The term “health and wellness” has become a core element of the food and beverage strategy. In fact, marketing the natural health benefits of foods has become the most commonly adopted strategy in the business of food and health worldwide, according to New Nutrition Business.1 Milk and milk products, with their unique profile of intrinsic nutrients, fits easily into this key consumer trend. Milk product consumption is associated with overall diet quality and adequacy of intake of many nutrients, according to the 2005 Dietary Guidelines for Americans.2 Together, milk, yogurt and cheese provide nine essential nutrients for optimal health, including calcium; potassium; phosphorus; protein; vitamins A, D and B 12; riboflavin; and niacin (niacin equivalents).
Potassium, calcium and vitamin DAs part of the overall conversation with consumers about the nutrients in dairy foods, there are currently opportunities to emphasize both potassium and vitamin D. Each of these nutrients has either a new or underused health claim approved by the Food and Drug Administration (FDA) for use on product packaging.
Potassium has important health benefits well recognized by the scientific community. Many consumers, however, may not be aware that many milk and milk products are a good source of potassium, or that potassium-containing foods can help reduce the risk of high blood pressure and stroke. There may be low awareness in the dairy industry that a health claim exists for diets with foods containing at least 10 percent of the Daily Value (DV) of potassium.3
Since the early 1930s, virtually all milk has been fortified with vitamin D in an effort to reduce rickets, a vitamin D deficiency disease. This nutrient has recently gotten more attention. At the end of September 2008, a new health claim for calcium and vitamin D as it relates to osteoporosis was approved by the Food and Drug Administration, expanding an existing claim for calcium to also include vitamin D and simplifying claim language. 4In addition, the American Academy of Pediatrics issued a clinical report in October 2008, doubling the amount of vitamin D it recommends for infants, children and adolescents to 400 IUs per day - the amount in 4 cups of vitamin D-fortified milk. 5
The risk of osteoporosis and high blood pressure both increase with age. As the U.S. population ages, consumer demand will likely shift toward products containing nutrients that can help address these conditions.
Many consumers shop for healthAccording to a survey commissioned by Dairy Management Inc.™ (DMI) in September 2007, 85 percent of respondents say that health and nutrition is “very/somewhat important” when choosing food and beverages. About two-thirds of the respondents say they are “very likely/somewhat likely” to buy products that communicate health benefits on the package, and most people “strongly/somewhat agree” that milk provides many nutrients beyond calcium. Similarly, 44 percent of respondents to the 2008 Nutrition and You Trends Survey, recently released by the American Dietetic Association (ADA), say, “I actively seek information about nutrition and healthy eating.”7This represents a 25 percent increase since 2000 when only 19 percent of respondents sought information.
The Nutrition Facts Panel and label claims on the food package can be used to identify the amount of key nutrients a serving provides to help ensure consumption of essential nutrients for good health.8Consumers can use the food label to learn which foods provide important nutrients that should beincreasedin the diet (such as potassium, calcium, vitamin D), rather than using the food label only to determine those nutrients that should potentially bedecreasedin the diet (such as fat and sodium). Since nutrients mentioned in nutrition-related claims must be listed on the Nutrition Facts panel, these claims give consumers the opportunity to learn about the positive health benefits of various nutrients not always included on the Nutrition Facts Panel, such as potassium.8The 2008 Shopping for Health Survey published byPreventionmagazine reports that 71 percent of all shoppers generally read food labels.9Among the 10 percent of respondents who consistently display healthy eating attitudes and behavior, dubbed “successful eaters,” 91 percent read food labels.
