Vol 3, Issue 10 October 2018 36 ......metabolism to the joint’s three structures: cartilage, synovial membrane, and subchondral bone. However, as it has been described, OA affects

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Healthy ageing:

Greater golden years

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CONTENT

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Learning

Goal

Achievement

Osteoarthritis: Physiopathology, prevention and treatmentOsteoarthritis increasingly affects the ageing population. With the number of diagnosed cases expected to climb significantly in the coming years, Jose Antonio Lopez Sanchez investigates minimising risk factors and preserving joint structures for greater quality of life.

Gamification and serious gaming science: A promising strategy for family nutrition and education?When it comes to a strategy for improving consumer education, experts are leaning toward gamified approaches hoping to draw greater engagement and influence behaviour. French experts investigate the science behind gaming and why consumers respond to this type of interaction.

Healthy ageing support with astaxanthinExperts have found natural astaxanthin to be significantly more powerful as an ROS scavenger than the popular likes of vitamin C, vitamin E, coenzyme Q10 and β-carotene. Tryggvi Stefansson explains how natural astaxanthin supports healthy bodily functions and lifestyle—regardless of age.

5

17

11

October 2018

Viewpoint3

Takeaways28

Vitamin K2: Vital nutrient for every stage of lifeVitamin K2 provides essential nutrients throughout all stages of life. But especially toward and during the ‘golden years,’ K2 works to replenish and protect cells and bones, as well as strengthen heart and blood circulatory function. Jim Beakey says that while most consumers will focus on more prominently-known vitamins, K2 complements many of these to create additional benefits.

22



IN THIS ISSUE Table of Contents p.2 Osteoarthritis p.5 Gamification p.11

Heather GranatoVice President, Content+1 (480) [email protected]

@heathergranato

GGlobally, the population is getting older. The United Nations reports that the number of

older persons—those age 60 or over—will more than double by 2050 and triple by 2100,

growing to represent 3.1 billion people. And Europe has the greatest percentage of population

aged 60 or over—25 percent. In fact, the UN states: ‘Population ageing is poised to become

one of the most significant social transformations of the twenty-first century, with implications

for nearly all sectors of society.’

Certainly, the desire for youth has been a pursuit for time immemorial. It has driven the

interest in anti-wrinkle creams, glucosamine supplements and enteral nutrition. But today’s

older population isn’t interested in ‘anti-ageing’; it’s all about ‘healthy ageing’. The goal is to

remain as healthy and active as possible for as long as possible—increasing the ‘health span’

rather than focusing solely on ‘lifespan’.

This month’s issue around healthy ageing is designed to support your own ideation, offering

insights into ingredients and opportunities that may spark that next best-selling product. On

the ingredient side, our contributors dive into the myriad benefits of natural astaxanthin and

vitamin K2 (menaquinone-7). Both have potential applications in many areas, making them a

possibility to bolster existing formulations or drive a new concept. We also focus in on the

osteoarthritis market and the science supporting chondronutrients. And there’s a unique twist

on the supplementation side with a look at gamification of nutrition education; in today’s

digital age, finding a way to connect with consumers and keep that connection long-term

could build the brand loyalty that pays off over time.

If you have additional thoughts you’d like to share on the topic of healthy ageing, please

reach out. We’re always interested in expert contributions on issues facing the industry, and

would like to know what you’re seeking to support your own business growth.

Searching for the ‘golden ticket’

Viewpoint


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Osteoarthritis

OOsteoarthritis (OA), one of the most disabling arthritic conditions, is a long-term chronic

disease. It involves movable joints characterised by cell stress and extracellular matrix degradation

initiated by micro- and macro-injury that activates maladaptive repair responses including the

proinflammatory pathways of innate immunity. The disease manifests first as a molecular

derangement (abnormal joint tissue metabolism) followed by anatomic and/or physiologic

derangements (characterised by cartilage degradation, bone remodeling, osteophyte formation,

joint inflammation and loss of normal joint function). The joint pain, swelling and stiffness

leads to activity limitations, participation restrictions, sleep interruption, fatigue and depressed

or anxious mood, and ultimately loss of independence and reduced quality of life.

What is osteoarthritis?OA is a disease of the whole organ—namely, the synovial joint. Cartilage is not the sole

tissue affected by OA; the subchondral bone and the synovial membrane also undergo

metabolic and structural modifications as the disease progresses.

OA is the most common form of arthritis and a major cause of disability, affecting 240 million

people globally. It ranks as the fifth highest cause of years lost to disability in high-income

countries, and the ninth highest cause in low- and middle-income countries. It accounts for 50%

of the entire musculoskeletal disease burden, and thus is considered the highest-burden condition

within the musculoskeletal group of diseases, which also includes rheumatoid arthritis (RA) and

osteoporosis. Radiographic evidence of knee OA is present in approximately 30% of men and

women over the age of 65. Worldwide estimates are that 9.6% of men and 18% of women over

the age of 60 years have symptomatic osteoarthritis. Approximately 80% of those with OA will

have limitations in movement, and 25% cannot perform their major activities of daily life.

Osteoarthritis: Physiopathology, prevention and treatmentby Jose Antonio Lopez Sanchez

IN THIS ISSUE Viewpoint p.3 Gamification p.11 Table of Contents p.2

ThinnedCartilage

Bone endsrub together

Osteoarthritis



The prevalence of OA is increasing, and with an increase in risk factors for OA, this is

expected to continue. The global impact of OA constitutes a major challenge for health

systems in the 21st century and in the coming years. Within the United States, the prevalence

of doctor-diagnosed arthritis is expected to increase in the coming decades—by 2030, an

estimated 67 million adults (25 percent of the projected total adult population) will have

doctor-diagnosed arthritis, compared with 52.5 million adults in 2010-2012.

Diving deeperThe most prevalent OA localisation is the knee joint, and symptomatic knee OA (KOA) affects

nearly one-quarter of the general population.

Different risk factors for the development of OA have been described as:

• general, unmodifiable risk factors (age, sex, genetic makeup),

• modifiable risk factors (obesity and hormonal factors), and

• local risk factors (prior joint anomalies and joint overload).

Notable among the main factors related to disease progression are joint alignment defects

and generalised OA.

A joint is considered a single organ, a functional unit composed of different tissues—mainly

cartilage, synovial membrane and subchondral bone—all involved in the etiopathogenesis of

osteoarthritis. OA has three fundamental manifestations: synovitis, destruction of the cartilage

and alterations in the subchondral bone (bone remodelling with subchondral sclerosis,

osteoarthritis and focal osteonecrosis).

At the level of the cartilage, a reduction in the number of chondrocytes is observed, mainly

by apoptosis (programmed cell death), which would be involved in different cellular mediators

present in excess in the affected joint, such as nitric oxide (NO), interleukin 1-beta (IL-1b) and

factor of tumor necrosis alpha (TNFα). These mediators can activate a series of proteolytic

proenzymes from the group of proteases, which contribute to the degradation of the

extracellular matrix of the cartilage, causing its progressive destruction.viii

There is also a component of synovial membrane inflammation in OA, caused by mechanical

overload of the joint and the presence of cartilage-degrading products. Throughout the

inflammatory process, released biochemical mediators have a destructive effect on the cartilage.

