No ‘Kid’ding Around

With the health of children in sharp decline, the nutraceuticals industry is focusing its efforts on improving their nutritional needs in order to ensure ahealthy future.

Marian Zboraj
Associate Editor

Data from the National Health and Nutrition Examination Survey (NHANES 2003-2004) indicates that 14% of two- to five-year-olds and 17% of children and adolescents ages 12 to 19 in the U.S. are overweight. Even more startling, the prevalence of overweight children and adolescents has quadrupled and tripled, respectively, in the last 30 years.

In a recent study, researchers from the Saint Louis University School of Medicine and School of Public Health, and pharmacy benefit manager Express Scripts, found that America’s “tweens” more than doubled their use of type 2 diabetes medications between 2002 and 2005. The study also found more children taking chronic medications for blood pressure, cholesterol, asthma, depression and diabetes.

“Children in the U.S. are certainly facing a number of serious health-related issues,” said Mark Meskin, PhD, RD, professor and director, Didactic Program in Dietetics, California State Polytechnic University, Pomona, CA. “These problems include childhood obesity, early onset type II diabetes and dietary habits that may contribute to heart disease, cancer and other chronic diseases that occur later in life.”

Taking these issues into consideration, consumers are increasingly looking to maintain and improve their family’s health and wellness through dietary habits, whether that includes functional foods and/or dietary supplements. In Mintel’s August 2007 U.S. report on “Functional Beverages,” some 45-50% survey respondents with children present in the household were purchasing both a functional food and drink.

Nutritional Report Card

The Office of Dietary Supplements (ODS), which is part of the National Institutes of Health (NIH), Bethesda, MD, recently published a study in the October issue of Archives of Pediatrics & Adolescent Medicine entitled, “Dietary Supplement Use Among Infants, Children, and Adolescents in the United States, 1999-2002.” According to Mary Frances Picciano, PhD, lead author of the study and senior nutrition research scientist at ODS, the purpose of the investigation was not only to determine the prevalence of dietary supplement usage, but also to reveal which nutrients the supplements provided to children. To do this, researchers analyzed NHANES data from 1999-2002, which included information on children from birth through 18 years of age.

Researchers found that nearly 32% or about one-third of U.S. children use dietary supplements, with the lowest use reported among infants younger than one year (12%) and teenagers 14- to 18-years-old (26%), and highest use among four- to eight-year-old children (49%). The type of supplement most commonly used was multivitamins and multi-minerals (18%). The leading supplemental nutrients consumed were found to be ascorbic acid (27%), retinol (26%), vitamin D (26%), calcium (21%) and iron (19%).

As Dr. Picciano points out, this analysis was a first phase study for ODS, which is working to further explore the nutrition habits of today’s children. More specifically, ODS wants to find out if children are in fact obtaining nutrients that are low in their diets, or if they are supplementing diets that are already adequate in those nutrients. “We are now looking at total nutrient intakes,” she said. “This would include nutritional intake from food, as well as nutritional intake from supplements to obtain total nutritional intake.” Results of this investigation should be available sometime next year.

When it comes to obtaining essential nutrients for children, Dr. Picciano em-phasizes that a proper diet is the best source. “Guidelines for nutrient intake are spearheaded by the American Academy of Pediatrics,” said Dr. Picciano. “They recommend children should ideally be getting nutrients from food, but if they do not obtain them from food for whatever reason, then supplementation is suggested.” One nutrient that Dr. Picciano mentioned the organization has made special recommendations for is vitamin D, indicating the importance of supplementing vitamin D to breastfed infants, as well as to children if they are consuming less than 500 milliliters of milk per day. Other nutrients that the American Academy of Pediatrics recommends to promote optimal growth and development in children include fluoride, calcium and iron.

