bnf looks at years 7 and 8 of the national diet and ... looks at... · salt – in 2016, ... a plan...
TRANSCRIPT
BNF looks at years 7 and 8 of the National Diet and Nutrition Survey
(NDNS) Rolling Programme (2014/2015-2015/2016)
Contents 1 Introduction ................................................................................................................................ 1
2. NDNS findings on intake compared to nutrient-based recommendations ................................... 3
3 Vitamins and minerals intake...................................................................................................... 8
4 Vitamins and minerals status (biochemical indices of nutritional status) .................................. 9
5 NDNS findings on current diets in relation to food-based guidelines ...................................... 10
6. Conclusion .................................................................................................................................... 12
1 Introduction The National Diet and Nutrition Survey (NDNS) is designed to assess the dietary habits and
nutritional status of the general adult and child population in the UK.
The NDNS is conducted continuously as part of a Rolling Programme. Reports are currently available
for Years 1&2 (2008-2010), Years 1-3 (2008-2011), Years 1-4 (2008-2012), Years 5&6 (2012-2014)
and, most recently, Public Health England has published the combined results from Years 7&8
(2014/2015-2015-2016)1. This report provides an update on results from Years 5&6 published in
2016.
In the report, results for food/drink consumption, nutrient intake and nutritional status are
presented for six age groups: 1½-3 years; 4 to 10 years; 11 to 18 years; 19-64 years; 65-74 years and
75 years and over, split by sex in all except the youngest age group. Certain population groups are
excluded from the survey, for example pregnant or breastfeeding women, and older people in
residential care. Fieldwork was carried out between 2014-2016, with an overall response rate of
53%.
The analyses of food consumption and nutrient intake are based on 2723 individuals (1417 adults
and 1306 children; see table below for breakdown by age group). The blood sample analyses are
based on 704 adults and 329 children.
Age group Number of participants
1.5-3 years 250
4-10 years 514
11-18 years 542
19-64 years 1082
65-74 years 181
75 years and over 154
1https://www.gov.uk/government/statistics/ndns-results-from-years-7-and-8-combined
The report also looks at dietary intake in relation to government recommendations, and statistically
compares current intake (Years 7&8) to past intake (Years 1&2).
Dietary intake in the UK - what’s new?
AOAC fibre and free sugars
For the first time, intakes of free sugars and AOAC fibre are presented and compared with the
recommendations. Previously, the NDNS measured sugars intake as non-milk extrinsic sugars
(NMES) and fibre intake as non-starch polysaccharides (NSP). However, following the 2015 SACN
Carbohydrates and Health report2, government recommendations for free sugars and AOAC fibre
were set, and these definitions were used for the analysis.
New age category
The latest report of the NDNS has split the results for food consumption and nutrient intakes for
older people over 65 years into two categories (65-74 years and 75 years and over) in order to
examine these groups more closely.
Overall findings
The report does not identify any new nutritional problems in the general population, but suggests
that the UK population continues to consume:
Too much
Free sugars
Saturated fat
Salt – in 2016, estimated salt intake data (based on 24-hour urinary sodium excretion) were
published for adults aged 19-64 years in England for 2014. This suggested that average
estimated salt intake for adults was 8.0 g/day (9.1 g/day for men and 6.8 g/day for women).
Too little
Fruit and vegetables
Fibre
Oily fish
Calcium, iodine, iron, potassium and zinc in girls aged 11-18 years
Iron in women aged 19-64 years and potassium in all adult women
2
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/445503/SACN_Carbohydrates_and_Health.pdf
Definition of free sugars
The definition of free sugars as described by SACN includes all monosaccharides and disaccharides added to foods by the manufacturer, cook or consumer, plus sugars naturally present in honey, syrups and unsweetened fruit juices. The definition of free sugars used in the NDNS Rolling Programme also includes fruit purees and pastes and vegetables in pureed and juice form. Under this definition, lactose (milk sugar) when naturally present in milk and milk products and sugars contained within the cellular structure of foods (particularly fruits and vegetables) are excluded.
