Research Article Unhealthy Fat in Street and Snack Foods in Low-Socioeconomic Settings in India: A Case Study of the Food Environments of Rural Villages and an Urban Slum Vidhu Gupta, MSc1; Shauna M. Downs, PhD2; Suparna Ghosh-Jerath, PhD, APD1; Karen Lock, PhD3; Archna Singh, PhD, MPH4

ABSTRACT Objective: To describe the food environment in rural villages and an urban slum setting in India with reference to commercially available unbranded packaged snacks and street foods sold by vendors, and to analyze the type and quantity of fat in these foods. Design: Cross-sectional. Setting: Two low-income villages in Haryana and an urban slum in Delhi. Participants: Street vendors (n ¼ 44) were surveyed and the nutritional content of snacks (n ¼ 49) sold by vendors was analyzed. Main Outcome Measures: Vendors’ awareness and perception of fats and oils, as well as the type of snacks sold, along with the content and quality of fat present in the snacks. Analysis: Descriptive statistics of vendor survey and gas chromatography to measure fatty acid content in snacks. Results: A variety of snacks were sold, including those in unlabeled transparent packages and open glass jars. Mean fat content in snacks was 28.8 g per 100-g serving in rural settings and 29.6 g per 100-g serving in urban settings. Sampled oils contained high levels of saturated fats (25% to 69% total fatty acids) and trans fats (0.1% to 30% of total fatty acids). Conclusions and Implications: Interventions need to target the manufacturers of oils and fats used in freshly prepared products to improve the quality of foods available in the food environment of low- socioeconomic groups in India. Key Words: trans fatty acids, fatty acids, food environment, snacks, low- or middle-income country (J Nutr Educ Behav. 2016;-:1-11.) Accepted November 28, 2015.

