VoedingsMagazine - nummer 4, december 2011, 24e jaargang
NutritionMagazine, No.4, 2011, Vol.24
New food consumption data.
The Dutch diet is too low in fruit, vegetables, fish and fibre
Over 3800 people participated in the period 2007—2010 in the large-scale Dutch food consumption survey. The participants' diet was found to be too low in some basic foods like vegetables, fruit, fish, bread and dairy products. Three quarters of the Dutch population use enriched foods, which provide B vitamins and vitamin C in particular.
In October 2010, data from the most recent Dutch National Food Consumption Survey (DNFCS) were published. In the period 2007—2010 an inventory was made of the dietary patterns of children and adults (people aged 7—69). The survey was commissioned by the ministry of Health, Welfare & Sports and coordinated by the Dutch National Institute for Public Health and the Environment (RIVM). Over 3800 people participated in the survey (response rate 69%). Striking outcomes were that the Dutch diet is still too low in fruit, vegetables, fish and fibre, that the levels of trans fatty acids in the diet have declined but that the share of saturated fatty acids is still too high. The DNFCS data revealed that for part of the population intakes of some vitamins (A, thiamine, C and E) and some minerals (magnesium, potassium and zinc) are lower than the respective recommended daily allowances (RDA). How do these outcomes relate to those found some decades ago? The previous large-scale food consumption surveys took place in 1987 and 1997/1998. Data reported for those surveys are not well comparable with the most recent figures because the survey design and methods have changed in the meantime. These changes were needed to respond to socio-demographic developments and trans in eating patterns and to enable exchange of data on a European level. The new design of the DNFCS was tested in 2003 in a pilot survey of young adults.
Eating outdoors or at home Do people enjoy a wedge of apple pie at home or rather on a pavement? Do they prefer to serve ice as a dessert themselves or have it served in a restaurant? Analysis of the use of all 17 product groups showed that 50% of the products are consumed at home. It can be expected that this share is higher for one food group than for another one. Legumes, potatoes and vegetables, for example, are predominantly eaten at home (80%) while cakes (43%), soup (39%), soft drinks and alcoholic beverages (35%) are used outdoors in particular. The researchers also measured the influence of the participants' sex on the size of the servings of the various product groups. The servings for men relative to women are usually larger, but women eat more of the product group of fruit, nuts and olives and drink more non-alcoholic beverages. Consumption levels of men and women are comparable for foods like vegetables, legumes, fish, crustaceans and shellfish, eggs and egg products, cakes, and soup and broth.
Large diversity in eating patterns The DNFCS revealed that the diversity in Dutch eating patterns is very large. The Dutch eat and drink all over the day. Dutch recommendations are to limit the number of eating or drinking moments to 7 a day, but most adults exceed that number. Most children do comply with the recommended maximum of 7 daily eating/drinking moments. Most basic foods are eaten during the main meal. Dieting is not unusual in the Netherlands: in particular older people follow an energy-restricted diet, a fat-restricted diet or a diet for diabetics. It appears from the DNFCS that few people eat sufficient vegetables and fruit. Not all people are used to add vegetables and fruit to their menu every day or to plan consumption of vegetables or fruit between meals. When food consumption is measured on two days it may happen to be days in which hardly vegetables and fruit are eaten if at all. Comparison with 2003 data shows that the recommendation ‘Eat more vegetables and fruit' remains a point of special attention for nutrition information. Not nearly everybody meets the recommendation ‘Eat fish twice a week', but many people (28—65% depending on the age group) eat fish once per week. Most participants reported not to meet the recommendations for bread, potatoes and dairy products, fats and oils (see the Guidelines of the Dutch Nutrition Centre). Men eat meat in excess of the recommendations. Potatoes are eaten on most days (cooked, mashed or fried), and pasta and rice are eaten twice weekly. Alcoholic beverages are used by men more than by women. The number of weekly ‘alcohol days' increases over the years. The Health Council's recommendation is ‘Have not more than one drink per day (women) or two drinks (men)'. That recommendation is met least of all (66%) by men and women over 55 years of age. The Health Council recommends children under 18 not to drink alcohol at all. However, one quarter of adolescents drink alcohol, especially on Fridays, Saturdays and Sundays. Three quarters of the population use enriched products, which provide B vitamins and vitamin C in particular. The Health Council states that people, except for women over 50, do not need to use vitamin and mineral supplements. However, such preparations in plenty; in particular young children and women (50%) use such supplements.