The subchondral bone generally increases in mineralisation along with the thickening of

subchondral tissues, and the appearance of bone spurs (growths along bone margins).ix

Beyond symptom managementUntil now, the management of OA has consisted mostly of symptom management—

essentially, reduction of pain and improvement of joint function—which relies on the

combination of pharmacological and non-pharmacological approaches, as has been proposed

by the main published guidelines. Although important, the control of symptoms is not the only

goal for OA patients. The ideal treatment for OA should preserve the joint structures, keeping

in mind the improvement in the quality of life of patients, and exhibit a good safety profile. It is

paramount to take into account the side effects due to the chronic use of OA therapies, such

as non-steroidal anti-inflammatory drugs (NSAIDs).ii

Osteoarthritis



To treat the symptoms caused by OA, there are a number of medications ranging from

fast-acting analgesics, NSAIDs and corticosteroids, to opioids. All medications quickly improve

painful symptoms, but none are capable of modifying the evolution of the disease since the

same symptoms reappear after the medication has been metabolised by the body. In addition,

none are completely free from safety concerns (gastrointestinal, cardiovascular, hepatic, renal)

and could cause problems in so far as interactions with other medications.ii

Historically, the lion’s share of OA research has been directed toward studies on the

metabolism to the joint’s three structures: cartilage, synovial membrane, and subchondral

bone. However, as it has been described, OA affects all structures of the joint, including not

only the abovementioned ones but also the meniscus, the ligaments, the joint capsule, and the

periarticular muscle, without systemic effects, and is clinically characterised by the presence of

pain and limitation of joint function, crepitus and possible spillage.

There are specific products for nourishing the affected joint tissue, such as tendons,

ligaments, muscles, the synovial membrane and the subchondral bone.

Focusing on the synovium, it is increasingly observed that some degree of synovitis may

appear even in early OA and may be evaluated on magnetic resonance imaging (MRI) or

ultrasonography. So, the inflammatory synovium could be considered as a potential predictive

factor of structural progression in OA. The ability to detect synovitis may therefore be clinically

useful for a better understanding of pathogenesis and, possibly, for predicting treatment

response. In addition, early detection of synovitis may allow specific targeting of treatments.

The quality of the synovial fluid can play an important role too. Hyaluronic acid (HA)

represents one of the main components of this synovial fluid and contributes to its elasticity

and viscosity. The HA concentration in normal synovial fluid decreases with age, and it is well

known that in osteoarthritic joints, synovial fluid contains a lower concentration and molecular

weight of HA than in healthy ones. Thus, HA seems to play an important role either in joint

function or OA treatment and prevention and for this reason, hyaluronans are used for the

viscosupplementation of joints.

Collagen behaviourIt is well described that cartilage degradation can also occur as a result of the body’s immune

response to endogenous type II collagen, which is the primary structural component of

cartilage tissue. Collagen hydrolysate (CH) as a food supplement has the potential to improve

joint comfort and function. Collagen itself is a natural component of the diet, found in animal

products, such as meat and fish. However, the absorption of orally-ingested collagen that has

Osteoarthritis

The control of symptoms is not the only goal in OA patients. The ideal treatment for OA should preserve the joint structures, keeping in mind the improvement in the quality of life of patients, and exhibit a good safety profile.



not been hydrolysed is poor. Collagen contains unique amino acids found in no other protein

(namely hydroxyproline and hydroxylysine). The use of CH, therefore, provides amino acids

specific to the collagen network, which could help to maintain the structure and function of

joint cartilage, thus improving joint comfort in a safe and efficacious manner.

CH has been shown in vitro to significantly increase biosynthesis of type II collagen in

chondrocytes in bovine and human cell cultures. Moreover, CH has been shown in vitro to

significantly increase biosynthesis of proteoglycans in chondrocytes in humans.lxix

There have also been several reports that a daily intake of 10 g/d CH for 60 days or longer

resulted in reduced pain in patients with OA of the hip or knee. This effect is due to a specific effect

of CH on joint tissues, since it is unlikely to have any analgesic or anti-inflammatory effects.lxix

Recently though, a more innovative collagen solution has gained popularity: native (non-

denatured) type II collagen. Native collagen differs from hydrolysed collagen in that it maintains

its three-dimensional structure that it would naturally have if endogenous, meaning that it

preserves the biologically active form of the molecule. This bioactive form of type II collagen acts

by curbing the body’s immune response to endogenous type ll collagen in the joint cartilage,

which is a totally different mechanism of action compared to the hydrolysed collagen. And

thanks to this, the native form shows activity at far lower doses than hydrolysed collagen.

This characteristic, immune-mediated, mechanism of action of the native type II collagen is

called oral tolerancexx-xxix and it comprises of a diminished immune response against

endogenous type II collagen: when orally taken, native type II collagen is recognised by the

immune system as an endogenous substance, blocking attacks from immune cells present in

the joint against endogenous type II collagen. Considering this mechanism of action, native

type II collagen may have positive effects on inflammation and degradation in joint diseases at

a very low dosage of only 40mg a day.lxxxi

Tough tendonsAnd finally, the importance of tendon health should be mentioned, as the tendon provides

structural support for proper joint function. Tendons are connective tissues principally made up

of type I collagen and specialised cells, called tenocytes. A tendon is a band of connective

tissue that connects muscle to bone and is capable of withstanding tension. Affectations of the

tendon are called tendinopathies, and can be caused by different factors (quick or sudden

movements, tendon overload, certain repetitive daily movements), and the main symptoms are

pain, inflammation and difficulty moving. Tendinopathies are the most common soft tissue

disorders. It is estimated that they affect the sedentary population and athletes.

The incidence of tendon injuries has increased substantially during the last few decades. It is

estimated tendon injuries account for one-third to half of all sports-related injuries. For some

years now, physical activity and participation in sports has been on a dramatic incline. More

people are making an effort to adopt a more active lifestyle as a means to stay healthy.

However, with the rise of the trend, joint problems have been more prevalent, and consumers

are looking for new solutions to maintain healthy joints and improve mobility. It is for this

reason that joint health must continue to be researched to find new ingredients, products, and

applications to respond to the population’s growing need.

Jose Antonio Lopez Sanchez is product manager, Human Health, at Bioiberica SAU.

Osteoarthritis



References

i. Kraus VB, et al. Call for standardized definitions of osteoarthritis and risk stratification for clinical trials and clinical use. Osteoarthritis Cartilage. 2015 Aug;23(8):1233-41

ii. Henrotin Y, et al. What is the current status of chondroitin sulfate and glucosamine for the treatment of knee osteoarthritis?. Maturitas. 2014 Jul;78(3):184-7.

iii. Bruyère O, et al. A consensus statement on the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) algorithm for the management of knee osteoarthritis-From evidence-based medicine to the real-life setting. Semin Arthritis Rheum. 2016 Feb;45(4 Suppl):S3-11.

iv. Background Paper 6.12 Osteoarthritis. January 28th 2013. http://www.who.int/medicines/areas/priority_medicines/BP6_12Osteo.pdf

v. Osteoarthritis: A Serious Disease, Submitted to the U.S. Food and Drug Administration December 1, 2016. https://www.oarsi.org/sites/default/files/docs/2016/oarsi_white_paper_oa_serious_disease_121416_1.pdf

vi. Pereira D, et al. The effect of osteoarthritis definition on prevalence and incidence estimates: a systematic review. Osteoarthr Cartilage. 2011; 19(11):1270-1285.

vii. Felson DT, et al. Osteoarthritis: new insights. Part 1: the disease and its risk factors. Ann Intern Med. 2000;133:635-46

viii. Monfort J, et al. Biochemical basis of the effect of chondroitin sulfate on osteoarthritis articular tissues. Ann Rheum Dis. 2008;67: 735-40.

ix. Hunter DJ, et al. Osteoarthritis. BMJ. 2006;332:639-42

x. Benito MJ, et al. Synovial tissue inflammation in early and late osteoarthritis. Ann Rheum Dis 2005; 64:1263-1267.

xi. Loeuille D, et al. Macroscopic and microscopic features of synovial membrane inflammation in the osteoarthritic knee. Arthritis Rheum 2005; 11:3492–3501

xii. Kumm J, et al. Association between ultrasonographic findings and bone/cartilage biomarkers in patients with early-stage knee osteoarthritis. Calcif Tissue Int 2009; 85:514-22.

