Using Scottish Data from UK studies to monitor progress towards Scottish Dietary Targets

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Using Scottish Data from UK studies to monitor
progress towards Scottish Dietary Targets
Dr Wendy L Wrieden, University of Dundee Karen L
Barton, University of Dundee Julie Armstrong,
Glasgow Caledonian University
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Scottish Dietary Targets

• Set of POPULATION LEVEL nutrient and food based
  targets set for achievement in 2005
• Derivation of the nutrient based targets
• Dietary Reference Values for Food Energy and
  Nutrients for the UK (Department of Health,1991)
• Derivation of the food based targets
• Scottish Diet Report (Scottish Office, 1993)

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What are these targets?

• Nutrient- based
• Fat and saturated fat
• Complex carbohydrate
• Sodium
• Non-milk extrinsic (added) sugars
• Food -based
• Fruit and vegetables
• Bread
• Breakfast Cereals
• Fish particularly oil rich fish

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Aim

• To review recent national dietary and health
  surveys and their ability to assess progress
  toward the Scottish Dietary Targets
• To compare findings with the Scottish Dietary
  Targets as set out in the Scottish Diet Action
  Plan (Scottish Office1996)

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Surveys reviewed

• HOUSEHOLD BUDGET SURVEYS
• National Food Survey (NFS) 1996-2000
• Expenditure and Food Survey (EFS) 2001 - 2004
• HEALTH SURVEYS
• The Scottish Health Survey (SHS), 1995, 1998 and
  2003
• Health Education Population Survey (HEPS),
  1996-2004
• NATIONAL DIET AND NUTRITION SURVEYS (NDNS)
• NDNS 1995 older adults aged 65
• NDNS 1997 - young people aged 4-18 years
• NDNS 2001 - adults aged 19-64 years

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Ability of 4 surveys to monitor progress towards
the Scottish Dietary Targets
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The Working Group on Monitoring Scottish Dietary
Targets (FSA,2004) concluded that

• the Expenditure and Food Survey should be used
  to monitor progress towards the Scottish Dietary
  Targets in 2005 and beyond

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The Scottish Dietary Targets Getting to Grips
with the Baseline

• Baseline figures, quoted in the SDAP, were
  derived from the Scottish Diet Report (Scottish
  Office,1993) and relate to combined data for
  1989-1991 from the National Food Survey
• These data therefore do not represent the
  situation in 1996, the year the SDAP was
  published
• Also, from 1994 onwards the NFS included food
  eaten outside the home
• In this work, intakes have been recalculated for
  1996 and the same calculations have been
  performed for subsequent years up to 2003/2004

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Methodology of Surveys

• National Food Survey (NFS) household and eating
  out purchases recorded by householder for 1 week
• Expenditure and Food Survey (EFS) household
  purchases and eating out recorded by all members
  of household (over 7) for 2 weeks.
• Around 600 households (1,300 people) per year

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Comment on EFS methodology

• Because the EFS records food acquisitions rather
  than consumption, it is possibly less susceptible
  to under-reporting and non-response bias than
  weighed intake dietary surveys (Wrieden, 2006
  Chesher, 1997)

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Calculation of NFS/EFS data

• Secondary analysis of the data sets from 1996-
  2003/2004 - data supplied by Data Archive, DEFRA
  and ONS
• Data fitted to the food groups used in the
  surveys to match the Scottish dietary targets
• Household foods and foods eaten outside the home
  combined to give total food and nutrient intake
  per capita (less 10 for waste)

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Calculation of SHS data

• The main data files for SHS 1995 and 1998 were
  obtained from the UK Data Archive.
• Foods which related to Scottish dietary targets
  were re-coded and where necessary new variables
  derived (for fruit and vegetables, foods high in
  NME sugars).
• Further analysis was carried out to calculate
  median (with IQR) and mean (with 95 CI)
  frequency of consumption of foods related to
  achieving the SDTs

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RESULTS
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Household and Eating out consumption in g per
person /day
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FRUIT AND VEGETABLES

• Average intake to double to more than 400g per
  day
• Picture by Gordon Douglas

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Progress Towards the Targets Fruit and
Vegetables (using 5 a day criteria)Data Source
NFS/EFS
Average intake to double to more than 400g per day
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Results from the Scottish Health Survey

• 1998 Median frequency fruit and vegetable
  consumption 2.9
• 2003 Median fruit and vegetable consumption 2.9
  portions
• Change???