Functions and benefits of potassiumPotassium is a mineral that works as an electrolyte, which along with sodium and chloride, helps maintain fluid balance. As such, potassium and other electrolytes in milk can help regulate hydration. In addition, potassium helps transmit nerve impulses and helps muscles contract; it also helps the body make new proteins by transporting amino acids across membranes. But most importantly for health-conscious Americans, it helps maintain normal blood pressure and reduce the risk of stroke and cardiovascular disease.310These benefits of potassium have also been recognized in other countries. Recent research from Japan found that the increased consumption of potassium is linked to a lower risk of cardiovascular disease.11
Blood pressure managementIn its report to the USDA, the 2005 Dietary Guidelines Advisory Committee, a group of scientists charged with reviewing the science on diet and health for the Dietary Guidelines for Americans, concluded that 4.7 gm/day of potassium would help lower blood pressure and blunt the effects of salt on blood pressure.12African-Americans are especially likely to benefit from reductions in sodium intake and increases in potassium intake. The reason being dietary potassium intake modifies the effects of sodium on blood pressure13and African-Americans are more likely to be salt-sensitive (their blood pressure responds to sodium intake). In addition, the effects of potassium on blood pressure are greater when salt intake is high versus when salt intake is low.14 This is important news for Americans who currently consume an average of 1½ times the daily recommended amount of sodium.15
Dairy foods help deliver the potassium Americans needIn 2004, after an extensive review of the scientific literature, the Institute of Medicine (IOM) set the Adequate Intake (AI) of potassium for adults at 4.7 grams per day (see Dietary Reference Intake table).16This was the first official recommendation for potassium intake.
Potassium was identified in the 2005 Dietary Guidelines as one of the nutrients of concern, typically low in the diets of both adults and children.2 Average potassium intakes did not meet the potassium recommendation (Adequate Intake) for any age group analyzed, according to a recent analysis of data from the National Health and Nutrition Examination Survey (1999-2002).10However, the authors say, “Increased consumption of dairy products had a significant positive impact on potassium intake for all age groups.” The average potassium intakes were significantly greater in those who met their dairy intake recommendations than in those who did not. That is most likely because milk is the No. 1 single food source of potassium in all age groups in the U.S.17
The 2010 Dietary Guidelines Advisory Committee has recently been appointed and will soon begin reviewing the latest science on diet and health. It is charged with developing food group suggestions that help Americans meet all current nutrient recommendations. The contribution of foods to potassium intake will continue to be an important consideration.
Consumers looking to increase their potassium intake will not often find it listed on the Nutrition Facts panel, because labeling potassium is not mandatory. Within the last couple of years, some dairy manufacturers have begun labeling the potassium content of their products, but few if any use the available health claim.18
Manufacturers can now leverage the health claims for potassium and reduced risk of stroke and hypertension (and calcium and vitamin D and reduced risk of osteoporosis). On July 3, 2000, Tropicana Products, Inc. (Tropicana) submitted to the FDA, under provision of the FDA Modernization Act of 1997 (FDAMA) a notification containing a proposed claim about the relationship of potassium-containing foods to blood pressure and stroke. The claim became effective October 31, 2000.3The claim reads, “Diets containing foods that are good sources of potassium and low in sodium may reduce the risk of high blood pressure and stroke.” Foods making this claim must be a “good source” of potassium (10 percent or more of the Daily Value (DV); at least 350 mg of potassium) and less than 140 mg of sodium per reference amount customarily consumed and per 50 g if the food’s reference amount is 30 g or less or 2 Tbsp or less, and be low in fat (no more than 3 g total fat), saturated fat (no more than 1 g) and cholesterol (no more than 20 mg) and without fortification, contain 10 percent or more of the DV for one of the six nutrients (vitamin A, vitamin C, iron, calcium, protein, fiber) per reference amount .3The claim is available to any product meeting these criteria, including fat-free milk.
New calcium, vitamin D and osteoporosis health claimsThe new health claim for calcium, vitamin D as it relates to osteoporosis updates an existing claim by allowing for claims about a reduced risk of osteoporosis with the consumption of calcium or calciumandvitamin D in conjunction with a well-balanced diet and physical activity.
There are two versions of the new osteoporosis health claim that the FDA has approved for use. One version describes the relationship between calcium and vitamin D and how they reduce the risk of osteoporosis, and the other discusses the relationship between calcium and a reduced risk of osteoporosis (see table of claim language). The claims can be used on packages of reduced-fat, low-fat and fat-free milk, and qualifying yogurt varieties, as well as other food products (e.g., fortified orange juice) that qualify as excellent sources (20 percent or more of recommended DV) of calcium or calciumandvitamin D per reference amount. Additional criteria that a product must have to make this health claim is available at the FDA Web site:http://www.cfsan.fda.gov/~dms/lab-ind.html.
Companies whose products currently make the calcium and osteoporosis health claims and wish to continue doing so will have until January 1, 2010, to update the current wording of the calcium and osteoporosis health claims on those packages.