INTRODUCTION ronment.1 The food environment is nutrition labeling, offering healthier one of the major domains in which foods, setting standards in public insti- What people eat depends not only on policies can intervene to improve the tutions, using economic tools to individual and cultural factors but availability, affordability, and accept- address food affordability, restricting also on their surrounding food envi- ability of healthier food.2 By improving food advertising, improving the qual- ity of the food supply, and setting in- centives and rules to create a healthy 1Indian Institute for Public Health–Delhi, Public Health Foundation of India, Haryana, India retail environment, the food environ- 2Menzies Centre for Health Policy, University of Sydney, Sydney, Australia ment can better support consumers to 3London School of Hygiene and Tropical Medicine and Leverhulme Centre for Integrative make healthier food choices.2 Research on Agriculture and Health, London, United Kingdom Most research on food environ- 4Indian Institute for Public Health–Delhi, Public Health Foundation of India and All India ments has been conducted in the US Institute of Medical Sciences, Delhi, India and other high-income countries.1 In Conflict of Interest Disclosure: The authors’ conflict of interest disclosures can be found online the US, studies have shown that lower- with this article on www.jneb.org. socioeconomic communities tend to Address for correspondence: Shauna M. Downs, PhD, Menzies Centre for Health Policy, be characterized by the high availabil- Victor Coppleson Bldg (D02), University of Sydney, Sydney NSW 2006, Australia; Phone: ity of convenience and energy-dense þ(1 347) 431 5630; E-mail: [email protected] foods of little nutritional value and Ó2016 The Authors. Published by Elsevier, Inc. on behalf of the Society for Nutrition the low availability of fresh produce Education and Behavior. This is an open access article under the CC BY license (http:// and other nutritious foods.3,4 Barriers creativecommons.org/licenses/by/4.0/). to access can make it difficult for http://dx.doi.org/10.1016/j.jneb.2015.11.006 people to choose healthy food.5-7 How- Journal of Nutrition Education and Behavior Volume -, Number -, 2016 1 2 Gupta et al Journal of Nutrition Education and Behavior Volume -, Number -, 2016 ever, there is a paucity of research deficient in key nutrients20 while eat snacks and street foods sold by assessing the food environments of consuming high intakes of trans fatty vendors; and (2) analyze the type and low-socioeconomic status (SES) set- acids (TFAs) from hydrogenated oils.21 quantity of fat in these foods to under- tings in low-income (defined as those These dietary TFAs have adverse effects stand the exposure to the population. with a gross national income per cap- on blood lipoprotein profiles and coro- ita of # $1,045 in 2013) and middle- nary heart disease risk affecting indi- income countries (defined as those viduals and populations. The adverse METHODS with a gross national income per cap- effects on coronary heart disease are This study analyzed the retail food ita of > $1,045 but < $12,746) (LMICs). mediated by increases in plasma con- environment in terms of the snacks Therefore, it is important to examine centrations of low-density lipoprotein and street foods available and sampled the situation in LMICs, because little cholesterol and lipoprotein A, and re- from the vendors in the low-SES set- is known about the nature of their ductions in high-density lipoprotein tings in North India. The researchers food environments. cholesterol, promotion of inflamma- determined the snack sampling strat- Many LMICs worldwide are currently tion, and endothelial dysfunction.22 egy using data obtained from the undergoing a nutrition transition: a Many Indian snacks have been found consumer-level study. This included a shift from traditional dietary patterns to be high in TFA ($2% of total fatty survey of the dietary intake patterns toward a more Western diet consist- acids).23,24 The Government of India with an emphasis on snacking patterns ing of energy-dense foods high in recently took steps to limit the amo- conducted in low-SES HHs (260 HH in fat, , and salt.8-10 The transition, unt of TFA in foods by publishing a each community). The HH surveys which has been linked to a rise in regulation setting an upper limit of included a dietary intake questionnaire diet-related noncommunicable dis- 10% TFA in partially hydrogenated as well as 2 24-hour dietary recalls, eases, is rooted in globalization.11 As vegetables oils (PHVOs). This regu- which were conducted on 2 consecu- a result, many countries now face a lation was subsequently revised to a tive days. The dietary questionnaire, double burden of diet-related diseases 5% limit that will come into effect in in addition to the 24-hour recalls, pro- in which undernutrition and overnu- August, 2016, in addition to requiring vided information regarding consump- trition coexist, even within the same that TFA be labeled on packaged tion of commercially prepared snacks, household (HH).12-14 foods.25,26 However, it is unclear to which was then subsequently used to Although the dietary intakes of what extent this regulation will be en- determine the snack sampling strategy. lower-socioeconomic groups in LMICs forced and what substitutions vendors Only unbranded (unlabeled, open, or are often limited by the scarcity of will make to keep consumers satisfied freshly prepared) snacks from all ven- food, it may no longer be the main fac- and maintain product demand despite dors willing to participate were sampled tor affecting energy intakes in some the changes. (details are provided subsequently). settings; instead, the availability of There is currently limited informa- Therefore, snacks sampled from the cheap, energy-dense foods, including tion about the food retail environ- vendors were those consumed (if repo- those from street vendors, may result ments of low-socioeconomic groups rted in the 24-hour recall) by participants in increased energy intake.15 Street in LMICs, particularly those living in in the HH survey. The authors ob- and snack foods have become a signif- rural areas and urban slums. Creating tained ethics approval for the study icant source of food for many people healthy public policies and supportive from the Public Health Foundation of in LMICs as people migrate from food environments can facilitate access India's Institutional Ethics Committees. rural to urban areas.16 In particular, to safe, affordable, nutritious food.27 To low-income populations often depend identify which policies might be the almost exclusively on food prepared most effective in specific settings, it is Setting by street vendors.16 Unfortunately, important to gain a thorough under- many vendors sell food of suboptimal standing of the existing food environ- The researchers examined the food en- nutritional quality.15 A study conduct- ment. Thus, a project was designed vironments of 3 purposively selected ed in India found that migrant and ur- that aimed to examine awareness of settings, which included 2 rural vil- ban men consumed a higher proportion and use of TFAs and the feasibility of lages (Sundh and Hasanpur) in the Me- of energy from fat and saturated fat their removal from the Indian food wat district of Haryana and an urban than do rural men, which suggests a supply chain by integrating perspec- slum (Chanderpuri) in the northeast shift toward a lower-quality diet after tives from 3 levels: manufacturers, re- district of Delhi. These communities migration.17 In the absence of a diver- tailers, and consumers. The current were selected specifically to examine sified, nutrient-dense diet, there may study, which is part of the larger proj- snacking patterns (through the HH be a propensity for overconsumption ect, describes the retail food environ- survey) in low-SES settings in 2 adja- leading to overweight and obesity ment with a focus on unbranded cent states that typically consume but a simultaneous failure to meet mi- packaged products and street foods in vanaspati (PHVO high in TFA) and cronutrient requirements.18 rural and urban low-SES settings of 2 unbranded snacks made using PHVOs. In India, HHs in both urban and ru- states in North India. The objectives Before beginning the study, the au- ral areas are dealing concomitantly of this study were to (1) describe the thors obtained permission to conduct with undernutrition and diet-related food environment in selected low-SES the study from the local leader (a noncommunicable diseases, particu- rural and urban settings in North India community representative such as larly heart disease and diabetes.19 Ur- with reference to commercially avail- the Councilor, Pradhan,orSarpanch) ban slum dwellers in India are often able, unbranded, packaged, ready-to- of the study areas. The populations of Journal of Nutrition Education and Behavior Volume -, Number -, 2016 Gupta et al 3

