Title: The National Diet and Nutritional Survey

Key words: MAFF data, reference nutrient intake, intake, deficiencies, physical measurements, alcohol consumption, oral health, osteoporosis

Date: Aug 1999

Category: 14. Measurement

Type: Article

Author: Dr van Rhijn

 

The National Diet and Nutritional Survey

For people aged 65 years and over

 

Introduction

The National Diet and Food Survey1 is a cross-sectional survey of household food consumption, commissioned by the UK Ministry of Food and Fisheries (MAFF), assessing nutrient intake and expenditure of people aged 65 and over. Key findings of data obtained (1994 – 1995) from interviews, questionnaires, consecutive days (4 & 7) diaries, anthropometric & oral health assessments and biochemical laboratory analysis are discussed.

Main Findings

The most commonly consumed foods were tea, potatoes, pork, bread, biscuits, cereals and milk. Less than 50% of participants consumed fresh fruit and vegetables. Daily energy intake (48% carbohydrate, 16% protein, 36% fat) was lower than the estimated average requirements (EAR) for this age group, despite a mean BMI of 26.6 (free-living) and 25 (institutions). Obesity (BMI > 25), was found in 50 – 66%, and hypertension2 in 57% (men) and 68% (women) and 44% had a salt intake above 6g/l3. The average protein intake was above the reference nutrient intake (RNI), total fat intake close to COMA population average recommendation (35%), but saturated fatty acids intake (15%) exceeded the recommended 11%.

Anaemia (iron deficiency), vitamin deficiencies (A, C, B1, B2, B12, D and Folate) and mineral deficiencies (Ca, Zn, Cu, K and Mg) was prevalent, even more so among elderly people residing in institutions ( 40% for Vit C & D, B2 & Folate). The exceptions are calcium, riboflavin and vit A, all provided by the milk that is consumed more by institutionalised elderly. Hypercholesterolaemia (7.8 mmol/l) was more prevalent among the free-living population (3% men & 14% women).

Average alcohol consumption was < 7 units of alcohol per week, and even less for women living in institutions. These moderate intakes were associated with higher blood concentrations of iron, folate, lutein, Vit C & E, b -cryptoxanthin, antioxidants and calcium. This was directly correlated with plasma lycopene, HDL-cholesterol, PLP, retinol4, and higher NSP, meat, fruit & energy intakes (appetite stimulant), representing a decreased risk of CHD.

The choice of whether to eat "Healthy vs Unhealthy" foods was determined by indicators of lower economic status and being "North of the Border" where intakes of macro- and micronutrients were significantly lower5.

The increased evidence of periodontal disease was associated with various symptoms (toothache, loose natural teeth, edentulousness, ill-fitting dentures) which interfere with mastication and food choice. Edentate subjects had lower intakes of calcium, iron, vitamin (B1 & C), protein and NSP, and tooth decay related to intake of non-extrinsic sugars (in institutions).

The majority of elderly individuals (82 %) took medicines (especially those in institutions), influencing several biochemical indices (vitamins) which may be difficult to interpret6. Free-living (28% men & 34% women) commonly used nutrient supplements, but the reliability of a 4-day diet record is questionable7.

Conclusion
At least three public health issues, concerning oral health, osteoporosis and the relationship between folate intake and cardiovascular disease arise from the data. Health professionals should be aware of inadequate food intake in the elderly and nutritional assessments should be standard routine on admission to hospital. In general, an active lifestyle, exposure to sunlight, a diet limiting salt and cholesterol intake and an abundance of fruit, vegetables and NSPs should be recommended.

 

References
  1. Finch, S. et al. National Diet and Nutritional Survey: people aged 65 years and over. Volume 1. Report on the diet and nutrition survey. The Stationery Office. London. 1998
  2. Steele, J.G. et al. National Diet and Nutritional Survey: people aged 65 years and over. Volume 2. Report of the Oral Health Survey. The Stationery Office. London. 1998
  3. Bates, C.J. Micronutrients: highlights and research challlenges from the 1994-5 National Diet and Nutritional Survey: people aged 65 years and over. Br. J. Nutr. 1999; 81, 1 – 9.
  4. Walmsley, C.M. et al. Relationship between alcohol and nutrient intakes and blood status indices of older people living in the UK: further analysis of data from the National Diet and Nutritional Survey of people aged 65 years and over 1994/1995. Publ. Health Nutr. 1998; 1(3), 157 – 167.
  5. Smithers, G. et al. The National Diet and Nutritional Survey: people aged 65 years and over. Nutrition & Food Science. 1998; 133 – 137.
  6. Bates, C.J. et al. Use of medicines by older people in a large British national survey, and their relation to vitamin status indices. Publ. Health Nutr. 1998; 2(1), 15 – 22.
  7. Bates, C.J. et al. Estimation of the use of dietary supplements in the National Diet and Nutritional Survey: people aged 65 years and over. An observed paradox and a recommendation. Eur. J. Clin. Nutr. 1998; 52, 917 – 923.