Adequate amounts of iron and calcium are particularly important to adolescents as their bodies undergo an intensive growth period. “According to the National Osteoporosis Foundation, only 10% of girls and 25% of boys get the calcium they need in the tween years (ages 9-13) to build peak bone mass,” said Coni Francis, PhD, RD, senior manager of science, marketing and technical Services for GTC Nutrition, Golden, CO.

Dr. Francis went on to reference a July 2007 survey of parents of school-aged children that was conducted by Opinion Research Corporation for GTC Nutrition. “The survey found that the majority of parents—almost 60%—are in the dark when it comes to knowing how much calcium their kids need on a daily basis,” she said. “Furthermore, over 30% of the parents surveyed mistakenly believe their children need less than half of the daily recommended 1300 mg of calcium for kids aged nine years and older.”

A Well-Schooled Diet

There is a long laundry list of barriers to eating a healthy diet. “Unfortunately health-related decisions often intersect with factors such as security, convenience, availability, cost and familiarity,” said Cal State’s Dr. Meskin. “People actually know what they should be eating, but they find it difficult to overcome these barriers.”

Recent federal initiatives have been working to overcome some of these obstacles, starting with educational institutions.

“We are on the cusp of a sea change regarding food and children,” commented Michael Neuwirth, senior director of public relations, The Dannon Co., White Plains, NY. “Schools are changing what foods they make available to children, and the guidelines for competitive foods sold in schools, developed by the Alliance for a Healthier Generation, is a great example of this.”

The Alliance for a Healthier Generation is a partnership between the American Heart Association and the William J. Clinton Foundation, which is working to combat childhood obesity. The Alliance provides a four-pronged approach that works with schools, children, the food and beverage industries and healthcare insurers. The school initiative helps provide healthy school programs that improve access to nutritional foods and beverages. One of the Alliance’s major goals is to halt the nationwide increase in childhood obesity by 2010, and reverse the trend by 2015.

Food companies such as Dannon are also lending a hand to provide additional nutrition education for children. Last October, Dannon awarded the second annual Dannon Next Generation Nutrition Grants to address the need for educating children about healthy eating practices and proper nutrition. “We established the Dannon Next Generation Nutrition Grants in 2006 to promote childhood nutrition education and provide total funding of more than $100,000 each year to four nonprofit organizations that operate in communities where a Dannon facility is located,” said Mr. Neuwirth. “Each recipient organization developed a program that nurtures healthy eating habits among children in the community and encourages children to develop life-long habits for good nutrition and exercise.”

As the call for healthier food options in schools rages on, many are starting to offer more nutritional breakfast and lunch options that include more fruits and veggies, involve less calories and sugar-based products, and offer fortified favorites like wheat pizza.

The good news is kids are more than willing to eat these healthier foods. In fact, a University of Minnesota study recently found that school lunch sales don’t decline when healthier meals are served. The study, which appears in the December issue of the Review of Agricultural Economics, analyzed five years of data for 330 Minnesota public school districts. It looked at compliance with federal standards for calories, nutrients and fats.

Demand for On-The-Go Snacking

In order to meet energy needs, children should eat at least three meals a day, be-ginning with breakfast. Unfortunately, today’s children seem to be in a rush just like their parents, and it’s been shown that they eat everywhere but home. As a result, on-the-go products continue to be the trend based on the increase of out-of-home food consumption.

According to ADM’s (Decatur, IL) “On-The-Go Nutrition for Children” study, preschool children eat out 18% of the time, and middle school children 26% of the time. About one in every three kids eats a fast-food meal every day—because of both their own ex-tracurricular activities and the entire family’s lifestyle. This situation typically increases as kids get older, be-cause they are more likely to have opportunities and their own disposable income to eat more snacks and meals away from home. They also have more control over their food choices. The money in kids’ pockets has nearly doubled every decade over the past 30 years, with a current average disposable income of $91 per week.

Because of this, the demand for healthy snacking is on the rise, especially as more parents realize that snacks can help children meet their daily nutrient needs. New Nutrition Business, London U.K., even names “Healthy Snacking” as one of the key trends driving the 2008 children’s marketplace in its November/December “Kids Nutrition Report.”

