Prune Consumption & Bone Clinical Research Trial Update
The long-anticipated, first large-randomized clinical trial to offer a strong level of evidence linking prunes to bone health in postmenopausal women is completed with further extensive data analysis to come. The study entitled “Randomized Control Trial on Dietary Supplementation with Dried Plums/Prunes on Bone Density, Geometry and Estimated Bone Strength in Postmenopausal Women” was led by principal investigator Mary Jane De Souza, Ph.D., Department of Kinesiology, the Pennsylvania State University, who provided an update at the May 18, 2021, virtual meeting of the International Prune Association.
Based on preliminary findings, participants in the control group lost bone; however, prunes seemed to limit bone mineral density loss, particularly at the hip. Specifically, the women in the 6-prune group maintained total hip-bone mineral density throughout the intervention compared to women in the control group who experienced bone loss at this region. While preliminary findings are promising, these results still need to be confirmed once the full dataset is closed and evaluated based on the participants who both completed and were compliant with the study protocol.
Study Design Provides High Level of Evidence
Dr. De Souza emphasized that the study was designed to provide a high level of evidence on prune’s role in bone health: a one-year, large, randomized, dose-response intervention. Recruitment began in July 2016 and the final participants completed the study in March 2021. The investigators screened over 600 postmenopausal women and randomized 235 into 3 groups: 78 to a control group (no prunes); 79 to a 6-prune group; and 78 women to a 12-prune group (all groups received calcium and vitamin D supplements.) A total of 183 completed the study for an overall completion rate of 78%.
Multiple measures taken at the beginning of the study (baseline) 3,6,9 and 12 months will provide information on whether prunes helped the participants maintain existing bone, or if prunes helped participants gain bone. At 3 different time points (baseline, 6 and 12 months), DXA scan measured bone mineral density of the lumbar spine, femoral neck, and total hip, and pQCT (peripheral quantitative tomography) measured the radius (long bone in arm) and tibia (long bone in the lower leg). While DXA estimates how much bone is present, pQCT estimates how strong the bone is – its structure and ability to resist fracture. Blood samples analyzed for bone biomarkers will provide information on the chemistry at the cellular level indicative of bone formation and resorption. Analysis of prunes for phenolics – and analysis of participants’ urine samples for phenolics as a measure of compliance – will provide a connection between compounds in prunes and their role in bone health. The fecal analysis will provide information on the potential role of the gut microbiota in inflammation and the formation and breakdown of bone. Such a comprehensive study design provides a level of evidence sought by the scientific community when evaluating the results of clinical trials.
Principal investigator Mary Jane De Souza, Ph.D., Department of Kinesiology, the Pennsylvania State University is an expert in bone health in pre-and postmenopausal women and is an expert at executing randomized clinical trials. Co-investigators conducting and interpreting components of the dataset are all leading researchers in their areas of expertise. Connie Weaver Ph.D., professor emeritus, Purdue University, is an internationally recognized bone researcher with expertise in bone metabolism. Connie Rogers, Ph.D., Penn State University, has expertise in inflammation and its role in bone breakdown; Cindy Nakatsu Ph.D., Purdue University, with expertise in microbial ecology is examining the fecal samples; Mario Ferruzzi Ph.D. North Carolina State University, research interest includes phenolics, phytochemicals, and their bioavailability.
A Case Report – and More to Come
Results from the clinical trial will provide a very rich dataset for continued analysis. Multiple manuscripts are anticipated. While the investigators continue to review this extensive dataset, “Dried plum consumption improves bone mineral density in osteopenic postmenopausal woman: A case report” was recently published in BoneReports.
This paper describes how a woman reversed the 7.6% bone loss at the lumbar spine she experienced as a participant in the control group. After she completed the initial clinical trial and on her own initiative, she began eating 6 prunes daily (in addition to calcium and vitamin D3) for about 16 months while enrolled in a different study at Penn State University that also measured bone mineral density. She experienced a 7.8% improvement in BMD at the lumbar spine improving her BMD slightly more than her previous baseline.
