Interpretation of data from the National Diet and Nutrition Survey for Children

Interpretation of the results from Table 1 (finding from the National Diet and Nutrition Survey for children aged 1 ½ to 4 ½ years)

The National Diet and Nutrition Survey (NDNS), found that although children are taller and heavier than 25 years ago, their energy intake is 17% lower and the protein intake is 10% lower. This may mean that children are eating more of the type food that encourages weight gain such as fats and sugars, and less of the foods needed to provide energy for growth and development such as protein and starchy carbohydrates. The children may also be less active than they were 25 years ago, leading to less energy being used and more being stored as fat.

At this age children still need a diet that is high in energy and high in the proportion of nutrients required for their size.

Whilst the NDNS does show 51% of the energy coming from carbohydrates, 18.7% is from non milk extrinsic sugars (NMES) which are foods with sugar added to them. It is recommended that this should be a maximum of 11%, with the rest of the carbohydrates being found in starchy foods such as bread, rice, pasta and potatoes.

A diet too high in sugar can lead to tooth decay, diabetes, heart disease and obesity. A diet without enough starch can mean that children are missing out on key nutrients including iron, calcium, fibre and B vitamins. They may also feel hungrier more often leading to more frequent snacking. The evidence in the survey shows that 17% of the children had some kind of tooth decay.

Fruit and Vegetable intake has been recorded as being low. Although the fiveaday is for those age 5 and over the expectation for toddlers is that they meet this through a proportionally smaller serving. By not providing children with enough fruit and vegetables it is likely that their nutritional requirements for a range of vitamins and minerals are not being met. The NDNS shows that 8% of children had very low intake of vitamin A with 44% being below the RNI and 38% of children in this category had levels of vitamin C below the RNI. There is also biochemical evidence that 23% had a deficiency in vitamin B2, 72% had below the RNI of zinc and 20% with a deficiency in iron.

The findings in the NDNS have also highlighted that the intake of meat was generally low. Meat is an important part of the diet as it provides the body with protein, it is high in energy, and contains vitamins and minerals including vitamins D, K, B12, magnesium, potassium, phosphorous, iron and zinc. Although the recommendation is for children up to the age of 2 is to take supplements for vitamin D, 1% of children show a deficiency and 18% show as only having marginal levels. As mentioned above, Zinc and iron are seen as deficient, and a lack of meat in the diet may contribute towards 7% of children showing signs of anaemia.

The NHS recommends that children aged 1-3 years have no more than 2g of salt (0.8g sodium) per day, and children age 4-6 have no more than 3g of salt (1.2g sodium) per day. However, salt intake has been recorded as being twice the recommended amount. This may indicate that children of this age are eating too much of processed foods which are high in salt, such as breakfast cereals, bread and pasta sauces. Or it may indicate that children are eating other foods high in salt including cheese, bacon, prawns or stock/ gravy. A high salt intake as a child leads to acquiring a taste for more salty foods as an adult. Long term this can raise blood pressure leading to heart disease.

Only 16% children were recorded as eating oily fish during this study which could mean that levels of essential fatty acids are low. The essential fatty acids are Omega 3 and 6, these can not be made in the body so must be obtained from the foods we eat. They are used for forming cell membranes and hormones as well as helping to prevent cardiovascular disease and reducing inflammation and cholesterol.

It is concerning to see the result of this survey, particularly as the minimum recommendations are given to ensure our children are well nourished and that their bodies have the fuel needed to grow and develop into strong and healthy adults.

The summary of results does not show whether the children represented as not meeting each guideline belong to the same group of children. It is therefore difficult to pinpoint why this may be occurring. A few suggestions would be; some children from low income families may not be able to afford a wide variety of food; some middle class families may fall into the muesli belt syndrome where the children are given a diet more suited to an adult watching their weight leading to certain essential foods being deprived; some children are very fussy eaters so may only have limited number of foods that they eat; there may be lack of parental awareness of what is a balanced diet for a toddler and how to supplement to support this; parental habits may be passed onto children.