2. NDNS findings on intake compared to nutrient-based recommendations
2.1 Free sugars
For the first time, the NDNS presents intakes of free sugars for all paired years (Years 1&2, 3&4, 5&6,
7&8) of the Rolling Programme. In Years 7&8, mean intakes of free sugars were more than double
the recommended maximum of 5% total energy in all age groups.
Reduction in free sugars intake is a key target in the government’s Childhood Obesity: A Plan for
Action3. Many foods and drinks that contain high amounts of free sugars can be high in energy and
may have few other nutrients. Having these foods or drinks too often can mean more calories are
consumed than needed, which can lead to weight gain and obesity, and obesity is one of the most
significant current health concerns in the UK. The amount and frequency of foods and drinks with
free sugars we consume can also increase risk of dental decay.
Table 1: Free sugars intake (% of total energy) in all age groups for all paired years of the NDNS Rolling Programme
Years 1&2
Years 3&4
Years 5&6
Years 7&8
(2008/09 - 2009/10)
(2010/11 - 2011/12)
(2012/13 - 2013/14)
(2014/15-2015/16)
Children 1.5-3 years 12.1 13.0 12.8 11.3
Children 4-10 years 14.7 15.5* 14.0 13.5**
Children 11-18 years 15.9 15.8 15.8 14.1**
Adults 19-64 years 11.8 11.7 12.1 11.1*
Men 19-64 years 12.0 12.3 12.5 11.1*
Women 19-64 years 11.6 11.2 11.6 11.2
Adults 65-74 years 9.9 11.2 10.5 11.0
Men 65-74 years 9.7 11.0 11.6 11.8*
Women 65-74 years 10.1 11.3 9.5 10.4
Adults 75 years and over 12.2 11.8 11.3 11.3
Men 75 years and over 11.8 12.3 [11.5] 12.5
Women 75 years and over 12.4 11.2 11.2 10.4*
*p<0.05 and **p<0.01
[ ] data and bases for a variable with a cell size between 30-49 are presented in square brackets
Mean intakes of free sugars in children (both 4-10 years and 11-18 years) and adult men aged 19-64
years were significantly lower in the current survey compared with Years 1&2. In children, the
reduction in free sugars intakes is thought in part to be due to a decrease in consumption of sugars-
sweetened beverages, which is significantly lower in children aged 4-10 years in the current survey
compared to Years 1&2 (83 g/day vs. 130 g/day).
3https://www.nutrition.org.uk/nutritioninthenews/new-reports/childhoodobesityplan.html
2.2.1 Contribution of foods to free sugars intake
Table 2: Percentage contribution to average daily free sugars intake by highest 5 food contributors in current NDNS
(Years 7&8) vs contribution in Years 1&2 Years 1&2 Years 7&8
1.5-3 y
Fruit juice 15 12
Yogurt, fromage frais and other dairy desserts 12 11
Sugars, including table sugar, preserves and sweet spreads 7 9
Buns, cakes, pastries and fruit pies 6 8
Soft drinks, not low calorie 9 7
4-10 y
Fruit juice 13 11
Soft drinks, not low calorie 16 10
Buns, cakes, pastries and fruit pies 10 10
Sugars, including table sugar, preserves and sweet spreads 7 9
Biscuits 7 9
11-18 y
Soft drinks, not low calorie 28 22
Fruit juice 11 10
Sugars, including table sugar, preserves and sweet spreads 7 10
Chocolate confectionery 8 7
Biscuits 7 8
19-64 y
Sugars, including table sugar, preserves and sweet spreads 17 16
Soft drinks, not low calorie 15 14
Biscuits 5 7
Beer, lager, cider and perry 8 7
Buns, cakes, pastries and fruit pies 6 7
65-74 y
Sugars, including table sugar, preserves and sweet spreads 19 20
Buns, cakes, pastries and fruit pies 12 10
Biscuits 6 7
Fruit juice 7 7
Soft drinks, not low calorie 8 7
75 y+
Sugars, including table sugar, preserves and sweet spreads 22 28
Buns, cakes, pastries and fruit pies 13 12
Biscuits 6 8
Fruit juice 8 6
Puddings 6 5
The government’s Childhood Obesity: A Plan for Action tasks industry to cut the amount of sugar in
food and drinks, working towards a 20% reduction in the sugar content of products popular with
children (such as breakfast cereals, yogurts, biscuits, cakes, confectionery, pastries, puddings, ice
cream and sweet spreads). In addition, a new levy on sugar-containing soft drinks (often referred to
as the ‘sugar tax’) will be introduced in April 2018.
