MRC Elsie Widdowson Laboratory

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Results of the National Diet and Nutrition Survey (NDNS) Rolling Programme Years 7&8 combined (2014 to 2015 and 2015 to 2016) are now published.

On 16th March 2018, Public Health England (PHE) published the latest results of the National Diet and Nutrition Survey (NDNS) Rolling Programme for Years 7&8 combined (2014 to 2015 and 2015 to 2016).  MRC Elsie Widdowson Laboratory provides the scientific lead for the NDNS RP; the survey is carried out in collaboration with NatCen Social Research. 

The Year 7&8 report presents a particular focus on free sugars and AOAC fibre intakes which are reported for the first time for all age and sex groups. Also for the first time, results are shown for food and nutrient intakes for older adults split into those aged 65 to 74 years and 75 years and over. Furthermore, the report provides an overview of food consumption, nutrient intakes and nutritional status as well as results on blood folate and urinary iodine for the UK overall. We’ve summarised some of the survey findings below, the full report can be found on the Government website. Reports for the NDNS RP combining Years 5 to 9 (2012/2013 – 2016/2017) are expected later this year.

Free sugars and AOAC fibre intakes

In 2015 SACN published its report on Carbohydrates and Health, in light of the findings in the report, SACN recommended that the definition of free sugars and the AOAC definition of fibre should be adopted in the UK, replacing non-milk extrinsic sugars (NMES) and non-starch polysaccharides (NSP) respectively. For the first time, the NDNS RP includes descriptive statistics for free sugars and AOAC fibre intakes for all paired years and in all age groups. It also includes further details of the classification and methodology for determining free sugars and AOAC fibre values in the NDNS RP. These values were derived for foods in the NDNS Nutrient Databank by MRC EWL and PHE using a new free sugar estimation method that MRC EWL developed.

Key findings

Mean intakes of free sugars were more than double the recommended maximum of no more than 5% of total energy in all age groups. Mean intakes of free sugars for children aged 4 to 10 years and 11 to 18 years and men aged 19 to 64 years were significantly lower in years 7&8 than in years 1&2. The fall in free sugars intake in children is at least partly attributable to a decline in consumption of sugar sweetened soft drinks in both age groups.

Mean intakes of AOAC fibre in adults were 15-21g, below the recommendation of 30g. In children aged 4 to 18 years mean intakes were 14-16g, in children aged 1.5 to 3 years 10g, which are below the age-adjusted recommendations for each age group.

Foods consumed and nutrient intakes for adults aged 65 to 74 years and 75 year and over

For the first time in the NDNS RP, results for food and nutrient intakes are presented for the 65 years and over age group split into those aged 65 to 74 years and those aged 75 years and over so that these two broad age groups can be considered in more detail.

Key findings

Mean intake of saturated fatty acids exceeded the recommendation (no more than 11% food energy) in all older age/sex groups; 13.1% for adults aged 65 to 74 years and 14.6% for adults aged 75 years and over. Mean intakes of free sugars exceeded the recommendation and mean AOAC fibre intakes fell below the recommendation for all older age and sex groups.

Mean daily intakes of most vitamins from food sources were close to or above the recommendation (RNI) for all the older age/sex groups. However, mean vitamin D intakes from food sources were below the recommendation of 10µg/day in all older age groups (35% of the RNI for adults aged 65 to 74 years and 28% of the RNI for adults aged 75 years and over).

Mean intakes of minerals were close to or above the recommendations (RNI) for all older age/sex groups with the exception of magnesium (range 76% to 95% of RNI), potassium (64% to 91% of RNI) and selenium (58% to 72% of RNI).

Mean consumption of fruit and vegetables in Years 7 and 8 (combined) was 4.3 portions per day for adults aged 65 to 74 years and 3.4 portions per day for adults aged 75 years and over.  Thirty-one per cent of men and 32% of women aged 65 to 74 years, 18% of men and 20% of women aged 75 years and over met the “5 A Day” recommendation.  Consumption of oily fish in both older age groups was below the recommended one portion (140g) per week.

