According to the World Health Organization (WHO), non-communicable diseases (NCDs) represent the leading causes of death in the world today. Among them, cardiovascular disease accounts for most NCD deaths, killing 17 million people every year. Cancer, which ranks second on the list, causes fewer than eight million fatalities annually.
 
Euromonitor International’s data show that in 2010 Eastern European countries experienced the highest death toll from diseases of the circulatory system (which include ischemic heart disease as well as cerebrovascular disease), topped by Ukraine with 1026 deaths per 100,000 inhabitants, followed by Bulgaria, Russia and Belarus with 895, 863 and 810, respectively. Patchy healthcare is one major reason behind these high fatality rates. By comparison, in the U.S., 292 deaths per 100,000 inhabitants were a result of circulatory system diseases in 2010, while in France the number was 244.
 
The global incidence of cardiovascular disease is unlikely to decline in the foreseeable future. In fact, there are plenty of indications the number of people affected will only increase. For instance, diabetics have a fivefold increased risk of developing cardiovascular disease, and a recent global study published by the medical journal The Lancet in June 2011 indicates that diabetes prevalence may be significantly higher than previously estimated. Current WHO statistics, which may soon have to be revised, claim that around 220 million people worldwide have diabetes, but the new study, funded by WHO and the Gates Foundation, now puts the figure closer to 350 million. The researchers point out that the number of people with diabetes has doubled since 1980, 80% of which live in low- and middle-income countries.
 
If this worrisome trend continues at this rate, the economic burden is likely to cripple existing healthcare systems and severely impact countries’ economic performance, resulting in depressed GDPs. For example, the WHO estimates that over the 2006-2015 period, China will have sacrificed $558 billion of its national income to diabetes, heart disease and stroke.
 
Consumers Are Price Conscious
 
Lifestyle factors, such as diet, play a key role in the development as well as the prevention and management of cardiovascular disease. The food industry is well aware of this, and heart-healthy offerings can now be considered mainstream in most packaged food markets.
 
Euromonitor International estimates that in 2010 the value of products with cardiovascular health as their prime positioning focus amounted to $6.8 billion for the 32 markets in which it conducts in-depth health and wellness research, up from $5 billion in 2005.
 
The U.S. is the world’s largest health and wellness market. According to Euromonitor International statistics, the country’s $153 billion accrued in total health and wellness food and beverage retail value sales accounted for one-quarter of global sales in 2010.
 
Euromonitor International’s prime positioning statistics show that just under $4 billion of health and wellness foods and beverages in the U.S. were chiefly positioned as benefiting cardiovascular health. Value sales declined marginally (by 1%) in 2010, but the main reason for this was the recession—items like cholesterol-reducing functional spreads, for example, are significantly more expensive than the standard equivalent. Indeed, statistics show that cardiovascular health-positioned oils and fats declined by 6% in 2010, following on from a 7% decline the previous year.
 
Data on soft drinks show that the clearly heart-health positioned POM Wonderful (from Roll International Corp) brand, which includes the company’s flagship, super-premium priced 100% pomegranate juice product, experienced a small decline in off-trade volume sales from 51 million litres in 2009 to 49 million litres in 2010. To illustrate, Euromonitor International price check figures reveal that 60 fl. oz. (1.8 litres) of POM Wonderful 100% Pomegranate Juice cost around three-and-a-half times more than Ocean Spray 100% Premium Cranberry Juice.
 
This does not mean, however, that U.S. consumers are no longer interested in products with cardiovascular health benefits. The Food Marketing Institute’s annual “Shopping For Health” survey, carried out at the end of 2010 and which evaluated responses from a nationally representative sample of almost 1600 adult grocery shoppers, found that heart health topped the list of what U.S. shoppers were looking for in terms of health claims. An impressive 73% stated that heart-health claims mattered to them when choosing their grocery items. However, it seems the recession has made consumers more cautious about spending their money on premium-priced items.
 
Olive oil, for example, which is widely known to be beneficial to heart health, as well as being a category that includes many reasonably priced offerings, managed to hold strong, registering a 2% value gain in 2010, an admirable performance considering that overall oil and fat sales declined by 3% in the U.S. market in 2010. So, manufacturers of cardiovascular health-positioned products need to take into consideration that the global economic woes may have lowered grocery shoppers’ financial pain threshold but have not made them less keen on heart-healthy products.
 