In addition to the publication of this case report, Drs. Rogers and De Souza have prepared a review article “The role of dried plums in modulating inflammatory pathways to improve bone health in postmenopausal women” for submission to Advances in Nutrition. This review looks at the current state of knowledge between inflammation and bone health from previous preclinical and clinical studies that have assessed the effect of prunes on bone health in a model of postmenopausal osteoporosis.
We look forward to continuing to update you on the findings from this most important clinical trial.
Published Prune Research Garners Global Headlines
A study by Drs. Hooshmand and Kern published in the Journal of Medicinal Food this spring found that daily consumption of prunes improved risk factors for cardiovascular disease (CVD) including raising antioxidant capacity and reducing inflammation among healthy, postmenopausal women. A press release headlined these findings along with the recently published case study from Dr. DeSouza’s team in Bone Reports.
The campaign included a globally distributed press release, with outreach to a variety of media outlets. The positive coverage for California Prunes appeared in media outlets that reach more than 207 million people domestically and the news was adapted for export market distribution with great international interest, including coverage in Japan, Argentina, UK/EU, and Italy. The press release was also well-received in Canada with pick up from more than 20 news outlets.
In addition to this initial coverage, the research findings will be used in the future to generate additional media coverage, as well as updates on the California Prunes social media channels and highlighted in upcoming nutrition newsletters globally. Coverage highlights include:
U.S. Consumer Media Coverage:
Eat This, Not That!: Eating This Fruit Daily Slashes Your Risk of Heart Disease, New Study Finds
- Also picked up by MSN Lifestyle
U.S. Trade Media Coverage:
America Fruit: Prunes may help heart health
California Farm Bureau: Food and Farm Newsletter
Clarin, Buena Vida (Good Life): Hallan beneficios en comer un puñado de ciruelas pasas por día
Fresh Produce Journal: Prunes may help heart health
247.libero.it: News -focused with a dedicated section to Health
excite.co.jp: 毎日プルーンを食べると心臓疾患や炎症のリスク要因が減少 ―閉経後の女性を対象とした新研究結果発表 (Eating Prunes Daily Reduces Risk Factors for Heart Disease and Inflammation-New Research Results for Postmenopausal Women)
Social Media Coverage:
Joel Kahn MD, FACC @drjkahn
New study: Eating prunes daily improves risk factors for heart disease and inflammation | EurekAlert! Science News. #kahnchronicle
Viewers/readers: 26.2K Followers
Consumer Survey Reveals Family Snacking Habits
Have you ever wondered what eating habits you may have inherited from your parents? A recent consumer survey of 2,000 Americans conducted by OnePoll on behalf of California Prunes, revealed that our snacking habits may be – in part – due to mom and dad.
To raise awareness and inspire the consumption of California Prunes by aligning the brand with timely pop culture news, cultural zeitgeist, and food trends, the survey generated consumer headlines through a national publicity poll, focusing on American snacking influences. A press release highlighted the survey results alongside an infographic catching the attention of Moms, The Sun, Yahoo!, MSN, and local news sites nationwide.
Survey respondents said food played an important role in their upbringing, with three in five saying their snacking habits were influenced by their cultural heritage. While many respondents link their snacking habit to their families, more than half (52%) said they snack out of necessity because they don’t have consistent mealtime, and 59% added the snacks in their home are hard to resist. Consequently, seven in 10 admit that their snacking schedule is not optimal for their health. Emotional tension can be linked to snacking as well; 29% blame stress at home for their snacking habits, and 22% blame stress at work.
“Snacking is here to stay, so it’s time to reset our habits and retrain our cravings. Think about snacks as mini-meals – quick and delicious, but also nutritious,” said Leslie J. Bonci, MPH, RD, CSSD, LDN. “Go for powerful pairings to get the most out of snacking occasions such as protein and produce: guacamole with bean-based chips, cheese, and prunes, hummus and veggies, or a smoothie made with milk, yogurt, berries, and prunes to add some great fiber.”
Other food lessons that respondents plan on implementing include trying new foods, not wasting food, and the importance of eating as a family. Moreover, food helps keep families close, as nearly half (49%) of participants said they made a new recipe they found online with a family member during the pandemic.
To date, the survey has generated 75 pieces of coverage, for a potential audience of 6.36M. See a full coverage recap here.
