Cost Implications of Alternative Sources of (n-3) Fatty Acid Consumption in the United States 1 3

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1 The Journal of Nutrition. First published ahead of print January 25, 2012 as doi: /jn The Journal of Nutrition Supplement: Heart Healthy Omega-3s for Food Stearidonic Acid (SDA) as a Sustainable Choice Cost Implications of Alternative Sources of (n-3) Fatty Acid Consumption in the United States 1 3 Eileen T. Kennedy,* Hanqi Luo, and Lynne M. Ausman Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA Abstract The Dietary Guidelines for Americans 2010 provides authoritative advice on what Americans should eat to stay healthy. These guidelines provide a quantitative recommendation to consume 250 mg/d of (n-3) fatty acids (also known as omega-3 fatty acids). To achieve this goal, Americans would need to more than triple the amount of EPA and DHA currently consumed. This paper assessed the cost implications of increased levels of EPA and DHA from marine and nonmarine food sources using data from the NHANES, USDA nutrient data base, and the USDA Center for the Nutrition Policy and Promotion food price data. Stearidonic acid (SDA)-enhanced soybean oil is a lower cost alternative to commonly consumed marine food as a source of EPA. In addition, given that SDA-enhanced soybean oil is intended to be used as an ingredient in a variety of products, this may enable consumers to increase consumption of EPA through commonly consumed foods. J. Nutr. doi: /jn Introduction The DGA 4 serves as the scientific basis of nutrition policy in the United States (1). When first published in 1980, the DGA posed the question, What should Americans eat to stay healthy? (2). These guidelines have been reviewed and revised every 5 y. The 1 Published in a supplement to The Journal of Nutrition. Presented at the Experimental Biology 2011 satellite session, Heart Healthy Omega-3s for Food: Stearidonic Acid (SDA) as a Sustainable Choice, held in Washington, DC, April 8, 2011.The conference was organized by the American Society for Nutrition and was supported by an unrestricted educational grant from Solae, LLC, and Monsanto. The coordinators for this supplement were D Ann Finley, University of California, Davis; Richard J. Deckelbaum, Columbia University; and Eileen Kennedy, Tufts University. Supplement Coordinator disclosures: D Ann Finley has no relationships to disclose, Richard J. Deckelbaum has received an honorarium from the American Society for Nutrition for editing this supplement, Eileen Kennedy is a member of the Advisory Committee with Solae, Co. The supplement is the responsibility of the Guest Editor to whom the Editor of The Journal of Nutrition has delegated supervision of both technical conformity to the published regulations of The Journal of Nutrition and general oversight of the scientific merit of each article. The Guest Editor for this supplement is Kevin Schalinske. Guest Editor disclosure: Kevin Schalinske has no relationships to disclose. Publication costs for this supplement were defrayed in part by the payment of page charges. This publication must therefore be hereby marked advertisement in accordance with 18 USC section 1734 solely to indicate this fact. The opinions expressed in this publication are those of the authors and are not attributable to the sponsors or the publisher, Editor, or Editorial Board of The Journal of Nutrition. 2 Supported by the Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA. 3 Author disclosures: E. Kennedy is a member of the Solae Scientific Advisory Committee and received travel funds and an honorarium from the ASN for organizing the symposium, giving a presentation, and writing a paper for the symposium. H. Luo and L. Ausman, no conflicts of interest. 4 The detail on calculations of nutrient density based on the FQS can be found in the reference. 