How do Intakes of Foods Targeted for Change Relate to Energy Density? Karen Barton Centre for Public Health Nutrition Research, University of Dundee Wendy Wrieden School of Pharmacy and Life Sciences, Robert Gordon University Andrea Sheriff Dental Public Health, University of Glasgow

Background Longstanding recognition of Scotlands poor diet Associated with high rates of chronic disease Poor diet and health more likely with increasing deprivation

The Scottish Diet Published by the Scottish Office Home and Health Department 1993

The Scottish Diet Action Plan Scottish Dietary Targets (SDTs) set in 1996 Mixture of food and nutrient based targets No target set for energy density

Energy Density Energy density can be defined as the available energy in a standard weight of food The regular consumption of energy dense foods has been linked to weight gain and obesity In 2007, the World Cancer Research Fund (WCRF) set a population level energy density (ED) goal for diets of 125kcal/100g including milk but not other drinks

10 to 100kcals/100g Non starch vegetables, roots and tubers, and fruit Low Energy Density 60 to 150kcals/100g Cereals (grains) and pulses (legumes) 100 to 225 kcals/100g Bread, lean meat, poultry and fish

Good source of desirable nutrients >225 to 275 kcals +/100g Savoury >225 to 275 kcals+/100g Sweet >225 to 275 kcals+/ 100g High Energy Density

Fast Foods Readily available convenience foods - Energy dense - Consumed frequently - Large portions 1420 Kcal Fast Foods

Obesity Route Map In 2010, the Scottish Government highlighted the importance of consuming a less energy dense diet in the Obesity Route Map with an explicit commitment to support consumers to make more nutrient dense food choices

Aims To use data from the Scottish sample of the UK Expenditure and Food Survey to estimate the energy density of the Scottish Diet To examine food intakes by quintiles of energy density To compare the results with the Scottish Dietary Targets (SDTs)

Scottish Dietary Targets Target FoodScottish Dietary Target Fruit and VegetablesMore than 400g per day Bread (all types)154g per day Brown/Wholemeal BreadMore than 77g per day Breakfast Cereals (all types)34g per day Oil Rich Fish88g per week White FishNo decrease (107g per week)

Expenditure and Food Survey (EFS) (now Living Costs and Food Survey) Household purchase survey (conducted annually) Average annual Scottish sample: 560 households and 1270 people Collects information about household and eating out food and expenditure over 14 day period Valuable source of information about food purchases of the population Translated into estimates of the food consumption and nutrient intake Can be used to calculate energy density and linked to indices of deprivation and diet cost

Methods (1) Household food purchase data for Scotland from the UK Expenditure and Food Survey (EFS) were pooled from and analysed to estimate energy density Food and nutrient data obtained from UK Data Archive and ONS Foods grouped relevant to the SDTs e.g. fruit and vegetables Household foods and foods eaten outside the home combined to give total food intake per capita

Methods (2) Adjustments made for fractions of composite foods, waste and any weight increase or loss due to cooking or dilution ED was calculated for food and milk to reflect the definition used in setting the WCRF public health goal Statistical analysis carried out using the complex samples component of SPSS Allows for survey sampling methods to be taken into account Results are presented as population means with 95% confidence intervals (i.e. includes consumers and non-consumers) for household and eating out foods combined by quintiles of energy density

Results The mean combined ED of the Scottish diet was 172kcal /100g The mean ED of households in the lowest quintile was 123kcal /100g Comparable to the WCRF target (125kcal/100g) The mean ED of households in the highest quintile was 231kcal /100g

Fruit & Vegetable Consumption Lowest Highest

Bread Consumption Lowest Highest

Breakfast Cereal Consumption Lowest Highest

Oil Rich Fish Consumption Lowest Highest

White Fish Consumption Lowest Highest

Non SDT Foods Targeted for Reduction In contrast consumption of cakes, sweet pies and pastries; confectionery, sugar containing soft drinks; red and processed meat was lowest in households within the lowest quintile of energy density

Conclusion (1) Food purchase data from the EFS has successfully provided a means of estimating the ED for the Scottish diet Average ED of the Scottish diet is considerably higher than the public health goal recommended by the WCRF ED was not uniform across the population The analysis suggests that only a small fraction of the population were able to achieve an ED close to the WCRF public health goal

Conclusion (2) The diet of households within the lowest quintile of ED were closest to the food based dietary targets These findings suggest that adherence to healthy eating advice can assist in reducing ED and may help prevent obesity

Acknowledgements Project steering group FSA Scotland Scottish Government