Figure 1. (A) Map of village (Sundh) showing the location of vendors (selling unbranded, open, and freshly prepared commercially available snack foods) and public buildings (eg, school, medical building) in the study community. (B) Map of village (Hasanpur) showing the location of vendors (selling unbranded, open, and freshly prepared commercially available snack foods) and public buildings (eg, school, medical building) in the study community. the villages were 5,000 and 6,000 peo- hawkers, especially in streets and available in unlabeled transparent pack- ple, which corresponded to 525 and other similar public places, and snack ages. Information about weight, brand, 800 HHs, respectively. The population foods were defined as foods eaten be- and manufacturing date was sometimes of the urban slum was approximately tween meals.20 Street and snack foods available but no nutritional composi- 10,812, which represented 1,802 HHs. included both branded and unbranded tion was mentioned on the package. Data collection took place between snacks; however, the focus of this Open snacks included those that were October and November, 2012 in the study was on unbranded snacks that not packaged and were available in villages and February to March, 2013 were unlabeled, as well as open or jars or tins (eg, soan papdi, mathri). in the urban slum. freshly prepared street foods. Branded Freshly prepared snacks (eg, , packaged snacks were defined as those kachodi [deep-fried, salted, puffed bread manufactured by multinational com- made of wheat flour]) were those Study Design panies, containing a label and brand cookedatthetimeofpurchase. name available in commercially avail- Before inviting vendors to partici- The researchers conducted a cross- able standard packages. Labels of pate in the study, the authors mapped sectional exploratory study that incl- these products included information the food environments (with a focus uded surveying local food vendors about the net weight, nutritional on snack foods) in the villages and and performing laboratory analyses composition, ingredients, brand name, the urban slum by documenting the of the fat content of snack and street standard packages, manufacturing, number and location of all HHs, ven- foods sampled from the study com- and expiration date. Unbranded pack- dors, and public buildings (including munities. Street foods were defined aged snacks were defined as those that schools, temples, etc) in each commu- as ready-to-eat foods and beverages were produced by local and district- nity to facilitate the survey (Figures 1 prepared and/or sold by vendors and level manufacturers but that were and 2). These maps were then used 4 Gupta et al Journal of Nutrition Education and Behavior Volume -, Number -, 2016

Figure 1. Continued to describe the food environment in structured survey administered in per- they used the oil and how they dis- terms of the location of vendors with son by the trained research staff; sur- carded it, and questions related to respect to the HHs, who sold un- veys were completed at the shops of preferences about the oil. Moreover, branded, open, and freshly prepared participating vendors. The majority of vendors were asked about their aware- commercially available snack foods the questions were open-ended (16 ness of TFAs and their views about in these survey communities. of 17), which allowed vendors to pro- the overall healthiness of oils. To All food vendors working in each vide specific answers to each question. assess awareness about TFAs, the re- of the communities were invited to The survey questionnaire was review- searchers asked vendors if they had participate in the study. All partici- ed by experts in the field (nutrition, heard of TFAs. If they responded yes, pating vendors provided informed public health, and biochemistry) the researchers asked them what the consent and all surveys were conduct- before data collection; however, it health implications were (both posi- ed in Hindi. Responses were subse- was not validated. Vendor practices tive and negative) of TFA consump- quently translated into English. were explored by collecting informa- tion. The average survey duration tion on the types of snack foods they was 20–30 minutes. sold, how they prepared them, and Vendor Surveys their use of cooking oils. Vendors were also asked about the oils they Sampling Strategy of Snacks and The research staff contacted the ven- use (if they prepared snacks them- Oils dors at their shops subsequent to map- selves), why they used them, where ping the survey areas. The vendor they purchased the oils, the quantity In addition to administering vendor survey instrument was a 17-question and cost of the oil, the length of time surveys, the researchers obtained Journal of Nutrition Education and Behavior Volume -, Number -, 2016 Gupta et al 5

