Title: The National Diet and Nutrition Survey: people aged 65 years and over

Key words: actual dietary intake, habits, energy and nutrient intakes, physical measurements, regional and socio-economic comparisons

Date: Jan 2002

Category: Measurements

Type: Abstract

Author: DoH

 

 

 

The National Diet and Nutrition Survey:

people aged 65 years and over

G. Smithers, S. Finch, W Doyle, C. Lowe, CJ Bates, A. Prentice and PC. Clarke

Abstract

Commissioned by the Ministry of Agriculture. Fisheries and Food, the Department of Health and carried out by Social and Community Planning Research and MRC Dunn Nutrition Unit, the dental hospitals of the Universities of Newcastle and Birmingham and the Department of Epidemiology of the University of London, this research forms part of the National Diet and Nutrition Survey. Set up in 1992 the surveys cover representative groups of the population and examine the diet of the over-65s in terms of actual dietary intake, habits, energy and nutrient intakes, physical measurements. Regional and socio-economic comparisons are made.

Introduction

The National Diet and Nutrition Survey of people aged 65 years and over is the largest and most detailed survey ever undertaken of the diet and nutritional status of older people in Britain, both living in the community and in institutions. It was commissioned jointly by the Ministry of Agriculture, Fisheries and Food and the Department of Health and carried out by Social and Community Planning Research, the MRC Dunn Nutrition Unit, the Dental Schools of the Universities of Newcastle and Birmingham and the Department of Epidemiology of the University of London.

The survey forms part of the National Diet and Nutrition Survey (NDNS) programme. This planned programme of surveys covering representative groups of the population was set up in 1992 by MAFF and DH following the successful completion and evaluation of the benefits of the Dietary and Nutritional Survey of British Adults (Gregory et al., 1990). The NDNS programme aims to provide a comprehensive cross-sectional picture of the dietary habits and nutritional status of the population of Great Britain.

Results of the survey will be published shortly in two volumes covering the diet and nutrition survey and the oral health survey respectively (Finch et al. 1998; Steele et al., 1998). The complete dataset will be deposited at The Data Archive at the University of Essex and will be available to researchers. The survey components and some of the main findings of the diet and nutrition survey are summarised below.

Components of the survey

 

Energy intake

In the free-living group the mean daily energy intake was 8.02 MJ (1,909kcal) for men and 5.98 MJ (1,422kcal) for women (Table II). Energy intakes were lower than the EARs, especially for women and were around 15 per cent lower than the intakes recorded by the last national survey of this age group in 1967/68 (Department of Health and Social Security, 1972). However, participants in this survey were also heavier than people in the previous survey and the prevalence of underweight was low, which suggests that in general their energy intakes were unlikely to be inadequate.

Energy intakes for those living in institutions were on average close to the EARs.

The main source of energy was cereals and cereal products, which provided 34 per cent of intake in the free-living group, followed by meat and meat products (14 per cent), milk and milk products (13 per cent) and vegetables and potatoes (10 per cent). The sources of energy were similar in institutions except that the contribution from cereal-based milk puddings was higher and that from meat and meat products lower.

 

Protein, carbohydrate and fibre intakes

Average protein intakes in both groups were well above the RNI and contributed 16.3 per cent of food energy (i.e. excluding energy from alcohol) in the free-living group. The main source of protein in the free-living group was meat and meat products which provided 32 per cent of total intake. In the institution group the main source of protein was cereals and cereal products (29 per cent), meat and meat products providing 26 per cent.

Total carbohydrate intake provided 47.8 per cent of food energy for the free-living group. Non-milk extrinsic sugars (NMES), implicated in the aetiology of dental caries, provided 12.2 per cent of food energy in the free-living group, close to the COMA recommended population average of no more than 11 per cent (Department of Health, 1991). In the institution group 18.4 percent of food energy was derived from NMES, above the COMA recommendation. The main source of non-milk extrinsic sugars was sugar, preserves and sweet spreads and confectionery, providing 42 per cent of intake for the free-living group and 48 per cent for those in institutions. Table sugar alone provided 38 per cent of total intake in the institution group.

Average daily intake of non-starch polysaccharide (NSP) ("dietary fibre") was below the daily intake of 1 8g recommended by COMA for both groups (Department of Health, 1991), at 12.lg for the free-living group. The main sources of NSP intake were cereals and cereal products providing 47 per cent of intake in the free-living group and vegetables and potatoes providing 34 per cent.

 

Fat intakes and blood lipid levels

Total fat intake for both groups was close to the COMA population average recommendation of no higher than 35 per cent, providing 35.9 per cent of food energy intake for the free-living group. The main sources of fat (Figure 1) were cereals and cereal products, which provided 21 per cent of intake (mainly from buns, cakes and pastries), fat spreads (20 per cent), meat and meat products (20 per cent) and milk and milk products (18 per cent). Intake of saturated fatty acids for both groups exceeded the COMA population average recommendation of no more than 11 per cent, providing 15 per cent of food energy for the free-living group. Transfatty acids intake was within the recommended level for the population of no more than 2 per cent, for both groups, providing 1.5 per cent of food energy for the free-living group.

