Please find below summaries of national nutrition survey results providing information on nutrient and energy intake, current food consumption, as well as on lifestyle, eating behavior, and related disease risk of various population groups.

Belgium

• ELAN

 

Germany 

• Nationale Verzehrstudie
• Nutrition and Cancer Risk

 

France: 

• Enquête Individuelle et Nationale des Consommations Alimentaires (INCA)
• Individuelle Nationale des Consomations Alimentaires 2 (INCA 2)
• CRÉDOC 2009

 

U.K.  

• The National Diet and Nutrition Surveys

U.S. 

• NHANES

 Belgium: ELAN

Oxidative stress is a cellular or physiological condition involving elevated concentrations of free radicals (reactive oxygen species) that cause molecular damage to vital structures and functions, which has been associated with the development of several disorders including atherosclerosis, cardiovascular disease, cancer, diabetes complications, macular degeneration and arthritis.

To limit the harmful effects of reactive oxygen species, a high-performance antioxidant system consisting of enzymes, proteins, vitamins (A, C and E), carotenoids, trace elements, and other small molecules may interact with the free radicals and regulate their production down to the physiological range. If these antioxidant defences are overwhelmed by excessive free radical production, or not sufficiently provided by diet or supplements, oxidative stress may consequently take place in the body.

Several factors influence the susceptibility to oxidative stress by affecting the antioxidant status or free oxygen radical generation. Regular exercise and carbohydrate-rich diets seem to increase the resistance to oxidative stress. Air pollution, alcohol, cigarette smoke, non-ionizing radiation and psychological stress seem to increase oxidative stress. Alcohol in lower doses may act as an antioxidant on low density lipoproteins and thereby have an anti-atherosclerotic property.

The ELAN (Etude Liègeoise sur les Antioxydants) cohort study, performed in the province of Liège, Belgium, in 2006, was the first large-scale trial investigating the relationship between oxidative stress status and the lifestyle of 897 people aged 40–60 years (1). For this purpose, information on the participants’ age, occupation, height, weight, blood pressure, smoking habits, alcohol and drugs consumption, waist circumference and physical activity was collected. In the same time, all participants completed a food questionnaire at home in order to evaluate their daily intake of fruit and vegetables. According to tables of diet composition, a score reflecting the daily consumption of both vitamin C and beta-carotene was established. In addition, plasma concentrations of the antioxidants were measured in blood samples. 

These values were compared with the critical antioxidant plasma concentrations defined by the WHO-MONICA study (2): plasma concentrations for vitamin C below 50–60 micromole/l (8.8–10.5 micrograms/ml) and beta-carotene concentrations below 0.4–0.5 micromole/l (0.21–0.27 micrograms/ml) have been associated with an increased risk of developing cancer and cardiovascular disease.

Results

• Men had a lower antioxidant status than women (in agreement with the French SUIVMAX study).
• 6% of the population were classified as clearly vitamin C deficient (plasma levels below 3.5 micrograms/ml), and another 10.3% were identified to be sub-deficient (levels below 6.2 micrograms/ml).
• For beta-carotene the results were significantly worse: almost one in two individuals (46.6%) was found to be beta-carotene deficient (levels below 0.22 micrograms/ml).
• The plasma concentrations of vitamin C and beta-carotene were clearly regulated by lifestyle factors such as physical activity, intake of fruit, smoking, oral contraception, and obesity.

A statistical model allows predictions to be made about how bad lifestyle behaviors increase the chance of getting plasma concentrations below values of 6 micrograms/ml vitamin C and 0.22 micrograms/ml beta-carotene (see also image).

References
1. Pincemail J. et al. Impact of lifestyle factors on plasma levels of vitamin C and beta-carotene in the ELAN cohort study (Liège, Belgium). SFRR Meeting, Rome, 2009; Free Radical Res. 43(1).