2.2.2 Sugars-sweetened soft drinks.
SACN recommended that the consumption of sugars-sweetened beverages should be minimised in
children and adults. There is evidence in the NDNS report that consumption of sugars-sweetened
soft drinks has reduced in children and adolescents. Mean consumption was significantly lower in all
age groups except for children aged 1.5-3 years and older adults aged 65 years and over in Years
7&8 compared with Years 1&2. The decreased intake perhaps reflects an increased availability of
low calorie drinks and increased consumption of water, although in other ages the decrease in daily
consumption was not significant.
Table 3: Average daily intake of sugars-sweetened beverages (current NDNS Years 7&8 vs. Years 1&2)
Soft drinks, not low calorie or sugars-sweetened beverages
Mean Consumption g/d
Years 1&2 Years 7&8
1.5-3 y 56 37
4-10 y 130 83**
11-18 y 275 191**
19-64 y 138 129**
65-74 y 47 46
75 y and over 58 32 ** p< 0.01
2.3 Dietary fibre
The recommendation for fibre intake for those aged 2 years and over is now defined using
the AOAC method of analysis. The latest report of the NDNS Rolling Programme has, for the first
time, reported fibre intake using this method for all paired years. Mean intakes of fibre remain well
below the recommended amounts in all age groups. Fibre intake in children in particular appears to
be falling.
The SACN report Carbohydrates and Health suggests that high intake of total dietary fibre is
associated with a lower risk of heart disease, stroke, type 2 diabetes and bowel cancer, and confers
benefit on digestive health. Government guidelines recommend for adults (over 16 years) that fibre
intake should increase to 30 g AOAC fibre a day. For children recommendations are as follows:
2-5 year-olds: need about 15 g of fibre a day
5-11 year-olds: need about 20 g
11-16 year-olds: need about 25 g
Table 4: AOAC fibre intake (g/day) in all age groups for all paired years of the NDNS Rolling Programme
Table 5: Percentage contribution to average AOAC fibre intake by highest 5 food contributors in current NDNS (Years 7&8) vs contribution in Years 1&2 Years 1&2 Years 7&8
1.5-3 y
Fruit 14 16
Vegetables (not raw) including vegetable dishes 15 12
High-fibre breakfast cereals 8 8
White bread 8 8
Wholemeal bread 5 6
4-10 y
Fruit 10 12
Vegetables (not raw) including vegetable dishes 14 12
White bread 9 9
Pasta, rice, pizza and other miscellaneous cereals 8 8
High-fibre breakfast cereals 7 7
11-18 y
Vegetables (not raw) including vegetable dishes 12 12
Pasta, rice, pizza and other miscellaneous cereals 10 12
White bread 11 11
Chips, fried and roast potatoes and potato products 12 10
Fruit 5 6
Years 1&2 Years 3&4 Years 5&6 Years 7&8 Years 7&8 % achieving
recommended 30 g/d
(2008/09 - 2009/10)
(2010/11 - 2011/12)
(2012/13 - 2013/14)
(2014/15-2015/16)
Children 1.5-3 years 10.6 10.7 10.3 10.3 10
Children 4-10 years 14.9 14.7 14.1* 14.0** 10
Children 11-18 years 16.1 15.5 15.9 15.3* 4
Adults 19-64 years 18.5 18.0 18.4 19.0 9
Men 19-64 years 19.8 19.4 19.7 20.7 13
Women 19-64 years 17.3 16.7 17.0 17.4 4
Adults 65-74 years 19.1 19.7 18.7 18.4 7
Men 65-74 years 22.1 21.2 19.8* 19.5* 9
Women 65-74 years 16.7 18.7* 17.6 17.4 6
Adults 75 years and over 16.7 17.6 16.8 16.5 6
Men 75 years and over 16.5 18.1 [17.5] 18.3 10
Women 75 years and over 16.8 17.0 16.4 15.1 2
*p<0.05 and **p<0.01
[ ] data and bases for a variable with a cell size between 30-49 are presented in square brackets
19-64 y
Vegetables (not raw) including vegetable dishes 15 16
Pasta, rice, pizza and other miscellaneous cereals 8 9
White bread 9 8
Fruit 8 8
Chips, fried and roast potatoes and potato products 8 7
65-74 y
Vegetables (not raw) including vegetable dishes 18 16
Fruit 11 12
High-fibre breakfast cereals 6 9
Wholemeal bread 7 8
White bread 7 7
75 y+
Vegetables (not raw) including vegetable dishes 15 13
Fruit 10 9
Wholemeal bread 8 9
White bread 8 8
High-fibre breakfast cereals 9 8
2.4 Saturated fat
UK health guidelines recommend that, on average, we need to reduce our saturated fat intake.