samples of a variety of snacks from the vendors to assess the content and fatty acid composition of the snacks. Selec- tion criteria for the sampling of snacks included unbranded snacks that were unlabeled, open, or freshly prepared and public build- and reportedly consumed in the 24- hour dietary recall (that was conducted as part of the HH survey). In addition, the authors sampled snacks that were reported to be commonly consumed ($3 times/wk) in the dietary question- naire but did not happen to be consumed on the day when dietary re- calls were conducted. There is a large unorganized sector of regionally popu- lar snacks and convenience foods oper- ating in low-SES settings. This is an established source of snacks for the local population. Therefore, snacks be- ing sold in standard packaging (from multinational companies) and with food labels were excluded from the sampling. The types of oils and fats that were reportedly consumed in the HH survey and commonly purchased by consumers in the vendor survey were sampled from both communities. These included refined oil, mustard oil, vanaspati,anddesi (clarified but- ter). The fatty acid profile of sampled oils and fats was also analyzed.

Fat Composition of Snacks and Oils

The snacks and oils sampled from the 2 settings were examined using gas chro- matography to assess their fatty acid composition. All samples from vendors were collected at a single time point. Snack foods included unlabeled pack- aged products (such as biscuits and chips), open and freshly prepared ready-to-eat foods such as samosas, namkeens, and other similar items. Fat extraction and estimation was done based on Association of Official Analyt- ical Chemists protocol 996.06 on a gas chromatograph equipped with a flame ionization detector (Nucon Series II, 5700/5765, Nucon Engineers, Delhi, In- dia, 2005). The limit of detections was calculated based on the multiple dilu- tion of standard fatty acid methyl ester mix. The fatty acid profiles were analyzed using a fatty acid methyl ester mix (GLC-607) and individual Map of urban slum (Chanderpuri) showing the location of vendors (selling unbranded, open, and freshly prepared commercially available snack foods) fatty acid esters from NuChek Prep, Inc (Waterville, Maine), to characterize and identify individual fatty acids. All ings (eg, school, medical building, temple) in the study community. Figure 2. analyses were done in duplicate. 6 Gupta et al Journal of Nutrition Education and Behavior Volume -, Number -, 2016