2. Gey K. F. Vitamins E plus C and interacting conutrients required for optimal health. A critical and constructive review of epidemiology and supplementation data regarding cardiovascular disease and cancer. Biofactors, 1998; 7:113–174.

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 Germany: Nationale Verzehrsstudie II

20 years after the last representative survey was carried out in the western part of Germany before reunification (Nationale Verzehrstudie I, 1985-1988) the Federal Minister for Food, Agriculture and Consumer Protection commissioned the Federal Research Centre for Nutrition and Food to conduct a second national nutrition survey.

 

In 2007, the Nationale Verzehrsstudie II (NVS II) provided information on the nutrient and energy intake of almost 20,000 14 to 80-year-old Germans, their current food consumption, and on lifestyle and eating behavior (what, when, where and why do Germans eat?).

 

Two reports with the results were published in 2008: the first report dealing with the description of the participants, and data on health and lifestyle aspects, and a second report about the food and nutrient intake data.

 

Results

1. Food consumption

• 87.4% of those surveyed do not meet the recommendations of the German Society for Nutrition (Deutsche Gesellschaft für Ernährung – DGE) of 400 g/day for vegetable consumption.
• 59% of those surveyed do not consume the amount of fruit recommended by the DGE (250 g/day).
• 16% of study participants had not eaten fish or food containing fish in the four weeks preceding the survey.

 

2. Vitamins

• 82% of men and 91% of women do not meet the recommendations for vitamin D consumption. This is particularly true of young adults and senior citizens.
• 79% of men and 86% of women do not meet the recommendation for consumption of vitamin B9 (folic acid). The percentages rise with increasing age.

Further analysis showed that

• 48% of men and 49% of women are below the recommended reference value for vitamin E.
• 32% of men and 29% of women are below the recommended reference value for vitamin C.
• 15% of men and 10% of women are below the recommended reference value for vitamin A. The intake of milk, butter and liver products as sources of preformed vitamin A (retinol) is insufficient.
• As a vitamin A precursor, beta-carotene contributes (especially in women) significantly to the overall vitamin A intake.
• 21% of men and 10% of women are below the recommended value for vitamin B1.
• 20% of men and 26% of women are below the recommended reference value for vitamin B2.
• 12% of men and 13% of women are below the recommended reference value for vitamin B6.
• 8% of men and 26% of women are below the recommended reference value for vitamin B12.
• 1.2% of men and 1.8% of women are below the recommended reference value for vitamin B3.

 

3. Minerals

• Iodine is a nutrient risk factor in the population. When iodized salt is not used, 96% of men and 97% of women consume less than the recommended amount of iodine.
• For women of reproductive age the issue of iron intake is also problematic. More than 75% of women in this age group consume less than the recommended amount of iron.
• Of female adolescents (14–18 years), 74% consume less than the recommended amount of calcium. Among older men and women (65–80 years) the percentages are 61 and 65 respectively.

 

4. Supplements

• Among those who took supplements median reference values for nutrient intake are met through supplementation alone for vitamin D and are exceeded for vitamin B1, vitamin B2, vitamin B3 and vitamin B6.
• The reference values are not met through supplementation alone for vitamin A, vitamin E, vitamin B12, vitamin C or vitamin B9 (folic acid) or for minerals.
• Among supplement users the proportion of those who do not meet the reference values for nutrient intake diminishes by 6–25% in respect of vitamins D, E, C, folic acid, calcium and magnesium when the intake of supplements is taken into account.

 

Reference

Max Rubner-Institut (Hrsg.) Nationale Verzehrsstudie II, Ergebnisbericht, Teil 1. Karlsruhe 2008. www.mri.bund.de/cln_045/nn_784936/SharedDocs/Publikationen/nvs__ergebnisbericht__teil2.html

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 Germany: Nutrition and cancer risk

In Germany, around 340,000 people a year are diagnosed with cancer. Around 210,000 die as a consequence of the disease. Thus cancer is the second greatest killer, after heart and circulatory diseases. About a third of all cancer cases, experts believe, are due to poor eating habits (1).

