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

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)

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

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)

Surveys reviewed HOUSEHOLD BUDGET SURVEYS National Food Survey (NFS) Expenditure and Food Survey (EFS) HEALTH SURVEYS The Scottish Health Survey (SHS), 1995, 1998 and 2003 Health Education Population Survey (HEPS), NATIONAL DIET AND NUTRITION SURVEYS (NDNS) NDNS 1995 – older adults aged 65+ NDNS young people aged 4-18 years NDNS adults aged years

Ability of 4 surveys to monitor progress towards the Scottish Dietary Targets MethodScottish sample size Frequency Suitability of methods NFS/EFS Household food survey Reasonable size, representative sample AnnualAcceptable SHS Limited food frequency Excellent, large and representative 3-5 yearsWeak HEPS Fruit and vegetable questions Reasonable size, representative sample Annual/ 2 years Unsatisfactory NDNS 7-day weighed intake Too small (n=123) InfrequentGood

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

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 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

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

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)

Calculation of NFS/EFS data Secondary analysis of the data sets from / 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)

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

RESULTS

Household and Eating out consumption in g per person /day Food National Food SurveyExpenditure and Food Survey / / / 2004 H=775 P=1885 H=541 P=1341 H=546 P=1320 H=618 P=1412 H=585 P=1342 H=546 P=1266 Mean Mean (95% CI) Fruit and Vegetables (including fruit and vegetable juice and baked beans) ( ) 263 ( ) 246 ( ) Bread (all types) ( ) 124 ( ) 116 ( ) Brown / Wholemeal Bread ( ) 22.4 ( ) 19.7 ( )

FRUIT AND VEGETABLES Average intake to double to more than 400g per day Picture by Gordon Douglas

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

Results from the Scottish Health Survey 1998 Median frequency fruit and vegetable consumption = Median fruit and vegetable consumption = 2.9 portions Change???

Mean (with 95% confidence intervals) fruit and vegetable consumption) by SIMD quintiles EFS 2001/ /2004 SIMD = Scottish Index of Multiple Deprivation SIMD Quintiles: 1= Least Deprived; 5 = Most Deprived

Median total fruit and vegetable intake (g per day) by men and women aged from the Scottish Health Survey 2003 by deprivation Quintile 1 = least deprived Quintile 5 = most deprived

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

Progress Towards the Targets: Bread Data Source :NFS/EFS Intake to increase by 45% from present daily intake of 106g, mainly using wholemeal and brown bread

Scottish Health Survey consumption of starchy carbohydrates by women aged (% consuming Bread 2-3+ slices/day)

Progress Towards the Targets: Breakfast Cereals Data Source :NFS/EFS Average intake to double from present intake of 17g per day

Scottish Health Survey consumption of starchy carbohydrates by women aged (% consuming Breakfast cereal 5-6+ times/week)

Oil Rich Fish Oil rich fish consumption to double from 44g to 88 g per week Image From

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

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

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)

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

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

Cakes, Biscuits and Pastries Data Source :NFS/EFS Average intake to reduce by half

Meat and Meat Products Data Source :NFS/EFS Processed meat and sausage intake to reduce by half. Bacon and ham to reduce by 20%

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 year olds were soft and alcoholic drinks (57%). In year olds this contribution was only 27%.

Progress Towards the Targets: NMES (% total energy ) Data Source :NFS/EFS Average intake of NME sugars in adults not to increase

Confectionery Data Source :NFS/EFS Intake to be cut by 1/3 for adults and by ½ for children

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

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.

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

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

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

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

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