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Mean (with 95 confidence intervals) fruit and
vegetable consumption) by SIMD quintiles EFS
2001/2002-2003/2004 SIMD Scottish Index of
Multiple Deprivation SIMD Quintiles 1 Least
Deprived 5 Most Deprived
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Median total fruit and vegetable intake (g per
day) by men and women aged 16-74 from the
Scottish Health Survey 2003 by deprivationQuinti
le 1 least deprived Quintile 5 most deprived
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BREAD

• Intake to increase by 45 from present daily
  intake of 106g, mainly using wholemeal and brown
  breads

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Progress Towards the Targets BreadData Source
NFS/EFS
Intake to increase by 45 from present daily
intake of 106g, mainly using wholemeal and brown
bread
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Scottish Health Survey consumption of starchy
carbohydrates by women aged 16-74 ( consuming
Bread 2-3 slices/day)
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Progress Towards the Targets Breakfast Cereals
Data Source NFS/EFS
Average intake to double from present intake of
17g per day
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Scottish Health Survey consumption of starchy
carbohydrates by women aged 16-74 ( consuming
Breakfast cereal 5-6 times/week)
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Oil Rich Fish

• Oil rich fish consumption to double from 44g to
  88 g per week
• Image From http//www.charlestonseafood.com/images
  /Amazon/Salmon-8Steaks-375.jpg

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Progress Towards the Targets Oil Rich Fish (ex
canned tuna) Data Source NFS/EFS
Oily fish consumption to double from 44g per
week to 88g per week
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Other findings from NFS/EFS

• White fish consumption fell from 107g in 1996 to
  76g in 2003/2004
• Fresh potato (as purchased) fell from 99g to 68g
  over same period

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FAT

• Average intake of total fat to reduce from 40.7
  to no more than 35 of food energy
• Average intake of saturated fatty acids to reduce
  from 16.6 to no more than 11 of food energy
• The National Diet and Nutrition Survey
  (2000/2001) showed main contributors to fat were
• Meat and meat products (23)
• Cereals and cereal products (19)
• Milk and milk products (14 of total, 24 of
  saturated)

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Progress Towards the Targets Total Fat ( food
energy)Data Source NFS/EFS
Average intake of total fat to reduce from
40.7 to no more than 35 of food energy
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Progress Towards the Targets Saturated Fat (
food energy) Data Source NFS/EFS
Average intake of saturated fatty acids to reduce
from 16.6 to no more than 11 of food energy
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Cakes, Biscuits and PastriesData Source NFS/EFS
Average intake to reduce by half
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Meat and Meat ProductsData Source NFS/EFS
Processed meat and sausage intake to reduce by
half. Bacon and ham to reduce by 20
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NON MILK EXTRINSIC SUGARS

• Average intake of NME sugars in adults not to
  increase
• The National Diet and Nutrition Survey
  (2000/2001) showed main contributors to non-milk
  extrinsic sugars for 19-24 year olds were soft
  and alcoholic drinks (57). In 50-64 year olds
  this contribution was only 27.

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Progress Towards the Targets NMES ( total
energy) Data Source NFS/EFS
Average intake of NME sugars in adults not to
increase
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ConfectioneryData Source NFS/EFS
Intake to be cut by 1/3 for adults and by ½ for
children
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Soft drinks (NFS sugar containing and sugar free
does not include Eating Out)Data Source NFS/EFS
Intake to cut by one third for adults and by one
half for children
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How does this inform policy?

• Using the best data available
• Some progress towards the target for total fat
• No change in intakes of fruit and vegetables,
  breakfast cereal, oil rich fish, saturated fat or
  total complex carbohydrate
• Fall in bread intake (including brown and whole
  grain), white fish and fresh potatoes
• Foods targeted for increase have highest mean
  consumption in the least deprived quintile of the
  SIMD.
• Rise in NME sugar consumption (as energy).
  Significantly higher in more deprived quintiles.

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How does this inform policy?

• The Scottish Diet Action Plan in 1996 set out
• a framework in which everyone with an influence
  on what we eat from food producers and
  processors to the NHS, local authorities, school,
  caterers, retailers, the media and of course
  consumers themselves can choose to work
  together to bring dietary improvement in
  Scotland.
• Forward to Eating for Health- A Diet Action
  Plan for Scotland

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How does this inform policy?

• In 2006 a Review of the Scottish Diet Action Plan
  was carried out by independent panel of English
  experts.
• Whilst acknowledging the substantial progress in
  initiatives to improving health
• Current dietary patterns appear, for the most
  part to be making no move , and in some cases to
  be moving in the opposite direction to those
  desired in the Scottish Diet Action Plan. Based
  on current evidence it is unlikely that
  substantial increases will be observed in the
  next 5 years without significant policy
  initiatives to promote greater intake of these
  commodities.
• Lang, Dowler and Hunter p. 105 of review of the
  Scottish Diet Action Plan. Progress and Impacts
  1996-2005

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Conclusions

• All 4 surveys reviewed concur that the SDTs would
  not be met in 2005
• The Scottish Health Survey and Health Education
  and Population Survey can be used to monitor
  differences due to deprivation, sex and age.
  However they can only be used to provide
  information on food consumption in broad terms
• Actual consumption, calculated from food
  purchases in the EFS suggests little improvement
  to date and is based on a standard measure of
  what is included in the various food target
  categories across the years
• Data from EFS will continue to be used to monitor
  the Scottish diet in the future

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Commissioned by the Food Standards Agency
Scotland Authors Dr Wendy L Wrieden, University
of Dundee Karen L Barton, University of
Dundee Julie Armstrong, Glasgow Caledonian
University Dr Geraldine McNeill, University of
Aberdeen
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Acknowledgements

• Jim Holding of DEFRA
• Data Archive, University of Essex
• UK Office of National Statistics