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National Diet and Nutrition Survey Dietary results: Years 1 to 4 Dr Toni Steer Public Health Nutritionist MRC Human Nutrition Research, Cambridge, UK MRC Human Nutrition Research Conduct nutrition research and surveillance to improve the health of the population with a focus on cardiometabolic risk and obesity, musculoskeletal health, intestinal function and nutritional vulnerabilities. The National Diet and Nutrition Survey (NDNS) • A national survey of the dietary habits and nutritional status of the UK population • Dietary habits: • the foods people eat • the nutrients they take in in their food • Nutritional status • physical measures (in blood, urine or anthropometry) that reflect how well (or badly) nourished people are in relation to the nutrients in the diet How are NDNS data used? • Monitor diet and nutritional status of the UK population • Tool for monitoring progress towards public health objectives, e.g. salt, saturated fat, fruit and vegetables • Provides the evidence base to support development of public health nutrition policy • Public Health Responsibility Deal, Change4Life • Food consumption data used by FSA for food safety risk assessments Who pays? • Public Health England (PHE) for the core UK NDNS survey • With the boost samples funded by: • The Food Standards Agency in Scotland • The Food Standards Agency in Northern Ireland • The Welsh Assembly Who undertakes the NDNS? National Centre for Social Research, London MRC Human Nutrition Research Department of Epidemiology and Public Health, University College, London Previous NDNS surveys NDNS programme: • Children aged 1.5 - 4.5 years - fieldwork 1992-3 • People aged 65 + years - fieldwork 1994-5 • Young people aged 4-18 years - fieldwork 1997 • Adults aged 19-64 years - fieldwork 2000-1 • NDNS Rolling Programme 2008-17 NDNS Timeline – Years 1-5 April - July 2007 Comparison study fieldwork Feb - March 2008 Run-in to main study April 2008 - March 2009 Main study Year 1 April 2009 – March 2010 Main study Year 2 April 2010 – March 2011 Main study Year 3 April 2011 – March 2012 Main study Year 4 April 2012 – March 2013 Main study Year 5 May 2014 Years 1-4 UK report published NDNS – Coverage • 1000 people per year (in the core sample) - enables trend data every 2-3 years • All ages from 1½ years upwards • Private households representative of UK • England, Scotland, Wales, Northern Ireland • Excluding: • Pregnant and lactating • Those in institutions • children’s homes, prisons, residential homes NDNS – Components • Face to face interview – dietary habits, socio-demographic data, lifestyle • 4 day prospective estimated (unweighed) diary, including both weekend days • Tracer water on sub-sample – Years 1, 3, 6 and 7 • Physical measures: height, weight, waist hip, mid upper arm circumference (Y1-5 only), demispan and infant length • Blood pressure • Fasting blood sample • 24 hour urine (part of the main survey for Years 1-5 only and as a single time point boost study for adults during Y69) • Physical activity – questionnaire age 16 years +, Actigraph 4-15 years (Y1-4 only) What is the blood sample analysed for? • • • • • • • • • Full blood count Lipid profile (triglycerides; total, HDL- and LDL cholesterol) C-reactive protein Creatinine Homocysteine Vitamins – A, B1, B2, B6, B12, C, D, E, folate, carotenoids Iron status – Hb, ferritin, transferrin receptor Minerals – selenium, zinc Age groups: Glucose and HbA1c – funded by Diabetes UK 16 + yrs – 35 ml 