Dr Wendy L Wrieden, University of DundeeKaren L Barton, University of Dundee

Julie Armstrong, Glasgow Caledonian University

Using Scottish Data from UK studies to monitor

progress towards Scottish Dietary Targets

Scottish Dietary Targets

• Set of POPULATION LEVEL nutrient and food based targets set for achievement in 2005

• Derivation of the nutrient based targets:

–Dietary Reference Values for Food Energy and Nutrients for the UK (Department of Health,1991)

• Derivation of the food based targets:

– Scottish Diet Report (Scottish Office, 1993)

What are these targets?

Nutrient- based• Fat and saturated fat• Complex carbohydrate• Sodium• Non-milk extrinsic (added) sugarsFood -based• Fruit and vegetables• Bread• Breakfast Cereals• Fish particularly oil rich fish

Aim

• To review recent national dietary and health surveys and their ability to assess progress toward the Scottish Dietary Targets

• To compare findings with the Scottish Dietary Targets as set out in the Scottish Diet Action Plan (Scottish Office1996)

Surveys reviewed• HOUSEHOLD BUDGET SURVEYS

National Food Survey (NFS) 1996-2000 Expenditure and Food Survey (EFS) 2001 - 2004

• HEALTH SURVEYSThe Scottish Health Survey (SHS), 1995, 1998 and 2003Health Education Population Survey (HEPS), 1996-2004

• NATIONAL DIET AND NUTRITION SURVEYS (NDNS)NDNS 1995 – older adults aged 65+NDNS 1997 - young people aged 4-18 years NDNS 2001 - adults aged 19-64 years

Ability of 4 surveys to monitor progress towards the Scottish Dietary Targets

Method Scottish sample size

Frequency 1996-2005

Suitability of methods

NFS/EFS Household food survey

Reasonable

size, representative sample

Annual Acceptable

SHS Limited food frequency

Excellent, large and representative

3-5 years Weak

HEPS Fruit and vegetable questions

Reasonable

size, representative sample

Annual/

2 years

Unsatisfactory

NDNS 7-day weighed intake

Too small (n=123)

Infrequent Good

The Working Group on Monitoring Scottish Dietary Targets (FSA,2004)

concluded that:

“the Expenditure and Food Survey should be used to monitor progress towards the Scottish

Dietary Targets in 2005 and beyond”

The Scottish Dietary Targets: Getting to Grips with the Baseline

• Baseline figures, quoted in the SDAP, were derived from the Scottish Diet Report (Scottish Office,1993) and relate to combined data for 1989-1991 from the National Food Survey

• These data therefore do not represent the situation in 1996, the year the SDAP was published

• Also, from 1994 onwards the NFS included food eaten outside the home

• In this work, intakes have been recalculated for 1996 and the same calculations have been performed for subsequent years up to 2003/2004

Methodology of Surveys

• National Food Survey (NFS) – household and eating out purchases recorded by householder for 1 week

• Expenditure and Food Survey (EFS) – household purchases and eating out recorded by all members of household (over 7) for 2 weeks.

• Around 600 households (1,300 people) per year

Comment on EFS methodology

• Because the EFS records food acquisitions rather than consumption, it is possibly less susceptible to under-reporting and non-response bias than weighed intake dietary surveys (Wrieden, 2006; Chesher, 1997)

Calculation of NFS/EFS data

• Secondary analysis of the data sets from 1996- 2003/2004 - data supplied by Data Archive, DEFRA and ONS

• Data fitted to the food groups used in the surveys to match the Scottish dietary targets

• Household foods and foods eaten outside the home combined to give total food and nutrient intake per capita (less 10% for waste)

Calculation of SHS data

• The main data files for SHS 1995 and 1998 were obtained from the UK Data Archive.

• Foods which related to Scottish dietary targets were re-coded and where necessary new variables derived (for fruit and vegetables, foods high in NME sugars).

• Further analysis was carried out to calculate median (with IQR) and mean (with 95% CI) frequency of consumption of foods related to achieving the SDTs

RESULTS

Household and Eating out consumption in g per person /day

Food

National Food Survey Expenditure and Food Survey

1996 1998 2000 2001 / 2002 2002 / 2003 2003 / 2004

H=775 P=1885

H=541 P=1341

H=546 P=1320

H=618 P=1412

H=585 P=1342

H=546 P=1266

Mean Mean MeanMean (95% CI)

Mean (95% CI)

Mean (95% CI)

Fruit and Vegetables

(including fruit and vegetable juice and baked beans)

249 258 234255

(239 - 271)263

(246 - 280)246

(229 - 263)

Bread

(all types)133 122 122

126 (120 - 132)

124 (118 - 130)