Blood folate

The report also presents the latest results Years 5 and 6 (combined) (2012/13-2013/14) and Years 7 and 8 (combined) (2014/15-2015/16) alongside previous paired years for red blood cell folate, serum folate and unmetabolised (free) folic acid in serum.

Key findings

There was evidence of low blood folate levels indicating risk of anaemia in over a quarter (28%) of girls aged 11-18 years, 15% of boys aged 11-18 years and 7% of adults 19-64 years, based on red blood cell folate concentrations. Substantial proportions of all age/sex groups had red blood cell folate levels indicating risk of biochemical insufficiency based on raised homocysteine levels. Overall, between about a third and 60% had red blood cell folate levels below the estimated threshold range indicating biochemical folate insufficiency. These proportions were higher in older girls and women of childbearing age and lower in younger children. Over 90% of women of childbearing age had a red blood cell folate concentration below the threshold indicating elevated risk of neural tube defects

Urinary iodine

Urinary iodine measurement was introduced in Year 6 (2013/14) of the NDNS RP. Commentary in the report is based on three years data: Year 6 only and Years 7 and 8 (combined) for all age groups including women of childbearing age (16 to 49 years).

Key findings

Analysis of urinary iodine concentrations showed that all age/sex groups met the WHO criteria for adequate iodine status, i.e. median urinary iodine concentrations between 100 and 199µg/l and fewer than 20% of the population were below 50µg

NDNS Data

The NDNS data will be available on the UK Data Archive shortly.

Next NDNS RP reports

Separate reports for the UK, Northern Ireland and Wales, combining Years 5 to 9 (2012/2013 – 2016/2017), are expected later this year.

The future of the NDNS RP Years 11 to 14

The contract to provide the next four years (Years 11 to 14: 2018/19 to 2021/22) of the NDNS RP has been awarded to MRC Epidemiology Unit at the University of Cambridge and NatCen Social Research. Further details can be found here.

Revised blood folate status for the UK has been published as part of the National Diet and Nutrition Survey Rolling Programme (NDNS RP)

chard nitrates

Leafy green vegetables are high in folate. Credit: Samantha Forsberg Flickr

In November 2017, Public Health England published a revised report: blood folate results for the UK as a whole, Scotland, Northern Ireland (Years 1 to 4 combined: 2008/09 – 2011/12) and Wales (Years 2 to 5 combined 2009/10 – 2012/13). The report presents results for the UK overall, and separately for Scotland, Northern Ireland and Wales for red blood cell (RBC) folate, serum total folate and unmetabolised (free) folic acid concentrations for adults and children aged 1.5 years and over and women of childbearing age (16 to 49 years).

MRC EWL provides the scientific lead for the NDNS RP; the survey is carried out in collaboration with NatCen Social Research and, for this period (2008-2012), the University College London Medical School.

The report, first published in March 2015, has been updated in 3 ways:

  • changes to the criteria used to assess the extent of population folate deficiency in the light of publication of revised thresholds and uncertainty about the applicability of the biochemical threshold to the NDNS RP data
  • incorporation of the new World Health Organization (WHO) recommended threshold (assay-specific) for folate concentration delineating relative risk of fetal folate-sensitive neural tube defects (NTDs), and
  • correction of a calibration error which had led to a bias in the assay used in the NDNS RP for quantitation of serum unmetabolised (free) folic acid.

Key findings of the report for the UK overall

Two measures of blood folate are reported: red blood cell folate, which reflects longer term body stores and is generally considered the better measure of long term status and serum total folate, which reflects recent dietary intake.

Red blood cell (RBC) folate

The percentage of girls aged 11 to 18 years with RBC folate concentration below the clinical threshold indicating risk of anaemia (305nmol/L) was 13%; it was 5% or less in the other age/sex groups.

Among women of childbearing age (16 to 49 years), 75% of participants had a RBC folate concentration lower than the threshold for optimal avoidance of folate-sensitive fetal NTDs (748nmol/L). Mean RBC folate was significantly lower for women aged 16 to 24 years than for those aged 35 to 49 years.

The overall proportion of women of childbearing age with a RBC folate concentration below the clinical threshold indicating risk of anaemia (305nmol/L) was 7%, with the highest proportion being those aged 16 to 24 years (12%).