The Power of Influencers
To reach a broader consumer base, California Prunes partnered with influencers in the U.S. and Italy. These influencers ranged from foodie, fitness, and baking focuses and amplified the reach of California Prunes messaging of health, nutrition, taste, and versatility to consumers that we may not normally reach and attract.
The Domestic 2020-21 influencer program resulted in over 12 million impressions, 264,000 views, and 100,000 engagements through September 2020-June 2021. Content featuring baking recipes and comfort foods made with CA Prunes and offering health messages and tips for swapping fats, eggs, and refined sugar for prunes or prune puree was created by 11 influencers along with CA Grown and Bake From Scratch magazine. Many consumers commented that they’d never had prunes, hadn’t thought of using them in the ways displayed in the content, or would try them due to seeing the recipes. Indulgent treats or comfort foods made healthier and tastier with the addition of prunes has been the highest performing content. The program exceeded reach goals by over 10x, due to both the popularity of the content and utilization of Pinterest. Plans for 21-22 include increased health messaging and continued focus on healthy swaps.
In Italy, there have been several social media collaborations throughout 2020-21 with a range of high-profile influencers from the fitness, well-being, and foodie communities. The influencer content reached 3,495,233 and received 258,633 engagements in April and May.
The Fitness influencer Davide Campagna has created recipes and workout suggestions. Valeria Airoldi collaborated with Annamaria Acquaviva in a ‘Work Hard, Eat Smart’ online event aimed at wellbeing and healthy nutrition. The foodie influencers, Sonia Peronaci and Teresa Balzano have created recipes and hosted online social media events.
As a result of the success of the influencer campaign, CPB is currently working on an ‘influencer empowerment’ campaign to identify new influencers working in different fields, such as the young mom, womens’ health, and food/fitness/wellbeing arenas. This activity will also explore whether new social media platforms such as TikTok could become valuable platforms for the marketing of California Prunes.
Chef-driven Content Proves Valuable
California Prunes Chef-driven content is being developed and featured globally. The creation of these assets to fill content gaps for chef and consumer audiences has proved valuable. In the U.S., we partnered with Chef’s Roll to establish relationships with two industry-leading chefs, and in the EU, CPB continued the partnership with Chef Peter Sidwell.
The Chef’s Roll partnership resumed this spring with exciting, chef-driven content. Chef’s Roll provides an avenue to build on our library of chef-created recipes featuring California Prunes to use in pitching efforts – particularly to the IFEC-related trades, as well as bolstering trending content on social media. Partnered chefs and designated concepts are chosen for flexibility in serving the future needs of restaurant take-out menus offering texture, versatility, and big flavor. Recipe concepts are also designed to offer an approachable style for home-cook interest and are based on needs to fill content gaps. This partnership resulted in 3 savory and 3 sweet recipes showcased in videos that will be shared on Chef’s Roll’s website and social media as well as our social channels and website.
Peter Sidwell has continued to create video recipes for new and existing California Prunes’ recipes, generating interest and conversation about California Prunes with trade and consumer targets. With a wide range of recipes and an emphasis on the various flavor pairings, Peter continues to educate about California Prunes’ versatility and health benefits with posts on his social media platforms that are linked to each recipe on the California Prunes’ EU website.
Since November 2019, Peter has produced 16 video recipes reaching more than 40,000 social media users across all Peter Sidwell platforms and providing a library of valuable video and photo assets for use in marketing activities globally.
Spring Japan TVCM Campaign Helps Sales Growth Trajectory
CPB Japan conducted the 2021 Spring TVCM campaign featuring the “Blessings of California” TVCM in April in three major metropolitan areas and four regional hubs.
The 2021 Spring TVCM Campaign pushed the Nikkei POS national figure (Nikkei POS Vision) up by 7.3 percent month-over-month in April 2021, maintaining California Prune sales on a growth trajectory for eight consecutive months since the beginning of the 2020/21 product year, achieving an 8.9 percent increase year over year.
A consumer survey conducted immediately after the 2021 Spring TVCM Campaign in the Greater Tokyo Area showed that more than 60 percent of respondents said that they would “definitely buy prunes” or “probably buy prunes” because of the “Blessings of California” TVCM.