Eating a diet that is high in saturated fat can raise the level of cholesterol in the blood. Having high
cholesterol increases the risk of heart disease. Wherever possible we should replace saturated fats
with small amounts of monounsaturated and polyunsaturated fats.
Population average intake of saturated fat should be no more than 11% of food energy for those
aged 5 years and over. SACN is currently reviewing the evidence for saturated fat and health and its
report is expected to be published later in 2018.
Table 6: Average daily intake of saturated fat as % food energy (current NDNS Years 7&8 vs. Years 1&2) % of food energy
Years 1&2 Years 7&8
4-10 y 13.4 13.0*
11-18 y 12.6 12.4
19-64 y 12.8 12.5
65-74 y 13.9 13.1
75 y and over 15.0 14.6
*p<0.05
There has been a significant reduction in the saturated fat intake in older adult men aged 65-74
years, men aged 19-64 years and boys aged 4-10 years in Years 7&8 from Years 1&2, but a clear
downward trend over time in these age groups was not suggested by the data. There was no
reduction in other age groups, and all groups exceed the saturated fat intake recommendations.
3 Vitamins and minerals intake In this section we look at the percentage intake of vitamins and minerals below the Lower Reference
Nutrient Intake (LRNI) as reported in the latest NDNS data.
The LRNI is the amount of a nutrient that is enough for only a small number of people in a group
who have low requirements (2.5%). Intakes below the LRNI are considered inadequate for most
individuals. The percentage of population with intake of vitamins and minerals below the LRNI is,
therefore, an indicator of inadequate intake.
Table 7: Proportion of males and females of different age groups in the UK with intakes of micronutrients
below the lower reference nutrient intake (LRNI)*
Age groups
1.5-3 y 4-10 y 11-18 y 19 to 64 y 65-74 y 75 y+
All Boys Girls Boys Girls Men Women Men Women Men Women
Nutrient
Calcium (food sources only)
1 2 1 11 22 7 11 0 11 4 10
Folate (incl. folic acid supplements)
1 0 1 2 15 3 5** 0 3 3 6
Iodine (food sources only)
3 6 4 14 27 9 15 2 6 4 9
Iron (food sources only)
10 0 3 12 54 2 27 0 8 2 12
Potassium (food sources only)
0 0 0 18 38 11 23 4 22 16 34
Zinc (food sources only)
5 9 14 18 27 7 8 5 3 8 12
*Intakes below the LRNI are inadequate for most individuals.
**7% of women aged 19-49 y (defined by NDNS as 'childbearing age') were reported to have intakes below LRNI
As demonstrated by previous NDNS data, there appears to be low intakes of certain vitamins and
minerals, in particular amongst adolescent females. For example, around 1 in 5 of 11-18 year-old
girls have inadequate calcium intake at a life stage where calcium is particularly vital because of
rapid bone growth.