 

In their 2008 report the German Nutrition Society (Deutsche Gesellschaft für Ernährung, DGE) investigated the risk relationship between dietary factors and malignant tumors in various organs (2). The report is based on a systematic analysis of the available scientific literature, taking into account the design and quality of the studies. The level of reliability of the evidence for increased risk, reduced risk or no effect is designated as "convincing", “probable”, “possible” or “insufficient.”

 

Results

• Alcohol has the greatest cancer-inducing potential: there is convincing evidence that it increases the risk of developing tumors in the mouth, throat, larynx, esophagus, large intestine, rectum, breast and liver. A meta-analysis of 111 trials shows: for each 10 g of alcohol consumed per day the risk of developing breast cancer rises by around 10%. Ten grams of alcohol is equivalent to around 125 ml of wine or 250 ml beer.
• Red meat and meat products probably increase the risk of developing cancer of the large intestine or rectum, according to the evidence.
• Evidence that fat and saturated fatty acids increase the risk of developing breast cancer after the menopause is classed as possible, while the evidence for an elevated risk regarding cancer of the large intestine, rectum, lung, ovaries, uterus or prostate is judged to be insufficient.
• In contrast, fruit and vegetables demonstrate preventive potential. It is probable that they reduce the risk of developing cancer of the mouth, throat, larynx, esophagus, stomach and large intestine. An analysis of 14 cohort studies investigated the association of risk between consumption of fruit and vegetables and tumors of the large intestine, and compared a high intake of fruit and vegetables (800 g/day) with a low intake (200 g/day). The calculated risk reduction was 26%. It is possible that fruit and vegetables protect against tumors of the kidney and the rectum. For lung cancer, evidence shows a probable risk reduction through fruit consumption, and a possible one for vegetables. With regard to prostatic and ovarian cancer the evidence for an influence of fruit and vegetable consumption is insufficient.
• There is a possible connection between omega-3 fatty acids and a reduction in the risk of developing colorectal tumors.
• Milk and dairy products, as well as a diet high in fiber, probably reduce the risk for cancer of the large intestine. Results from the EPIC study (European Prospective Investigation into Cancer) show that men with a fiber intake of 31 g per day have a round 21% lower risk of developing colorectal carcinomas than men whose daily fiber intake is less than 18 g. The same reduction of risk was observed for women with an intake of 24 g as compared to 16 g fiber per day.

 

The results of the 2008 Nutrition Report confirm the recommendations of the DGE for a balanced diet in respect of cancer prevention. It should be rich in vegetables and fruit (for adults 400 g of vegetables and 250 g of fruit per day), and many fiber-rich cereal products, combined with a moderate consumption of meat and meat products (approximately 300 to 600 g/week). In particular, consumption of red meat should be reduced and alcohol avoided.

References

1. Deutsche Krebsgesellschaft e.V. 2007. www.krebsgesellschaft.de

 

2. Deutsche Gesellschaft für Ernährung e.V. 2009. www.dge.de

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 France: Enquête Individuelle et Nationale des Consommations Alimentaires (INCA)

As part of the national survey on food consumption in France (1), 1,171 adults recorded their food consumption over seven days. Researchers analyzed the results of the study using a statistical method to assess individual food preferences, individual dietary patterns and restrictions imposed by food intolerances (2). They determined the percentage of people who could be provided with 30 essential nutrients by modifying their food intake.

 

Results

• Mathematically, only 22% of the population could obtain all 30 nutrients from their habitual food intake. 
• 78% need to add new foods to their diet to meet their nutritional requirements.
• Vitamin D, sodium, magnesium, saturated fatty acids and free sugar were the nutrients that presented a significant problem for all.
• Women did not take in sufficient calcium, vitamin E or iron. 
• Eggs, butter, cheese and foods rich in fat and sugar are the main sources of vitamin D – foods which should all be consumed in moderation because of their saturated fat, cholesterol, sugar and salt content.