The consumer survey and the Nikkei POS national figure indicated that “Blessings of California” TVCM maintained a high level of popularity ratings amongst Japanese consumers, and the 2021 TVCM campaign clearly promoted momentum in increasing California Prune purchase and consumption.
Taking the New Smoothie Wheel for a Spin in Canada
Inspired by the healthy snacking and smoothie regimens of the athlete ambassadors in our successful “Team Up with California Prunes” campaign in Canada, a unique new resource for consumers, the “Smoothie Wheel”, is now available in print or online. Consumers are eager to try new recipes at home during COVID that support their personal health and fitness goals, and the Smoothie Wheel lets them pick their favorite ingredients from food group categories to customize smoothies that meet their nutrition needs. This new resource was developed with the help of a registered dietitian who created a delicious variety of food categories and pairings, all featuring California Prunes.
The goal is to generate 500,000 impressions of the online version of the Smoothie Wheel, which will be promoted through social channels and digital advertising. This will drive traffic to californiaprunes.ca, where consumers can try out the Smoothie Wheel and also engage with other unique and useful information like athlete training videos, podcasts, recipes, and more.
The Team Up campaign is all about motivating consumers in their own athletic endeavors, no matter their age or skill level. California Prunes has partnered with 36 Canadian athletes of various ages and backgrounds, many of whom compete on the world stage, to inspire all Canadians to be active and healthy.
Our athlete ambassadors talk about California Prunes’ nutritional benefits and their favorite ways to eat prunes throughout the campaign, including in smoothies. By making a strong emotional connection while also offering practical information and resources like the Smoothie Wheel, the Team Up campaign is driving awareness of the specific health benefits of California Prunes and increasing the number of Canadian consumers who view and purchase California Prunes as a healthy snack option.
A Closer Look: Using LinkedIn for Trade Connections
Throughout 2020-21, CPB Europe has been growing trade engagement on the business social media platform LinkedIn. A strategy that includes regular posts to inform trade of the bone health, versatility, and nutritional benefits of California Prunes, as well as updating the trade on trends and political issues such as trade tariffs, has increased the number of followers, reach, and engagements. In addition, the re-sharing of Peter Sidwell’s posts on the CPB LinkedIn feed has further extended the reach and resulted in positive engagement. As a result, California Prunes have been brought California Prunes to the attention of a wider audience within the business community and has increased the number of followers by 425% across the year.
Regular review of posts that create particular interest ensure that content is adjusted to obtain maximum engagement:
Year to date reach: 16,784
Year to date engagement: 6.7%
Unlocking Business Potential in China
Trade events continue to be a necessary tool to bring traders together and help to build strong and long-term relationships where CPB can share the latest information about the harvest of California Prunes, their quality positioning in the market, their nutritional benefits, and the latest research developments. While California Prunes already enjoys high awareness in first-tier cities in China, the awareness in second-tier markets is still limited. To unlock the business potential in second-tier cities, California Prunes exhibited and sampled at the U.S. Trade Food & Beverage Expo organized by the Agricultural Trade Office (ATO) of Beijing in Southwest China’s Chengdu city in April. More than 300 traders and professionals from the local food industry attended the event. Media outreach is also an effective way of promoting the California Prune message in China among consumers. Messaging dedicated to California Prunes’ role in keeping the immune system healthy and offering cells protection from oxidative stress was a key highlight in a spring print and digital media outreach campaign. California Prunes were promoted via 25 digital and media platforms and 1 influencer, reaching a total of 45,808,000 impressions.
California Prunes Hosts Virtual 19th IPA Congress
California Prunes hosted global industry colleagues for a virtual gathering of the 19th International Prune Association Congress (IPA) this spring. The 2021 IPA Congress brought attendees together for a taste of the Golden State to celebrate the “Global Goodness of Prunes,” as the congress theme. International prune industry leaders joined experts in their fields for various sessions that provided a deeper insight into how weather, science, nutrition, and culinary expertise shape the prunes that are consumed around the world. 226 people registered for the event and over 200 individuals attended the congress live.
All of the on-demand session videos can be viewed here.