Whilst there is evidence of intakes below the LRNI in a substantial proportion of older children and
adults for some minerals, particularly potassium, iron, zinc and iodine, it should be noted that the
DRVs for these minerals are based on limited data. Caution should be used when assessing adequacy
of intake using the LRNI for these minerals as the health implications of this are unclear.
3.1 Vitamin D
The SACN report Vitamin D and Health4 was published around the end of the data collection in Year
8 (2015/2016) of the NDNS, so the impact of the new recommendation for all those over the age of
1 year to consume 10 µg of vitamin D a day will not be seen yet. There is no LRNI set for vitamin D.
The table below shows the intake of vitamin D per day (from food sources only and from food
sources plus supplements), in micrograms (µg) and as a percentage of recommended intake (10 µg)
in all age groups.
Table 8: Average daily intake of vitamin D (µg) and % RNI
From food sources only From food sources plus supplements
Intake % RNI Intake % RNI
1.5-3 y 2.0 20 2.9 29
4-10 y 2.0 20 2.7 27
11-18 y 2.1 21 3.5 35
19-64 y 2.7 27 4.2 42
65-74 y 3.5 35 6.0 60
75 y and over 2.8 28 5.3 53
Lower intake from food sources only reflects the fact that only a small number of foods are a source
of vitamin D (either naturally occurring or fortified). As it might be difficult to get enough from foods
alone, everyone should consider taking a daily supplement containing 10 µg of vitamin D,
particularly in the winter months (October to March) when we cannot obtain sufficient vitamin D
from sunlight when outdoors.
4 Vitamins and minerals status (biochemical indices of nutritional
status) Analysis of participant blood/urine samples provides information of micronutrient status to give an
estimate of the proportion of the population at greater risk of deficiency due to depleted body
stores or tissue concentrations.
4.1 Iron deficiency anaemia
Based on the WHO thresholds of haemoglobin and serum ferritin concentrations used to define iron
deficiency and anaemia, the prevalence of iron deficiency anaemia was 9% for girls aged 11-18
years.
4.2 Iodine
Lack of dietary iodine can lead to goitre (enlargement of the thyroid), hypothyroidism and
impairment of mental health including retardation in infants and children. Despite indication that
4
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/537616/SACN_Vitamin_D_and_Health_report.pdf
iodine intake may be low in certain groups such as teenage girls and adult women5,6, analyses of
urinary iodine concentrations showed that all age and sex groups met the WHO criteria for adequate
iodine intake (median urinary iodine concentration within the range 100-199 μg/L and fewer than
20% of samples below 50 μg/L).
4.3 Vitamin D
Low vitamin D status (as indicated by low plasma 25-hydroxy vitamin D concentrations in blood) was
present in all age groups. It will be interesting in future reports to see the impact of the new
government supplement recommendations.
Table 9: Biochemical Indices of vitamin D status, percentages below established threshold by age and sex
% low vitamin D status (concentration below 25nmol/L)
4-10 y All 10
11-18 y All 26 Boys 15 Girls 39
19-64 y All 17 Men 19 Women 16
65 y and over All 13 Men 11 Women 15
5 NDNS findings on current diets in relation to food-based guidelines
5.1 Fruit and vegetables
The recommendation to eat at least 5 portions per day (equivalent to 400 g) is well recognised. This
is based on advice from the World Health Organization, which recommends eating a minimum of
400 g of fruit and vegetables a day to lower the risk of serious health problems, such as heart
disease, stroke and some cancers.
However, on average, we are currently not meeting the recommendation for 5 A DAY. Intake in
adolescents still remains low, with the average number of portions consumed 2.7 per day. Less than
8% of the individuals in this age group in the survey eat 5 or more portions a day.
Table 10: Average daily intake of fruit and vegetables (current NDNS Years 7&8 vs. Years 1&2)
No. of portions/d (average)
% meeting recommendation
Years 7&8 Years 1&2 Years 7&8 Years 1&2
11-18 y 2.7 2.8 8 10
19-64 y 4.2 4.1 31 29
65-74 years 4.3 4.4 32 36
75 years and over 3.4 3.8 19 26
In Years 7&8, the proportion of adults aged 65 years and over meeting 5 A DAY is significantly lower
(26%) compared with Years 1&2 (36%).
