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Towards a healthier Britain
Dr Carrie Ruxton
Registered Dietitian
Nutrition Communications
Plan of talk
• What are we eating today?
• Evidence from the NDNS
• Hot nutrients for 2011
• Role of fortified products and supplements
What are we eating today?
30% of calories from nutrient-poor foods and drinks
Source: NDNS (2010) 19-64 years
30% of calories from treats, alcohol, soft drinks, chips and crisps
Similar picture in children
0 5 10 15 20
Bread
RTEC
Milk
Chips/crisps
Soft drinks
Meat/fish
Treats
% of daily calories
32% of calories from treats, soft drinks, chips and crisps
Source: NDNS (2010) 11-18 years
Fruit and vegetable intake improving in adults but not in children
0
5
10
15
20
25
30
35
40
2001 2002 2003 2004 2005 2006 2010
% achieving 5-a-day
Men Women Children
Source: NDNS (2010) and SACN reports
Deficiency amongst plenty?
Half of adults overweight or obese1 in 5 children overweight
Half of adults overweight or obese1 in 5 children overweight
Half of women have inadequate selenium intakes1 in 5 pre-schoolers have low iron stores
Why does only one side of equation get our attention?
Proven role of nutrients in health
Calcium, magnesium, Vit D
Normal bones and teeth
Vit B12, zinc Normal immune function
Vit A Normal vision
Niacin Normal nervous system
Iron, zinc Normal cognitive function
Folate Normal tissue growth during pregnancy
DHA/EPA Maintenance of normal blood pressure and normal serum triglycerides
Source: EFSA opinions on Article 13 claims, 2010
Evidence from the NDNS
Men and women
Average intakes of vitamins and minerals seem OK, probably influenced by fortified foods
0 50 100 150 200 250 300
Vit A
Folate
Vit C
Iron
Calcium
Magnesium
Potassium
Zinc
Iodine
Selenium
%RNI
Women
Men
NDNS (2010) Adults
But averages mask adults with poor intakes
Source: NDNS (2010) Adults
0 10 20 30 40 50 60
Vit A
Folate
Vit C
Iron
Calcium
Magnesium
Potassium
Zinc
Iodine
Selenium
% adults < LRNI
Women
Men
NDNS (2010) Adults
Most adults have low vitamin D intakes
0
2
4
6
8
10
12
14
16
18
20
>0.5 0.5 to 1 1 to 1.5 1.5 to 2 2 to 2.5 2.5 to 3 3 to 3.5 3.5 to 5 5 to 7 7 to 7.5 7.5 to 9 >9
Intake (micrograms per day)
% w
ith in
take
s in
rang
e
Men
Women
EU RDA for adults < 50 years71% men + 78% of women below RDA
NDNS (2003) Adults
0
5
10
15
20
25
30
35
40
% d
efic
ien
t
15-18 19-24 25-34 35-49 50-64 Instit
Age (years)
Men
Women
25% of adults deficient in winter months
Source: National Diet & Nutrition Surveys (2000, 2003)
25-hydroxy vitamin D <25 nanomoles/litre
Children and teens
Younger children doing better on average
NDNS (2010) Children
0 50 100 150 200 250 300
Vit A
Folate
Vit C
Iron
Calcium
Magnesium
Potassium
Zinc
Iodine
Selenium
% RNI
11-18 yr
4-11 yr
But closer examination reveals the issues
0 10 20 30 40
Vit A
Folate
Vit C
Iron
Calcium
Magnesium
Potassium
Zinc
Iodine
Selenium
% children < LRNI
11-18 yr
4-11 yr
Intakes of iron, magnesium and selenium particularly worrying
NDNS (2010) Children
0
5
10
15
20
25
30
35
40
45
50
% g
irls
11-1
8yr
< L
RN
ITeenage girls most at risk from deficiency
NDNS (2010) Children
Most children have low vitamin D intakes
94% boys + 97% of girls below EU RDA of 5 micrograms/day
0
5
10
15
20
25
30
35
<0.5 0.5 to 1 1 to 1.5 1.5 to 2 2 to 3 3 to 5 >5
Intake (micrograms per day)
% w
ith in
take
s in
ra
ng
e
Boys
Girls
Source: NDNS (2000) Children
Diets have improved little over the years
50
100
150
1997 2008/9
%R
NI
BoysGirls
0
50
100
1997 2008/9
%R
NI
BoysGirls
Folate
Vitamin D*
* EU labelling RDA of 5 micrograms used
50
100
1997 2008/9
%R
NI
Iron
50
100
1997 2008/9
%R
NI
Calcium
Where are they going wrong?
