The NDNS survey report for 2019 – 2023 was published this week (National Diet and Nutrition Survey 2019 to 2023: report – GOV.UK). This is a really important source of evidence that will be used by the UK government to inform diet and nutrition policies. The sample population is selected to be representative of all nations within the UK and consists of those aged 18 months and over living in private households. For the first time this year the four-day food diary was recorded using an online tool called Intake24, this meant the data couldn’t be compared to that from previous years as the methodology differed. Other data collected included, physical activity, blood and urine samples to asses biomarkers of specific nutrients, height and weight measurements.
A summary of the main findings:
- Most participants did not meet the UK government recommendation to eat at least five portions of a variety of fruit and vegetables each day, this was lower than previously recorded data for adults and older adults
- Average consumption of red and processed meat was below 70g per day (current recommended limit) in all age and sex groups but 27% of men aged 19 to 64 ate more than 90g per day.
- The highest average consumption of sugar sweetened soft drinks was by children aged 11 to 18 years (124 ml per day). The highest consumers in this age group drank 606 ml per day.
- The UK government recommends that no more than 10% of energy comes from saturated fats, on average this was exceeded by 85% of children and 82% of adults.
- The UK government recommends that no more than 5% of energy comes from free sugars, less than 1 in 10 children (9%) and less than 1 in 5 adults (19%) met the recommendation.
- Most people do not meet UK government fibre recommendations (at least 30g per day for adults and 15 to 25g per day for children depending on their age). For children aged 11 to 18 years and for adults, 96% did not meet the fibre recommendation.
- Low vitamin D status was highest in children aged 11 to 18 years at 23%.
- 83% of women of child-bearing age had a blood folate level below the recommended concentration at which there is an increased risk of neural tube defects in pregnancy
- Iodine status was insufficient for women (16-49 years) and girls (11-18 years). A worrying decline in overall iodine status has been observed across the population since 2013.
- 72% of participants reported buying food or drink out of the home (cafes, takeaways, pubs etc) 1-2 times a week, this was mostly children (11-18 years) and adults (19-64 years). Of these almost a quarter of their energy, saturated fat, sugar and salt came from these eating occasions.
It is unfortunately nothing new that the 5-a-day fruit and vegetable goal is still not being achieved, but it is concerning that this is lower than previously recorded, this could be due to changes in methodology, the effect of the Covid-19 pandemic or the cost-of-living crisis that has left many people unable to afford healthy food.
This report shows that there are a few population demographics that need to be targeted by public health intervention such as encouraging adult men to eat less processed and red meat, this is particularly important as this group is also at high risk of cardiovascular disease (Pana et al, 2024).
The consumption of sugar-sweetened soft drinks by children is an ongoing area of concern, the highest volumes consumed; 606ml/day is equivalent to around two cans of soft drink a day, which on average contains 9 teaspoons of sugar each (Hashem et al., 2016).
Low vitamin D status of children could be improved by promotion of the need to supplement during the winter months.
The low folate status of women of childbearing age will hopefully become addressed by the implementation of flour fortification in the UK in 2026, in the meantime it is important to raise awareness and encourage the use of folic acid supplementation when planning a family.
The steady decline of iodine status in the overall population is concerning, it is thought that this could be attributed to the reduced consumption of iodine-rich foods such as cow’s milk and seafood. Growing numbers are using plant-based milk and following a vegan diet has become increasingly popular, these groups along with pregnant women are vulnerable and should be made aware of the risks of iodine deficiency which can lead to serious birth complications and hypothyroidism (Kayes et al, 2022).
The increased frequency of eating out of the home is an area for concern because the food being consumed is of poor quality and provides a significant contribution to overall calorie, fat, salt and sugar intake. Reducing the frequency or making healthier food choices could lead to considerable dietary improvement.
References
Hashem, K. M., He, F. J., Jenner, K. H., & MacGregor, G. A. (2016). Cross-sectional survey of the amount of free sugars and calories in carbonated sugar-sweetened beverages on sale in the UK. BMJ Open, 6(11), e010874. https://doi.org/10.1136/bmjopen-2015-010874
Kayes L, Mullan KR, Woodside JV. A review of current knowledge about the importance of iodine among women of child-bearing age and healthcare professionals. J Nutr Sci. 2022 Jul 8;11:e56. doi: 10.1017/jns.2022.50. PMID: 35836700; PMCID: PMC9274385.
Pana TA, Mamas MA, Wareham NJ, Khaw KT, Dawson DK, Myint PK. Sex-specific lifetime risk of cardiovascular events: the European Prospective Investigation into Cancer-Norfolk prospective population cohort study. Eur J Prev Cardiol. 2024 Jan 25;31(2):230-241. doi: 10.1093/eurjpc/zwad283. PMID: 38031203; PMCID: PMC10809170.
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