 

The researchers concluded from this analysis that, mathematically speaking, it is impossible for the great majority of French adults to achieve an optimal diet with adequate nutrient content without expanding the range of foods consumed. Such information could be useful to committees establishing dietary recommendations. 

 

References

 

1.   Volatier JL. Enquête INCA (Individuelle et Nationale sur les Consommations Alimentaires). Agence Française de Sécurité Sanitaire des Aliments, editor. Paris: Lavoisier; 2000.

 

2.   Maillot M. et al. To Meet Nutrient Recommendations, Most French Adults Need to Expand Their Habitual Food Repertoire. J Nutr. 2009; 139(9):1721–1727.

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 France: Individuelle Nationale des Consomations Alimentaires 2 (INCA 2)

Between late 2005 and April 2007, the Dietary Survey Unit of the French Food Safety Agency (Afssa) conducted the second individual and national food consumption survey (INCA 2). This study followed the first INCA study, conducted in 1998–1999.

 

INCA 2 involved 2,624 adults (18–79 years old) and 1,455 children (3–17 years old). The participants recorded their food and supplement intake over seven days, answered a questionnaire to evaluate their physical activity level, sedentary behavior, and their food supplement consumption over the past 12 months.

 

Thus, the INCA 2 study results provide a very detailed food consumption database on an individual level on people living in mainland France, essential for health and nutritional risk assessment.

 

Results

• Although less frequent in adolescents and young adults, the dietary routine of three main meals per day still characterizes the French food model. Meals are often shared with family or friends and at home.
• Dairy products, fish and fruit are consumed more by women.
• Seafood, fruit, vegetables, cakes and pastries are consumed more by individuals with a higher education level.
• Since 1999, intakes of fruit, vegetables, pasta, rice, and chocolate have increased; inversely, those of milk, cheese, meat, cakes and sweet biscuits and bread have decreased.
• Since 1999, intakes of bread, potatoes, milk, meat and poultry, and sweet products decreased in children aged between three and 14 years old; in those aged between 15 and 17 years old, only meat and poultry intake decreased. Intakes of vegetables and fruit remained similar whereas intakes of puréed fruits increased strongly.
• Women have a higher intake of lipids but also higher intakes of polyunsaturated fatty acids; their vitamin and mineral intakes are also higher; their protein intake is lower.
• 26.5% of women, 12.6% of men and 11.5% of children used food supplements over the 12 months prior to the study: these rates increase with educational level. Medical prescription and advice from a health professional are the main reasons for purchase. 70% of adults and 65% of children report using food supplements to maintain or improve their health. 23% of food supplements consumed by adults and 37% of those consumed by children are medicines. 63% of food supplements consumed by adults and 79% of those consumed by children are mainly composed of vitamins and minerals.

 

Additional analyses will determine how often recommended intake levels of vitamins and minerals are not met or are exceeded, by taking into account intakes from food supplements on the one hand and fortified and unfortified foods on the other.

Reference

Afssa, Étude INCA 2, 2006-07. www.afssa.fr/Documents/PASER-Sy-INCA2.pdf

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 France: CRÉDOC 2009

In 2009, the French Research Centre for the Study and Monitoring of Living Standards (Centre de Recherche pour l’Étude et l’Observation des Conditions de Vie, CRÉDOC) conducted a survey assessing the nutrition habits of over 400 French consumers.

 

 

Results

• 89% of the participants believed that food has an impact on health.
• Only 24% of the adults claimed eating 5 portions of fruit and vegetables a day.
• Young people showed to consume 8 times less fresh fruits than their grand-parents.
• The majority of young women did not reach the mean nutritional need (‘Besoin Nutritionnel Moyen’ equal to 70% of the RDA) for micronutrients such as iron, zinc, magnesium, calcium, vitamin B9 (folic acid), even when dietary supplement consumption was taken into account.

