Cardiovascular Health In Japan

Examining trends and product opportunities in the Japanese market with respect to heart health.

By Ron Bailey

The Japanese Ministry of Health, Labor and Welfare (MHLW) publishes an annual list of “Causes of Death” in Japan. In recent years, “cardiac failure” has been the second leading cause of death, well behind the leading cause of death, cancer, and just slightly ahead of “cerebrovascular failure.” In 2001, nearly 150,000 Japanese died of cardiac failure. The incentive for maintaining cardiovascular health is therefore very clear, particularly considering the rapidly aging population in Japan.

The annual National Nutrition Survey in Japan, also published by MHLW, is an excellent source of current and historical data related both directly and indirectly to cardiovascular health. Relevant data extracted from the 2001 survey include the following:

Cholesterol:12% of men and nearly 16% of women had total serum cholesterol levels greater than the 240 mg/dl recommended upper limit. Nearly 50% of men and 55% of women had cholesterol levels greater than 200 mg/dl. The highest cholesterol readings were in the 40’s age group for men and in the 50’s for women, but then declining in the later age groups for both sexes.

Triglycerides: Nearly 40% of men and 25% of women had serum triglycerides above the 150 mg/dl recommended upper limit, including nearly 25% of men with triglyceride readings above 200 mg/dl.

Blood Pressure: Over 60% of men and 55% of women over 60 years of age had a blood pressure reading greater than the 140/90 mm Hg upper limit for “normal” blood pressure. For men, the problem became more serious in the 40’s age group, and for women a decade later in their 50’s.

Salt Intake: The relationship be­tween salt consumption and blood pressure is well accepted in Japan. For many years the average salt intake in Japan has exceeded government guidelines, for both men and women. In 2001 the average intake for men was just over 12 grams per day and for women 11 grams per day. Not surprisingly, soy sauce was the primary food source contributing to the problem, with over 2.5 grams of salt per day from soy sauce alone.

FOSHU (Foods for Specified
Health Uses) Products and
Cardiovascular Health

It is common in Japan for MHLW and other government agencies responsible for health to use the annual health and nutrition data to relatively quickly (re)formulate policies and regulations for dealing with issues. Cardiovascular health is one such problem, and for several years the Japanese government has been encouraging the development of FOSHU products targeted at reducing cholesterol levels and reducing blood pressure.

A recently issued status report on the FOSHU market prepared by the Japan Health Food and Nutrition Food Association (JHNFA), the organization responsible for administering the FOSHU approval pro­cess, is a useful resource. Specific data in the report on cholesterol-lowering and blood pressure lowering FOSHU products as of the end of 2003 included the following:

Cholesterol: There were 52 ap­proved FOSHU products focused on cholesterol-lowering, incorporating as “functional ingredients” soy protein, several types of dietary fiber, phytosterols and phytosterol and phytostanol esters. These 52 products represented 13% of the total number of approved FOSHU products as of the end of 2003. Sales for the cholesterol-lowering category had increased to over $100 million at retail in 2003, a four-fold increase from only two years earlier. This is a clear indication of the level of interest in the category, and possibly even a confirmation that the products are known to be effective in reducing cholesterol levels.

Blood Pressure: There were 38 approved FOSHU products targeted at reducing blood pressure, mostly peptides from marine and other sources, representing nearly 10% of the total FOSHU approvals. Retail sales for the products, however, actually declined in the past two years to just over $80 million, down from nearly $100 million two years ago. It is not yet known why this category is in decline, since the need for blood pressure lowering products is obvious from the nutrition survey data.

Neutral Fats, Body Fat: The JHNFA status report grouped the “neutral fats” (triglycerides) and “body fat” FOSHU products into a single category, based on the approved product claims. It is very clear that the Japanese population is gaining weight on average, and an obesity problem is emerging that is expected to have a negative impact directly on cardiovascular health. The JHNFA summary indicates that although there were only 17 approved FOSHU products in the category claiming reduced “neutral blood fats” and “for people who are overweight,” these products represented nearly $600 million in retail sales in 2003. This is a four-fold increase from 2001, and a nine-fold increase from 1999. The majority of the products and much of the sales increase is attributed to the line of diacylglycerol “Econa” cooking oils marketed by Kao Corporation. The Kirin Beverage “Healthya” green tea with added green tea catechins “suitable for people beginning to be concerned about body fat” is also in this category, with claimed first year sales of nearly $150 million.

Non-FOSHU Products &
Cardiovascular Health

Although non-FOSHU products are not allowed to make on-label health claims, in practice it is possible to communicate the health benefits of ingredients and products through television talk shows, books and off-label literature. As a result, Japanese consumers are very much aware of the potential cardiovascular health benefits from ingredients in foods and dietary supplements. Popular examples include:

CoQ10: This active drug ingredient for treating congestive heart failure was also approved by the government as a food additive two years ago and has now been incorporated into a range of foods and dietary supplements in Japan.

Polyphenols: Japanese consumers believe that the antioxidant and anti-aging properties of polyphenols, such as green tea catechins and cocoa polyphenols, are also at least indirectly related to improved cardiovascular health. These ingredients are very popular in confectionery, beverages and many other product forms.

Gamma-Amino butyric Acid (GABA): This very popular food ingredient extracted from malted brown rice and more recently from malted soybean soymilk is now also being positioned for reducing blood pressure. The market success has supported the approval in March of the first FOSHU products with GABA as the functional ingredient, a lactic acid bacteria drink from Yakult and a tableted product from Otsuka, both with claims that the product will “suppress hypertension.”

Relevance of U.S. Cardiovascular Health Controversies in Japan

There are several reasons why many of the public controversies in the U.S. food industry are not particularly relevant to Japan. The Japanese diet of course is the most obvious difference, since it is generally more healthful and certainly more calorie-controlled than a typical U.S. diet. Trans fats are not a major issue in Japan, for example, where the overall fat consumption has actually declined slightly to only 25% of calories, as reported in the 2001 nutrition survey.

Low carbohydrate diets are of virtually no interest in Japan, where white rice alone is responsible for 30% of the daily caloric intake. The Atkins and South Beach diets are not well known in Japan. Even though the Japanese level of obesity is increasing year after year (using their own definition of obesity as having a Body Mass Index—BMI— of 25 or greater, not the 30 BMI standard of the U.S.), the Japanese are not likely to be willing to make such a drastic lifestyle change in order to lose weight and promote cardiovascular health.

It is reasonably clear that one major Japanese approach for maintaining cardiovascular health will be to encourage the consumption of healthy foods, including allowing new stronger health claims for FOSHU products, while carefully monitoring the diet and nutrition trends through the annual surveys. The aging population and the rising costs of healthcare mandate this approach, particularly in the context of a flat to declining population who will be expected to pay for most of the healthcare funding.NW

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Note: Important sources of information for this summary are the Ministry of Health, Labor, and Welfare in Japan, the National Nutrition Survey in Japan 2001, Japanscan Food Industry Bulletin in the UK, and the Japan Health Food and Nutrition Food Association.