xiii. Ayral X, et al. Synovitis: a potential predictive factor of structural progression of medial tibiofemoral knee osteoarthritis – results of a 1 year longitudinal arthroscopic study in 422 patients. Osteoarthritis Cartilage 2005; 13:361-67.

xiv. Conhagan P, et al. Burmester G, Schmidely N, Emery P, Dougados M. EULAR report on the use of ultrasonography in painful knee osteoarthritis. Part 2: Exploring decision rules for clinical utility. Ann Rheum Dis 2005; 64:1710-14.

xv. Haq I, et al. Osteoarthritis. Postgrad Med J 2003; 79:377-383.

xvi. Abramson SB, et al. Developments in the scientific understanding of osteoarthritis. Arthritis Res Ther 2009; 11:227-35.

xvii. Bauer DC, et al. Osteoarthritis Biomarkers Network: Classification of osteoarthritis biomarkers: a proposed approach. Osteoarthritis Cartilage 2006; 14:723-27.

xviii. Kandahari AM, et al. Recognition of Immune Response for the Early Diagnosis and Treatment of Osteoarthritis. J Immunol Res. 2015;2015:192415.

xix. Benito-Ruiz P, et al. A randomized controlled trial on the efficacy and safety of a food ingredient, collagen hydrolysate, for improving joint comfort. Int J Food Sci Nutr. 2009;60 Suppl 2:99-113.

xx. Barnett ML, et al. Treatment of rheumatoid arthritis with oral type II collagen. Results of a multicenter, doubleblind, placebo-controlled trial. Arthritis Rheum 1998; 41: 290-7.

xxi. Ausar S, et al. Treatment of rheumatoid arthritis by oral administration of bovine tracheal type II collagen. Rheumat Internat 2001; 20: 138-44.

xxii. Wei W, et al. A multicenter, double-blind, randomized, controlled phase III Clinical trial of chicken type II collagen in rheumatoid arthritis. Arthritis Res Ther 2009; 11: 180.

xxiii. Gupta RC, et al. Therapeutic efficacy of undenatured type-II collagen (UC-II) in comparison to glucosamine and chondroitin in arthritic horses. J Vet Pharmacol Ther 2009; 32: 577-84.

xxiv. Deparle LA, et al. Efficacy and safety of glycosylated undenatured type-II (UC-II) collagen in therapy of arthritic dogs. J Vet Pharmacol Ther 2005; 28: 385-90.

xxv. Mannelli LDC, et al. Low dose native type II collagen prevents pain in a rat osteoarthritis model. BMC Musculoskelet Disord 2013; 14: 228.

xxvi. Crowley DC, et al. Safety and efficacy of undenatured type II collagen in the treatment of osteoarthritis of the knee: a clinical trial. Int J Med Sci 2009; 6: 312-21.

xxvii. Scarpellini M, et al. Biomarkers, type II collagen, glucosamine and chondroitin sulfate in osteoarthritis follow-up: the ‘‘Magenta osteoarthritis study’’. J Orthopaed Traumatol 2008; 9: 81-7.

xxviii. Mannelli et al. Low dose chicken native type ii collagen is active in a ratmodel of osteoarthritis. Ost International. (2015)26;S1: P184.

xxix. Park KS, et al. Type II collagen oral tolerance; mechanism and role in collagen-induced arthritis and rheumatoid arthritis. Mod Rheumatol. 2009;19(6):581-9.

xxx. Magra M, et al. Genetics: does it play a role in tendinopathy?. Clin J Sport Med 2007; 17:231-3.

xxxi. Gross MT. Chronic tendonitis: pathomechanics of injury, factors affecting the healing response, and treatment. J Orthop Sports Phys Ther1992;16:248-61

Osteoarthritis


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Reward

Learning

Goal

Achievement

Skill

Gamification

I In 2012, the French national epidemiological survey OBEPI on overweight and obesity showed

that the way we eat is directly related to the risks of certain nutritional pathologies. Indeed,

this study shows, for instance, that the frequency of cardiovascular complications increases

significantly with the body mass index (BMI) of individuals—with 31.7% of obese individuals

having at least one cardiovascular problem, and seven times more diabetic individuals treated

in cases of declared obesity.1 Moreover, a recent study by the French National Institute of

Health and Medical research, INSERM, shows nearly one out of two French people is

overweight, and that global obesity is now approaching 16% of the population.2

Game onIt is therefore obvious that more public health nutritional interventions are needed to raise

public awareness about better eating habits and to prevent the risks related to nutritional

diseases in a more relevant way. It is in this context that a global nutrition policy has been

developed in France over the last 15 years, with the creation of the ‘Programme National

Nutrition Santé’ (PNNS). Despite a few encouraging results during the program, the last

evaluation of the PNNS 3 (2011-2015) revealed it needed more engagement and use of new

disruptive tools such as games or social media, in a more collective manner.3 It is in this context of

questioning and searching for new promising solutions for nutritional education that the science

of gamification and serious gaming comes into play, by postulating that a playful and social

approach would be more motivating and sustainable to change eating behaviours positively.

Gamification and serious gaming science: A promising strategy for family nutrition and education? by François Barbet, Grégory Dubourg, Didier Paquelin et Isabel Urdapilleta

IN THIS ISSUE Osteoarthritis p.5 Astaxanthin p.17 Table of Contents p.2



Despite a well-developed national nutritional policy in France, and a growing offer of tools

dedicated to the nutrition education and improved eating markets, it still seems very difficult to

change eating behaviours in an effective and sustainable way. Indeed, eating behaviours are

complex concepts to deal with, due to all the determinants that model and influence them.

Previously, literature tended to explain our behaviours and processes of change of eating

behaviours through a supporting theory that only a consumer can maintain control over his or

her decisions and choices of behavior.4 Lahlou explains it is difficult to move away from this

primitive model, but that basic human will is, however, only a determinant among so many

others and is not enough to explain eating behaviours by itself. According to this respected

author, it is well known that our eating behaviours are influenced by different techno-

economic, psychological and social underlying determinants. Indeed, consumers meet many

material constraints modeling their behavioural routines, along with cognitive bias determining

their own food representations, and various environmental and social spheres directly

influencing their behaviours. To try changing eating behaviours without considering all these

aspects and underlying determinants can be ineffective in the context of a nutrition education

intervention. Based on these observations, it is thus important to understand, above all, the

nature of a nutrition education intervention and the many determinants that make it an

effective, captivating and sustainable action to positively change eating behaviours. Literature

and previous experiments show interventions based only on the transmission of knowledge

about nutrition are not enough to generate eating behaviour change for targeted populations.

So, what does nutrition education need to go beyond a basic educational approach and speak

about impactful and engaging interventions?

Breaking it downContemporary nutrition education can now be judiciously defined as a combination of

educational strategies and environmental support to facilitate healthy eating behaviours and

food choices.5 To be effective and sustainable, nutrition education must essentially consist of

three fundamental elements:

• A motivational phase (aiming at increase individual motivation to act).

• An action phase (aiming at facilitating ability to act).

• An environmental component (aiming at supporting the two previous elements, especially the action phase).

Contento brilliantly exposes the main key elements of success facilitating an effective

nutrition education intervention:

• Focusing the intervention on the process of behavioural change.

• Identifying and addressing precise intermediate behavioural determinants.

• Relying on behavioural theories according to objectives of change.

• Addressing multiple levels for the intervention (individual or collective).

• Using interventional tools and strategies directly based from theories.

Among these key factors, it is particularly important to focus a nutrition education intervention

design on the intermediate determinants that influence and model change in eating behaviour.