Analysis open and freshly prepared street (n ¼ 5) indicated that they either did foods. The total number of snacks not know which oils could be consid- Responses to the open-ended vendor available was 33 and 52 in the rural ered better or worse for health or that survey questions were summarized by area and the urban slum, respec- mustard oil was healthy (n ¼ 8). The key themes such as type of snacks sold, tively. Thirty-six percent of snacks majority (n ¼ 10) of urban vendors vendor practices, and health aware- were branded packaged snacks in indicated that refined oils (including ness among vendors. All descriptive the rural setting compared with 33% soybean, mustard, and safflower) were statistics for the vendor survey were in the urban setting. The remaining healthy. conducted using Microsoft Excel snacks (64% rural and 67% urban) (version 12.1, Washington, DC, were unbranded. In addition to un- 2008). AIMIL software (New Delhi, In- branded snacks, confectionery and Fat Content of Street and Snack dia) was used to edit the chromato- freshly prepared snacks (8 in the rural Foods gram (the graph of detector response area and 13 in the urban slum) were against the retention time of the indi- available. The researchers sampled and an- vidual fatty acids). The chromatogram alyzed 17 snack samples from the vil- provides the range of peaks represent- lages and 32 from the slums. Tables 1 ing the specific fatty acids present in Vendor Practices and 2 provide the fat and fatty acid the sample. Editing is analogous to profiles of the unbranded, open, and A variety of oils including soybean and data cleaning and involves integrating freshly prepared snacks from both other unspecified refined oils, vanas- the peaks eluted. Once this is the rural and urban settings. The fat pati, and local oil brands were used by completed, the individual peak areas content of snacks in their usual serv- the rural and urban vendors. Vendors represent the percentage contributed ings ranged from 0.1 to 32 g in vil- in both settings reported preparing to the sample by individual fatty acids. lages and 0.6 to 26 g in the urban snacks using refined oil to fry snacks Thus, the saturated, monounsatu- slum. The mean fat content in snacks such as , kachodi, bhatura, bread rated, polyunsaturated, and TFA con- in villages was 28.8 g per 100-g pakoda,andgolgappe. Vanaspati was tent of the fats extracted from the serving (SD, 17.8 g) and in the urban used as shortening in these snacks by sampled snacks was calculated. The slum it was 29.6 g per 100-g serving 2 (out of 7) and 3 (out of 6) of vendors content of each fatty acid in the sam- (SD, 12.6 g). The fat content (per in rural and urban settings, respec- ple was expressed as a percentage of 100 g) was highest in the open snack tively. Most of the urban vendors (4 the total fatty acids in that sample. mixture (salted tidbits of wheat and of 6) bought the oils from a local lentils: 64.8 g per 100 g) and freshly RESULTS market whereas the rural vendors (5 prepared kachodi (46.6 g per 100-g in 7) bought them from the nearby Characteristics of Vendors serving) in rural and urban settings, town. Vendors indicated that they respectively. The overall average ser- chose these oils based on the quality, Of the 40 vendors in the villages and ving size of all snacks combined was including organoleptic properties (4 the 29 vendors in the slum, 27 (68% larger in the urban slum compared of 7 in rural areas; 2 of 6 in the urban participation rate) and 17 (59% partic- with the rural setting (41 vs 25 g, area), taste (1 of 7 in the rural settings; ipation rate) agreed to participate, respectively); however, there was a 5 of 6 in the urban setting), traditional respectively. The 2 rural adjacent vil- greater variety of snacks in the urban use (1 of 7 in the rural areas), cost (1 of lages that were examined had a bus slum. Fat (per 100 g) and TFA levels 6 in the urban slum), and customer stop between them where the vendors were higher in the open and freshly preferences (1 of 7 in the rural set- of both villages procured the snacks prepared snacks than in the un- tings). Most urban vendors (n ¼ 5of for their shops; however, 7 village brandedpackagedsnacks. 6) indicated that they would be willing vendors (26%) prepared at least some Three and 7 oils and fats were to change the type of oil used provided of the items themselves. Six of the sampled from rural and urban set- the taste (n ¼ 1), cost (n ¼ 3), and vendors (35%) in the urban slum pre- tings, respectively. Table 3 provides customer acceptability (n ¼ 1) were fi pared some of their own snacks; the the fatty acid pro le of the different adequate; rural vendors (n ¼ 3of7) remaining snacks were procured from oils sampled from both vendors and were more resistant to change. Howev- third-party wholesalers who came to HHs. The fat content of sampled oils, er, some vendors (n ¼ 2 of 7) stated the slum to sell directly to the ven- expressed as a percentage of total fatty that they would change if the quality dors, and from wholesale distribu- acids, contained high levels of satu- were maintained. tors and grocery shops. However, rated fat (ranging from 24.7% to snacks sampled from vendors for testing 69.3%) and TFA (ranging from 0.1% included those purchased from third- Health Awareness Among to 29.9%). The TFA levels exceeded party vendors or prepared fresh as Vendors 20% of total fatty acids in both the long as they were also unbranded. vanaspati samples and the sample of Awareness regarding TFAs was low desi ghee from the village market. Types of Snacks Sold by among vendors. Only 1 of the village Vendors vendors and 2 of the urban slum ven- DISCUSSION dors stated that they were aware of Vendors sold both branded and un- TFAs and described them as being bad Understanding the broad food envi- branded packaged snacks as well as for health. Overall, village vendors ronment is crucial in terms of informing Journal of Nutrition Education and Behavior Volume -, Number -, 2016 Gupta et al 7