The headline results from Table 5 confirm those previously reviewed in in Table 1. In particular, for the toddler age range oily fish continues to be eaten at below the recommended amount. The mean energy intake measured at 1137kcal is slightly lower than the recommended 1165 for females and 1230 for males in this age range. And while fat intakes meets the DRV, the saturated fat exceeds it. This is demonstrated is Table 1, showing low consumption of fish (unsaturated fat) and high salt indicating higher consumption of fatty processed (saturated fats) foods.

Recommendations for the parents of the children surveyed regarding the diet of their children meeting nutritional requirements

Children need a balanced and varied diet to ensure that their needs for healthy growth and development are met. It can be difficult to feed children as they have such a varied appetite and can be fussy. To ensure their daily nutritional requirements are met they should be offered 3 meals and 2 snacks. For those times when the appetite is reduced offer smaller portions more frequently. Children under 5 years old are recommended to take supplements for vitamins A, C and D.

The British Nutrition Foundation have created an alternative to the over 5’s Eatwell Plate. It is called 5532-a-day and is designed with the government guidelines in mind to enable parents to provide children with the correct portions of the four main food groups.

They recommend 5 portions of fruit and vegetables, 5 portions of starchy foods, 3 portions of dairy and 2 portions of protein per day. Portion size is very important to ensure children eat enough to obtain the RNI of essential energy, vitamins and minerals whilst not too much to cause obesity and other health concerns.

For example,

  • 1 portion of starch is:

    • ½ to 1 slice of bread,

    • 3-5 tbsp breakfast cereal

    • 2-4 tbsp canned spaghetti hoops.

  • 1 portion of fruit and vegetables is:

    • ½-2 tbsp raisins,

    • ¼ – ½ apple

    • ½ – 2 tbsp broccoli.

  • 1 portion of dairy is:

    • 100ml milk,

    • 2-3 tbsp grated cheese

    • 2 60ml pots fromage frais.

  • 1 portion of protein is:

    • 2-3 tbsp beans or lentils,

    • 1-2 fish fingers

    • 1-2 tbsp hummus

In line with the NHS the British Nutrition Foundation recommend that sweet things can be given in small amounts, but should not be a regular part of the children’s diet. To reduce tooth decay it is better to have anything sweet, including dried fruit, at meal times. Water is the best option for drinks.

The NHS also highlight the importance of iron, which the survey has shown as an area needing attention. The most easily absorbed iron comes from meat, but is also found in some plant based foods and in fortified foods such as breakfast cereals.

A wide range of fresh, cooked, raw, canned, frozen and full fat foods with no added salt or sugar is required to keep a healthy diet on track for children, whilst also building good habits and tastes for adult life.

Interpretations of the results from the NDNS survey for ages 4-18 years old including areas for concern

The National Diet and Nutrition Survey (NDNS) for children aged 4-18 years shows that fruit and vegetable intake are low to none. With the school provision of fruit snacks in Primary school, home economics should not play as large a part in this intake as in the early years. Yet this statistic shows that if children were exposed to more fruit and vegetables at home, then they would probably eat the same and more at school. This has a long term effect on the children that have more choice over their food, those at secondary school age may shop for their own lunches and snacks and may not be making the healthiest choices. Maybe the provision in shops of individual fruits are not as obvious as the packs. By missing out on what should be one of the largest food groups on the Eatwell Plate for this age group, these children are not consuming enough of the essential vitamins, minerals and fibre needed for healthy growth and development.

Consumption of fruits and vegetables, with the most popular recorded as apples and pears, declines with age from 70% to 39% for boys and 66% to 44% for girls. Secondary school aged children are more in control of buying their own foods, they are more likely to pass by shops to grab an item on route to school or home and are choosing the higher sugar, higher salt, higher fat options. This may be because of a lack of availability of healthy options in smaller local newsagents, less visibility of the healthier options compared to the mass of chocolates, crisps and fizzy drinks, or from peer pressure and advertising.

As the children’s height and weight did not indicate an inadequate diet, Gregory et al (2000) have concluded that there was under reporting of what was eaten. Perhaps the children weren’t aware of fruits and vegetables being part of a meal, or perhaps they just forgot about these items and remembered the more enjoyable snack items such as crisps, chocolate and fizzy drinks.

Vitamin A, riboflavin, zinc are most noted micronutrients for falling below the lower recommended nutritional intake (LRNI), these are mostly found in vegetables, eggs and dairy. Milk is no longer a staple drink with children, instead they are choosing sugary squashes and carbonated drinks as an alternative.