The report credits changing eating habits and the desire among parents who want to give their children something “guilt-free” as major drivers in this market. According to the report, “It’s in snack products that by far the most successful kids’ food concepts can be found—and this will continue to be the case in the future. Again and again it’s successful snack-formats that are most in demand and produce the fastest sales growth for companies around the world.”

And some companies have already responded. In order to help parents get their children to eat enough fruit each day, Abbott Nutrition, Abbott Park, IL, recently launched PediaSure NutriPals Fruit Bars, the only kids’ snack bar made with one serving of real fruit in every bar. Available in Strawberry, Mixed Berry and Blueberry, NutriPals Fruit Bars are low-fat, healthy snacks, and they contain no high-fructose corn syrup, hydrogenated oils, trans fat or preservatives. Each 150-calorie bar is a good source of protein, fiber and more than 20 vitamins and minerals.

Innovations like NutriPals Fruit Bars can help parents and children by lowering some of the barriers to healthy eating. “There is no reason why healthy fruit, vegetable and whole grain products cannot be ‘fast,’ ‘convenient’ and reasonably priced. Further, there is no reason why fruit, vegetable and whole grain products cannot be attractively packaged and fun to eat,” said Cal State’s Dr. Meskin. “Fast food doesn’t have to be unhealthy. Making fruit and vegetable products that are healthy and that can be eaten in the car or taken to school as a snack are goals that can easily be accomplished by the food industry.”

As part of the on-the-go snacking phenomenon, there is also a strong need for functional beverages. According to Mintel’s “Functional Beverage” report, among respondents who have bought a functional drink in past three months for themselves, almost half (49%) would like to see functional drinks made specifically for kids. The report went on to explain that parents have become an attractive target for kids’ products. Taking into account the 36 million children aged three to 11, parents spent an estimated $4.3 billion on beverages for this group in 2006, according to the USDA.

Products like Crayons, Inc.’s (Bellevue, WA) all-natural Crayons Fruit Drinks can also help parents provide children with essential nutrients in a sweet beverage that contains 33% fewer sugar grams. At only 90 calories per serving, the beverage contains 30% real fruit juice and 25% of the RDI of vitamins A, D and E, 100% of the RDI of vitamin C, 12% of the RDI of fiber and 10% of the RDI of calcium. Crayons Fruit Drinks’ SugarGuard Protection System also helps control the rate of sugar ab-sorption within the body.

Formulation Factors

Safety is a big concern when formulating products for children. With recent toys recalls for lead and other hazards, and a ban on medicine for children’s colds, the nutraceuticals industry should tread lightly when it comes to children. Eric Anderson, brand manager, PL Thomas & Co., Morristown, NJ, said issues such as appropriate dose and any long-term implications of daily use need to be determined. “Parents must be vigilant in their selection of supplements, and nutraceutical marketers need to do the work to ensure what they’re offering is safe for kids,” he said.

Once safety is established, formulators can then explore the matter of taste. Taste and texture are usually a priority when developing new products, but they are especially crucial when targeting kids. Children are notoriously picky eaters, refusing to comprise when it comes to taste. They typically prefer sweet foods and don’t like bitterness.

Udi Alroy, vice president of global marketing and sales for LycoRed, Beer Sheva, Israel, agrees that taste is one of the biggest priorities in reformulating existing products to make them more nutritious. “Children are much more sensitive to changes and tastes than adults are used to,” he said. “Our solution is to apply our technologies to taste and mask those benefits (i.e., vitamins, minerals, amino acids, etc.),” said Mr. Alroy. “That way, the young consumer cannot distinguish between the old product and the new healthier product.”

But taste isn’t only an issue for foods and beverages, as Mr. Anderson points out. Taste and delivery form can be big hurdles for supplements too. “Chewable supplements are preferred, and liquids are the best choice for most—we definitely see the number of these offerings increasing,” he said. “However, at the end of the day, if taste issues aren’t overcome the supplement is not likely to succeed.”

