Title: Nutritional Surveillance in the UK.
Key words: MAFF data, Dept of Health (DoH), average daily intake (ADI), deficiencies, micronutrients, COMA
Date: Jan 1999
Category: 14. Measurement
Author: Dr van Rhijn
Nutritional Surveillance in the UK.
Cause for concern in pre-school children, adults and the elderly in relation to several nutrients
The Ministry of Agriculture, Fisheries and Food (MAFF) and the Department of Health jointly commissioned the three detailed reports from the National Diet and Nutritional Survey programmes. These cross-sectional surveys cover nationally representative samples of three defined age groups (1½ to 4½, 16-64 and adults over 65 years) of the population and its findings may have great implications for nutritional policy.
The survey results are extensive, and emphasis will only be placed on areas for concern where the Average Daily Intake (ADI) of a nutrient fell below or above the Reference Nutrient Values (RNI) for each age group respectively, without elaborating on exact values of the results.
The ADI of protein and salt were both in excess of the RNI set for this group.
The ADI for several vital nutrients fell well below the expected RNI, such as Vit A, (50% below 400m g.); Vit D (95% below 7m g.); Iron (85% below 6.5 mg); Ferritin - low iron status (20% below 10m g/L.); Zinc (72%-89% below 5 mg.); Copper (36%-68% below 0.5mg).
Again, the ADI for protein (providing > 10 total energy), was well in excess of the RDI for both genders. Overall, 68% of men and 64% of women had a serum total cholesterol of above 5.2 mmol/L. Iron intakes were lower in both genders, especially younger woman. 4% of men and 33% of women (again younger) had serum ferritin levels below 25m g/L.
As before, the ADI for protein (providing 16.3 % of food energy) was well above the RNI. Some 18.4% of food energy was derived from non-milk extrinsic sugar. This group also had a lower ADI of fibre (NSP). Generally, 64% of men and 76% of women had a serum total cholesterol of above 5.2 mmol/L.
The ADI for Vit A, Vit D, Vit B1, Vit B2, Vit B6, Vit B12, Vit C, folate were below the expected RNIs. The same was found for magnesium, potassium, iron, zinc, calcium and iodine. The elderly in institutions tended to be more deficient as a group compared to the free-living group.
The above findings are quite alarming considering that children and the elderly are most at risk of major deficiencies. Thus, numerous secondary and chronic diseases could be prevented with awareness and proper resources. This would result in lower morbidity and mortality of diet related chronic diseases such as anaemia, osteoporosis, CHD and cancer. Dietary supplementation and food fortification provide some additional sources of nutrients, but often tend to miss the target group that need it most.
These surveys provide excellent approximations about the nutritional status of the population and identify target groups to focus on. The Committee on Medical Aspects of Food and Nutrition (COMA) is subsequently able to provide better informed advice to several governmental departments and health authorities to implement health guidelines, education programmes and campaigns to encourage a more preventative awareness to combat disease.
RDA: The average amount of the nutrient, which should be provided per head of a group of people if the needs of practically all members of the group are to be met. (Average for a group of people).
RDI: The amounts sufficient, or more than sufficient, for the nutritional needs of practically all healthy persons in a population. (Food as actually eaten).
EAR: The estimated average requirement (mean) of a group for a particular nutrient or for energy.
RNI: The amount of a nutrient (mean + 2SD), which is sufficient for almost all individuals. It exceeds the requirement of most people and habitual intakes above RNI are almost certain to be adequate.
LRNI: The amount of a nutrient or energy (mean 2SD), which is sufficient for only a few individuals. Habitual intakes below the LRNI by an individual will almost certainly be inadequate.
DRV: A general term (statistical concept), which covers all the figures of EAR, RNI, and LRNI. It includes guidance on high intakes, and is presented as average requirements for the population as a whole.
National Diet and Nutritional Survey: Children aged 1½ to 4½: Summary.
The Dietary and Nutritional Survey of British Adults: Introduction.
National Diet and Nutritional Survey: People aged 65 years and over.
Scientific Basis of Nutrition Education: 1996; Health Education Authority.
Cromwell press. Melksham.
Vitamins, Minerals and Health: 1997; National Dairy Council. London.
Report on Health and Social Subjects No 41 (COMA) : 1997: Dietary Reference Values for Food Energy and Nutrients for the United Kingdom. The Stationery Office. London.
Margetts B. & Nelson M. 1998; Design Concepts in Nutritional Epidemiology. Second Edition. Oxford University Press. New York.