Serum folate

The percentage of adults and children with serum folate below the WHO clinical threshold for folate deficiency (7nmol/L) was no more than 5% in any age group. The percentage with serum folate concentration below the WHO threshold for possible deficiency (13nmol/L) was 31% for adults aged 19 to 64 years, 27% for adults aged 65 years and over, 41% for older children and 6% for children aged 4 to 10 years.

For women of childbearing age (16 to 49 years), the proportion with a serum folate concentration below the WHO clinical threshold for folate deficiency (7nmol/L) was 3%. There is no recommended serum folate threshold for minimising folate-sensitive NTDs.

Biochemical folate insufficiency

Substantial proportions of all age/sex groups had blood folate levels indicating risk of biochemical insufficiency. In the UK population between a fifth and a half of most age/sex groups (excluding children aged 4 to 10 years) had RBC folate levels below the estimated threshold range indicating biochemical folate insufficiency (450 to 550nmol/L).

The full revised report is available on the UK Government website.

The adjusted results for folate status will be available in the UK Data Archive after the publication of the Years 7 and 8 NDNS RP combined report later in 2018, and will include a further 4 years (2012/13 – 2015/16) of blood folate status for the NDNS RP.

Dr Chris Bates

We have received the sad news that Dr Chris Bates passed away on Sunday 7th January 2018, following a heart attack. Dr Bates was a world-renowned expert on vitamin metabolism and made extensive contributions to the development of current micronutrient recommendations.  After many years leading research at the Dunn Nutrition Unit, he was Head of the Micronutrient Status Research Group at MRC Human Nutrition Research from 1998 to his retirement in 2003. Following his retirement he continued to provide valuable advisory input and support for MRC HNR and then MRC EWL staff, students and collaborators as well as the National Diet and Nutrition Survey until his death.

Personal messages of condolence to Chris’ family can be sent by email c/o Dr Ann Prentice.

A book of remembrance is being arranged at The Elsie Widdowson Laboratory in Cambridge. If you would like to contribute but cannot come in please send your contribution to Dr Gail Goldberg by email or by post: MRC Elsie Widdowson Laboratory, Fulbourn Road, Cambridge, CB1 9NL.

A fuller obituary will follow and the Nutrition Society will be paying a full tribute to Dr Chris Bates later in the year.

MRC Elsie Widdowson Laboratory staff take part in the 2017 Cambridge Science Festival

MRC EWL staff had a successful day running a stand at the Cambridge Science Festival on Saturday 18th March 2017 in the Guildhall, Cambridge.

Staff and students developed new resources and activities to bring to life MRC EWL’s work with stable isotopes. The theme was ‘stable isotope detectives’. Activities were aimed at both younger and older children (and adults too). Quizzes, puzzles, stickers, colouring and craft activities were linked together with a detective theme to explore how stable isotopes are used in nutrition science. Our detective team included: Elise Orford, Priya Singh, Kevin Donkers, Sara Wassell, Michelle Venables, Kerry Jones, Sarah Meadows and students Sarah Kefyalew and Tabitha Hawes.

Making its debut on our stand was the MRC colouring book, a resource developed in collaboration with MRC Cambridge scientists to help explore the variety of MRC funded work that takes place in Cambridge. The colouring book included Illustrations from MRC EWL highlighting our work with stable isotopes and the UK National Diet and Nutrition Survey.

There were very positive comments from people who attended:

It was really brilliant; well-conceived, professionally presented, lots of interest from children and from parents.”

One of our MRC EWL team, Elise Orford, who helped develop the activities and run the stand on the day said:

It was a fantastic opportunity to share some of the work we do using stable isotopes at MRC EWL. It was great to see so many people engaging in the activities, including guessing who had the highest energy expenditure – and seeing their surprise at the astronaut’s value! I’m looking forward to participating at the next festival.

We’re planning on re-running our stable isotope detective activities at upcoming public engagement events.