7-15 yrs – 19 ml 1.5-6 yrs – 10 ml What is the 24 hour urine sample analysed for? • Measure of nutrient intake: • • • • Sodium (salt) Potassium Urea, nitrogen (protein, adults only) Other measures • • Creatinine (kidney function) Para-aminobenzoic acid (completeness of collection) NDNS Years 1, 2, 3 and 4 (NDNS Y1-4) UK report Prepared by: (Editors) Beverley Bates, Alison Lennox, Ann Prentice, Chris Bates, Polly Page, Sonja Nicholson and Gillian Swan NDNS Y1-4 UK report – dietary data • Food consumption • Consumption of foods and food groups for 1.5-3y, 410y, 11-18y, 19-64y, 65+y • Fruit and vegetable portions compared with 5-a-day – not toddlers or young children • Nutrient Intakes • Intakes of macronutrients, selected minerals and vitamins for 1.5-3y, 4-10y, 11-18y, 19-64y, 65+y • Comparisons with government recommendations. NDNS Y1-4 UK report – dietary data • Comparisons in the UK Y1-4 report for dietary data: • New age splits (16–24y, 25–49y, 50–64y) • Equivalised income quintiles • Y1&2 versus Y3&4 • With previous surveys. Diet In Nutrients Out (DINO) • Dietary data is coded using Diet In Nutrients Out (DINO) a dietary assessment system developed at MRC Human Nutrition Research, incorporating the NDNS food composition databank • Information used for DINO: • Manufactured product information • Standard recipes from McCance and Widdowson’s “The Composition of Foods” • Homemade recipes from respondents’ food diaries Total Energy intake kcal/d NDNS Y1-4 compared to previous NDNS 2500 2308 2111 Total Energy intake kcal/d 2131 1972 2000 1907 1935 1613 1684 1573 16631569 1635 15091489 1510 1420 F 4-10y F 11-18y F 19-64y F 65+ 1500 1000 500 0 M 4-10y M 11-18y M 19-64y M 65+ 1994/95,1997,2000/01 2008/12 Sources of total energy – NDNS Y1-4 100 Cereals and cereal products Milk and milk products 90 80 70 31 Meat and meat products Vegetables, potatoes Sugar, preserves, confectionery 31 50 9 40 25 9 12 15 17 17 30 15 13 11 11 11 6 5 10 9 10 8 4 Alcoholic beverages 31 60 20 Non-alcoholic beverages 35 36 0 4 6 0 0 1 1.5-3y 4-10y 11-18y % contribution to energy intake 6 4 19-64y 65+y Sources of total energy NDNS – adults 19-64y 1986/87 vs 2000/01 vs 2008/12 100 Cereals and cereal products Milk and milk products 90 80 70 Meat and meat products Vegetables, potatoes Sugar, preserves, confectionery Non-alcoholic beverages Alcoholic beverages 30 31 31 11 10 9 16 15 17 20 12 13 11 10 6 6 5 3 4 7 7 6 1986/87 2000/01 2008/12 60 50 40 30 0 2 % contribution to energy intake Macronutrient recommendations Nutrient Population Average (% of food energy) Total Fat Not more than 35% Of which Saturated fat Trans fat Total Carbohydrate Not more than 11% Not more than 2% At least 50% Of which Starch & sugars in milk & fruit* Added sugars** Fibre*** *Intrinsic and milk sugars (IMS) **Non-milk extrinsic milk sugars (NMES) ***Non-starch polysaccharides (NSP) At least 39% Not more than 11% 18g per day Fat intake % food energy NDNS Y1-4 compared with previous surveys Total fat intake (% food energy) by equivalised income quintiles – NDNS Y1-4 Women 19 to 64 years 36.5 36 35.5 35 34.5 34 * * 33.5 33 32.5 32 q1 * p<0.05 q2 q3 q4 q5 Sources of total fat – NDNS Y1-4 Saturated fatty acids (% food energy) NDNS Y1-4 Saturated fat intake (% of food energy) by equivalised income quintiles ** ** * * ** ** * * p<0.05, ** p<0.01 ** Sources of saturated fatty acids, NDNS Y1-4 Fat and saturated intake % food energy (combined) – NDNS y1-4 NMES intake in NDNS Y1-4 vs earlier NDNS surveys NMES intake by equivalised income