Table 1. Total and Trans Fat Content of Snacks Sampled From Village Settings

Fat per Saturated Trans Weight of Total 100-g Fatty Monounsaturated Polyunsaturated Fatty Snack Name and Description Snack, ga Fat, g Serving, g Acidsb Fatty Acidsb Fatty Acidsb Acidsb Packaged unlabeled snacks Bhindi (wheat puffs) 4.00 0.32 8.00 61.27 19.11 18.45 0.53 Sweet biscuits (1 biscuit) 5.40 0.76 14.07 53.72 33.28 11.43 0.00 Salted biscuits (1 biscuit)c 4.50 1.56 34.67 Rusk (dry biscuit, 8.00 1.68 21.00 44.42 13.70 40.77 0.29 twice-baked bread) Pao (bread buns) 2.00 0.08 4.00 34.13 18.96 41.53 1.15 Fan (wafer-shaped, flaky, 28.78 6.91 24.01 87.00 2.17 0.51 10.25 salted pastry puffs) Open snacks Mixture (salted tidbits 10.00 6.48 64.80 42.79 36.71 12.22 0.39 in a pack-mix of wheat and lentils) Mathri (fried, salted thick 11.00 6.29 57.18 18.19 22.79 57.76 1.26 wheat crackers) Moong (savory lentils) 21.00 3.74 17.81 59.39 19.41 18.15 0.60 Soan papdi (a flaky sweet 20.00 7.80 39.00 62.94 12.05 15.03 9.86 made of graham flour) Freshly prepared snacks Samosaa (potato-stuffed, 79.25 23.46 29.62 60.21 14.25 13.27 10.35 deep-fried, salted, refined-wheat flour pockets) (deep-fried, salted, 55.70 17.82 31.99 45.73 1.84 31.49 11.67 puffed bread made of wheat flour) Bread (deep-fried graham 67.50 32.13 47.60 25.95 23.24 41.36 0.37 flour–coated bread triangles) Bhatura (deep-fried, leavened, 33.00 3.30 10.00 47.01 37.40 9.09 0.00 puffed bread made of refined wheat flour) aThe weight reflects the serving size in which the snack was sold in the village markets, with the exception of biscuits, which refers to the weight of 1 biscuit; bExpressed as a percentage of total fatty acids; cFatty acid profile not available. the development of policy interven- and/or high levels of saturated fat, currently does not reach the large tions aimed at improving the quality mainly palmitic acid (from palm informal food processing and retail of the food supply. As the food envi- oil).24 In the current study, high levels sectors in the country and new ap- ronments of LMICs such as India of TFA were found in open snacks that proaches are needed to target these evolve, policy interventions will need do not contain labels. These high foods, which reinforces the need to to be context-specific to improve diet levels of unhealthy fat are consistent target more upstream steps in the quality and reduce the risk of diet- with the levels found in a recent study food supply chain. Moreover, the use related disease most effectively. The conducted in , India.28 of nutrition labels is limited in India authors found that both rural villages Although India recently published a and knowledge about how to use and an urban slum setting in India regulation requiring TFA labeling in them is low.29 In addition to inter- had a large number of vendors selling packaged foods, it is likely that the vening at the manufacturing level, energy-dense snacks high in fat (incl- regulation will not apply to snack alternative approaches to increase con- uding saturated fat and TFA). foods that are sold open or freshly pre- sumer demand for improved transpar- pared, which contain the highest ency and healthier snack food options Nutrition Labels levels of TFA in the Indian food envi- are needed, which would in turn facil- ronment.25,26 Moreover, packaged unbr- itate greater emphasis on these as- The lack of nutrition labels on snack anded snacks produced by the informal pects by vendors and manufacturers. foods in this study is problematic sector will likely evade regulation as and was previously noted in a study well. Because many foods do not con- Food Sold by Vendors conducted in the Indian state of Ker- tain labels, consumers will be unable ala.24 The majority of confectionery to identify the contents of foods they Although a small number of vendors in products in that study contained TFA are consuming. Labeling regulation this study prepared their own snacks ut ta ora fNtiinEuainadBehavior and Education Nutrition of Journal al et Gupta 8 Table 2. Total and Trans Fat Content of Snacks Sampled From Urban Slum