Other things to consider: children prefer smaller and softer food; they enjoy a variety of flavors, colors and shapes; and long term, portion control and 100-calorie snack packs will become commonplace in the kids market.

As pointed out by New Nutrition Business’ “Kids Nutrition Report,” “all-natural” and “free from” have become established as the key requirements for foods marketed to children. Similarly, messages that were once perceived as strictly allergy-related, such as “free from gluten,” are also being sought by parents whose children have no allergies, but who want to be sure they are not taking any risks with what they give their children.

Kid-Specific Opportunities

For the future, as indicated by the “Kids Nutrition Report,” immunity and digestion represent the most attractive targets in the children’s health market. “The biggest opportunities lie in the related areas of digestion and immunity—the latter being a subject that market research consistently shows is ‘top-of-mind’ for parents of children aged one to six,” the report states. Luckily science has proven that a healthy gut and an effective immune system are linked, which means that a product formulated to target one benefit might also be able to target another.

Quickly building momentum, probiotics have been found to benefit both immunity and digestion. As indicated by Dannon’s Mr. Neuwirth, the U.S. probiotic market is estimated to grow to more than $1 billion in sales by 2010. Contributing to this growth is Dannon’s 2007 launch of Danimals smoothies for children, which contain Lactobacillus GG (LGG).

“LGG is the most widely researched probiotic in kids and is clinically proven to have a positive impact on the digestive tract, immune function and the maintenance of oral health,” said Mr. Neuwirth.

Preserving strong bones is another area that many parents take into consideration. New research from the University of Maastricht has established vitamin K’s importance in promoting healthy, growing bones in children. Researchers screened children for markers of bone health, including osteocalcin, the vitamin K-dependent protein necessary to use calcium to build healthy bones.

“The findings suggest a pronounced low vitamin K status of bone during growth, which means young children could benefit from additional vitamin K,” said PL Thomas’ Mr. Anderson. “It is important to note that the vast majority of vitamin K’s activity outside the liver is attributed to natural vitamin K2, particularly the longer chain menaquinones like PL Thomas’ Menaquinone-7 (Mk-7).” Additional research for natural vitamin K2 as Mk-7 is underway. A safety and efficacy study with MenaQ7 in children has demonstrated very promising results for bone and cardiovascular health.

Attention Deficit Hyperactivity Disorder (ADHD) is another prevailing issue in the U.S., with millions of children getting diagnosed each year. A placebo-controlled study has revealed that Pycnogenol, an antioxidant plant extract from the bark of the French maritime pine tree created by Horphag Research and distributed in North America by Natural Health Science, Hoboken, NJ, reduces ADHD in children by balancing stress hormones, which lowers adrenaline and dopamine.

The findings, to be published in an upcoming issue of the journal Nutritional Neuroscience is a spin-off of a 2006 study that revealed Pycnogenol’s ability to reduce hyperactivity and improve attention, concentration and motor-visual coordination in children with ADHD.

Stress hormones were quantified from urine samples of the children taken before and after supplementation with either Pycnogenol or the placebo for one month. After a one-month discontinuation of treatment, a third urine sample was taken, revealing that ADHD symptoms had recurred. The stress hormone levels had increased again during the period when children had stopped taking Pycnogenol, suggesting the effect of Pycnogenol on stress hormones accounts for the improvement of inattention and hyperactivity of the children. In this study, Pycnogenol lowered stress hormones by 26% in the case of adrenaline, and decreased neurostimulant dopamine by 11%. Dopamine plays an important role in brain physiology involving learning, cognition, attention and behavior.

“ADHD is affecting the quality of life for so many children and their families,” said Dr. Frank Schönlau, director of scientific communications for Horphag Research and Natural Health Science. “It is imperative that science explore a natural means to provide expanded treatment options. We look forward to advancing this promising research.”
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