Who needs supplements? Why are they necessary?

Dr Carrie Ruxton RD

Supported by

Key points today

1. If we all ate a healthy balanced diet, we

could get all the nutrients we need

2. Many people do not currently eat a

healthy balanced diet

3. Vulnerable groups have increased needs

for specific nutrients

4. This is why supplements are necessary in

certain cases.

THE GREAT BRITISH DIET

1/3 of calories from nutrient-poor foods and drinks

NDNS (2014) 11-18 years

Comparison with targets: 19-64y

Area Current intakes Target

Fruit & veg 4.1 portions/day 5 portions/day

Dietary fibre 13.7 grams/day 18 grams/day

Salt 7-8 grams/day 6 grams/day

Total fat 32.9% energy 35% energy

Saturated fat 12.0% energy 10% energy

Trans fats 0.6% energy < 2% energy

NME sugars 11.5% energy 5% energy*

NDNS (2014); 30% achieve 5-a-day; * new 2015 guideline

Comparison with targets: 11-18y

Area Current intakes Target

Fruit & veg 2.9 portions/day 5 portions/day

Dietary fibre 11.8 grams/day 18 grams/day

Salt 7-8 grams/day 6 grams/day

Total fat 33.7% energy 35% energy

Saturated fat 12.4% energy 10% energy

Trans fats 0.6% energy <2% energy

NME sugars 15.4% energy 5% energy*

NDNS (2014); 9% achieve 5-a-day; * new 2015 guideline

Fruit and vegetable intakes flat lining

0

5

10

15

20

25

30

35

40

2001

2002

2003

2004

2005

2006

2010

2011

2012

2014

% achieving

5-a-day

Men Women Children

NDNS various years

Oily fish consumption poor

0

50

100

150

200

250

1.5-3y 4-10y 11-18y 19-24y 25-34y

Gra

ms p

er

week

Total fish/wk Oily fish/wk

Bates et al. (2012) NDNS

Target 2 portions/wk % consumers: 1.5-3y = 10% 4-10y = 11% 11-18y = 8% 19-24y = 18% 25-34y = 33%

Sugar falling but not enough

NDNS various years; 2000 was the adult survey

Guideline 5% total energy

NUTRIENT GAPS

Vitamin & mineral DRVs

EAR RNI LRNI

% population needs met by each rec. RNI = 97.5% EAR = 50% LRNI = 2.5%

Message: It’s bad to have intakes below the LRNI

COMA report 1991

Average intakes fine

Source: NDNS (2010) Adults

But .. hide at risk groups

NDNS (2014)

Lowest intakes in teenage girls

NDNS (2014)

Nutrients of concern

Folate

Vitamin D

Long-chain omega-3 fatty acids

Iron

Iron

• More than 20% of women and 40% of girls have inadequate intakes < LRNI

• 10% of women have low haemoglobin

• 30% of girls have low ferritin

• Probably due to low intakes of red meat and fortified breakfast cereals

• Low iron levels cause tiredness, and may impact on immune function

Folate

• Prevents neural tube defects (75% reduced risk in suppl. takers)

• 400 mcg recommended pre-pregnancy and for first trimester (4 mg in ‘at risk’)

• 2/3 women do not take a supplement prior to becoming pregnant (RCOG)

• Food fortification being debated in UK.

Poor folate status in UK women

PHE (2015) www.gov.uk/government/statistics/national-diet-and-nutrition-survey-supplementary-report-blood-folate

Vitamin D

• Normal teeth, bones, immune function

• Low vitamin D during pregnancy linked with higher risk of child type 1 diabetes

• Higher risk of deficiency in people from lower socio-economic groups and those living in Scotland

• 10 mcg/day supplement recommended during pregnancy & lactation.

Widespread deficiency in UK

nmol/L Male Female

Teens 46.1 42.5

Adults 45.6 49.6

14 16 18 20 22Boys

Men

Girls

Wom

en

% < 25nmol/L

Average vitamin D status (25 hydroxyvitamin D)

NDNS (2012)

Limitations of sources

• 90% vitamin D from sun exposure but you would need 9-25 min* daily midday sun (shorts & t-shirt) from March-Sept to ensure adequate status

• 10% from foods but limited natural sources and oily fish/egg intakes low

• Current mean daily intakes of 2-4 mcg are well below draft DRV of 10 mcg.*

*SACN (2015) draft report on vitamin D

LC omega-3 fatty acids

• Important for normal brain and eye development during pregnancy at intakes of 200-3000mg daily (esp DHA)

• Population recommendation of 400 mg EPA+DHA per day in UK*

• Intakes are around half of this in women of child-bearing age.

SACN/COT (2004) Report on fish

New review article

• Encouraging data on giving omega-3s during pregnancy for cognitive and eye development but more RCT needed

• Barriers to oily fish consumption are driving poor intakes in UK

• 29% adults surveyed took oily fish supplements.

Ruxton C (2015) Complete Nutrition; September issue

Premature birth

• Women consuming less than 150 mg of omega-3 fatty acids a day (ie less than 3.5 oz [90g] of fish weekly) were at the highest risk of delivering prematurely1

• Fish Oil Trials in Pregnancy study (n=232) found fish oil supplementation reduced risk of recurrent preterm birth by 46%2.

1. Greenberg JA et al. (2008) Rev Obstet Gynecol 1: 162-9. 2. Olsen SF et al. (2000) BJOG 107: 382–395.

Benefits during lactation

• Lactating women given 200 mg/d DHA for 4 months had infants who performed significantly better on the Bayley Psychomotor Development Index compared with vegetable oil control

• Fish oil supplementation during pregnancy and lactation resulted in a decreased risk of infant allergies.

Coletta JM et al. (2010) Obstet Gynecol 3: 163-1. REVIEW

IMPACT OF SUPPLEMENTS

Fewer have inadequate intakes when supplements taken

0

5

10

15

20

25

30

35

40

45

% b

elo

w L

RN

I

Supplements

No supplements

11-18 year olds < LRNI

NDNS 2014

Compliance with folate advice improves status

• Survey of 296 pregnant Irish women

• Only 19% complied with advice to take 400 mcg folic acid prior to becoming pregnant

• Red cell folate status was signif. higher in supplement takers

McNulty B et al. (2011) Women's compliance with current folic acid recommendations and achievement of optimal vitamin status for preventing neural tube defects. Hum Reprod 26: 1530-6.

Fish oil supplementation

• Improves omega-3 status in women and their offspring1

• May lower risk of some atopic conditions e.g. eczema, egg allergy2

• May improve infant cognitive function but depends on baseline status3

• Free from heavy metals.

1. Carlson SE et al (2013) Am J Clin Nutr 97: 808-15. 2. Cochrane Database Syst Rev 7: CD010085. 3. Gould JF et al. (2013) Am J Clin Nutr 97: 531-44

Conclusions

• In an ideal world, we wouldn’t need nutritional supplements

• The reality is that poor diets are common in women and girls

• Nutrients of concern include iron, folate, vitamin D and LC omega-3 fatty acids

• So, what can HCPs advise?

Population advice

• Healthy balanced diet is the cornerstone

• Daily multinutrient supplement can help bridge the gap between intakes and recommendations

• Folic acid pre- and during pregnancy*

• Vitamin D (10mcg) during pregnancy and lactation*

• Daily omega-3fish oil supplement in women who don’t eat enough oily fish (140g portion/wk).

* Already Govt advice

Thank you