4 Abbreviations used: ALA, a-linolenic acid; DGA, Dietary Guidelines for Americans; FQS, food quality score; SDA, stearidonic acid. * To whom correspondence should be addressed. eileen.kennedy@tufts.edu. latest version of the guidelines (3) is based on an expert panel, evidence-based review of research; the panel concluded that moderate evidence suggests that consumption of 250 mg/d of (n- 3) fatty acids (also known as omega-3 fatty acids) is associated with a reduced risk of mortality from coronary heart disease (4). In addition, results suggest that maternal intake of (n-3) fatty acids during pregnancy and lactation is associated with increased DHA levels in breast milk and improved infant health outcomes such as visual acuity and cognitive development (4). The DGA report further emphasizes that, currently, seafood is the main food source of two types of (n-3) fatty acids, EPA and DHA, in the American diet. However, in the US, intake of seafood is ~99 g (3.5 oz)/wk (3). The DGA suggests, for the first time, a quantitative recommendation for people to increase seafood consumption to 250 g/wk. Three different scenarios with different levels of seafood consumption were analyzed by the expert panel: 1) 113 g/wk of seafood of high (n-3) fatty acids; 2) 227 g/wk of seafood including seafood both low and high in (n-3) fatty acids; and 3) 340 g/wk of seafood low in (n-3) fatty acids (4). This paper assesses the cost implications of increased consumption of (n-3) fatty acids from marine and nonmarine sources. The paper examines current consumption patterns of seafood in adults in the US as a source of (n-3) fatty acids and is followed by an analysis of nonmarine and supplements as alternatives to seafood to achieve similar recommended levels of (n-3) fatty acids. Factors Influencing (n-3) Fatty Acid Consumption in the United States The major food source of EPA and DHA in the American diet is seafood. Therefore, the expert panel-based recommendations for increasing these (n-3) fatty acids were based on additional seafood consumption (4). The average intake of seafood in the ã 2012 American Society for Nutrition. Manuscript received September 27, Initial review completed October 12, Revision accepted October 26, doi: /jn Copyright (C) 2012 by the American Society for Nutrition 1S of 5S

2 TABLE 1 Percentage of US adult population y old that reported fish consumption in the past 30 d (NHANES ) 1,2 Both sexes Male Female n = 4284 n = 2159 n = 2125 % Fish consumed in the past 30 d Tuna Salmon Trout Sardines Mackerel Fish (any) Source: (6). 2 Data are means 6 SEM. US is low at ~ g/wk. The DGA recommend an intake of 250 mg/d of EPA and DHA combined. To achieve this intake, Americans would, on average, have to double their consumption of seafood. The major determinants of food consumption are taste, price, and convenience (5). Data are based on the latest NHANES for (Table 1);.70% of men and women consume fish in any given month, with the major fish sources being tuna and salmon (6). However, the amount of EPA and DHA in commonly consumed seafood varies; we provide a breakdown of EPA and DHA content of selected fish (Table 2). The amount needed per month to meet a daily consumption level of 250 mg of EPA and DHA combined and cost per month to achieve this consumption level varies. Sources such as herring are high in EPA and DHA and relatively inexpensive. Herring, however, is not one of the most commonly consumed fish in the US. Tuna and salmon are consumed by 35.0 and 26.8% of American adults, respectively (Table 1). However, because canned tuna is a relatively poor source of EPA and DHA, the cost per month to supply the recommended levels of EPA and DHA is more than 3 times that of salmon (Table 2). The DGA report limits the recommendation for increased EPA and DHA to food sources only. However, based on NHANES data, the majority of Americans consume one or more dietary supplements (6). The data presented provide an analysis of EPA and DHA costs from 3 types of fish oil supplements: regular, double, and triple, which contain 300, 600, and 900 mg, respectively, of EPA and DHA (Table 3). Similar to the data provided for fish, there is wide variation in the cost of consuming EPA and DHA exclusively from fish oils. On average, however, EPA and DHA provided from fish oils are substantially less expensive than from marine food sources. The issue of nonmarine sources of EPA and DHA has recently received more attention as novel products have been developed. SDA-enhanced soybean oil has been under development, although it is not yet available commercially. The conversion of SDA to EPA is more efficient than that of ALA to EPA (9). The EPA equivalent produced by SDA-enhanced soybean oil is examined (Table 4). Note that the data are characterized by low, medium, and high conversion rates of SDA to EPA based