Table II Average daily energy intake (Kcals/MJ) by sex and age (free-living group)

Energy intake

65-74
years

Men
75-84
years

85 years and over

MI

65-74
years

Women
75-84
years

85 years
and over

All

Kcals/day

1,954

1,843

1,713

1,909

1,445

1,399

1,374

1,422

MJ/day

8.21

7.75

7.20

8.02

6.07

5.88

5.77

5.98

from food. In the free-living group, dietary supplements increased average intakes by around 10-15 per cent for vitamins A, C and D, by about one-third for vitamin E and by 5 per cent for iron. Supplements also made a large contribution to intakes of thiamin, riboflavin, and vitamin B6 in free-living women, increasing average intakes by 20-50 per cent, due to a small number of women having high intakes from supplements.

Physical measurements

Free-living men and women were on average significantly heavier than those living in institutions. Mean BMI was 26.5 and 26.8 for free-living men and women respectively and 25 and 24.9 for men and women in institutions. Two-thirds of free-living participants and just under half of those in institutions were classified as overweight or obese (BMI> 25). Few free-living participants but one in six of those in institutions were classified as underweight (BMI 20 or less).

Fifty-seven per cent of men and 65 per cent of women in the free-living group and 58 per cent and 68 per cent of men and women in the institution group were classified as having high blood pressure. Of these two thirds were taking blood pressure reducing drugs.

Regional and socio-economic findings

A number of differences were observed between the dietary patterns and nutrient intakes in Scotland and the North and London and the South East with Central, South West and Wales falling in between. Participants in Scotland and the North were less likely to consume fruit than other regions but were more likely to eat beef and veal (and dishes made from them), meat pies and soup. Participants in London and the South East were more likely to consume leafy green vegetables, semi-skimmed milk and coffee than in Scotland and the North.

There were few significant differences in energy and macronutrient intakes between regions. However intakes of some vitamins, in particular vitamin C and some minerals tended to be lower in Scotland and the North than in London and the South East.

Indicators of socio-economic status, e.g. social class, income, receipt of benefits, showed that for the free-living group, those with lower socio-economic status had on average significantly lower intakes of energy, protein, carbohydrates and fibre and also of some vitamins and minerals, notably vitamin C. Those in the manual social class and those receiving benefits had significantly lower levels of plasma vitamin C than those in the non-manual group and those not receiving benefits. These differences were generally more marked in men than in women.

Oral health

The survey has demonstrated a relationship between diet and nutritional status and oral health status, particularly the number of natural teeth present. The condition of the mouth and presence, number and distribution of natural teeth was related to dietary habits, including the ability to eat foods, which require a greater effort to chew, such as uncooked fruit and vegetables and nuts.

 

Other surveys in the NDNS programme

The current survey in the NDNS programme is of young people aged 4-18 years. Fieldwork for this survey was completed at the end of 1997 and a report will be published in 1999. The survey of pre-school children aged 1-4 years was published in 1995 (Gregory and Hinds, 1995; Gregory et al., 1995). The next survey of adults aged 19-64 years is in its early planning stages and it is hoped that fieldwork will begin in 1999.

 

References

Department of Health (1991), Dietary Reference Values for Food Energy and Nutrients for the United Kingdom, HMSO, London (Report on Health and Social Subjects: 41).

Department of Health and Social Security (1972), A Nutrition Survey of the Elderly 1967-68, HMSO, London (Report on Health and Social Subjects: 3).

Finch, S., Doyle, W., Lowe, C., Bates, Ci., Prentice, A., Smithers, G. and Clarke, P.C. (1998), National Diet and Nutrition Survey: People aged 65 years and over, Volume 1: Report of the Diet and Nutrition Survey, SO, London, in press.

Gregory, I; and Hinds, K. (1995), National Diet and Nutrition Survey: Children Aged 1-4 years, Volume 2:Report of the Dental Survey, HMSO, London.

Gregory, I., Foster, K., Tyler, H. and Wiseman, M. (1990), The Dietary and Nutritional Survey of British Adults, HMSO, London.

Gregory, I., Collins, D.L., Davies, P.S.W.. Hughes, J.M. and Clarke, P.C. (199S), National Diet and Nutrition Survey: Children Aged 1-4 years. Volume 1: Report of the Diet and Nutrition Survey, HMSO, London.

Steele, J.G., Sheiham, A., Marcenes, W. and Walls, A.W.G. (1998), National Diet and Nutrition Survey: People aged 65 years and over, Volume 2: Report of the Oral Health Survey, SO, London, in press.