5 Vanderpump et al. (2011) Iodine status of UK schoolgirls: a cross-sectional survey. The Lancet 377
(9782):2007-2012 6 Vanderpump (2014) Thyroid and iodine nutritional status: a UK perspective. Clinical Medicine 14(6):s7-s11
For younger children, portion sizes are smaller and therefore 400 g is inapplicable. The NDNS though
does report mean consumption of fruit and vegetable (g/d) for children.
Table 11: Average (range 2.5th
– 97.5th
centile) daily intake of fruit and vegetables (g) in children ages 1.5 to
10 years (current NDNS Years 7&8 vs. Years 1&2)
Despite evidence of widespread awareness of the 5 A DAY message, there has been a lack of change
over time. It is important that we promote fruit and vegetable consumption and understand the
barriers to change so that we may facilitate increased intake in all ages.
5.2 Oily fish
Oily fish (e.g. salmon, mackerel, sardines, trout) are high in long-chain omega-3 fatty acids, which
may help to prevent heart disease, and are a good source of vitamin D.
Government recommendations, based on advice from the UK’s Scientific Advisory Committee on
Nutrition (SACN)7, are that the general population should consume at least 1 portion of oily fish per
week (140 g cooked weight). Mean daily intake of oily fish is shown in the table below. There was no
evidence of any change in consumption over time, with average intake still falling well below the
recommendation.
Table 12: Average daily intake of oily fish (current NDNS Years 7&8 vs. Years 1&2)
Mean daily consumption oily fish g/d
Years 7&8 Years 1&2
1.5-3 y 2 1
4-10 y 2 2
11-18 y 2 2
19-64 y 8 8
65-74 y 15 15
75 y and over 10 9
Essential long-chain omega-3 fatty acids and vitamin D are important to include in the diet for health
yet consumption of oily fish is particularly uncommon in children, and although higher in adults is
still very much below recommendations. Current school food recommendations state that oily fish
must be provided once or more every three weeks.
7https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/338801/SACN_Advice_on_
Fish_Consumption.pdf
Years 7&8 Years 1&2
1.5 – 3 y 170 (26-402) 178 (16 – 386)
4-10 y 193 (27-418) 199 (23 – 433)
5.3 Red and processed meat
UK recommendations are for high consumers of red and processed meats (those consuming more
than 90 g cooked weight per day) to reduce their intake to not exceed 70 g per day. This is because
evidence suggests a diet high in red and processed meat can increase risk of developing bowel
cancer.
Table 13: Average daily intake of red and processed meat (current NDNS Years 7&8 vs. Years 1&2)
Mean Consumption g/d
Years 7&8 Years 1&2
1.5-3 y 26 27
4-10 y 38* 46
11-18 y 53 64
19-64 y 62* 74
65-74 y 63 68
75 y and over 53 60 *p< 0.01
The World Cancer Research Fund (WCRF) recommends eating no more than 500 g a week or red
meat, and eating little if any processed meat, in order to reduce the risk of bowel cancer. There has
been a significant reduction in mean red and processed meat intake in children aged 4-10 years,
adults aged 19-64 years and women aged 65 years and over. Mean consumption in men (aged 19-64
years and 65-74 years) continues to exceed 70 g.
6. Conclusion Overall, findings suggest that, on average, our intakes of free sugars and saturated fat are above
recommendations, and we are not eating enough fruit, vegetables, oily fish and fibre. Now that the
Rolling Programme measures free sugars and AOAC fibre intakes, it will be interesting to monitor
these going forward to see whether any progress is being made through efforts from industry and
government to help the population achieve the dietary recommendations for these, and other,
nutrients. In light of concern around the intake of some micronutrients, such as vitamin D, iodine
and folate, in particular age groups, data from the NDNS Rolling Programme will continue to be
useful as a way of monitoring the UK population’s intake and status of these micronutrients, and
may be useful when setting new recommendations in government policy in the future.