Salt Reduction Is a Key Focus
 
While high value ingredients such as cholesterol-lowering plant stanol/sterol esters, beta-glucans and green tea extracts will continue to appeal to the more affluent consumer groups, even during an economic slump, products that have had their artery-clogging saturated fat or blood pressure-hiking salt content reduced, while remaining as close as possible to the price point of their standard counterparts, will remain of key importance to the mainstream consumer base.
 
The WHO recommends the reduction of sodium intake as one of the top three priority actions required to tackle the global non-communicable disease crisis. It is widely recognized that high intake of sodium is linked to high blood pressure (hypertension). Table salt (sodium chloride) is the main source of sodium in the human diet, and 1 mg of sodium equates to roughly 2.5 grams of table salt.
 
Humans need sodium, but actual physical requirements are small and range somewhere between 70-460 mg per day, depending on climate and activity levels. However, in many highly developed markets such as the U.S., the average intake tends to hover around the 10-gram mark. The WHO recommends that an adult’s daily sodium intake should not exceed 5 grams.
 
It is estimated that in industrialized countries around 75% of salt in the diet comes from processed packaged foods. In line with the global health and wellness trend, manufacturers are making an effort to reduce the sodium chloride content of their packaged food offerings. Sometimes this happens gradually—i.e. stealthily—across entire product portfolios, and sometimes manufacturers decide to offer brand extensions or new lines clearly labeled as low-salt options, targeted at heart-health-conscious consumers.
 
Euromonitor International’s health and wellness data show that the latter—i.e. packaged foods marketed as “better for you” (BFY) reduced in salt—garnered global value sales of $4.4 billion in 2010, up from $3.4 billion in 2005. BFY reduced-salt soup accounts for the biggest share of the category at 40% by value, compared to just 14% in 2005.
 
The U.S. is the leading market for BFY reduced-salt packaged foods in the world, accruing value sales of $3.6 billion in 2010—$1.6 billion of which came from BFY reduced-salt soup. Campbell Soup Co. leads the category, claiming 10% of value sales in 2010.
 
In 2006, the company voiced its aspiration to become an industry leader in sodium reduction. And although it was forced to add more sodium again to some of its soups in 2011 following a poor reception by consumer groups that were, evidently, not motivated by cardiovascular health issues, it still offers a range of 25 soups low in sodium, cholesterol and fat under its Campbell’s Healthy Request brand.
 
Soups, bread, ready meals (including pizzas), cheese and processed meat products may be among the most notorious for their high levels of added salt, but for larger, global companies trying to devise new product development (NPD) and launch strategies for BFY reduced-salt products, it is important to take into consideration the specifics of a country market.
 
Euromonitor International’s ingredients data show that nearly 4 million tons of sodium chloride were added to packaged food products in 2010, with China and the U.S. accounting for around one-quarter of this. However, the pattern of how sodium chloride input is distributed across the various packaged food categories varies by geography as well as the degree of market maturity.
 
For example, in China, where the market for packaged food has reached a medium level of development, 56% of sodium chloride was added to soy-based sauces in the sauces, dressings and condiments category in 2010. This category accounts for 67% of all sodium chloride added to packaged food in China. Soy-based sauces are an integral part of traditional meals in many parts of the Asia Pacific region. By contrast, in the U.S. the category responsible for the largest sodium chloride input (18%) is bakery products, while just 12% is added to sauces, dressings and condiments.
 
Unlike in the U.S., BFY reduced-salt ready meals have not yet arrived in China, but the fact that overall ready meals achieved retail value sales of $772 million in China in 2010, compared to the U.S.’s staggering $24 billion, illustrates that the ready meals category is still pretty much in its infancy in China. At present, canned/preserved ready meals dominate, with a small presence of chilled ready meals. Frozen and chilled pizzas, dinner mixes and other more “advanced” offerings remain largely absent in China. For this reason, significant penetration of health and wellness options cannot be expected just yet.
 