The NDNS shows levels of iron for 50% of girls in the older bracket falling below the LRNI. As girls head into puberty they need to increase iron in their diet to maintain the levels the body needs as well as replacing that lost through menstruation. Magnesium and potassium was 18% and 15% respectively below the LRNI, for boys in the older bracket. These minerals are used by the body for nerve and muscle function, so consumption should increase during this time of growth spurts and increased physical activity.

This population group has an inclination towards snacking more on sugary, salty and high fat foods. 80% of children in this age range ate foods falling into these categories including crisps, chocolate, biscuits, chips plus white bread and potatoes. 85% of boys and 73% of girls drink fizzy drinks. The majority of energy coming from cereals, bread, pastries, biscuits and cakes. It is easy to see that this group is eating above the recommended guideline amounts of saturated fat, sugar and salt.

It can be concluded from these results that when making independent food choices, children are choosing sweet and savoury fatty foods over healthier fresh fruit and vegetables. While the height and weight may not indicate immediate malnutrition; long term these eating patterns can lead to diabetes, obesity and heart disease. It is important to educate about balanced and healthy eating from an early age and to lead these healthy habits from home.

Recommendations for what the children can include in their diet to meet their nutritional requirements

To meet their nutritional requirements the children in this group need to increase their intake of fruit and vegetables. If they are shown what one portion of fruit and vegetables is equal to, then they can make the choice to have 2 satsumas, a medium banana, a handful of carrot sticks or of peppers as their snack, instead of a packet of crisps or chocolate bar.

This decision assists in two ways. Firstly, it can help to meet their nutritional requirements for vitamins and minerals needed for growth and development. Secondly,it reduces their intake of saturated fats, sugars and salts as the fruit and vegetables replace crisps, chocolates and biscuits as the go to snack choice.

For the girls to replenish their iron levels they will need to eat more meat, fish, nuts and green vegetables and need to be aware that the RNI increases from 6.1mg at age 4 to 14.8mg by the age of 11. To put this in perspective in 100g of minced meat or roasted mixed nuts there is about 2.6mg of iron. For fussy eater or those that are becoming aware of diets this may be difficult to obtain, for this reason supplements may be beneficial.

For boys to increase their intake of magnesium and potassium they will need to eat more vegetables, meat, fruits, seafood, nuts and dairy. During this age group (4-18) the needs for Magnesium increases from 120mg to 300mg and for potassium from 1100mg to 3500mg . As an example of what needs to be eaten, there is 21g of magnesium in 100g of minced meat and 79g in 100g of spinach, you will find 358mg potassium in a banana with similar amounts in 100g of minced meat.

Explaining to children why they need to meet certain nutritional requirements will empower them to make informed choices. With a more varied and balanced diet than those represented in the survey, children’s nutrition will not be in a deficit if they have a chocolate bar, packet of crisps or fizzy drink on an infrequent basis. Vincent Marks, the author of Panic Nation makes the point that no single food can make you unhealthy, but too much of anything can.

Compare the findings in Table 5 to those in Table 2

The findings in Table 5 confirm those in Table 2 with regards to the under consumption of fruit and vegetables, the mean portions being 3.0 for boys and 2.8 for girls aged 11-18. With only 11% of boys and 8% of girls in this group meeting the 5aday recommendation.

The mean consumption of oily fish in this population group is also considerably below the recommended amount. Compared to Table 2, this would be an ongoing concern with the levels of Vitamin A falling below the LRNI and for the low levels of iron recorded for girls.

While the mean intake of total fat was no more than the DRV, the mean intake of saturated fat exceeded the DRV. This is demonstrated in Table 2, where the children have been recorded as consuming snacks that are high in sugar, salt and saturated fats such as biscuits, savoury snacks and chocolate.

This shows that children’s snacking habits remain the same. If this could be addressed so younger children consume more of a balanced diet. When older, they may follow the knowledge and pattern of healthy snacking and apply it to their lunch or dinner choices to enjoy a more varied diet, which would supply them with nutrients needed for healthy growth and development.

