How do Intakes of Foods Targeted for Change Relate to Energy Density?

Karen BartonCentre for Public Health Nutrition Research, University of Dundee

Wendy WriedenSchool of Pharmacy and Life Sciences, Robert Gordon University

Andrea SheriffDental Public Health, University of Glasgow

Background

Longstanding recognition of Scotland’s 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/100gNon starch vegetables, roots and tubers, and fruit

Low Energy Density

60 to 150kcals/100gCereals (grains) and pulses (legumes)

100 to 225 kcals/100gBread, lean meat, poultry and fish

Good source of desirablenutrients>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 Food Scottish Dietary Target

Fruit and Vegetables More than 400g per day

Bread (all types) 154g per day

Brown/Wholemeal Bread More than 77g per day

Breakfast Cereals (all types) 34g per day

Oil Rich Fish 88g per week

White Fish No 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 2001-2008 and analysed to estimate energy density

Food and nutrient data obtained from UK Data Archive and ONSFoods grouped relevant to the SDTs

e.g. fruit and vegetablesHousehold 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