who needs supplements? why are they...
TRANSCRIPT
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