on the available research (10 12). In addition, because SDA-enhanced soybean oil has not been marketed, analysis is based on the assumption of a 10 or 20% increase in price above the regular soybean oil price. The cost per month needed for 250 mg/d of EPA is less than from either marine or supplement sources. However, SDA is converted only to EPA (9). The requirement of 250 mg/d is based on EPA and DHA combined. Additional analyses were conducted to evaluate the cost of obtaining EPA from SDA-enhanced soybean oil and EPA and DHA from supplements (Fig. 1). For the combined intake of SDA-enhanced soybean oil and fish oil supplements to provide 250 mg/d, the cost would be $0.7/mo (analysis available on request to author). There is no guidance of the percentage of EPA and DHA within the 250 mg/d standard. For these analyses, the assumption was 75% EPA and 25% DHA. Obtaining EPA and DHA from a combination of supplements and SDA-enhanced soybean oil increases the cost per month compared to the SDA soybean oil alone. EPA and DHA coming from marine sources exclusively are more expensive than SDA-enhanced soybean oil, fish oil supplements, or a combination of both (Fig. 2). The DGA has traditionally emphasized that nutrients should come from food rather than supplements (3). One rationale for this is that foods provide a range of nutrients as well as kilocalories. Rather than examining products on a nutrient by nutrient basis, a more appropriate approach is to analyze nutrient density. The FQS/g of a food item is the ratio of shortfall TABLE 2 The amount of EPA and DHA and the cost estimate from commonly consumed fish EPA 1 DHA 1 EPA and DHA 1 Amount needed 2 Price 3 Cost g/100 g g/100 g g/100 g g/mo $/100 g $/mo Fish Commonly consumed fish Tuna, white, canned Tuna, bluefin, cooked Salmon, Atlantic, cooked High in EPA and DHA Anchovy, EU, canned Herring, Atlantic, kippered Other fish Mackerel, Atlantic, cooked Trout, mixed, cooked Sardine, Atlantic, canned EPA and DHA concentration based on (7). 2 Amount needed calculated based on daily requirement of 250 mg/d of long-chain (n-3) fatty acids. 3 Cost estimate based on (8). 2S of 5S Supplement

3 TABLE 3 Dietary supplements Regular fish oil [300 mg Double fish oil [600 mg Triple fish oil [900 mg The amount of EPA and DHA consumed and cost estimate from fish oil supplements 1 EPA and DHA 1 Amount needed 3 Price 1 Cost g/soft gel 2 Soft gels/mo $/soft gel $/mo EPA and DHA concentration and price estimate based on the nutrition fact label of an US retail and commercial enterprise mainly selling dietary supplements. In the fish oil supplements listed above, the soft gel contains 300, 600, and 900 g of EPA and DHA, respectively. 2 One soft gel = ;1000 mg. 3 Amount needed calculated based on daily requirement of 250 mg/d of long-chain (n-3) fatty acids. nutrients:avoidance nutrients (13). The nutrient density of selected food categories per 100 g of product per dollar spent is shown (Table 5). A higher FQS value in Table 5 indicates that for each dollar spent, more nutrient-dense foods are purchased. Salmon is a nutrient-dense food; however, the category of legumes is even more nutrient dense per dollar spent than salmon. Thus, obtaining nutrients from the legumes group is a cost-efficient way to increase the nutrient density of the diet. Several other issues have emerged related to the increased consumption of fish and seafood. The DGA is unambiguous that people should increase their intakes of EPA and DHA, with a specific recommendation to increase consumption of seafood. However, there are some caveats put forth. Due to the high methyl mercury content of some seafood sources (Table 6), pregnant and breast-feeding women are advised to avoid tilefish, shark, swordfish, and king mackerel. In addition, pregnant and breast-feeding women are also advised to limit consumption of white albacore tuna to 170 g/wk. With these caveats, the expert panel (4) concluded the benefits of FIGURE 1 Evaluating the cost of obtaining EPA from SDAenhanced soybean oil and EPA and DHA from supplements. In the scenario, to meet the requirement of 250 mg/d of long-chain (n-3) fatty acids, people consume 125 mg/d of fatty acids from SDA soybean oil and 125 mg/d of fatty acids from a fish oil supplement. Because SDA soybean oil contains only EPA, people consume 125 mg/d of EPA from SDA soybean