Some are characterised as modifiable, such as food accessibility, or weakly modifiable, such as

Gamification



the socio-economic situation or the level of education of individuals. It can be distinguished

biological or physiological factors (other determinants related directly to people and their

interactions), or factors from the environmental and social spheres as well.

Many different and complementary behavioural theories have addressed these underlying

constructs, determining the shift from inaction to intention, and vice versa. In nutrition

education interventions, some theories can be applied to address the motivational phase on

the one hand or the action phase on the other. However, it is essential to underline that any

intervention that neglects an effective motivational phase would be doomed to failure. But

how could the motivation and engagement of individuals be effectively enhanced in the

context of a nutrition education approach? That is precisely the reason why the hypothesis of

using gaming and gamification sciences as motivational strategies for nutritional education

seems relevant for this purpose. Indeed, it is important to remember that playing remains one

of the first socialisation means of humanity, and remains useful in many aspects of our lives.

Playful interaction is one of the very first natural vectors for learning that we experience from

birth.6 But why do people attach so much importance to games? Why does playing represent

such a vast field of possibilities in terms of people’s engagement? How could a gamification

approach be reconciled with effective nutrition education interventions? There are many

questions that gaming sciences could answer in a promising way.

Why do we respond to games? Gamification can be defined as the integration of concepts and constructs directly from

game mechanics into a neutral activity or non-playful objective such as nutrition education.

Among these elements, we find at the same time basic elements of any game like point

scoring, badges, results, leaderboards, scenarios, avatars and teammates.7 Certain authors also

identified fundamental concepts and intrapersonal values, such as the sense of achievement,

or self-efficacy.8 It is precisely these complementary elements that are essential in the process of

gamification because they are key components of motivational theories as well. For instance,

among these motivational concepts there is the self-determination theory, based on the basic

psychological needs of competence, autonomy and relatedness that would allow the

behavioural engagement of individuals.9

Competence refers to the feelings of efficacy and control experienced during the

achievement of an activity or task. This inner feeling relates to that of being able to perform an

action or task. This concept is, in a way, very close to the concept of self-efficacy—often

addressed in behavioural change literature and nutrition education science.

Gamification

It is particularly important to focus a nutrition education intervention design on the intermediate determinants that influence and model change in eating behaviour.



As for the need for autonomy, it is essential and central in this theory: it refers to the feeling

of one being responsible for one’s own actions and accomplishing them either for personal

interest, or because these actions are in accordance with their intrapersonal values.

Finally, the need for relatedness translates as a feeling of being connected to others in a

certain way—of being part of an entity, or a group, agreeably gathered around an activity or a

cause. Thus, the previous set of gamification concepts could perfectly reinforce these basic

human psychological needs. Points and badges would, for instance, show the player that he or

she is gaining skill. The immersion of a scenario or the personalisation of an avatar will

reinforce the feeling of autonomy and self-realisation in an individual. All the other players in

the community will give the player that much-needed sense of relatedness and belonging.

In light of these theoretical observations, it seems more than relevant to consider gaming

strategies as a motivational vector to engage consumers in a process of positive eating

behavioural change. Underlying the concept of general gamification, the use of serious

gaming, and other videogaming devices represent great potential for nutrition education as

well. Unlike a basic gamification approach, serious games are exclusively developed towards

serious objectives, such as educational or behavioural purposes. Although there is still much

supporting research to be done in this area, some previous studies and serious games have

already shown encouraging results in terms of nutrition education and eating behaviour

change.10 Indeed, the Squire’s Quest! serious game, a playful program consisting of 10 sessions

and five weeks of multimedia games, showed an increase in children’s consumption of fruits

and vegetables, with one serving per day by the end of the intervention—although the total

consumption remained below the five daily servings recommended by the national nutritional

policy. This game focuses on the acting phase and the Implementation Intention Theory and

the setting of personalised objectives among other behavioural models.

Watch this spaceMuch work needs to be done in this promising research field to understand how to

develop effective interventions in nutrition education science with specific mechanics from

the world of games better. This is essentially the academic purpose of the whole research

program initiated by the French consulting agency, NUTRIKEO, since 2015 with the

development of the KOAM Initiative, in partnership with Bordeaux Montaigne and Paris 8

University. This unique and innovative research program aims at studying the impact of a global

nutrition education intervention at family level—based entirely on theoretical concepts from

serious gaming and gamification sciences, first focusing on motivational processes specific to

consumer behavioural changes. The original version of the program consisted of an online

platform, nutrition serious games for children and teenagers, a coaching mobile application for

parents, and a global family rewarding system. The KOAM Initiative programme will soon

conduct a three-month interventional pilot study to evaluate the impact of using gamification

elements through serious games and mobile applications on eating behaviour change and

different food behaviour determinants. This information will be gathered from behaviour

change theories such as perceived risks, benefits and barriers, subjective norms or self-efficacy.

Gamification


http://www.nutrikeo.com

http://www.koam.fr/


The main purpose of this study is to assess whether gamification and family inter-personal

influence could enhance individual motivation towards positive and sustainable eating

behaviour change, according to national nutritional recommendations. All measures will be

performed through quantitative questionnaires, family logbooks, 24-hour recalls, and online

focus groups with a dietician. This research is the very first nutrition education intervention

assessing the impact of both gamification motivational factors and family inter-personal

influence on motivation and intention of eating behaviour change. This study will provide

precursory outcomes to assess the game design, the theoretical model or benefits and pitfalls

of the nutrition education approach and technical developments from the KOAM Initiative. The

development and assessment of the KOAM Initiative is part of a doctoral program supported

by Bordeaux Montaigne and Paris 8 University.

François Barbet and Didier Paquelin: Université Bordeaux Montaigne, Laboratoire Média – Information – Communication – Art (MICA), Maison des Sciences de l’Homme d’Aquitaine, Pessac, France Grégory Dubourg: Nutrikéo Consulting, Agence de Conseil en Stratégies Nutrition, Pessac, France Isabel Urdapilleta: Université Paris 8, Laboratoire Parisien de Psychologie Sociale (LAPPS), ED 224 : Cogni-tion - Langage - Interaction, Paris, France

References

1. INSERM, KANTAR HEALTH, ROCHE. ObéEpi 2012 : Enquête épidémiologique nationale sur le surpoids et l’obésité. 2012.

2. INSERM. L’excès de poids des Français confirmé par la cohorte Constances [Internet]. Salle de presse | Inserm. 2016 [cited 2018 Jul 9]. Available from: https://presse.inserm.fr/lexces-de-poids-des-francais-confirme-par-la-cohorte-constances/25515/

3. IGAS. Evaluation du programme national nutrition santé 2011-2015 et 2016 (PNNS 3) et du plan obésité 2010-2013. 2016 Jul p. 151. Report No.: 2016-020R.

4. Lahlou S. Penser manger: alimentation et représentations sociales. 1re éd. Paris: Presses universitaires de France; 1998. 239 p. (Psychologie sociale).

5. Contento IR. Nutrition education: linking research, theory, and practice. Asia Pac J Clin Nutr. 2008;17 Suppl 1:176–9.

6. Alvarez J, Djaouti D, Rampnoux O. Apprendre avec les serious games ? Futuroscope, France: Canopé Éditions; 2016. 126 p.

7. Sailer M, Hense JU, Mayr SK, Mandl H. How gamification motivates: An experimental study of the effects of specific game design elements on psychological need satisfaction. Computers in Human Behavior. 2017 Apr;69:371–80.

8. Chou Y-K. Actionable gamification: beyond points, badges, and leaderboards. Fremont, CA: Octalysis Media; 2016. 499 p.

9. Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000 Jan;55(1):68–78.