Interpretations of the results from the NDNS survey for adults ages 19-64 years old including areas for concern, with consideration to pregnant and lactating women

The National Diet and Nutrition Survey (NDNS) for ages 19-64 shows that energy from dietary fats has reduced to 33% in the preceding 15 years. The recommended amount according to the UK government guidelines is 30%. This shows adults are more aware of what foods they are consuming, this may in part be due to food labels and the traffic light system being introduced. This became popular in about 2013 with EU regulations to standardise front of packet labels becoming a legal requirement in 2014. The system has made it clear how much total fat, saturated fat, sugar and salt as well as how many calories, can be found per serving on many foods.

Most adults were meeting the recommendations for protein intake with only 2% of men and 4% women falling below what was needed for a healthy balanced diet. Fruit and vegetables are under the recommended amount with an average of just three out of the five-a-day being consumed.

The survey shows that a small percentage of the adult population were deficient in some micronutrients; 5% of all adults deficient in folate, 3% in B12, 3% in plasma vitamin C, 1% in plasma retinol (vitamin A), 2% of men and 5% of women were deficient in calcium.

All of these would be affected by dietary intake of fruit, vegetables and dairy. If these are seen as generally low for the population, then perhaps the majority of the adults are attaining these nutrients from fortified foods or supplements.

There are larger parts of the population with deficiencies in; potassium with 6% of men and 19% of women below the LRNI; magnesium with 9% of men and 13% of women below the LRNI; vitamin D with 14% men and 15% women deficient, with prevalence in the younger age groups and during the winter months.

Both potassium and magnesium are largely affected by low fruit and vegetable intake and are linked to poor nerve function. Low vitamin D for the younger part of the population is unsurprising when looked at in combination with the change in lifestyle and working patterns, as this working age group spends longer hours inside at work or, for the health conscious in the gym rather than taking part in leisure and physical activities outdoors.

The study shows that 8% of women and 3% of men had anaemia; a condition where there are not enough red blood cells to carry oxygen around the body. This leads to tiredness, headaches and appearing pale; other symptoms will depend on the cause of the anaemia. Iron deficiency is often the main cause of anaemia and this is reflected in the low levels of ferritin in the blood, representing iron deficiency for 11% of women and 4% of men. This can be linked to low fruit and vegetable intake – in particular leafy green vegetables. Women need to be aware of consuming more iron to replace that lost through menstruation and often supplements are needed to combat signs of deficiency.

High plasma retinol levels have been recorded for 7% of women age 50-64 and mildly high levels for 6% of all women and 14% of all men. High retinol levels may indicate kidney damage, yellowing skin, birth defects and vitamin A toxicity which has symptoms of vision and skin change as well as long term liver damage. Vitamin A can be found in dairy and vegetables as well as being found in multi-vitamin supplements.

Alcohol intake is above the safe guidelines of 21 units for 40% of men and above 14 units for 30% of women. While alcohol is a source of energy it contains no nutritional benefits and has a detrimental effect on physical and mental health, including being a factor in obesity.

In times of pregnancy and lactation, the women in this group need to ensure their nutritional intake meeting both their needs and those of the developing foetus or breastfeeding baby. Calorie intake only needs to increase in the final trimester of pregnancy and only by 200kcal per day (equivalent to a slice of bread and a glass of milk). While breastfeeding calories should increase by about 450kcal, fluid intake should increase by drinking more water to provide the extra fluid for milk production. Any more than this and the woman is at risk of putting on too much weight, which can lead to being overweight or obese and risking health complications during pregnancy or delivery.

Some supplements are recommended during pregnancy for example folic acid (folate) before conception and during the first trimester to reduce the risk of neural tube defects. Other supplements must be avoided such as vitamin A, as long as enough vitamin A is consumed from food sources there is no need to supplement as high doses can lead to birth defects.

During pregnancy iron levels may fluctuate during the different stages. Menstruation ceases so iron levels may rise for a while, as the foetus grows creating new blood decreases iron levels, early signs of deficiency such as tiredness and dizziness should be monitored with supplementation under medical advice.

Alcohol is best avoided completely during pregnancy, during the first few months the foetus is most vulnerable to miscarriage and facial features and organs are being formed. During the entire pregnancy the brain and central nervous system develop and the body grows and develops, which are all affected by by alcohol toxicity. While breastfeeding alcohol consumed by the mother can be passed from her bloodstream to the milk being produced to feed the baby. This can lead to ill health in the baby as their organs are unable to cope with the level of toxicity.