Food category g/day
4-10y 11-18y
Breakfast cereals 24 18
Bread 64 70
Milk 164 107
Fresh meat 46 58
Fish 19 17
Vegetables 74 77
Fruit 103 57
Soft drinks 284 417
NDNS (2010) Girls
Key nutrients
Men•Selenium•Potassium•Magnesium•Zinc•Vitamin A•Vitamin D
Women•Selenium•Potassium•Magnesium•Iron•Calcium•Vitamin D
Children•Selenium•Potassium•Magnesium•Iron•Calcium•Vitamin D•Zinc•Folate•Iodine
What are we missing?
Vitamin D
Selenium
Vitamin A
Zinc
Magnesium
Potassium
Calcium
Iron
Iodine
Folate
Hot nutrients for 2011
• Vitamin D
• Selenium
• Omega 3
• Flavonoids
Vitamin D – 90% from sunshine
But diet plays a role
5 to 22 mcg/portion0.02 to 1 mcg/egg
5 to 10 mcg/tsp
Mortality
Bone health
Immune function
Cell aging
Heart disease
Cancer
Cognitive function
Diabetes
Why are we interested?
Infection
Good Moderate Emerging
Selenium
• Essential trace element (Se)
• Antioxidant
• Stored in the body but topped up by our diet
Where do you get it?
Why are we interested?
Se
Supports fertility
Antioxidant
Immune function
Mood?
Anti-ageing
Heart health
Are we getting enough?
Selenium intake μg/d
UK rec60-75 μg/d
MAFF (1999), BNF (2001), Jackson et al (2003)
Omega-3s – still current
• Marine foods or supplements remain the best sources of EPA/DHA
• Vegetable omega-3s ‘don’t count’
Why are we interested?
Omega-3Heart health already known
IQ in children
Stress relief
Anti-ageing
Less depression?
Immune function
Omega-3 and the lifecycle
DHAEPA
Higher IQLess allergy Brain function
Better behaviour?Less stressMaintain brain function
Flavonoids
Flavonoid subclass
Examples Sources
Flavonols Kaempferol, quercetin Onions, kale, broccoli, tea, red wine
Flavones Apigenin, luteolin Parsley & leafy herbs
Flavanones Hesperetin, naringenin Citrus fruits
Isoflavones Daidzein, genistein Soybeans, legumes
Flavan-3-ols Catechin, epicatechin, epigallocatechin, EGCG
Tea, red wine, cocoa
Anthocyanidins Cyanidin, delphinidin, malvidin
Blueberries, black grapes, leafy veg
Heart disease Weight management
Blood pressure
Stroke Cognitive function
Diabetes
Why are we interested?
Good Moderate Emerging
Cancer
Oral health
The issue
• 30% of calories are from foods that tend to be low in micronutrients
• Significant groups of adults and children are low in key nutrients, risking deficiency
• Some nutrients, e.g. omega-3s, vitamin D, iron and selenium are only present in limited numbers of foods
Only some consumers are motivated to change their diets
managersdisciples investorshealers strugglers unmotivateds
health involved unmotivated
Source: Design Bridge
health involved unmotivated
Role of fortified products and supplements
• Boost what consumers already like to eat or find acceptable
• Take care to fortify where appropriate (chocolate bars with vitamin D!)
• Supplements only taken by 25% of consumers – room for improvement
• Consumers prefer ‘natural’ sources of nutrients