 

Findings from the Eating environment and meal satisfaction study

Study purpose

The environment in which food is eaten may affect how much we eat and the way we consume the food. An important environmental factor to this respect is the amount of food that is placed on our plate (portion size). This study looked at how being exposed to different portion sizes of the same food affects the way in which we eat a meal. The main purpose was to investigate the way in which small and large portion sizes affect how much food is loaded on the fork (known as bite size); how fast the food is eaten (known as eating speed); how the eating speed changes over the course of the meal (known as deceleration rate); and the overall duration of the meal. Because knowing this information beforehand can unconsciously affect the way in which we eat, the participants in our study were initially informed that the study was investigating the relationship between eating environment and meal satisfaction, but were debriefed of the true purpose of the study at the end of the last session.

Participants

A total of 37 overweight women took part and completed the study between June 2012 and February 2014 in Cambridge. The mean age of the group was 44 (± 11) years and the mean body mass index was 29 (± 3) kg/m2. The majority reported being of White ethnic background.

Method

eating stationParticipants attended a training session followed by five lunch sessions at the MRC Human Nutrition Research to consume a meal and complete a number of brief questionnaires. On arrival participants were asked to drink a glass of water and complete a questionnaire on the computer asking about their hunger and fullness levels. Participants were then served a lunch made of a single course of chilli-con-carne with rice while seated at the eating station (depicted right).
The portion size of the chilli-con-carne meal varied between 229 g (about 8 ounces) and 700 g (about 24 ounces) and provided between 300 and 900 calories (depicted below).

chilliAfter completing the meal participants filled in a third questionnaire asking about their enjoyment of the meal and their hunger and fullness levels again. On the last study visit participants filled in an additional questionnaire asking about their eating habits and were debriefed about the main purpose of the study.

Study findings

Participants ate differently when exposed to the larger compared with the smaller portions of the chilli-con-carne meal. Specifically, participants loaded more food on their fork, ate faster, and continued to eat at the same speed for longer, when served the larger portions, compared with the smaller ones. So compared with the smallest portion of 229 g, the average bite size increased by 0.22 g for every 100 g increase in portion size, and the change in speed of eating (deceleration rate) went down by 20%. In other words, participants continued to eat quicker for longer and put more on their fork at each bite with the larger portions. Participants also took longer in finishing the largest meal compared with the smallest one (11 vs. 4 min on average).

The smallest portion size corresponded to about half of a standard portion size (a standard portion size is what is normally included in a commercial ready meal); while the largest study portion represented 75% more than the standard portion. This study showed that varying the portion size within this range affects the way in which we eat the food, in particular the speed of eating. Related research[1] has shown that we tend to eat more energy when we eat faster. Taken together these results suggest that larger portion sizes have the potential to make us eat more by altering the amount of food we load on our fork and how fast we eat it. Interestingly we did not observe a marked increase in hunger after the smaller portion sizes, and we also know that reducing the speed of eating does not increase hunger necessarily1. We can conclude then that strategies leading to portion control via a reduction in eating rate could be sustainable and help individuals eat less in the face of large portions.

Conclusions

This study showed that being exposed to large portions makes us eat quicker and load more on our fork. The changes in the speed of eating and amount loaded on the fork may explain why large portion sizes lead to increased energy intakes. While excessive portion sizes persist in the environment, strategies to reduce how much we load on our fork and that reduce the speed of eating may provide individuals with coping strategies to reduce the risk of overeating.

Additional information:

The results of the study have been published in the journal Physiology and Behaviour and are accessible at:

http://www.sciencedirect.com/science/article/pii/S0031938414005599.

[1] Robinson E, Almiron-Roig E, Rutters F et al. A systematic review and meta-analysis examining the effect of eating rate on energy intake and hunger American Journal of Clinical Nutrition, 2014. 100: p. 123-151.

Estimated salt intake status for adults (19 to 64 years) in Northern Ireland now published

Today, Food Standards Agency in Northern Ireland have released the first Northern Ireland specific report with 24-hour urine estimated salt intake results; National Diet and Nutrition Survey: Assessment of dietary sodium Adults (19 to 64 years) in Northern Ireland, 2015. The report covers urinary sodium excretion and estimated salt intake results for 609 adults aged 19 to 64 years in Northern Ireland, based on analysis of 24-hour urine samples collected over seven months (February to August) in 2015. Similar surveys were run in England, published on the 22nd March 2016 and Scotland, published on the 23rd March 2016.