Total fat consumed is decreasing, although more protein and perhaps carbohydrates are being eaten; when consumed in excess of individual needs both of these are stored as fat. This can lead to increased health risks from cardiovascular disease, type 2 diabetes, high blood pressure and obesity. The UK and indeed most countries across the world are seeing an increase in obesity and associated, preventable disease and death. Very few people have a low BMI (under 18.5kg/m2), only 1% of men and 3% of women. This means that the majority of the UK population is of a normal, overweight or obese BMI with an increasing trend towards the overweight and obese.

If adults consumed more fruit and vegetables instead of carbohydrates and protein, their nutritional needs would be met and their health improve. The journey towards a healthy population is just beginning with the awareness of eating lower fat foods leading the way. A focus needs to be made on how too much of some types of food can also create fat once it is inside the body. The government report Reducing obesity; future choices (2007) advises that dietary change is the ultimate goal. However, consideration needs to be given social and economic factors such as working patterns, levels of physical activity and food sources, plus the changes need to be long term and sustainable to see continuing improvement in health and well being of the population.

Recommendations for women as to what they need to include in their diet to meet their nutritional requirements

To reduce health risks associated with alcohol consumption including organ damage, weight gain and depression women should reduce their weekly alcohol intake to a maximum of 14 units.

As iron deficiency anaemia is a cause for concern in this population group, meat, fish, green vegetables and lentils should be increased in the diet. For high levels of deficiency a supplement may be taken to increase levels of iron in the blood.

Meat and green vegetables in the diet will also help to increase levels of folate and vitamin B12. B12 enables the body to use energy from food and uses folate to make healthy red blood cells.

Eating more fruits and vegetables will also increase vitamin C intake to encourage healthy cells including skin, blood and bone as well as wound healing.

During pregnancy the mother’s diet will influence her health and that of the foetus during its time in the womb and more long term effects once they come into the world.

Pregnant women are advised to avoid alcohol completely. During the first trimester, weeks 1-12, the foetus is particularly vulnerable. Regular alcohol consumption in this time can increase the risk of miscarriage and have an adverse effect on foetal development in particular facial features and organs. The central nervous system continues to develop throughout pregnancy so can be affected at any time. Alcoholic pregnant women have a high risk of babies born with foetal alcohol syndrome, this means the baby can have severe neurological damage where the brain and/ or spinal cord have not developed properly.

When planning a pregnancy and during the first trimester pregnant women should take folic acid supplements to aid the growth and development of the foetus and reduce the risk of neural tube defects such as found with spina bifida.

During the last trimester the foetus’ requirements for vitamin C increases, so more fruit and vegetables should be consumed.

While vitamin A is required for the health and development of the foetus too much can cause foetal abnormalities. During pregnancy is is advisable to ensure that any supplements taken do not contain vitamin A, and to avoid eating liver as it contains high amounts.

In the summer pregnant women should be outside to get sufficient sunlight to provide themselves and their foetus with vitamin D. During the winter supplements of 10?g can be taken. Vitamin D is essential for normal bone growth of the foetus, avoiding rickets and reducing the risk of a low birth weight. It is important also for the mother to reduce the risk of gestational diabetes, preeclampsia and pre-term labour. Vitamin D also regulates Calcium and phosphates in the body aiding bone and teeth development.

Lactating women need to increase their calories and most micronutrients as they are now nourishing themselves and creating the breastmilk to nourish their babies.

As alcohol can be passed from mother to baby through breastmilk it is better to avoid drinking it. Furthermore, alcohol is dehydrating, so even more fluid is needed to create the milk.

It is recommended that an extra 60?g of folate is needed during lactation and it is needed for synthesising DNA and creating new cells. It is a water soluble vitamin and therefore passed on to the baby through breastmilk.

Extra vitamin C (+30mg) is needed to pass on to the baby through breastmilk and for maternal use. This can be obtained from fruit, vegetables, orange juice and potatoes.

Consumption of full fat milk, eggs, liver and some vegetables should be increased to provide an additional 350?g of vitamin A in the diet to supply the content of the milk when breastfeeding.