oil. Whereas, a fish oil supplement contains a combination of EPA and DHA, we assume people consume 62.5 mg/d of EPA and 62.5 mg/d of DHA from fish oil supplements. In conclusion, people consume mg/d of EPA and 62.5 mg/d of DHA.SDA, stearidonic acid. TABLE 4 The amount of EPA and cost estimate from SDA soybean oil 1 Soybean SDA, g/100 g Conversion level 2 Converstion rate 2, % Equivalent EPA, g/100 g Amount needed, 3 g/mo Price, 4 $/100 g Cost, 4 $/mo Regular soybean oil Not detected SDA soybean oil 28.2 Low Medium High SDA soybean oil (10% price increase) 28.2 Low Medium High SDA soybean oil (20% price increase) 28.2 Low Medium High SDA soybean oil from biotechnology-derived soybean MON 87769, containing 28.2% SDA as TG. Commercially available SDA soybean oil expected to contain at least 20.0% SDA as TG. 2 Conversion based on the studies by Harris et al. (low) (10), Lemke et al. (medium) (11), and James et al. (high) (12). 3 Amount needed calculated based on daily requirement of 250 mg/d of long-chain (n-3) fatty acids. 4 Cost estimate based on (8). Cost of (n-3) fatty acid consumption 3S of 5S

4 FIGURE 2 Cost per month from marine, supplement, and SDA-enhanced soybean sources. This figure presents how much it takes to meet the requirement of 250 mg/d of long-chain (n-3) fatty acid from a combination of fish oil supplement and SDA soybean oil. SDA, stearidonic acid. consuming seafood as a source of EPA and DHA outweigh the risks. Another concern related to seafood intake is the overfishing and strain on sustainable supplies. From a production viewpoint, the United Nations FAO reports that there has been exponential growth in both caught and farmed fish (14). Growth in the latter category is most pronounced since Concomitant with the production data, the FAO reports that the number of extinct or almost extinct species of fish continues to increase (14). A related issue is that as populations increase their incomes, even slightly, there is a greater demand for animal products, including seafood (15). The combined effect of overfishing and changing consumption patterns creates a strain on marine sources of EPA and DHA as the exclusive source of (n-3) fatty acids. The DGA report does caution that increased consumption of seafood will require efficient and ecologically friendly strategies be developed to allow for greater consumption of seafood that is high in EPA and DHA and low in environmental pollutants (4). The challenge now is to identify strategies that allow for increased seafood consumption in an environmentally friendly manner. Conclusions As discussed at the beginning of this paper, the DGA provide the science behind nutrition policy in the US. However, equally TABLE 5 Meat, fish, legumes, eggs Food quality score on meat, fish, legumes, and eggs group 1 Food quality score/dollars spent Bacon 0.2 Hot dog 0.3 Egg 1.0 Chicken, breast, fried 1.2 Salmon, canned 3.6 Pinto, calico, or red beans Adapted with permission from (13). important, the DGA must be promoted to effectively change consumer behavior (16). The data presented in this paper illustrate that there are a range of strategies that can be used to achieve an optimal level of intake of EPA and DHA. Although recommendations to increase intake of seafood are one such strategy, this approach has cost implications. The cost of plant, marine, and supplement sources for EPA and DHA vary widely. Seafood as the primary or only source of EPA and DHA is, on average, more expensive than plant-or supplement-based strategies. The advantage of encouraging an increase in seafood consumption is that ~70% of Americans eat seafood in any given month. However, for people who do not consume and/or cannot afford seafood as the primary source of EPA and DHA, alternative sources are needed. To respond to consumer food preferences and income constraints across households, it is likely that a menu of interventions will be needed to achieve the goal of increased intake of EPA and DHA. Although plant sources of (n-3) fatty acids appear promising, the DGA Expert Committee was cautious and noted, Evidence TABLE 6 Methyl mercury content of selected seafood 1 Fish Mercury mg/133 g 2 Tilefish: Gulf of Mexico 219 Shark 151 Swordfish 147 Mackerel: king 110 Tuna: bluefin and Albacore Tuna: white (Albacore) canned 40 Tuna: light canned 13 Mackerel: Atlantic and Pacific (not king) 8 13 Trout: freshwater 11 Anchovies, herring, and shad 5 10 Salmon: Atlantic, chinook, coho 2 Sardines: Atlantic and Pacific 2 1 Table adapted from (3). 2 A total of 39 mg/wk of mercury would reach the EPA reference dose limit [0.1 mg/ (kg d)] for a woman who is pregnant or breastfeeding and who weights124 pounds (56 kg). 4S of 5S Supplement