Fat per Saturated Trans Weight of Total 100-g Fatty Monounsaturated Polyunsaturated Fatty Snack Name and Description Snack, ga Fat, g Serving, g Acidsb Fatty Acidsb Fatty Acidsb Acidsb Packaged unlabeled snacks Chakri (deep-fried spiral wheat crackers) 21.42 7.88 36.79 63.94 16.79 18.73 0.97 Kachri (rice puffs) 9.06 3.22 35.54 48.48 38.90 10.61 0.33 Fun Pop (rice puffs, chips) 3.89 0.61 15.68 54.02 27.01 18.46 0.42 Jo’s Onion Rings (chips) 14.65 6.62 45.19 57.22 26.82 14.91 0.45 Bun (2 pieces) 78.20 3.28 4.19 39.22 5.35 49.94 4.56 Rusk (dry biscuit, twice-baked bread) 23.94 3.16 13.20 44.32 22.76 40.76 0.53 Open snacks Mathri (fried, salted thick wheat crackers) 21.35 8.22 38.50 87.34 5.05 2.62 4.43 Biscuits, unpackaged (4 biscuits) 20.26 8.27 40.82 88.45 9.00 0.08 0.35 Bhujia (fried, salted snack made of graham flour and shredded) 31.96 12.66 39.61 59.62 22.71 16.43 0.46 Moong dal (savory lentils) 18.29 5.01 27.39 33.28 8.94 55.27 1.26 Besan ladoo (a ball-shaped sweet made of fried graham flour) 33.33 7.93 23.79 62.45 29.17 7.42 0.37 Besan barfi (sweet graham flour squares) 49.10 10.51 21.41 68.37 5.40 0.50 22.96 Maida barfi (sweet flour and condensed milk triangles) 44.52 2.58 5.80 50.77 26.38 20.19 0.00 Soan papdi (a flaky sweet made of graham flour) 49.01 9.90 20.20 49.81 38.54 11.14 0.29 Besan papdic (a flaky sweet made with graham flour) (1 piece) 32.80 16.53 50.40 Besan papdic (a flaky sweet made of graham flour with ground nuts) 30.13 17.47 57.98 (1 piece) Confectionery snacks Cream roll 58.00 18.44 31.79 86.79 2.10 0.60 2.88 Pastry 32.53 6.90 21.21 67.50 16.89 14.76 0.26 Patty 89.34 26.09 29.20 69.62 6.86 11.21 10.25 Fan (wafer-shaped, flaky, salted pastry puffs) 23.67 7.77 32.83 90.74 2.66 0.54 4.98 Muffin 21.87 8.40 38.41 61.70 27.83 9.13 0.37 Freshly prepared snacks

Bhatura (deep-fried, leavened, puffed bread made of refined wheat 52.04 10.20 19.60 58.81 28.55 11.42 0.44

flour) Volume Kachodi (deep-fried, salted, puffed bread made of wheat flour) 53.83 25.09 46.61 85.40 1.81 0.31 11.77 Bread pakora (deep-fried graham flour–coated bread triangles) 90.10 23.79 26.40 64.07 19.93 14.59 1.06

Namakpara (fried, salted wheat flour cubes) 64.12 22.44 35.00 84.49 1.71 0.42 12.81 -

Samosa (potato-stuffed, deep-fried, salted, refined-wheat flour 46.66 13.62 29.19 49.16 41.56 8.99 0.29 Number , pockets) (deep-fried, graham flour–coated bread triangles) 54.16 16.57 30.59 46.95 40.07 11.61 0.34 (deep- or shallow-fried patty made of potato) 45.24 12.40 27.41 60.39 33.77 4.98 0.38

Boondi ladoo (a ball-shaped sweet made of fried graham flour 87.84 12.82 14.59 55.68 22.61 20.81 0.44 -

granules dipped in sugar syrup) 2016 , aThe weight reflects the serving size in which the snack was sold in the urban slum markets; bExpressed as a percentage of total fatty acids; cFatty acid profile not available. Journal of Nutrition Education and Behavior Volume -, Number -, 2016 Gupta et al 9