10. Thompson D, Bhatt R, Lazarus M, Cullen K, Baranowski J, Baranowski T. A Serious Video Game to Increase Fruit and Vegetable Consumption Among Elementary Aged Youth (Squire’s Quest! II): Rationale, Design, and Methods. JMIR Res Protoc. 2012 Nov 21;1(2):e19.

Gamification


https://presse.inserm.fr/lexces-de-poids-des-francais-confirme-par-la-cohorte-constances/25515/

http://atlantiafoodclinicaltrials.com/


IN THIS ISSUE Gamification p.11 Vitamin K2 p.22 Table of Contents p.2

Astaxanthin

NNearly all countries are experiencing significant growth in the senior population, which is

projected to accelerate in the coming decades. According to the United Nations, one in eight

people worldwide was aged 60 years or over in 2015. By 2030, older individuals are projected

to account for one in six people globally, and this will jump to one in every five by 2050.1 This

trend is boosting demand for healthy ageing supplements as these populations seek preventive

strategies and nutritional supplementation to live longer, healthier lives.

What is ROS?Reactive oxygen species (ROS) is a collective term that includes not only oxygen-centered free

radicals, but also some non-radical derivatives of oxygen. ROS, otherwise known as pro-

oxidants, are formed as by-products of normal metabolism in our body when food is converted

into energy.2 Immune cells fighting bacterial infections also release ROS.3 Additionally, lifestyle

and environmental factors such as pollutants, smoke, stress, sedentary lifestyle, extreme

exercise, and the use of certain medications can all contribute to an excess of ROS.4

Oxidative stressA diverse range of oxygen-free radicals and other ROS can be formed in the human body.

The interplay between ROS and antioxidants is critical in maintaining good health. If the ROS

generated exceeds the protective effects of antioxidants, it can cause oxidative stress. In a

normal healthy human body, the generation of ROS and other free radicals is kept in check

through antioxidant defenses. However, when the body is exposed to adverse physicochemical,

environmental or pathological stressors, this delicate balance is shifted in favor of pro-oxidants,

and results in oxidative stress. Oxidative stress occurs when more ROS are generated than the

body’s natural defenses can counteract, which can damage cells, lipids, proteins and DNA.

From a biological point of view, ageing involves the accumulation of oxidative damage in

cells and tissues. Younger people are naturally better protected from free radicals and other

ROS through balanced activity of the mitochondria, efficient antioxidant and DNA repair

systems, and active protein degradation machinery. Ageing, on the other hand, is generally

Healthy ageing support with astaxanthinby Tryggvi Stefansson

Normal cell Free radicalsattacking cell

Cell withoxidative stress



Astaxanthin

accompanied by mitochondrial dysfunction leading to increased free radical production that, in

turn, leads to an overloading of the defense systems and oxidative damage of cellular

components.5 Oxidative stress and an imbalance of pro-oxidants and antioxidants can impact

several health issues such as oxidation of blood lipids (cholesterol and triglyceride), increased

risk of heart disease, cognitive decline, joint pain and stiffness, granular pigment accumulation

in retinal vessels, loss of skin elasticity, and thinning of skin layers, etc.

The ageing process is accompanied by numerous heath challenges, which vary from

individual to individual due to a number of factors, including genetics, lifestyle choices,

environmental factors, and life events—to name a few. Balanced nutrition is a key lifestyle

factor that helps support general wellness. Antioxidants are natural substances that help to

prevent the harmful effects of excessive ROS activity, and combat or delay cell damage.

Avoiding an excess of ROS, adopting a healthy lifestyle, and introducing astaxanthin into the

diet, can help to prevent oxidative stress.

How astaxanthin helps Natural astaxanthin belongs to a family of naturally-occurring organic pigments called

carotenoids. There are over 600 known carotenoids, such as lycopene, lutein, and β-carotene.

They are responsible for the bright red, yellow and orange colours found in many fruits and

vegetables. Natural astaxanthin is the main carotenoid in aquatic animals such as shrimp,

lobster, salmon, trout, and red seabream. It contributes to the pinkish-red color of their flesh.

Natural astaxanthin is also found in some birds such as the flamingo. Synthetic astaxanthin can

be produced by chemical synthesis using petrochemicals. Natural astaxanthin has been

extensively studied and has a breadth of science around its efficacy, safety and chemical

assembly, including isomers and esterification.

Although astaxanthin has a long history of use in the human diet as a naturally occurring

component of seafood, most people do not consume enough of it in their diet. For instance,

the US population consumes only two to three pounds of wild and farmed salmon per year,

with an estimated astaxanthin intake of 0.029 mg/d.6 This is about 200 times less astaxanthin

than the documented dose for health benefits, which ranges from 2 mg to 12 mg.7-13 The

microalgae, Haematococcus pluvialis, synthesises the highest amount of natural astaxanthin in

nature, which makes it an optimal choice for commercial production of natural astaxanthin.

Dry meal of Haematococcus pluvialis has been marketed as a dietary supplement in the United

States since at least 1999.8 There is enough scientific evidence, including human and animal

data, to support the safety of natural astaxanthin.15-18

Research continues to show natural astaxanthin is one of the most potent antioxidants

available. Studies demonstrate that when it comes to trapping energy from singlet oxygen—

one of the most common ROS found in the body—natural astaxanthin is 6,000 times more

powerful than vitamin C, 770 times more than coenzyme Q10 (CoQ10), 100 times more

powerful than vitamin E, and five times more powerful than β-carotene.9

Figure 1: Natural astaxanthin in comparison to other antioxidants. Natural astaxanthin is more powerful than other antioxidants in trapping energy from singlet oxygen19-20

Vitamin C CoenzymeQ10

Vitamin E SyntheticAstaxanthin

B-Carotene Lutein Lycopene

770x6,000x 100x 55x 5x 3x 2x



Cell exterior

Bi-layerMembrane

Cytoplasm

Fatty acidstrails

(hydrophobic)

Phospholipids(Hydrophilic)

Astaxanthin

Vitamin C

β-carotene

Astaxanthin

The antioxidant properties of various antioxidants in vivo are strongly influenced by how they

interact with the membrane bilayer, their orientation, and location within the membrane.

Nonpolar carotenoids (such as β-carotene and lycopene) are located between membrane

bilayers and therefore may disrupt the intermolecular packing of the phospholipid

molecules.10-11 In contrast, polar astaxanthin spans the membrane with its polar end groups

extending toward the head group regions of the membrane bilayer. Astaxanthin position does

not modify the structure of constituent membrane lipids (Figure 2).12, 22 As a result, astaxanthin

acts as a chain-breaking antioxidant by stopping free radical chain reactions and scavenging

lipid peroxyl radicals. Furthermore, since astaxanthin spans the cell membrane bilayer, its

terminal rings can effectively scavenge ROS on the membrane surface, while its polyene chain

is responsible for trapping ROS in the interior of the membrane.22

Figure 2: Astaxanthin orients into optimal hydrophilic and hydrophobic position within cell membrane and acts as a chain-breaking antioxidant. Since astaxanthin spans the cell membrane bilayer, it can effectively scavenge ROS at the membrane surface as well as in the interior of the membrane

Astaxanthin advantagesAstaxanthin can use different methods to prevent oxidative stress. Astaxanthin counteracts

potentially harmful free radicals/ROS by trapping energy (quenching) and the transfer of

electrons, or through hydrogen abstraction (scavenging).19,21,12-14 Energy from the high-energy

ROS compounds can be transferred to astaxanthin by direct contact, and that energy is

converted to heat.21 In this process of quenching, astaxanthin remains intact so it can undergo

further cycles of singlet oxygen quenching. Singlet molecular oxygen is a strong pro-oxidant

that displays substantial reactivity towards DNA, proteins, and lipids.13

Natural astaxanthin is a highly potent scavenger of ROS, and thereby a valuable ingredient

for healthy ageing formulations. Numerous studies back astaxanthin supplementation for

supporting an active, healthy lifestyle regardless of age.