HNR provides the scientific lead for the UK NDNS Rolling Programme and country-specific sodium surveys These are government funded and are carried out in collaboration with NatCen Social Research.

This report provides the first Northern Ireland specific assessment of salt intake in adults (19 to 64 years) and includes a comparison between estimated salt intakes in Northern Ireland in 2015 and those in England and Scotland in 2014. Estimated salt intake was calculated using the equation 17.1mmol of sodium = 1g of salt and assumes all sodium was derived from salt. Results for estimated salt intake are compared with the Scientific Advisory Committee for Nutrition (SACN) threshold for the population salt intake to reduce to no more than 6g per day.

Key findings

2015 estimated salt intake in Northern Ireland

  • In 2015 the mean estimated salt intake for adults aged 19 to 64 years in Northern Ireland was 8.6g/day (on average 43% higher than the recommended maximum); 10.0g/day for men and 7.1g/day for women.

Comparison of estimated salt intake in Northern Ireland in 2015 with that in England and Scotland in 2014

  • There was no statistically significant difference between the geometric mean salt intake for all adults combined in the Northern Ireland 2015 sodium survey (7.7g/day) and the England 2014 sodium survey (7.2g/day). However, geometric mean salt intake was significantly higher in Northern Ireland (7.7g/day) than in the Scotland 2014 sodium survey (7.1g/day) for all adults combined.
  • Geometric mean salt intake was significantly higher for men in Northern Ireland in 2015 (9.3g/day) compared with men in England (8.5g/day) and Scotland (8.0g/day) in 2014. There were no statistically significant differences for women.

For more information and data, see the full report on the Food Standards Agency in Northern Ireland website.

See also

Estimated salt intake status for adults (19 to 64 years) in Scotland now published

Today, Food Standards Scotland published the latest 24-hour urine estimated salt intake results from the National Diet and Nutrition Survey: Assessment of dietary sodium Adults (19 to 64 years) in Scotland, 2014. The report covers urinary sodium excretion and estimated salt intake results for 663 adults aged 19 to 64 years in Scotland, based on analysis of 24-hour urine samples collected over five months (May to September) in 2014. An identical survey was run concurrently in England published on the 22nd March 2016. The report for a recent sodium survey in Northern Ireland was published on 28th July 2016.

HNR provides the scientific lead for the UK NDNS Rolling Programme and country-specific sodium surveys These are government funded and are carried out in collaboration with NatCen Social Research.

This report provides the latest assessment of salt intake in adults (19 to 64 years) in Scotland and includes an updated trend analysis, which supersedes that presented in previous reports. As part of the current report, work was undertaken to enable comparison of data from different time points which were obtained using different laboratory methods. Estimated salt intake was calculated using the equation 17.1mmol of sodium = 1g of salt and assumes all sodium was derived from salt. Results for estimated salt intake are compared with the Scientific Advisory Committee for Nutrition (SACN) threshold and long standing Scottish Dietary Goal for the population salt intake to reduce to no more than 6g per day.

Key findings

2014 estimated salt intake in Scotland

  • In 2014 the mean estimated salt intake for adults aged 19 to 64 years was 7.8g/day; 8.6g/day for men and 6.9g/day for women. On average 29% higher than the recommended maximum. 

Estimated salt intake in Scotland 2006 – 2014

  • The analysis which investigated both gradual trends and step-changes between the period 2006 and 2014 showed a statistically significant downward linear trend in the geometric mean salt intake from 2006 (8.2g/day) to 2014 (7.1g/day). This 1.1g difference equates to a relative reduction in mean estimated salt intake of approximately 13%.

Comparison of estimated salt intake in Scotland and England in 2014

  • There were no statistically significant differences between the salt intake for adults in Scotland and England for the 2014 surveys for all adults combined and when split by sex. The results showed that in 2014 the geometric mean salt intake in Scotland (7.1g/day) was similar to that in England (7.2g/day) for males and females combined.

For more information and data, see the full report on the Food Standards Scotland website.