 

Reference

CRÉDOC, Enquêtes L’alimentation par la santé 2006 et 2009

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 U.K.: The National Diet and Nutrition Surveys

The National Diet and Nutrition Surveys (NDNS) are a series of government-funded surveys of food intake, nutrient intake and nutritional status of the British population (adults aged 16 to 64), undertaken to support nutritional policy and risk assessment. In 2008, the UK Scientific Advisory Committee on Nutrition (SACN) reviewed the latest NDNS, carried out between July 2000 and June 2001, to identify specific health outcomes where the population fails to meet dietary recommendations and specific groups are at risk. In addition, the SACN provided practical proposals for improvement where sections of the population had been shown to consume a poor diet.

 

Results

• Specific population groups identified as most at risk of poor dietary variety and low  
   nutrient intake and biochemical status were
  • Children aged 18 and under
  • Young adults aged 19–24 years (particularly women)
  • Smokers
  • People in lower socio-economic groups
  • Adults aged 65 years and over living in institutions
• Many women had a micronutrient intake significantly below the reference 
   nutrient intakes (RNIs) and lower reference nutrient intakes (LRNIs)
   (see Table below for details)
• Many girls between ages 11 and 19 were missing out on nutrients they require to grow and develop as a result of not having a balanced diet.
• Adults taking dietary supplements tended to be those with higher intakes of these micronutrients from food. In other words, those who could benefit most from the use of food supplements are likely not to be taking them.

 

Percentage of women with certain micronutrient intakes from food sources below the reference nutrient intakes (NDNS 2000/2001)

 

 

	19-24yr <RNI <LRNI	25-34yr <RNI <LRNI	35-49yr <RNI <LRNI	50-64yr <RNI <LRNI
Vitamin A*	81     19	68     11	45     08	46    05
Vitamin B2	24     15	38     10	22     05	08    06
Vitamin B9	40     03	36     02	28     02	25    02
Iron	96     42	93     41	90     07	38    04
Calcium	56     08	47     06	38     06	36    03
Magensium	85     22	84     20	71     10	66    07
Iodine	63     12	56     05	38     04	31    01
Zinc	58     05	60     05	39     04	33    03
Potassium	67     30	68     30	78     16	82    10

 

*Retinol equivalents 

 

Reference

UK Scientific Advisory Committee on Nutrition. The Nutritional Wellbeing of the
British Population. London: The Stationery Office, 2008.

 

 

In 2010, the results from the first year of the National Diet Nutrition Survey (NDNS) 2008/2009 were published. The NDNS rolling programme aims to provide quantitative data on the food and nutrient intakes, sources of nutrients and nutritional status. The programme is carried out in all four countries of the United Kingdom (UK) and is designed to be representative of the UK population. The results are based on a dietary assessment of 1,131 individuals aged between 1.5 and 64 years.

 

Results

• Men only consumed a total of 234g fruit and vegetables per day, and women consumed 253g per day. This is low in comparison to the UK Food Standards Agency’s recommendation of 400g per day. The proportion of participants meeting the “5-a-day” guideline was relatively small: only 7% of girls and 22% of boys aged 11 to 18 years, 33% of women and 37% of men adhered to the recommendation.
• In 10% of the population vitamin A intake was below UK Lower Reference Nutrient Intake (LRNI). LRNI is the level of intake considered likely to be sufficient to meet the needs of only 2.5% of the population.
• Consumption of oily fish, which is the main source of omega 3 fatty acids, remained below the recommended one portion per week.
• Iron intakes among teenage girls and women were significantly below LRNIs.

 

Reference

Bates B. et al. National Diet and Nutrition Survey – Headline results from Year 1 of the Rolling Programme (2008/2009). Food Standards Agency and Department of Health. 2010.