Astaxanthin

Astaxanthin supports cardiovascular health by improving blood lipid profiles. It also has a

protective effect against cholesterol and triglyceride oxidation.9-10,13 Natural astaxanthin helps

boost energy delivery, and in turn, helps the heart muscle contract strongly and efficiently.14

When it comes to skin health, human studies show that 6 mg/d of astaxanthin for six to eight

weeks may reduce wrinkles, water loss, and age spots.15 Astaxanthin also improves the

elasticity, moisture content and texture of the skin, and the effects seem to be enhanced when

combined with the application of astaxanthin topically.16 Astaxanthin supports normal healthy

skin by improving skin elasticity and moisture, and reducing wrinkle formation.16

One study demonstrated that daily astaxanthin supplementation improved cognitive health

and learning scores in healthy middle-aged and elderly subjects with age-related

forgetfulness.17 Another human trial suggested that astaxanthin may help protect against

age-related cognitive decline.18

Studies of individuals with age-related macular degeneration have demonstrated

significant improvements in retinal health when given astaxanthin and other carotenoids.19

Astaxanthin helps support eye health by reducing oxidative damage and improving blood

flow in capillaries.20,21

A growing body of clinically-validated evidence indicates the benefits of natural astaxanthin

for a range of target groups—from young, highly-trained athletes with increased ROS

production, to healthy middle-aged and senior subjects with weakened antioxidant defense

activity. Astaxanthin is a valuable functional ingredient that supports normal immunity, heart,

eye, joint, and skin health—expanding our healthy ageing options throughout life.

Health and wellbeing in older age are shaped by events, lifestyle choices, and

environmental factors throughout the lifespan.22 For instance, cardiovascular disease, high

blood pressure, and diabetes typically occur in individuals with an unhealthy diet and/or

sedentary lifestyle beginning early in life. Therefore, concerns regarding healthy ageing must

be addressed throughout life, and it is never too late to start supplementing with a powerful

antioxidant like astaxanthin.

Tryggvi Stefánsson, Ph.D., is the science manager at Algalif

Astaxanthin counteracts potentially harmful free radicals/ROS by trapping energy (quenching) and the transfer of electrons, or through hydrogen abstraction



Astaxanthin

References:

1. United Nations, World Population Prospects: The 2015 Revision, 2015, available at: https://esa.un.org/unpd/wpp/Publications/Files/Key_Findings_WPP_2015.pdf

2. Valko, M., D. Leibfritz, J. Moncol, et al., The InternationalJournal of Biochemistry & Cell Biology, 2007. 39, 44-84.

3. Belikov, A.V., B. Schraven and L. Simeoni, J Biomed Sci, 2015. 22, 85.

4. Krumova, K. and G. Cosa, Singlet Oxygen: Applications in Biosciences and Nanosciences, 2016. 1, 1-21.

5. Shigenaga MK, Hagen TM, Ames BN, Proc Natl Acad Sci USA, 1994, 91:10771-8

6. FDA, FDA GRAS Notice (GRN) No. 580, 2016. 1-75.

7. Karppi, J., T.H. Rissanen, K. Nyyssonen, et al., Int J Vitam Nutr Res, 2007. 77, 3-11.

8. FDA, NDI Haematococcus pluvialis algae, 1999

9. Nishida, Yamashita, Miki. Carotenoid Science, 2007, 11, 16-20

10. McNulty, H., R.F. Jacob and R.P. Mason, American Journal of Cardiology, 2008. 101, S20-S29.

11. McNulty, H.P., J. Byun, S.F. Lockwood, et al., Biochim Biochys Acta, 2007. 1768,

12. Martinez, A., M.A. Rodriguez-Girones, A. Barbosa, et al., J Phys. Chem.A, 2008. 112, 9037-9042.

13. Cadet, J., T. Douki, J.-P. Pouget, et al., 2000, Academic Press

14. Nakao R et al, Anticancer Res, 2010, Jul;30(7):2721-5

15. Tominaga et al, Acta Biochim Pol, 2012 59:43-7

16. Yoon et al, J Med Food, 2014, 17(7): 810-816

17. Katagiri et al, Journal of Clinical Biochemistry and Nutrition, 2012, 51(2): 102-107

18. Satoh A et at, J Clin Biochem Nutr, 2009 May;44(3):280-4

19. Parisi V et al, Ophthalmology, 2008, Feb;115(2):324-33 e2

20. Saito et al, Graefes Arch Clin Exp Ophthalmol, 2012, 250:239-45

21. Hashimoto et al, J Clin Biochem Nutr. 2016, 59:10-5

22. Wassel, NC Medical Journal: Healthy Ageing, 2008, (69:5), available at: https://libres.uncg.edu/ir/uncg/f/J_Wassel_Healthy_2008.pdf



Vitamin K2

VVitamin K2: Vital nutrient for every stage of lifeby Jim Beakey

Vitamin K2—particularly menaquinione-7 (MK-7)—is vital for all people in all stages of life—

from conception to the retirement home. Boys and girls, men and women of all ages benefit

from K2 for different reasons at different stages. The bone health, heart health and circulatory

system benefits of vitamin K2 create dynamic opportunities for virtually all consumer types and

market categories. In fact, vitamin K2 plays a role in seven or eight top supplement categories,

as diverse as children’s health, sports nutrition and healthy ageing. Synergistic bone and heart

health benefits complement four of the top five selling ingredients: calcium, magnesium,

omega-3 and multivitamin blend. K2 and vitamin D3 also depend on each another for optimal

effect, widening commercial opportunity.

K2 is an essential fat-soluble vitamin, just like vitamins A, D, E and K1, and most diets are

K2-deficient. K2 is the necessary co-factor for the activation of osteocalcin, the proteins that

incorporate calcium into bone. K2 also activates matrix Gla proteins (MGP), which bind excess

calcium to prevent hardening of the arteries and circulatory system. MK-7 is the mediator of

calcium. Working with D3, vitamin K2 ensures that calcium goes to where it is helpful and

away from where it can be harmful. This is a lifelong process, with K2 balancing the body’s

changing requirements for calcium throughout the different stages of life. Vitamin K2 is an

essential and important nutrient, which offers unparalleled commercial opportunity as it makes

its way to mass markets and all consumer groups.

Men and women in late adulthood: active autumn yearsBone health, maintenance and prevention

Late adulthood (ages 40 to 60) is, in many ways, the ‘sweet-spot’ for vitamin K2’s bone and

heart health benefits. While K2 is integral to the process that incorporates calcium into the bone

matrix all through life, the effects of K2 deficiency become more apparent in late adulthood.

Bones undergo a natural cycle of disassembly and regeneration approximately every seven years.

Specialised cells called osteoblasts and osteoclasts build up and remove old bone. When we

are young, new bone is created faster than old bone is taken away. Peak bone mass is reached

around the age of 20, then levels off and maintains a more or less stable plateau. Around the

age of 40, however, the balance tips in favour of the cells that break down bone—old bone is

then removed faster than it is replaced, and bone mass begins to decrease. For men, this is

a steady decline. For women, the drop off is steeper and accelerated

by the hormonal effects of menopause.

Bones become more porous, brittle and weak. The risk for

fractures increases and the body’s ability to mend broken bones

decreases. Despite this, many of today’s 40 or 50-year-olds strive

IN THIS ISSUE Astaxanthin p.17 Takeaways p.28 Table of Contents p.2



to be as active as they were in their twenties. On the other side of the ledger,

a few decades of bad habits, such as smoking or drinking, can also affect

bone health—both cause calcium loss in bones. Finally, the risk of developing

bone-weakening diseases like osteopenia and osteoporosis increases during

the 40- to 60-year-old timeframe.