See also

Estimated salt intake status for adults (19 to 64 years) in England now published

Today, Public Health England published the latest 24-hour urine estimated salt intake results from the National Diet and Nutrition Survey: Assessment of dietary sodium Adults (19 to 64 years) in England, 2014. The report covers urinary sodium excretion and estimated salt intake results for 689 adults aged 19 to 64 years in England, based on analysis of 24-hour urine samples collected over five months (May to September) in 2014. An identical survey was run concurrently in Scotland and results were published on the 23rd March 2016.The report for a recent sodium survey in Northern Ireland was published on 28th July 2016.

HNR provides the scientific lead for the UK NDNS Rolling Programme and country-specific sodium surveys are carried out in collaboration with NatCen Social Research.

There is an established relationship between salt intake and risk of high blood pressure (BP). High blood pressure (hypertension) is a risk factor for cardiovascular disease (CVD) and scientific evidence shows that a high salt intake can contribute to the development of elevated blood pressure. CVD is a major cause of morbidity and mortality in the UK and worldwide. The British Heart Foundation (BHF) in 2015 estimated that CVD causes 155,000 deaths in the UK and costs the UK economy £19 billion annually. Dietary modification is a major component in the preventative strategy to reduce the risk of CVD. Targeted public awareness campaigns by the Food Standards Agency (FSA) have aimed to inform the population about health risks associated with high salt consumption. More recently the national Change 4 Life campaign has focused on healthy lifestyles, including salt reduction. These campaigns have advised individuals to decrease their salt intake to no more than 6g/day (less for children). For more information about salt intake and effects on health, please visit the NHS website and Change 4 Life website.

This report provides the latest assessment of salt intake in adults (19 to 64 years) in England and includes an updated trend analysis, which supersedes that presented in the previous England 2011 report. As part of the current report, work was undertaken to enable comparison of data from different time points which were obtained using different laboratory methods. Estimated salt intake was calculated using the equation 17.1mmol of sodium = 1g of salt and assumes all sodium was derived from salt. Results for estimated salt intake are compared with the Scientific Advisory Committee for Nutrition (SACN) threshold for population salt intake to reduce to no more than 6g per day.

Key findings

Estimated salt intake in England in 2014

  • In 2014, mean estimated salt intake for adults aged 19 to 64 years was 8.0g/day (33% higher than the SACN recommended maximum); 9.1g/day for men and 6.8g/day for women. Median estimated salt intake was 7.6g/day (27% above the SACN recommended maximum); 8.6g/day for men, 6.2g/day for women.
  • As in the past, the distribution of sodium excretion/estimated salt intake among the adult population aged 19 to 64 years was wide, ranging from 0.8g/day to 24.2g/day. The estimated salt intake of adult men aged 19 to 64 years was on average higher than women of the same age.

Estimated salt intake in England 2005/06 – 2014

  • The revised trend analysis, which investigated both gradual trends and step-changes between 2005/06 and 2014, used log-transformed data and geometric means due to the skewed nature of the data. The results showed a downward linear trend in the geometric mean salt intake from 2005/06 (8.1g/day) to 2014 (7.2g/day). This 0.9g difference equates to a relative reduction in mean estimated salt intake of approximately 11%.
  • This is a smaller difference than found in the earlier trend analysis published with the 2011 survey, due to (a) adjustments of data from previous analytical surveys to take account of changes in laboratory analytical methods for sodium over time (b) a focus on England only urinary sodium data (rather than UK data as used in the previously published trend analysis) and (c) exclusion of data from the 2000/01 NDNS of adults aged 19 to 64 years from this analysis (this was included in the previous trend analysis).
  • There was a statistically significant downward step-change in salt intake between 2005/06 and 2008/09. The change in mean estimated salt intake between 2005/06 and 2008/09 was 0.5g/day. This difference equates to a relative reduction in mean estimated salt intake of approximately 6%. Whilst the data suggest further gradual decline in subsequent years, there was no statistically significant downward linear trend or further significant step-change between the remaining neighbouring years from 2008/09 to 2014.

For more information and data, see the full report on the UK government website.

See also