The revised claims provide new opportunities for food and beverage manufacturers to communicate to consumers the role of key dairy nutrients in overall bone health and in reducing the risk of osteoporosis. This news also gives consumers another reason to get the recommended three servings of dairy foods daily.
Role of vitamin D in bone healthCalcium and vitamin D work together to help build strong bones. Calcium provides the raw material to build bone, while vitamin D helps increase calcium absorption. Vitamin D also increases calcium resorption in the kidneys to limit urinary calcium loss. A review of research published in a recent issue of theAmerican Journal of Clinical Nutrition found that foods fortified with vitamin D, including dairy foods, increased circulating levels of the vitamin.19
Together, milk, cheese and yogurt are the main sources of calcium and vitamin D in the diets of Americans.20Three 8-ounce glasses of vitamin D-fortified milk provide 90 percent of the DV for calcium and 75 percent of the DV for vitamin D.21“Current consumption data indicate that most people aren’t getting enough vitamin D or calcium. The new health claim helps communicate the critical need for calcium, vitamin D and physical activity and their role in reducing the risk of osteoporosis,” says Dr. Frank R. Greer, chairman of the American Academy of Pediatrics Committee on Nutrition. With more than one in 10 Americans either diagnosed with or at risk for developing a bone disease, and an additional 44 million Americans at risk for osteoporosis,22consuming calcium and vitamin D-rich dairy foods along with a healthy diet and physical activity is more important than ever.
Dairy foods have the edge for bone healthCompetitive beverages are already promoting new products in multiple formats with the new claim, but nondairy foods fortified with calcium and vitamin D cannot compare with the abundance of nutrients present in milk and dairy foods. Beyond calcium and vitamin D, the U.S. Surgeon General22recognizes essential nutrients in dairy foods that support bone health, including magnesium, phosphorus, potassium and protein.
What do the health claims for potassium and vitamin D mean for processors?Milk was rated as “very/somewhat healthy” by 85 percent of respondents, and “very healthy” by 48 percent, according to a recent DMI-commissioned survey.6Milk processors that use the available potassium claim on fat-free milk can capitalize on milk’s healthy image, while raising consumer awareness about its potassium content and corresponding health benefits.
In addition, consumers believe milk to be the best beverage available for providing calcium, vitamin D and consequently helping reduce the risk of osteoporosis.6The majority of consumers (74 percent) say it is extremely/somewhat important that an osteoporosis health claim that promotes calcium and vitamin D be prominently displayed on the product label, and more than 25 percent said they were more positive about milk fortified with vitamin D after hearing about the new claim.
In a slowed economy, the focus of food manufacturers will be on core nutrition business trends, not short-lived fads. A trend with no sign of slowing down is consumers’ desire for naturally healthy products.23Calling attention to the inherent and fortified nutrient content of milk and milk products is part of the ongoing conversation the dairy industry has with consumers - helping them understand that dairy foods are a fundamental part of health and wellness. Promoting dairy’s benefits to consumers on packaging and/or in marketing efforts is an important way dairy processors can protect dairy’s competitive superiority in the marketplace.
Sources of PotassiumMedium baked potato (with skin) 751 mg
8 oz yogurt (plain, low-fat) 573 mg
8 oz low-fat milk 366 mg
6 inch banana 362 mg
1/2 cup pasta sauce (PREGO) 360 mg
Small orange (2-5/8") 237 mg
1 oz almonds 200 mg
1/2 cup cottage cheese 118 mg
Sources: U.S. Department of Agriculture, Agricultural Research Service. USDA National Nutrient Database for Standard Reference, Release 21.http://www.nal.usda.gov/fnic/foodcomp
DIETARY REFERENCE INTAKE FOR POTASSIUMMales & Females Adequate Intake, mg/day
1-3 years 3000
4-8 years 3800
9-13 years 4500
14-18 years 4700
19-50 years 4700
>50 years 4700
Source: Institute of Medicine, Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. National Academy Press. Washington, DC. 2004.