Vitamin K2 supplementation, along with calcium and vitamin D3, provides

‘bone insurance’ for late adulthood. Clinical studies demonstrate that vitamin

K2 supports bone growth1, reduces bone fracture risk2-3 and increases bone

mineral density compared to a control group.4 K2 MK-7 in late adulthood is

vital to support an active lifestyle and help prevent the development of more

serious bone conditions.

Heart health, maintenance and preventionCalcium requires balance and regulation in the body, and vitamin K2 is the

‘mediator of calcium.’ Too much calcium in the bloodstream, from diet or

supplementation, can be deposited in the cardiovascular system. Arteries and

vessels harden and lose flexibility, limiting their ability to expand outward. This

forces the heart to work harder to push blood through reduced-diameter

vessels, thereby increasing cardiovascular disease (CVD) risks. This calcification

builds over decades, affecting as many as one in three adults5, with the late adult years

marking a period of increased risk.

K2 also activates matrix Gla proteins (MGP), which bind excess calcium in blood to prevent

deposit in vessels and arteries. This action plays a preventive role in maintaining heart health.

Vitamin K2 can also reverse existing calcification and restore flexibility to vessels and arteries.6

K2 regulates calcium by transporting it to where it is needed (bones) and away from where it is

harmful (heart and blood vessels), reducing CDV risk factors and helping maintain wellness and

quality of life in late adulthood.

Other age 40+ benefitsVitamin K2 has shown other possible benefits relevant to the 40+ age group. K2 deficiency is

associated with lower testosterone7, and a study conducted on rats demonstrated a 58%

testosterone increase in blood and 88% increase in testes over a period of five weeks.8 Low

testosterone levels in men is considered a result of some age-related diseases. An association

between prostate cancer risk reduction and K2 has also been reported.9 K2 is also under

investigation for healthy skin, potentially as an anti-wrinkle agent. MGP activation may protect

the skin elastin fibres and the flexibility of small capillaries that supply blood to skin, allowing it

to remain supple for longer. K2 may also inhibit the mineralisation associated with varicose

veins10—both a health and a cosmetic issue for many. Finally, several lines of investigation

indicate that K2 may play a role in preserving health cognitive abilities and protecting the brain

from the damage associated with neurological diseases like Parkinson’s and Alzheimer’s.

K2 and the senior years: ages 60+Bone health: prevention of bone disease

Osteoporosis weakens bones, leaving them susceptible to fracture. Impact-related fractures

to the hip, wrist or spine are most common, but osteoporosis can leave bones so fragile that

even coughing can cause fractures. Bones begin to weaken when the rate of new bone

Vitamin K2

Normal

Osteoporosis



formation slows, and old bone is removed faster than it is replaced. This adjustment is natural,

occurs for all people, and results in a lower bone mineral density (BMD) over time. A critical

imbalance, however, leads to the onset of bone disease. Bone weakening begins decades

before the risk of clinical osteoporosis become apparent, and the pace accelerates markedly for

women over the age of 45.

Osteoporosis affects three times as many women than men and, within this group, women

have a higher fracture rate (40% for women vs 30% for men). Decreases in oestrogen levels at

menopause, as well as other genetic and environmental factors, put women at higher risk.

Women are more likely to cross the line from normal age-related bone weakening to disease

condition. Osteoporosis accounts for approximately 8.9 million fractures worldwide each

year—and incidents and related costs are rising. European healthcare costs for osteoporosis are

estimated to reach €47 billion per year by 2025.11 Greying populations will become

increasingly affected worldwide.

Japan, by exception, has lower rates of bone disease compared to western countries.3 This

has been attributed to higher K2 MK-7 content in diets.12 Japanese foods rich in MK-7 have

been correlated with a reduced risk of hip fracture in postmenopausal women2 and improved

BMD in elderly men.13 Another Japanese study showed that MK-7 reduced fracture risk for

both men and women.3

These Japanese studies on fracture risk are not the only evidence for MK-7’s bone health

benefits. A European study among women with osteopenia demonstrated that MK-7

preserved bone microarchitecture.14 Another study showed that daily supplementation of

MK-7 over three years (180μg) reduced declines in BMD and bone strength among post-

menopausal women.4 Although K2 is needed throughout life, much of the early research was

focused on at-risk populations. Now, over two decades of studies demonstrate the preventive

benefits of vitamin MK-7 in the fight against osteoporosis.

Heart health: the link between osteoporosis and CVDVitamin K2 regulates calcium in the body, directing it to where it is helpful and away from

where it can be harmful. Over time, K2 deficiency can manifest in the accumulation of excess

calcium in arteries and blood vessels in the form of calcium plaques. The circulatory

system becomes less flexible, causing the heart to work harder to pump blood

to where it is needed. Two of the leading causes of cardiovascular disease are

directly related to calcium build-up. Calcium, therefore, is a common factor

for both bone and heart health. It’s little surprise that studies demonstrate

associations between osteoporosis and CVD, and that the risk of one

may signify the risk of the other.15

Osteoporosis, for example, is correlated with the presence of calcium

deposits in blood vessels. Low BMD in postmenopausal women is also

linked to increased cardiovascular incident mortality. Vitamin K2’s duel

influence on calcium likely explains these associations. Calcium that is

not properly integrated into bones (through K2 osteocalcin activation) is

free for deposit into soft tissues and arteries. Supplementation with K2

solves this problem two ways: K2 helps integrate calcium into bones, and also

activates MGP to bind excess calcium to prevent deposit.

Vitamin K2



Studies have shown that high levels of non-activated MGP are correlated with lower CVD

survival rates16, and that K2 supplementation increases activated MGP levels.17 An important

population-based study also demonstrated a 50% reduction in arterial calcification and

cardiovascular death, and a 25% reduction in all-cause mortality associated with K2 intake.18

Another study found a 9% reduced risk for CVD for every 10µg K2 increase.19 A 2015 study

demonstrates that MK-7 can even reverse existing calcification, restoring arteries and vessels to

a previous stage of health.6

Though the visible signs of osteoporosis and calcium-related CVD may only manifest in later years,

they develop over decades and there is a relationship between the two. Supplementation of

vitamin K2 helps preserve BMD, prevents calcium build-up in arteries, and reverses existing

calcification – ensuring health and longevity in the senior years.

The healthy ageing opportunityThe essential bone, heart and circulatory system benefits of vitamin K2/MK-7 create dynamic

commercial opportunities for product upgrade and extension for virtually all consumer types

and market categories. Vitamin K2 complements many top-selling ingredients, and most diets

are K2-deficient. Companies can therefore develop products that will transition along with

consumers from one life stage to the next, ensuring healthy bones, a healthy heart and the

pursuit of an active, fulfilling life.

Jim Beakey has been promoting the bone and heart health benefits of Kappa Bioscience’s K2VITAL® vitamin K2 MK-7 for several years. Before that, Jim had a long career in research-based business consulting—primarily for the healthcare and pharmaceutical industries.

Vitamin K2



References

1. Huang, Z.B., et al., Does vitamin K2 play a role in the prevention and treatment of osteoporosis for postmenopausal women: a meta-analysis of randomized controlled trials. Osteoporos Int, 2015. 26(3): p. 1175-86.

2. Kaneki, M., et al., Japanese fermented soybean food as the major determinant of the large geographic difference in circulating levels of vitamin K2: possible implications for hip-fracture risk. Nutrition, 2001. 17(4): p. 315-21.

3. Yaegashi, Y., et al., Association of hip fracture incidence and intake of calcium, magnesium, vitamin D, and vitamin K. Eur J Epidemiol, 2008. 23(3): p. 219-25.