by vendors do not contain TFA, which Table 3. Fatty Acid Profile of Oils Sampled in Village and Urban Slum Settings would reduce the risk of cardiovascu- lar disease for HHs that frequently Fatty Acids (% Total Fat) consume these foods.31 The majority of vendors were not Saturated Trans aware of TFA or the health risks associ- Fatty Monounsaturated Polyunsaturated Fatty ated with its consumption. It is likely Type of Oil Acids Fatty Acids Fatty Acids Acids that increased awareness and capacity Villages for reformulation of recipes among ven- Vanaspati 68.8 6.9 2.2 21.9 dors will be needed to ensure a shift Desi ghee 69.3 24.6 1.0 2.5 from the use of vanaspati to healthier (homemade) oils in some traditional snacks. Pro- Desi ghee (market) 57.8 6.5 5.5 29.9 grams aimed at improving street vendor Urban slum practices tend to focus on food safety Mustard oil and hygiene issues; however, other A 44.1 32.2 15.6 5.2 practices such as the use of oil could B 24.7 40.3 32.6 0.8 be targeted in these programs. In Ghana, C 35.1 18.1 36.6 2.9 food vendor knowledge increased and Refined oil practices improved after the vendors A 47.9 41.4 11.1 0.1 underwent training on food safety B 29.1 18.8 51.7 0.3 and hygiene practices.32 The Food Vanaspati 62.8 9.5 2.4 25.3 Safety and Standards Authority of Desi ghee 69.3 24.6 1.0 2.5 India has already committed to im- (homemade) proving street vendor practices. By Desi ghee (market) 58.8 2.7 34.5 3.9 moving beyond the narrow definition of food safety, the Authority could Note: Three varieties of mustard oil and 2 varieties of refined oil were sampled from facilitate broader improvements in the urban slum community. A, B, and C label the different varieties. street vendor practices with the poten- tial to improve the quality of foods for sale, the majority purchased snacks fat levels are < 38 g per 100 g of oil.30 that are available in low-income set- from a third-party wholesaler. This has This initiative increases vendor access tings. important implications in terms of pol- to healthier oils and could also help icy interventions. Interventions aimed create consumer demand for healthier at improving the quality of snacks sold oils in ready-to-eat foods. Nutrition Education by vendors will need to be directed at both the manufacturers of these foods Nutrition education has an important and the vendors themselves in the Oil Use by Vendors role in the selection of oils and fats for case of those preparing fresh snacks. preparing snacks. This is not restricted Vendors in this study were aware only Although many vendors (of those pre- to vendors preparing the snacks or of the type of cooking fat used in the paring their own snacks) used refined manufacturers producing the cooking products that they prepared them- oils to fry freshly prepared snacks, oil; it extends to the consumers who selves. Of those who prepared their and identified refined oils as being actually consume these fats and oils own snacks, they seemed to be amen- healthy, many still used vanaspati in the form of cooking oil or as snacks able to changes in the type of cooking containing high amounts of TFA as purchased in the market. Nutrition fat used. The Singapore Health Pro- the shortening in preparing items education is needed at every level of motion Board recently began an such as samosa, kachodi, and other the food supply chain, from manufac- initiative called the Healthier Hawker similar snack items. In addition to turers to consumers, to be an effective Program, which aims to reduce the the high levels of TFA in some snack approach to decreasing the availabil- saturated fat content of cooking oils foods, there were signs of possible ity of TFA in the food supply and its used by street vendors.30 To ensure adulteration of the oils used by ven- consumption at the consumer level. that there was an affordable supply dors. For example, levels of saturated Manufacturers and vendors need to of healthier oils, the Health Promo- fat were higher than would be antici- be informed of the benefits of using tion Board worked with local man- pated in pure mustard oil, as were blended oils to decrease saturated fat ufacturing companies to increase the TFA levels in the desi ghee available and TFA content. In Singapore, blen- supply of blended oils containing in rural markets. This reinforces the ding of oils by manufacturers led to a 25% less saturated fat.30 Moreover, need to go beyond nutrition labeling reduction in saturated fat levels in the healthier ingredients symbol pro- policies to address fat quality in the these oils without jeopardizing taste.30 gram, which is part of the Healthier foods sold and prepared by street ven- Through negotiations with suppliers, Hawker Program, allows vendors to dors. Reducing the upper limit of the cost of these healthier oils re- put up a sign indicating the use of allowable TFA in PHVOs and ensuring mained low, which made it a feasible healthier ingredients if TFA levels are that it is adequately enforced would oil option for vendors.30 Consumers < 0.5 g per 100 g of oil and saturated ensure that foods sold and prepared need to be encouraged to select and 10 Gupta et al Journal of Nutrition Education and Behavior Volume -, Number -, 2016 use healthier oil for cooking and deep- production of healthier alternatives to REFERENCES frying purposes. At the same time, oils high in unhealthy fats. Both gov- alternate ways of cooking traditional ernment and nongovernmental orga- 1. Glanz K, Sallis JF, Saelens BE, snacks, such as baking rather than nizations in India should consider Frank LD. Healthy nutrition environ- frying, should be encouraged. adopting programs such as the Health- ments: concepts and measures. 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CONFLICT OF INTEREST

The authors have not stated any con- flicts of interest.