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