116 (110 - 122)

Brown / Wholemeal Bread

26.5 22.9 19.321.5

(19.1 - 23.9)

22.4 (20.0 - 24.8)

19.7 (17.3 - 22.1)

FRUIT AND VEGETABLES

Average intake to double to more than 400g per day

Picture by Gordon Douglas

Progress Towards the Targets: Fruit and Vegetables (using 5 a day criteria)

Data Source :NFS/EFS

Average intake to double to more than 400g per day

0

50

100

150

200

250

300

350

400

450

1996 1997 1998 1999 2000 20012002

20022003

20032004

NFS EFS

Me

an

g/d

ay

SDT 2005 (>400g/day)

Results from the Scottish Health Survey

• 1998 Median frequency fruit and vegetable consumption = 2.9

• 2003 Median fruit and vegetable consumption = 2.9 portions

• Change???

Mean (with 95% confidence intervals) fruit and vegetable consumption) by SIMD quintiles

EFS 2001/2002-2003/2004

SIMD = Scottish Index of Multiple Deprivation

SIMD Quintiles: 1= Least Deprived; 5 = Most Deprived

0

50

100

150

200

250

300

350

400

1 2 3 4 5

SIMD Quintile

Mea

n g

/day

Median total fruit and vegetable intake (g per day) by men and women aged 16-74 from the Scottish Health Survey 2003

by deprivation

Quintile 1 = least deprived Quintile 5 = most deprived

240 240216

160

280256

240

184160160

0

50

100

150

200

250

300

1 2 3 4 5

Scottish Index Multiple Deprivation quintiles

g/

day

Men

Women

BREAD

Intake to increase by 45% from present daily intake of 106g, mainly using wholemeal and brown breads

Progress Towards the Targets: Bread

Data Source :NFS/EFS

Intake to increase by 45% from “present” daily intake of 106g, mainly using wholemeal and brown bread

020

4060

80100

120140

160180

1996 1997 1998 1999 2000 20012002

20022003

20032004

NFS EFS

Mean

g/d

ay

SDT All types Brow n / Wholemeal

SDT 2005 (154g/day)

Scottish Health Survey consumption of starchy

carbohydrates by women aged 16-74

(% consuming Bread 2-3+ slices/day)

0

10

20

30

40

50

60

70

80

90

Bread High FibreBread

BreakfastCereal

High FibreBreakfast

Cereal

PotatoesPastaRice

%

1995

2003

Progress Towards the Targets: Breakfast Cereals

Data Source :NFS/EFS

Average intake to double from “present” intake of 17g per day

0

5

10

15

20

25

30

35

40

1996 1997 1998 1999 2000 20012002

20022003

20032004

NFS EFS

Mean

g/d

ay

SDT All Varieties Wholegrain / High Fibre

SDT 2005 (34g/day)

Scottish Health Survey consumption of starchy

carbohydrates by women aged 16-74

(% consuming Breakfast cereal 5-6+

times/week)

0

10

20

30

40

50

60

70

80

90

Bread High FibreBread

BreakfastCereal

High FibreBreakfast

Cereal

PotatoesPastaRice

%

1995

2003

Oil Rich Fish

Oil rich fish consumption to double from 44g to 88 g per week

Image From http://www.charlestonseafood.com/images/Amazon/Salmon-8Steaks-375.jpg

Progress Towards the Targets: Oil Rich Fish (ex canned tuna)

Data Source :NFS/EFS

Oily fish consumption to double from “44g” per week to 88g per week

0

10

20

30

40

50

60

70

80

90

100

1996 1997 1998 1999 2000 20012002

20022003

20032004

NFS EFS

Me

an

g/w

ee

k

SDT 2005 (88g/w eek)

Other findings from NFS/EFS

• White fish consumption fell from 107g in 1996 to 76g in 2003/2004

• Fresh potato (as purchased) fell from 99g to 68g over same period

FATAverage intake of total fat to reduce from 40.7%

to no more than 35% of food energyAverage intake of saturated fatty acids to

reduce from 16.6% to no more than 11% of food energy

The National Diet and Nutrition Survey (2000/2001) showed main contributors to fat were:

Meat and meat products (23%)Cereals and cereal products (19%)Milk and milk products (14% of total, 24% of saturated)

Progress Towards the Targets: Total Fat (% food energy)

Data Source: NFS/EFS

Average intake of total fat to reduce from “40.7%” to no more than 35% of food energy

0

5

10

15

20

25

30

35

40

45

1996 1997 1998 1999 2000 20012002

20022003

20032004

NFS EFS

Me

an

% o

f F

oo

d E

ne

rgy

SDT 2005 <35%

Progress Towards the Targets: Saturated Fat (% food energy)