4. Knapen, M.H., et al., Three-year low-dose menaquinone-7 supplementation helps decrease bone loss in healthy postmenopausal women. Osteoporos Int, 2013. 24(9): p. 2499-507.

5. Rocha-Singh KJ, Zeller T, Jaff MR. Peripheral arterial calcification: prevalence, mechanism, detection, and clinical implications. Catheter Cardiovasc Interv. 2014;83(6):E212-20.

6. Knapen, M.H., et al., Menaquinone-7 supplementation improves arterial stiffness in healthy postmenopausal women. A double-blind randomised clinical trial. Thromb Haemost, 2015. 113(5): p. 1135-44.

7. Shirakawa, H., et al., Vitamin K deficiency reduces testosterone production in the testis through down-regulation of the Cyp11a a cholesterol side chain cleavage enzyme in rats. Biochim Biophys Acta, 2006. 1760(10): p. 1482-8.

8. Ito, A., et al., Menaquinone-4 enhances testosterone production in rats and testis-derived tumor cells. Lipids Health Dis, 2011. 10: p. 158.

9. Nimptsch, K., et al., Dietary vitamin K intake in relation to cancer incidence and mortality: results from the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Heidelberg). Am J Clin Nutr, 2010. 91(5): p. 1348-58.

10. Cario-Toumaniantz, C., et al., Identification of differentially expressed genes in human varicose veins: involvement of matrix gla protein in extracellular matrix remodeling. J Vasc Res, 2007. 44(6): p. 444-59.

11. Hernlund, E., et al., Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos, 2013. 8: p. 136.

12. Iwamoto, J., T. Takeda, and S. Ichimura, Treatment with vitamin D3 and/or vitamin K2 for postmenopausal osteoporosis. Keio J Med, 2003. 52(3): p. 147-50.

13. Fujita, Y., et al., Association between vitamin K intake from fermented soybeans, natto, and bone mineral density in elderly Japanese men: the Fujiwara-kyo Osteoporosis Risk in Men (FORMEN) study. Osteoporos Int, 2012. 23(2): p. 705-14.

14. Ronn, S.H., et al., Vitamin K2 (menaquinone-7) prevents age-related deterioration of trabecular bone microarchitecture at the tibia in postmenopausal women. Eur J Endocrinol, 2016. 175(6): p. 541-549.

15. Sprini, D., et al., Correlation between osteoporosis and cardiovascular disease. Clin Cases Miner Bone Metab, 2014. 11(2): p. 117-9.

16. Ueland, T., et al., Undercarboxylated matrix Gla protein is associated with indices of heart failure and mortality in symptomatic aortic stenosis. J Intern Med, 2010. 268(5): p. 483-92.

17. Theuwissen, E., et al., Vitamin K status in healthy volunteers. Food Funct, 2014. 5(2): p. 229-34.

18. Geleijnse, J.M., et al., Dietary intake of menaquinone is associated with a reduced risk of coronary heart disease: the Rotterdam Study. J Nutr, 2004. 134(11): p. 3100-5.

19. Gast, G.C., et al., A high menaquinone intake reduces the incidence of coronary heart disease. Nutr Metab Cardiovasc Dis, 2009. 19(7): p. 504-10.

Vitamin K2


https://www.vitafoodsinsights.com/


Takeaways

ATakeaways for Your BusinessAs people increase in age, many fear the anticipated health setbacks that are typically

associated with getting older. Osteoarthritis (OA) remains the most common form of arthritis—

affecting over 240 million people worldwide. With a rise in the number of people participating

in physical activities, joint problems and injuries have also become more prevalent. Consumers

are looking for new solutions to maintaining their joints, improving their mobility and reducing

risk factors—as trauma to the joints is a well-known risk factor for OA. While the condition

itself and how to manage associated symptoms is well understood, there lies a gap for

products geared toward preserving joint structures—not only to reduce risk, but also to

improve quality of life. Medications to treat OA symptoms may cause fast-acting relief, but

none actually modify the evolution of the disease. Attention has historically been on cartilage,

the synovial membrane, and subchondral bone; but, specialists have noted that OA treatments

of the future will be focused on more granular factors, such as quality of synovial fluid,

innovative collagen solutions and preserving tendon health.

The idea of healthy ageing is not limited to preventing aches and pains—other parts of our body

experience stress, too. Few consumers know that the reactive oxygen species (ROS) in the body

should always be at a natural level. The body’s protective antioxidants can’t counteract an excess

of ROS (caused by environmental and lifestyle circumstances), and this leads to damaged cells, lipids,

proteins and DNA. Experts have found natural astaxanthin to be more powerful as a singlet

oxygen ROS scavenger than the popular likes of vitamin C, vitamin E, coenzyme Q10 and

β-carotene. Natural astaxanthin supports healthy bodily functions and lifestyle—regardless of age.

Daily supplementation has proven positive results, extending from cosmetic to mental benefits.

On the topic of lifelong supplements: vitamin K2 also shares the space of providing essential

nutrients through all stages of life. K2 works closely with other nutrients to carry out essential

processes throughout the body. However, experts have found most diets to be K2-deficient.

Especially toward and during the ‘golden years,’ K2 works to replenish and protect cells and

bones, as well as strengthen heart and blood circulatory function. While most consumers will

focus on more prominently-known vitamins, K2 complements many of these to create

additional benefits. Consumers will appreciate a vitamin K2 product that transitions with them

through their various stages of life.

None of these essential supplements will be any good if consumers aren’t educated about

the current and long-term benefits of leading a healthy, balanced and active lifestyle. When it

comes to a strategy for improving consumer education, experts are leaning toward gamified

approaches in the hopes to draw greater engagement and influence behaviour. The ability to

change eating and lifestyle behaviours has challenged nutrition specialists; however, tapping

into a market of educating consumers through interactive games (something most can relate

to) may be a likely solution for the future.

Increased awareness and education of what consumers can do for their bodies today will

only lead them to stronger, longer and quality lives—even during the years where most start

slowing down.

IN THIS ISSUE Vitamin K2 p.22 Contacts p.28 Table of Contents p.2



CONTACTS

Chris LeeManaging Director, GHNN [email protected]

Maria SidiropoulouClient Success [email protected]

Colin WilliamsSenior Marketing [email protected]

Charlotte BastiaanseAssistant [email protected]

Informa Exhibitions2nd Floor5 Howick PlaceLondon SW1P 1WGUnited Kingdom

Phone: +44 (0) 20 3777 3616www.vitafoods.eu.com

Jon BenningerVice President, Health & [email protected]

Heather Granato Vice President, Content [email protected]

Danielle DunlapVice President, Marketing [email protected]

Andrew Rosseau Art Director

Kristen Raymond Program Coordinator

Informa Exhibitions LLC2020 N. Central Ave, Suite 400Phoenix, AZ 85004United States

Phone: +1 480 990 1101www.naturalproductsinsider.com

Informa Exhibitions’ Global Health & Nutrition Network is one of the world’s leading knowledge providers. We create and deliver highly specialised information through events, digital media and publishing to provide business, learning and networking opportunities. Informa’s Global Health & Nutrition Network has an unrivalled offering within the health and nutrition marketplace for individuals, businesses and organisations around the globe.

Vitafoods is the leading brand in Europe and Asia connecting companies across the food, beverage, supplement and personal care markets with ingredient suppliers, contract manufacturers and service providers. Vitafoods Insights (vitafoodsinsights.com) is a premium content destination that delivers the best content from Vitafoods to a global audience.


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Documents

Vol 3, Issue 10 October 2018 36 ......metabolism to the joint’s three structures: cartilage, synovial membrane, and subchondral bone. However, as it has been described, OA affects