Potassium Poised for Heart Health
 
The mineral potassium, which is often used as a sodium replacer, is set to rise to prominence in the heart-health ingredient stakes, precipitated by still fairly recent events. One of these milestones was the adoption of an RDA (Recommended Daily Allowance) of 2000 mg for potassium within the European Union, by means of a new Commission directive implemented across Member States during 2009. Prior to that, no intake recommendations existed for potassium in the EU.
 
Following on from this, as part of its major health claims review heading for completion in the summer of 2011, the European Food Safety Authority (EFSA) conceded in 2010 that potassium’s roles in the maintenance of normal blood pressure as well as muscular and neurological functioning were scientifically well established, and that companies would therefore be permitted to make health claims pertaining to this benefit on products naturally high in potassium, as well as on products with added potassium.
 
Europe is not the only geography where potassium has suddenly been cast into the spotlight as an important nutrient. In November 2010, USDA published its new Dietary Guidelines for Americans, and in this influential document potassium was one of only four nutrients identified as “low enough to be of public health concern for both adults and children.” USDA recommended an Adequate Intake (AI) for adults of 4700 mg per day, which is more than double that of EU recommendations. Such discrepancies are common because individual needs of any nutrient can vary greatly and also depend on age, sex and physical activity levels, among other factors.
 
At present, calcium, chiefly lauded for its bone-health benefits, remains the dominant mineral added to packaged food, beverages and pet food. It accounted for 65% of total global mineral volumes in 2010, according to Euromonitor International ingredients data, followed by magnesium (5%) and iron (3%). As cardiovascular health continues to gain prominence as a positioning platform, potassium may yet come to feature as one of the top five minerals added to products for the purpose of health benefit functionality in the medium to long-term future.
 
There is certainly plenty of industry activity among ingredients companies developing suitable potassium salts to cater to this growing market. German company K+S Kali, for instance, launched KaliSel, its new brand of potassium chloride, in February 2011. KaliSel is particularly suitable as a sodium chloride replacer for use in soups, sauces, cheese products, ready meals and processed meats as well as beverages.
 
Jungbunzlauer, a German ingredients company keen to capitalize on the budding potassium-fortification boom in the fruit/vegetable juice category, has conducted a series of technical trials involving orange, apple and grape juice enriched with its potassium gluconate and tripotassium citrate ingredients. These trials demonstrated that potassium salts were highly soluble in all juice types tested, and that their addition did not compromise shelf life, appearance or taste to any significant degree, as long as dosage recommendations were followed.
 
Juices, a product category for which sodium chloride substitution is not really an issue, nevertheless have an inherent advantage here because fruits and vegetables are naturally rich in this mineral. So, juices tend to contain useful levels of potassium to start with, much in the way that dairy products are inherently rich in calcium. Owing to a high level of consumer awareness, dairy products already benefit greatly from the calcium connection, although juices still have quite a bit of catching up to do where their potassium content is concerned. Needless to say, the fact that a food already contains appreciable levels of a particular nutrient does not stand in the way of further fortification. If anything, augmentation only serves to heighten credibility.
 
Looking Ahead
 
The list of foods and ingredients potentially beneficial to heart health and the vascular system is endless, and, with the cardiovascular disease epidemic showing no signs of abating, compounded by the global phenomenon of population aging, there will always be a market for heart-healthy products. In addition, market development is being buoyed greatly by validation from regulatory bodies such as the FDA in the U.S. and EFSA in Europe, even if such official acknowledgement is still sparse, applying to a very limited number of substances.
 
Endorsement by nationally well-recognized, not-for-profit organizations can also be highly influential. For instance, in May 2011, the American Heart Association (AHA) released an updated set of recommendations, which, for the first time, include recommended intake amounts of EPA and DHA omega 3 for people with elevated triglyceride levels. According to the AHA, almost one-third of the U.S. population has borderline high triglyceride levels, a key predisposing risk factor for cardiovascular disease.
 
For the future, Euromonitor predicts Brazil, Russia, India and China (the BRIC countries) will emerge as the most dynamic growth markets for cardiovascular health products during the 2010-2015 forecast period, while some of the already quite sophisticated markets, such as the U.S. and Germany, will remain static as they struggle to recover from the impact of the recession.                             
 
 
About the author: Ewa Hudson is the head of health and wellness research at Euromonitor International, London, U.K. She can be reached at ewa.hudson@euromonitor.com.