5 is currently insufficient to make a formal guideline to increase (n-3) intake from plant source without additional evidence from randomized clinical and prospective observational studies among participants with a broad range of (n-3) intakes (4). The advantage of plant sources of EPA and DHA are not only the cost-effectiveness but also the SDA-enhanced soybean oil is intended to be an ingredient in a range of products. Thus, changes in consumption could occur without necessitating investment in social marketing campaigns to change consumer behavior. Acknowledgments The authors thank Gogi Grewal for her editorial support and thoughtful insights. E.K. designed research; E.K. and H.L. conducted research; H.L. analyzed data; E.K., H.L., and L.A. wrote the paper; and E.K., H.L., and L.A. had primary responsibility for final content. All authors read and approved the final manuscript. Literature Cited 1. Goldberg J, Folta S. The dietary guidelines and the food guide pyramid In: Kennedy E, Deckelbaum R, editors. The nation s nutrition. Washington, DC: ILSI Press; p USDA and U.S. Department of Health and Human Services. Nutrition and your health: dietary guidelines for Americans, st ed. Washington, DC: U.S. Government Printing Office; U.S. Department of Health and Human Services and USDA. Dietary guidelines for Americans, th ed. Washington, DC: U.S. Government Printing Office; Dietary Guidelines Advisory Committee. Report of the dietary guidelines advisory committee on the dietary guidelines for Americans, 2010, to the Secretary of Agriculture and the Secretary of Health and Human Services. Washington, DC: Government printing office; Glanz K, Basil M, Maibach E, Goldberg J, Snyder D. Why Americans eat what they do: taste, nutrition, cost, convenience, and weight control concerns as influences on food consumption. J Am Diet Assoc. 1998;98: National Health and Nutrition Examination Survey Data [homepage on the Internet]. Hyattsville (MD): U.S. Department of Health and Human Services, CDC; [cited October 20, 2011]. Available from: nhanes07_08.htm. 7. USDA national nutrient database for standard reference, release 23. [homepage on the Internet]. USDA, Agricultural Research Services, Nutrient Data Laboratory; 2009 [cited October 20, 2011]. Available from: 8. Food prices database [homepage on the Internet]. USDA, Center for Nutrition Promotion and Policy [cited October 20, 2011]. Available from: htm. 9. Coupland K. Stearidonic acid: a plant produced omega-3 PUFA and a potential alternative for marine oil fatty acids. Lipid Technol. 2008; 20: Harris WS, Lemke SL, Hansen SN, Goldstein DA, DiRienzo MA, Su H, Nemeth MA, Taylor ML, Ahmed G, George C. Stearidonic acidenriched soybean oil increased the omega-3 index, an emerging cardiovascular risk marker. Lipids. 2008;43: Lemke SL, Vicini JL, Su H, Goldstein DA, Nemeth MA, Krul ES, Harris WS. Dietary intake of stearidonic acid enriched soybean oil increases the omega-3 index: Randomized, double-blind clinical study of efficacy and safety. Am J Clin Nutr. 2010;92: James MJ, Ursin VM, Cleland LG. Metabolism of stearidonic acid in human subjects: Comparison with the metabolism of other n-3 fatty acids. Am J Clin Nutr. 2003;77: Kennedy E, Racsa P, Dallal G, Lichtenstein AH, Goldberg J, Jacques P, Hyatt R. Alternative approaches to the calculation of nutrient density. Nutr Rev. 2008;66: FAO of the United Nations. The state of world fisheries and aquaculture Rome: FAO; Delgado C, Wada N, Rosegrant MW, Meijer S, Ahmed M. The future of fish: issues and trends to Washington DC: IFPRI; Contento IR. Innovative approaches for behavior change in nutrition. In: Kennedy E, Deckelbaum R, editors. The nation s nutrition. Washington, DC: ILSI Press; p Cost of (n-3) fatty acid consumption 5S of 5S

Seafood and the 2010 Dietary Guidelines June 7, 2011

Seafood and the 2010 Dietary Guidelines June 7, 2011 Presenter: Madeleine Sigman-Grant, PhD, RD Professor and Area Extension Specialist University of Nevada Cooperative Extension Moderator: James M. Rippe,