Data Source :NFS/EFS

Average intake of saturated fatty acids to reduce from “16.6%” to no more than 11% of food energy

0

2

4

6

8

10

12

14

16

18

1996 1997 1998 1999 2000 20012002

20022003

20032004

NFS EFS

Me

an

% o

f F

oo

d E

ne

rgy

SDT 2005 <35%

Cakes, Biscuits and PastriesData Source :NFS/EFS

Average intake to reduce by half

0.0

10.0

20.0

30.0

40.0

50.0

60.0

NFS EFS

Me

an

g/d

ay

Cakes and Pastries Sweet Biscuits Total Cakes, Biscuits and Pastries

Meat and Meat ProductsData Source :NFS/EFS

Processed meat and sausage intake to reduce by half. Bacon and ham to reduce by 20%

0.0

10.0

20.0

30.0

40.0

50.0

60.0

1996 1997 1998 1999 2000 2001/2002 2002/2003 2003/2004

NFS EFS

Mea

n g/

day

Processed Meat and Sausages Bacon and Ham

NON MILK EXTRINSIC SUGARS

Average intake of NME sugars in adults not to increase

The National Diet and Nutrition Survey (2000/2001) showed main contributors to non-milk extrinsic sugars for 19-24 year olds were soft and alcoholic drinks (57%). In 50-64 year olds this contribution was only 27%.

Progress Towards the Targets: NMES (% total energy)

Data Source :NFS/EFS

Average intake of NME sugars in adults not to increase

02468

1012141618

1996 1997 1998 1999 2000 20012002

20022003

20032004

NFS EFS

Mea

n %

of

Fo

od

En

erg

y

SDT 2005

ConfectioneryData Source :NFS/EFS

Intake to be cut by 1/3 for adults and by ½ for children

0.0

5.0

10.0

15.0

20.0

25.0

1996 1997 1998 1999 2000 2001/2002 2002/2003 2003/2004

EFS NFS

Mea

n g

/day

Chocolate Confectionery Sugar Confectionery Total Confectionery

Soft drinks (NFS sugar containing and sugar free does not include Eating

Out)Data Source :NFS/EFS

Intake to cut by one third for adults and by one half for children

0.00

50.00

100.00

150.00

200.00

250.00

300.00

350.00

400.00

NFS EFS

Mean

g/d

ay

Sugar Containing Soft Drinks Sugar Free Soft Drinks Total soft drinks

How does this inform policy?Using the best data available:

• Some progress towards the target for total fat

• No change in intakes of fruit and vegetables, breakfast cereal, oil rich fish, saturated fat or total complex carbohydrate

• Fall in bread intake (including brown and whole grain), white fish and fresh potatoes

• Foods targeted for increase have highest mean consumption in the least deprived quintile of the SIMD.

• Rise in NME sugar consumption (as % energy). Significantly higher in more deprived quintiles.

How does this inform policy?The Scottish Diet Action Plan in 1996 set out

‘a framework in which everyone with an influence on what we eat – from food producers and processors to the NHS, local authorities, school, caterers, retailers, the media and of course consumers themselves – can choose to work together to bring dietary improvement in Scotland.

Forward to Eating for Health- A Diet Action Plan for Scotland

How does this inform policy?In 2006 a Review of the Scottish Diet Action Plan was carried out by

independent panel of English experts.

Whilst acknowledging the substantial progress in initiatives to improving health………

“Current dietary patterns appear, for the most part to be making no move , and in some cases to be moving in the opposite direction to those desired in the Scottish Diet Action Plan. Based on current evidence it is unlikely that substantial increases will be observed in the next 5 years without significant policy initiatives to promote greater intake of these commodities.”

Lang, Dowler and Hunter p. 105 of review of the Scottish Diet Action Plan. Progress and Impacts 1996-2005

Conclusions• All 4 surveys reviewed concur that the SDTs would not

be met in 2005

• The Scottish Health Survey and Health Education and Population Survey can be used to monitor differences due to deprivation, sex and age. However they can only be used to provide information on food consumption in broad terms

• Actual consumption, calculated from food purchases in the EFS suggests little improvement to date and is based on a standard measure of what is included in the various food target categories across the years

• Data from EFS will continue to be used to monitor the Scottish diet in the future

Commissioned by the Food Standards Agency ScotlandAuthors

Dr Wendy L Wrieden, University of DundeeKaren L Barton, University of Dundee

Julie Armstrong, Glasgow Caledonian UniversityDr Geraldine McNeill, University of Aberdeen

Acknowledgements

• Jim Holding of DEFRA

• Data Archive, University of Essex

• UK Office of National Statistics