quintiles – NDNS Y1-4 * ** ** * ** * * p<0.05, ** p<0.01 Sources of NMES – NDNS Y1-4 Non starch polysaccharides (NSP) by income quintiles NDNS Y1-4 ** * ** ** ** * ** * * NDNS Year 1 to 4 sodium intake (24 hr urinary analysis) 10 9 8 7 6 5 4 3 2 1 0 males females 4 to 6 years 7 to 10 years 11 to 18 years Maximum recommended salt intake per day 19 to 64 years* 65 years and over * Dietary sources of sodium – NDNS Y1-4 Dietary sources of sodium – cereals and cereal products Pasta, rice, misc cereals 40 35 White bread 7 30 10 7 6 Wholemeal, brown, granary bread Breakfast cereals 25 20 10 13 10 4 5 Buns, cakes, pastries, fruit pies 11 15 6 Biscuits 10 11 0 3 2 1.5-3y 8 5 4 4 6 4 3 3 2 2 2 4 2 2 4-10y 11-18y 19-64y % contribution to sodium intake 3 4 Micronutrient intake as % of Reference Nutrient Intake by age group 100% of RNI Vitamin A Folate Iron Calcium 1.5-3y Zinc 4-10y 11-18y Magnesium 19-64y 65y+ Potassium Copper Iodine 0 50 100 150 200 250 Intakes of thiamin, niacin, vitamin B6, vitamin B12, and vitamin C are not presented in this graph but were >100% of Reference Nutrient Intake for all age groups Mean iron intake by equivalised income – NDNS Y1-4 Women 19 to 64 years 11 10.5 10 ** 9.5 9 ** ** 8.5 8 7.5 q1 ** P<0.01 q2 q3 q4 q5 RNI: 14.8mg for 19–50 years 50+ years 8.7mg NDNS Years 1-4 (combined): Fruit and vegetable intake (disaggregated) % achieving 5-a-day 100 80 60 41 40 40 20 30 30 10 7 0 Boys 11-18 Men 19-64 Men 65+ Girls 11-18 Women 19-64 Women 65+ ‘5-a-day’ portions by income quintiles – NDNS Y1-4 ** ** * ** p<0.01 *P<0.05 * ** ** ** ** ** ** NDNS Year 1 – 4 summary: 1 19-64 years Males NDNS NDNS NDNS 2000/1 35 ↓ 35.8 34.8 34.9 34.5 Saturated fat 11 ↓ 13.4 12.6 13.2 12.6 Trans fat 2↓ 1.2 0.7 1.2 0.7 50 ↑ 47.7 47.8 48.5 48.2 39 ↑ 34.9 35.1 37.0 36.6 11 ↓ 13.6 12.7 11.9 11.6 18 ↑ 15.2 14.7 12.6 12.8 Total carbohydrate Starch & sugars in milk and fruit* Non-milk extrinsic sugars Dietary fibre (g/day) Intrinsic and milk sugars and starch 2008/12 2000/1 NDNS Target Total fat * Females 2008/12 NDNS Years 1 to 4 summary: 2 • Total fat intake meets population recommendations, but saturated fat, NMES and salt remain above recommended levels. Whilst fruit and vegetables, fibre and oily fish are generally below recommendations. • Some age groups are consistently not meeting dietary recommendations. Children aged 11 to 18 years in particular consumed the fewest portions of fruit and vegetables, had the highest percentage of food energy from NMES and substantial proportions of this age group fell below the LRNI for some vitamins and most minerals • Some differences observed in food consumption and energy and nutrient intakes by equivalised household income quintile, particularly for fruit and vegetable consumption, particularly for adult females. Differences were clearest between the lowest and highest income quintile but were not seen in all age/sex groups. • NDNS report: https://www.gov.uk/government/publications/national-diet-and-nutritionsurvey-results-from-years-1-to-4-combined-of-the-rolling-programme-for2008-and-2009-to-2011-and-2012 • NDNS data Years 1 to 4 available in UK Data archive shortly: http://www.data-archive.ac.uk/ • NDNS Rolling Programme 2008-17 NDNS Timeline – Years 6-9 April 2013 - March 2014 Main study Year 6 April 2014 – March 2015 Main study Year 7 April 2015 – March 2016 Main study Year 8 April 2016 – March 2017 Main study Year 9 Dates to be confirmed Possibly a Years 5&6 report MRC Human Nutrition Research Cambridge, UK [email protected]