Vitamin D, particularly during the winter months should be supplemented to an extra 10?g to ensure there is sufficient amounts in the blood plasma to pass on to the baby. Vitamin D helps with the utilisation of calcium and an extra 550mg is required during lactation. Bone mass can be depleted during lactation so the extra amounts consumed will help the mothers stores whilst also promoting healthy bone and teeth development in the baby.

Have there been any changes to the results between table 3 and 5 being published. The assessment is made presuming that the women in the survey were either pregnant or lactating.

In general the results in Table 5 confirm the facts reported in Table 3. 31% of adults met the 5 a day recommendation of fruits and vegetables with the average consuming 4.1 portions. As the diet of the mother influences that of the growing foetus. and that of the baby breast feeding. it is important that this food group is well represented in the mother’s diet.

The mean average of oily fish is below the one portion per week for adults. While the intake of oily fish is important for vitamins A, D and E, pregnant women should take care to have no more than 2 portions per week due to the heavy metals that they may contain which are harmful to the foetus and baby’s nervous system.

The average calorie intake for women was 1614kcal /day. This is particularly low and should be about 1900kcal/day plus an extra 200 during pregnancy or an extra 450-480 during lactation according to the COMA report on Dietary Reference Values for Food Energy and Nutrients for the United Kingdom, 1991. During pregnancy it is important to consume enough calories from the most nourishing sources to ensure that the baby has enough calories to grow and develop and to be born with a normal birth weight. During lactation the extra calories provide sustenance to the mother when the milk supply is being created on the baby’s demand.

While total fat met the DRV of no more than 35% of food energy, the mean saturated fat for adults was 12.7%, the recommended amount being 11%. Saturated fats can increase the risk of high cholesterol levels, heart disease and diabetes. Gestational diabetes is a particular concern during pregnancy as it puts the mothers and foetus’ health at risk. During breastfeeding extra saturated fats can lead to the baby consuming more calories and become overweight.

Keeping a balanced nutritious diet during pregnancy and lactation is important. The baby relies upon the mother to provide them with the best start in life. Also the mother needs to remain healthy and well nourished to deal mentally, emotionally and physically with the demands of a newborn child.

Interpretations of the results from the NDNS survey for older adults

The National Diet and Nutrition Survey for adults aged over 65 years shows that this group has an energy intake lower than the Estimated Average Requirements (EAR) while having a higher proportion of those overweight. This may be in part be due to less food being consumed because of economic burdens, reduced mobility so they may be unable to shop as often as needed, or this group may be following beliefs that certain food groups are not as ‘good’ for them, so for example, eat less carbohydrates and replace them with foods higher in salts and sugar to get a feeling of satisfaction from food. This age group may have more people overweight because of the diet choices mentioned, they may be the first generation of the elderly population where most had been in sedentary jobs (office based) rather than more active manual jobs. Economics may play a part with this group being more reliant upon food that is cheaper such as pre packaged, ready meals, some of which are higher in fats and sugars than freshly cooked meals.

Older adults with the lower energy intakes are from sub populations where they are alone (single men and women) or infirm (institutionalised elderly), so socialising as well as health may affect appetite.

Of the free-living adults 14% were underweight with this figure being only 2% more (16%) for those that are institutionalised. The elderly population have more sensitivity to taste and smell which can create less of an appetite. Illness can lead to a reduction in willingness or ability to eat food. The body’s metabolism also changes and lean muscle mass decreases showing as a lower weight.

Macronutrient intake remains the same in this group as it has been in the younger adult category. Some of the daily recommended values were not being met such as protein. Protein is particularly important in older adults as it can prevent muscle wastage (protein synthesis slows down) and maintains a healthy immune system (illnesses are more common in this age group).

Fibre (non starch polysaccharides NSP) are below the recommendations of 18g per day, with men having an intake of 13.5g and women 11g. Having enough fibre in the diet is important to maintain regular, healthy bowel function. Non prescribed laxatives and regular use of prescribed laxatives to aid bowel movement can lead to impaired cardiac function, depression and some micronutrients not being absorbed properly (e.g. potassium).