Prevalence of overweight and obesity increases over the years Dietary energy intake for men is highest in young adulthood (ca. 11 MJ per day) and declines to ca. 10 MJ per day for the oldest male survey participants. Women show a much more stable energy intake development over the years (ca. 8 MJ per day). Basic foods like cereals and cereal products (23%), dairy products (14%) and meat and meat products (11%) are the strongest contributors to energy provision, but other products such as sugar and sweets, cakes and soft drinks also make a substantial contribution (21% together). Three out of four children and adolescents have a normal body weight. That picture changes in an unfavourable direction when they grow older: only one out of three participants in the 50—69 age category has a normal body weight. The prevalence of overweight and obesity increases over the years: 15% of male adolescents are overweight or obese versus over 50% of male adults. The Dutch do not find difficulty, on average, at meeting the recommendations for protein. The median protein intake is ample with a range from 60 g per day for girls aged 7—8 to almost 100 g per day for some adult men. About 32—35% of energy comes from fats for the majority of the population. The share of saturated fat is still too high: for 85% of the interviewed saturated fat accounts for more than 10% of total energy intake. The intake of trans fatty acids declined over the past decades thanks to adjustments in the food industry. The share of carbohydrates in total energy intake varies from 53% in young children to 42% in participants aged 51—59. For most people dietary fibre intake does not meat by far recommendations of the Nutrition Council. In almost all age groups even the 95th percentile was lower than the guideline.
Stimulate healthy eating habits Intakes of the B vitamins riboflavin, B-6 and B-12 are sufficient for all, but vitamin D intake for older people and thiamine intake for female young adults are too low. On average, food supplements account for ca. 10% of daily vitamin intake. Enriched products predominantly provide extra B vitamins and vitamin C. The DNFCS researchers report that the evaluation of the levels of minerals in the diet of the Dutch population is troublesome because there is a lack of data on the health effects of a low mineral intake. For example, what is the effect of dietary calcium deficiency for adolescents? Or, what is the relevance of the outcome that the diet of women of child-bearing age is too low in iron? Calcium intake is low for the population at large. Higher consumption of vegetables and fruit is important for prevention of hypertension. Unfortunately, the latest DNFCS does not give clarity about sodium intake. The data of the new DNFCS should be used to stimulate healthier eating patterns, for example through adjustments in the foods offered but also through behavioural change. The government, the industry and information officials will attempt to start off change in order to prevent or suppress overweight, obesity and chronic diseases. To keep a finger on the pulse, the next DNFCS will be started off in 2012 and protracted over multiple years.
Daily allowances recommended by the Dutch Nutrition Centre All 50-year women are recommended to consume every day the following basic foods:
200 g fruit (2 pieces)
200 g vegetables (4 tablespoons)
201 g bread (6 slices)
30 g cheese (1.5 slices)
450 g milk and milk products
100—125 g meat or meat products, fish, chicken, egg or meat substitute
15 g frying fat or oil (1 soupspoon)
30 g low-fat margarine (5 g per slice of bread)
1500—2000 ml of drinks (including milk products)
Study design of the 2007—2010 DNFCS To measure food consumption in the 2007—2010 DNFCS, a two-day 24-h recall method was used. For children aged 7—15, the method was used with the help of parents in an interview in the children's homes while participants aged 16 and over were interviewed by telephone. A general questionnaire was used which was completed in writing and returned by mail or filled in via the website of the market research agency GfK. Body weight and height were self-reported. All participants were interviewed twice by trained interviewers with an interval of about four weeks. The survey population had a balance distribution in terms of age groups, social and demographic characteristics, region and degree of urbanization.
Dutch diet is too low in dairy products Data from the 2007—2010 DNFCS show that the diet of Dutch adults is too low or much too low in dairy products. Over the years consumption of dairy products even declines, which conflicts with the advice to use more milk and milk products. People in their thirties consume 297—344 g milk, or about two glasses of milk, a day (three glasses a day is the recommended use). People over 50 years of age consume 266—307 g milk and milk products, or less than two glasses, a day (the recommended use is three to four glasses per day). Dairy products are a major source of nutrients. The DNFCS researchers calculated the average contribution of dairy products to micronutrient intake. For the Dutch population at large aged 7—69, that contribution is 58% for calcium, 39% for riboflavin, 38% for vitamin B-12, 32% for phosphorus, 29% for vitamin A and 17% for potassium.
Seventeen food groups analysed The DNFCS researchers classified the food products and dishes eaten by the participants into 17 food groups: (1) potatoes (2) vegetables (including mushrooms, onions and garlic) (3) legumes (4) fruit, nuts and olives (5) dairy products (including curds, cheese, fresh cheese, coffee creamer and other creamers) (6) cereals and cereal products (including salted biscuits and pizzas) (7) meat and meat products (8) fish, shellfish and crustaceans (9) eggs and egg products (10) fats (11) sugar and sweets (including e.g. honey, jam, chocolate vermicelli and ice cream) (12) cakes (including pastry, biscuits and pies) (13) non-alcoholic beverages (14) alcoholic beverages (15) additions and sauces (e.g. mustard and Worcester sauce) (16) soups and broths (17) miscellany (e.g. soy products, diet products and snacks).