bnf looks at years 7 and 8 of the national diet and ... looks at... · salt – in 2016, ... a plan...

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

https://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

https://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




Biscuits 7 9

11-18 y


Fruit juice 11 10


Chocolate confectionery 8 7

Biscuits 7 8

19-64 y



Biscuits 5 7

Beer, lager, cider and perry 8 7


65-74 y



Biscuits 6 7

Fruit juice 7 7


75 y+



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


White bread 9 9

Pasta, rice, pizza and other miscellaneous cereals 8 8


11-18 y



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



White bread 9 8

Fruit 8 8

Chips, fried and roast potatoes and potato products 8 7

65-74 y


Fruit 11 12


Wholemeal bread 7 8

White bread 7 7

75 y+


Fruit 10 9

Wholemeal bread 8 9

White bread 8 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)

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/338801/SACN_Advice_on_Fish_Consumption.pdf

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/338801/SACN_Advice_on_Fish_Consumption.pdf

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.

bnf looks at years 7 and 8 of the national diet and ... looks at... · salt – in 2016, ... a plan...

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