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 U.S.: NHANES

The National Health and Nutrition Examination Survey (NHANES) is a program of studies designed to assess the health and nutritional status of adults and children in the United States, and to track changes over time. Findings from the survey are used to determine the prevalence of major diseases and risk factors for diseases. Information is used to assess nutritional status and its association with health promotion and disease prevention.

 

The first NHANES was conducted in 1971. The survey conducted between 2001 and 2002 generated data based on 8,940 individuals. The data, published in 2005, include nutrient intakes from food only and do not cover intakes from dietary supplements or over-the-counter medicines (1).

 

Results

• 93% of Americans had inadequate dietary intakes of vitamin E.
• The number of individuals with inadequate intakes was also high for vitamin A (44%) and vitamin C (31%).
• The prevalence of inadequacy was also high for magnesium (56%).
• For some nutrients, intakes were inadequate only for certain segments of the population: vitamin B6 for females over 50 years of age, and zinc for males and females over 70 years of age and females 14–18 years of age.
• Vitamin K, calcium, and potassium may also be of concern.
• Most Americans had adequate intakes from food for carbohydrate, selenium, vitamin B3 (niacin), and vitamin B2 (riboflavin).

In 2009, the latest data on the status of vitamin C deficiency in the US population were published. Blood serum concentrations of total vitamin C were measured in 7,277 civilians during NHANES 2003–2004 (2).

 

Results

• About 21 million Americans have serious vitamin C deficiency, 66 million may develop vitamin C deficiency depending upon their health habits and disease status, and less than 30 million Americans achieve optimal vitamin C levels (100 micromole per liter).
• Smokers and low-income groups who typically exhibit low blood serum concentrations of vitamin C also have the highest rates of disease and mortality.
• The current Recommended Daily Allowance (RDA) for vitamin C is too low as it was established for healthy Americans and does not apply to 35% of the population, including smokers (50 million), estrogen or birth control pill users (13 million and 18 million), diabetics (16 million), pregnant women (4 million) and people taking aspirin (inestimable millions) or other drugs, and those with chronic infection (viral hepatitis, herpes, HIV), who have increased need for vitamin C.

In 2009, the NHANES, 2005–2006, provided an update on nutrient intake distributions from food and water for vitamin D, calcium, phosphorus, and magnesium (3).

 

Results

• For both vitamin D and calcium, only about one-third of individuals aged one year and over showed an adequate intake. Females aged 14–50 years were even less likely than their male counterparts to exceed their recommended intake.
• For vitamin D, most individuals aged over 50 years regardless of gender did not meet their adequate intake.
• Nearly one-half of all individuals aged one year and over had inadequate intakes of magnesium.

 

In 2010, an analysis of NHANES 2003-2006 showed nutrition disparities in U.S. sub-populations with differing household income (4, 5).

 

Results

• Inadequate nutrient intakes from foods are prevalent in children and adults, especially for vitamin E.
• Groups with lower household income have a higher prevalence of inadequate intake for vitamin A, vitamin C, vitamin B6, and vitamin B9 (folate).

 

References

 

1. http://www.ars.usda.gov/Services/docs.htm?docid=7674

 

2. Schleicher R. L. et al. Serum vitamin C and the prevalence of vitamin C deficiency in the United States: 2003–2004 National Health and Nutrition Examination Survey (NHANES). Am J Clin Nutr, August 2009.

 

3. http://www.ars.usda.gov/....vitD_ca_phos_mg_2005-06.pdf

 

4. Fulgoni V.L. et al. Nutrition disparities occur in U.S. sub-populations with differing household income: An analysis of NHANES 2003-2006. Presentation at the Experimental Biology Meeting in Anaheim, CA, USA. April 2010.

 

5. Krebs-Smith S. N. et al. Americans Do Not Meet Federal Dietary Recommendations. J. Nutr. 2010; 140:1832-1838.

 

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