concerns the health and life of the public at large and to issue relevant directions thereby directing all courts in the state including Hon’ble Supreme Court, Hon’ble Delhi High Court and all district courts in Delhi and National Consumer Disputes Redressal Commission and Delhi State Consumer Disputes Redressal Commission, Delhi Metro Rail Corporation Limited and Ministry of Railways to:

a.     To open a dispensary in all courts, metro stations and all railway stations and said dispensaries should function properly.

b.    To train all their staff / employees / security personnel in Cardiac First Aid including Cardiopulmonary Resuscitation (CPR)

c.     To install “Automated External Defibrillator” (AED) machines at all relevant and conspicuous places like all courts, all metro stations, all railway stations, in all metro trains and in all railway trains.

d.    First Aid medicines for Sudden Cardiac Arrest (SCA) should be available in all courts, metro stations, all railway stations, in all metro trains and in all railway trains.

e.     All Courts, Metro stations and all railway stations should have a tie-up with ambulance services for the purposes of emergencies.

f.     Doctor should be available in the working hours at all places.

g.    At least one pharmacy / chemist shop should be available at all courts, all metro stations and at all railway stations

h.     All courts, metro stations and all railway stations should maintain a data w.r.t deaths taking place due to Sudden Cardiac Arrest.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA

Request of HCFI for formulation of law relating to national essential devices and disposables in India has been accepted by the central government

Dr KK Aggarwal & Advocate Ira Gupta

Heart Care Foundation of India (HCFI) had filed one RTI Application dated 22.01.2018 with National Pharmaceutical Pricing Authority, Department of Pharmaceuticals and also with Drug Controller General of India, Ministry of Health and Family Welfare asking them to provide following information:

1.           Is there any law relating to National Essential Medicine in India? If yes, please provide the details of the said law.

2.           Is there any policy of Ministry of Health relating to National Essential Medicine? If yes, please provide the copy of the said policy.

3.           Is there any list of National Essential Medicine in India? If yes, please provide the copy of the said list.

In response to the said RTI application dated 22.01.2018, the Ministry of Health and Family Welfare had given its reply dated 09.02.2018 wherein the Ministry of Health and Family Welfare had specifically stated that there is no separate list of National Essential Devices and Disposables and that the Ministry of Health & Family Welfare only issues the National List of Essential Medicines. The relevant portion of the reply dated 09.02.2018 is reproduced hereunder:

“Reference is invited to your RTI application dated 22.01.2018 forwarded by Shri Arun Kumar Diwan, CPIO, NPPA vide letter No. 23011/07(1)/16-Admn/NPPA-RTI/Pt.-I dated 24.01.2018 (received on 31.01.2018) and it is informed that there is no separate list of National Essential Devices and Disposables. Ministry of Health & Family Welfare issues only the National List of Essential Medicines (NLEM).”

Thereafter, the Directorate General of Health Services, Office of DCG (I) had also sent a reply dated 20.02.2018 thereby informing that they do not have any information relating to National Essential Devices and Disposables.

Thereafter, HCFI submitted one representation dated 08.06.2018 to Mr. Narendra Modi, Hon’ble Prime Minister of India, Mr. Jagat Prakash Nadda, Hon’ble Minister of Ministry of Health & Family Welfare and also to Mr. Ravi Shankar, Hon’ble Minister of Ministry of Law & Justice thereby requesting them to recognise and prepare the List of National Essential Devices and Disposables in the same manner as National List of Essential Medicines is being recognised and prepared.

The request of HCFI of formulation of law relating to National Essential Devices and Disposables in India is duly accepted by Hon’ble Ministers and accordingly, vide letter dated 07.08.2018, the Drug Controller General, Central Drugs Standard Control Organization, DGHS informed HCFI that Ministry of Health and Family Welfare has constituted as committee for preparing detailed guidelines and procedures for revision of National List of Essential Medicines and inclusion of Medical devices, Medical Disposables and Medical Consumables and other products used for Health and Hygiene of general public in NLEM.  The relevant portion of the letter dated 07.08.2018 is reproduced hereunder:

“This office has received a representation vide PMO ID No. PMOPG/D/2018/021845 enclosing your letter dated 08.06.2018 for taking appropriate action on the subject mentioned above.

In this regard, it is pertinent to mention here that Ministry of Health and Family Welfare vide F. No. 11053/923/2017-DRS dated 03.07.2018 has constituted a Standing National Committee on Medicines (SNCM) under the Chairmanship of Secretary, DHR and DG, ICMR.

           

As per the Term of reference of the SNCM, the committee will prepare detailed guidelines and procedures for revision of National List of Essential Medicines and suggest additions and deletion in the NLEM, Revision of NLEM 2-15, Inclusion of Medical Devices, Medical Disposables, Medical Consumables and other product used for Health and Hygiene of general public in NLEM.

It is important to mention herein that across the world, the National Essential Devices and Disposables is being recognised by law and which are as important as a National List of Essential Medicines. Now, after the constitution of the said Standing National Committee on Medicines, in India also there will be National List of Essential Medical Devices, Medical Disposables Medical Consumables and other product used for Health and Hygiene of general public in NLEM.