Model Language for Calcium, Vitamin D and Osteoporosis Health Claimo For foods that are excellent sources of calcium only:
o Adequate calcium throughout life, as part of a well-balanced diet, may reduce the risk of osteoporosis.
o Adequate calcium as part of a healthful diet, along with physical activity, may reduce the risk of osteoporosis in later life.
o For foods that are excellent sources of both calcium and vitamin D:
o Adequate calcium and vitamin D throughout life, as part of a well-balanced diet, may reduce the risk of osteoporosis.
o Adequate calcium and vitamin D as part of a healthful diet, along with physical activity, may reduce the risk of osteoporosis in later life.
Source: Food and Drug Administration. Final Rule: 21 CFR §101 [Docket No. FDA2004PO205] (9-29-08).
1Ten key trends in food, nutrition and health. New Nutrition Business 2008;13(4):1-33.
2U.S. Department of Health and Human Services and U.S. Department of Agriculture. Dietary Guidelines for Americans. 6th edition. Washington, D.C.: U.S. Government Printing Office, 2005.
3U.S. Food and Drug Administration. Health claim notification for potassium-containing foods, 2000. Available at: http://vm.cfsan.fda.gov/~dms/hclm-k.html. Accessed Nov. 7, 2008.
4Food and Drug Administration. Final Rule: 21 CFR §101 [Docket No. FDA2004PO205] (9-29-08).
5Wagner CL, Greer FR and the Section on Breastfeeding and Committee on Nutrition, Clinical Report: Prevention of rickets and vitamin D deficiency in infants, children and adolescents. Pediatrics 2008;122(5):1142-1152.
6Dairy Management Inc. 2007 Health and Nutrition Omnibus. Distributed by Synovate.
7American Dietetic Association. Nutrition and You: Trends 2008. Available at:http://www.eatright.org/ada/files/Nutrition_and_You_2008_Web.pdf Accessed Nov. 4, 2008.
8IFIC. Using nutrition-related claims to build a healthful diet. Food Insight 2005.
9Shopping for health. Prevention 2008.
10National Research Council. Diet and health: implications for reducing chronic disease risk. Washington, D.C.: National Academy Press, 1989.
11Umesawa M et al. Relations between dietary sodium and potassium intakes and mortality from cardiovascular disease: the Japan Collaborative Cohort Study for Evaluation of Cancer Risks. Am J Clin Nutr 2008;88:195-202.
122005 Dietary Guidelines Advisory Committee Report. Available at:http://www.health.gov/dietaryguidelines/dga2005/report/default.htm. Accessed Nov. 4, 2008.
13Appel LJ, Brands MW, Daniels SR, Karanja N, Elmer PJ, Sacks FM. Dietary approaches to prevent and treat hypertension: A scientific statement from the American Heart Association. Hypertension 2006;47:296-308.
14Geleijnse JM, Kok FJ, Grobbee DE. Blood pressure response to changes in sodium and potassium intake: a metaregression analysis of randomized trials. J Hum Hypertens 2003;17:471-480.
15USDA/ARS, What we eat in America, NHANES 2001-2002, 2005-2006: usual intakes from food compared to dietary reference intakes. Available at:http://www.ars.usda.gov/foodsurvey. Accessed November 2008.
16Institute of Medicine. Dietary reference intakes for water, potassium, sodium, chloride and sulfate. Washington, D.C.: National Academy Press, 2004.
17Heaney RP, Rafferty K. Nutrient effects on the calcium economy: emphasizing the potassium controversy. J Nutr 2008;138(1):1665-1715.
18Conversation with Michelle Matto, International Dairy Foods Association, November 2008.
19Cranney A et al. Summary of evidence-based review of vitamin D efficacy and safety in relation to bone health [review]. American Journal of Clinical Nutrition 2008;88(suppl):5135-5195.
20Weinberg et al. Nutrient contributions of dairy foods in the United States, continuing survey of food intakes by individuals, 1994-1996, 1998. Journal of the American Dietetic Association 2004;104:895-902.
21Based on rounded values from USDA Nutrient Database. Release 21. Available at:http://www.nal.usda.gov/fnic/foodcomp/search/. Accessed Nov. 30, 2008.
22Surgeon General’s Report on Bone Health, 2004. Available at:http://www.surgeongeneral.gov/library/bonehealth/. Accessed November 2008.
23Mellentin J. Key trends in functional foods. Nutraceuticals World 2008;60-67.