The majority of this population exceeded the RNIs for vitamins and minerals. Some sub groups feel below the LRNI. The adults most likely to be in this category were free living and would be preparing their own food. Institutionalised adults have their food prepared and these often contain milk and fortified foods. Calcium intake is above the RNI, partly for this reason but also because as a drink it becomes more popular again in this age group and is used heavily in tea – with tea being consumed by 95% of the over 65’s. Sodium is also above the RNI with more salt being added to food to give taste and cheaper cuts of meat being consumed.

Vitamin C is below the RNI of 40mg per day thought to be due to low intake of fresh fruit and vegetables. This could be in part due to the higher proportion of adults with dentures in this group, which may make eating raw, crispy foods difficult. Although more people are keeping their own teeth than previously recorded it is this age group that is more likely to experience this. Less vitamin C may also be absorbed due to ill health and the increase use of aspirin. (p.298 Factors influencing nutritional status in Human nutrition 2nd edition by Mary E Barasi)

The most popular food types consumed are milk, meat, potatoes, white bread and biscuits/ cakes, which goes some way to explaining the weight and nutritional imbalances reported in the survey.

Recommendations for older adults as to what they need to include in their diet to meet their nutritional requirements

Low energy intake will make a person lethargic and unable to take part in activities. For older adults it is important to keep activity levels up as much as possible to prevent unnecessary muscle wastage and to continue social interaction for mental and physical well being. Foods that are nutrient dense are ideal, as smaller amounts can be eaten for ultimate results, these would include whole grains such as as in wholemeal bread, milk and dairy products, legumes, sweet potatoes and fruit.

As cells slow down creating and degrading protein (protein synthesis) for use in maintaining muscle tissue, it is important to increase (or meet DRV) intake of protein so that the body can remain active and able for as long as possible. As illnesses are more common these reserves of protein are needed to aid recovery particularly with immune function and wound healing.

Fibre intake can be increased from consuming more vegetables, high fibre breakfast cereal or by swapping to wholemeal rather than white bread. Fibre in the diet is important for healthy bowel function, constipation is a common problem among the elderly.

Continue with the higher levels of calcium as this is helpful to maintain bone structure, delaying the onset of common ailments in this group such as osteoporosis and osteoarthritis.

Vitamin C is needed for a healthy immune system, with this population being more susceptible to illness increasing this micronutrient intake is key to a healthy life. It has also been reported that low vitamin C can be linked to an increase in the risk from stroke (Vitamin C and risk of death from stroke and coronary heart disease in cohort of elderly people BMJ, 1995). Foods to increase to meet required vitamin C levels are mainly raw fresh fruit and vegetables. Soft fruits are particularly advisable if the use of dentures makes eating firmer or raw foods uncomfortable.

c) Have there been any changes to the results between table 4 and 5 being published.

As with the other age groups, the results in Table 5 confirm those previously analysed in Table 4. An average of 4.4 portions of fruit and vegetables were eaten by the older adults (37% of this group were meeting the 5 a day recommendation), higher than the other age groups. This explains how most of the micronutrient RNIs are being met and perhaps indicates that vitamin C is low more because of absorption difficulties rather than low fruit intake.

Oily fish consumption was below the recommended portion of once per week. The British Nutrition Foundation recommends older adults eat oily fish to increase their intake of vitamin D, as ageing skin decreases its ability to synthesise this vitamin. Vitamin D helps the body use calcium, keeping bones stronger for longer.

Mean energy intake for the older adults is 1690 kcal/ day. Men consume 1934 kcal instead of the recommended 2330 kcal and women 1501 kcal instead of the recommended 1900kcal. These recommendations are based on the average healthy individual so it should be noted that energy needs should be measured on an individual basis. Where an elderly person is overweight their energy intake should be lowered and an underweight adult should increase their intake. Foods and supplements should be nutrient dense for this age group to ensure that the maximum nutrient and energy is provided in the most efficient and palatable way for the individual.

The mean intake of fat increases to above the recommended 35% of total energy intake (men 36.9% and women 35.4%). Saturated fats are also above the DRV (no more than 11% of total energy). This may indicate why more of this population are becoming overweight than in previous years.

The nutrition of the older adult population is difficult to assess, as this group is becoming larger and more diverse as the general population of the world lives to an older age. Many of the younger adults in this category can be treated the same as the19-64 years category. More research needs to be done on the nutritional requirements and digestive function of much older adults to enable more accurate recommendations.

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