The National List of Medical Devices, Medical Disposables, Medical Consumables and other products used for Health and Hygiene will be beneficial for the general public for the following reasons:

·         Guide safe and effective treatment of priority disease conditions of a population

·         Promote the rational use of Medical Devices, Medical Disposables, Medical Consumables and other products used for health and hygiene.

·         Optimize the available health resources of a country

·         State governments can use this national list as a guide to prepare their list of essential Medical Devices, Medical Disposables, Medical Consumables and other products used for health and hygiene

·         There will be uniformity in prices of Medical Devices, Medical Disposables, Medical Consumables and other products used for health and hygiene included in the national essential list.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA

FSSAI agrees to reduce the content of trans fats from 5% to 2% in all edible vegetable oils and fats on the representation of HCFI

The US Food and Drug Administration (FDA) has banned artificial trans fats from American restaurants and grocery store food items. The FDA had deemed trans fats as unsafe in the year 2015 and gave time to all the companies in America until June 18, 2018 to eliminate the ingredient i.e. trans fat from their use.

The trans fats have been a staple in the tastiest junk foods for more than 100 years. The FDA ban applies to artificial trans fats, which are made chemically by adding hydrogen to vegetable oil (partially hydrogenated oil is also trans-fat). Trans fats increase the shelf life of packaged foods, and restaurants like to use it as oil for deep frying because it does not need to be changed as often as other oils.

The FDA’s move to provide an ultimatum for the ban of trans fats in American restaurants is a highly welcome one and should be replicated with immediate effect in India as well. The health effects of these are not unknown but consumption in various forms continues, particularly when it comes to eating outside food. Trans fats are a byproduct of the chemical reaction that turns liquid vegetable oil into solid margarine or shortening and that prevents liquid vegetable oils from turning rancid. Trans fats boost LDL as much as saturated fats do. They also lower protective HDL, enhance inflammation and increase the tendency for blood clots to form inside blood vessels.

Trans fats are created by pumping hydrogen molecules into vegetable oils. This changes the chemical structure of the oil, turning it from a liquid into a solid. The process involves high pressure, hydrogen gas, and a metal catalyst – and the end-product is highly unsuitable for human consumption.

Foods rich in trans fats tend to be high in added sugar and calories. Over time, these can pave way for weight gain and even type 2 diabetes, not to mention heart problems. It is time to take a strong stand against their use in eateries outside considering the fact that many people eat in restaurants regularly in today’s day and age.

In view of the above, Heart Care Foundation of India (HCFI) humbly requested the Hon’ble Prime Minister, Hon’ble Minister of Ministry of Health and Family Welfare and Hon’ble Minister of Ministry of Law & Justice vide representation dated 21.06.2018 to take immediate steps and to pass necessary directions thereby banning the use of trans fat in all restaurants, cafes, hotels, grocery items in India also, in the same manner as it has been banned in America.

HCFI also requested them to pass necessary discretions and to take necessary action for creating awareness among the public at large and for encouraging the public at large to:

      i.        Choose foods lower in saturated fats, trans fats and cholesterol.

     ii.        Replace saturated and trans fats in their diet with mono- and polyunsaturated fats. These fats do not raise LDL (or “bad”) cholesterol levels and have health benefits when eaten in moderation. Sources of monounsaturated fats include olive and canola oils. Sources of polyunsaturated fats include soybean, corn, sunflower oils, and foods like nuts.

    iii.        Choose vegetable oils (except coconut and palm kernel oils) and soft margarines (liquid, tub, or spray) more often because the combined amount of saturated and trans fats is lower than the amount in solid shortenings, hard margarines, and animal fats, including butter.

   iv.        Most fish are lower in saturated fat than meat. Some fish, such as mackerel, sardines and salmon, contain omega–3 fatty acids that are being studied to determine if they offer protection against heart disease.

    v.        Limit foods high in cholesterol such as liver and other organ meats, egg yolks and full–fat dairy products, like whole milk.

   vi.        Choose foods low in saturated fat such as fat free or 1% dairy products, lean meats, fish, skinless poultry, whole grain foods and fruit and vegetables.

The said representation of HCFI has been duly accepted by the Central Government and vide letter dated 01.08.2018, the Food Safety and Standards Authority of India (FSSAI) has stated that the FSSAI is in the process of notifying the limits of trans-fat in all edible vegetable oil and fats to be not more than 2% by weight in a phased manner by 2022. The relevant portion of the letter dated 01.08.2018 is reproduced hereunder:

“Please refer to grievance dated 26.06.2018 with registration no. PMOPG/D/2018/0229751 regarding banning use of trans-fat in all restaurants, cafes, hotels, grocery items in India. In this regard, it is informed that the Food Safety and Standards (Food products Standard and Product Additives) Regulations, 2011, prescribe that the trans-fat shall not be more than 5% by weight in some types of vegetable fats. Further, the FSSAI is in the process of notifying the limits of trans-fat in all edible vegetable oils and fats to be not more than 2% by weight in a phased manner by 2022. The other concerns regarding creating awareness among the public have been noted.”

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA