Official Statistics

NDNS: results from years 9 to 11 (combined) – statistical summary

Published 11 December 2020

Public Health England has published the latest results from years 9 to 11 of the UK National Diet and Nutrition Survey (NDNS) rolling programme for year 2016 to 2017 to year 2018 to 2019.

The NDNS rolling programme is a continuous cross-sectional survey, designed to assess the diet, nutrient intake and nutritional status of a representative sample of around 1,000 people per year (500 adults and 500 children) from the population aged 18 months upwards living in private households in the UK. The NDNS comprises an interview, a 4-day diet diary and collection and analysis of blood and urine samples. Results are used by government to monitor the diet and nutritional status of the population, to provide the evidence base for policy development and to track progress towards public health nutrition objectives such as reducing intakes of sugar, calories, saturated fat and salt and increasing intakes of fibre.

The report includes statistical comparisons to analyse differences between results from year 2016 to 2017 to year 2018 to 2019 (abbreviated to 2016 to 2019) and the last report covering year 2014 to 2015 to year 2015 to 2016 (abbreviated to 2014 to 2016) for foods nutrients and analytes of public health interest. An analysis of time trends over the 11 years of the rolling programme (2008 to 2019) is also included.

The NDNS is jointly funded by Public Health England and the UK Food Standards Agency. Work for years 9 to 11 of the rolling programme was carried out by a consortium led by NatCen Social Research working with the National Institute of Health Research Cambridge Biomedical Research Centre (NIHR BRC, Cambridge).

1. Main findings

The findings in this report confirm that the UK population overall continues to consume too much sugar and saturated fat and not enough fruit and vegetables and fibre. Consumption of sugar-sweetened soft drinks has fallen in most age groups. There is evidence of low blood levels for folate and vitamin D in most age groups, and for folate there has been a fall in blood levels over time. Low iron intakes, and to a lesser extent low haemoglobin and iron stores, were seen in girls aged 11 to 18 years and women aged 19 to 64 years. The analyses presented in this report do not identify any new nutritional problems in the general population.

2. Food consumption

2.1 Sugar-sweetened soft drinks

Mean consumption was lower in 2016 to 2019 than in 2014 to 2016 for children aged 1 and a half to 3 years, 4 to 10 years, girls aged 11 to 18 years and adults aged 19 to 64 years. Over 11 years from 2008, the proportion of children consuming sugar-sweetened soft drinks fell by 32, 44 and 25 percentage points respectively for the 1 and a half to 3 years, 4 to 10 years and 11 to 18 year age groups and by 20 and 12 percentage points for adults aged 19 to 64 years and 65 years and over respectively.

2.2 Sugar confectionery

The proportion of participants with sugar confectionery consumption above the median was unchanged between 2014 to 2016 and 2016 to 2019 in all age groups. Over 11 years since 2008 there was an 8-percentage point reduction in the proportion of 11 to 18 year olds consuming sugar confectionery and a 10 percentage point increase for the 65 to 74 year age group. There were no changes in other age groups.

2.3 Chocolate confectionery

The proportion of participants with chocolate confectionery consumption above the median was unchanged between 2014 to 2016 and 2016 to 2019 in all age groups except men aged 75 years and over for whom there was a 28 percentage point reduction in the proportion above the median. Over 11 years since 2008 to 2009 there was a 10 percentage point reduction in the proportion of children aged 11 to 18 years who consumed chocolate confectionery over the 4-day diet diary and 17 percentage point increases for women aged 65 to 74 and men aged 75 and over.

2.4 Fruit and vegetables

Adults aged 19 to 64 years consumed on average 4.3 portions per day, older adults aged 65 to 74 years 4.5 portions, older adults aged 75 years and over 3.9 portions, and children aged 11 to 18 years 2.9 portions per day. Thirty-three per cent of adults, 40% of older adults aged 65 to 74 years, 27% of older adults aged 75 years and over and 12% of 11 to 18 year olds met the 5 A Day recommendation.

Mean fruit and vegetable consumption in 2016 to 2019 was unchanged compared with 2014 to 2016 in all age groups except for the 11 to 18 year age group for whom there was a 0.2 portions per day increase. The proportion of this age group meeting 5 A Day also increased from 8% to 12%. Adults aged 65 years and over also had an 8 percentage point increase in the percentage meeting 5 A Day between 2014 to 2016 and 2016 to 2019. Over the 11 years since 2008 there was a 7 percentage point increase in the proportion of women aged 19 to 64 years meeting 5 A Day but no change for other age groups.

2.5 Red and processed meat

Median consumption of red and processed meat was lower in 2016 to 2019 than in 2014 to 2016 for men aged 19 to 64 years and adults aged 65 years and over. Mean consumption in all age or sex groups met the recommendation of no more than 70g per day. Over the 11 years since 2008 there were reductions in mean consumption in all age groups (13, 23 and 19 g per day for the 11 to 18, 19 to 64 and 65 and over age groups respectively).

2.6 Oily fish

Mean consumption of oily fish was equivalent to 56g per week in adults aged 19 to 64 years and 86g per week in adults aged 65 years and over, well below the recommended one portion (140g) per week in all age groups. Mean consumption in children was less than 20g per week.

3. Macronutrients

3.1 Free sugars

Mean intakes of free sugars for children from age 4 years were more than double the recommended maximum of no more than 5% of total energy: 12.1% of total energy in children aged 4 to 10 years and 12.3% in children aged 11 to 18 years. For adults, older adults and children under 4 years, mean intakes were almost double the maximum recommendation: 9.9% of total energy in adults, 9.4% in older adults and 9.7% in children aged 1 and a half to 3 years.

Mean intakes of free sugars for children in all age groups, adults 19 to 64 years and men aged 65 to 74 years were significantly lower in 2016 to 2019 than in 2014 to 2016 and intake dropped by 3.8, 3.9 and 4.9 percentage points over the 11 years since 2008 for children aged 1.5 to 3 years, 4 to 10 years and 11 to 18 years respectively and by smaller amounts for adults. The fall in free sugars intake in children is at least partly attributable to a reduction in consumption of sugar-sweetened soft drinks in all age groups.

3.2 Total fat

Mean total fat intakes exceeded the recommendation of no more than 33% total energy in all age or sex groups. Mean intakes were 34.2% and 34.1% of total energy from fat in children aged 4 to 10 and 11 to 18 years respectively and 34.1%, 34.3% and 34.6% of total energy in adults aged 19 to 64 years, 65 to 74 years and 75 years and over respectively.

3.3 Saturated fat

Mean saturated fat intakes exceeded the recommendation of no more than 10% total energy in all age groups. Mean intakes were 13.1 and 12.6% of total energy from saturated fat in children aged 4 to 10 and 11 to 18 years respectively and 12.3, 12.8 and 14.1% of total energy in adults aged 19 to 64 years, 65 to 74 years and 75 years and over respectively. For men aged 19 to 64 years saturated fat intake was 0.5 percentage points higher in 2016 to 2019 than in 2014 to 2016 and the proportion meeting the recommendation fell by 7 percentage points from 33% to 26%. Over 11 years since 2008 there was no change in saturated fat intakes in any age or sex group.

3.4 Trans fat

Mean intakes of trans fat provided 0.5 to 0.6% of total energy for adults and older adults and 0.5% total energy for children, thus meeting the recommendation of no more than 2% total energy. Intakes at the 97.5th percentile ranged from 0.8 to 1.1% of total energy.

3.5 Cis monounsaturated fatty acids (cis MUFA)

Mean intakes were 12.0 to 13.0% of total energy for children and 11.6 to 12.7% of total energy for adults. There is no specific recommendation for cis MUFA in the UK. Mean cis MUFA intakes as a percentage of total energy were higher in children aged 4 to 10 years and adults aged 65 to 74 years in 2016 to 2019 than in 2014 to 2016. Over 11 years since 2008 there were small increases in most age groups.

3.6 Cis n-3 polyunsaturated fatty acids (cis n-3 PUFA)

Mean intakes were 1.0 to 1.2% of total energy for adults and 0.8 to 0.9% of total energy for children. There is no recommendation for total cis n-3 PUFA in the UK. Mean cis n-3 PUFA intakes were 0.1 to 0.2 percentage points higher in 2016 to 2019 than in 2014 to 2016 in most adult and some child age groups. Over 11 years since 2008 there were small increases in most age groups.

3.7 Cis n-6 polyunsaturated fatty acids (cis n-6 PUFA)

Mean intakes were 4.2 to 5.0% of total energy for adults and children. Mean cis n-6 PUFA intakes were 0.3 percentage points higher in 2016 to 2019 than in 2014 to 2016 for the 4 to 10 year age group and 0.4 percentage points higher in the 65 to 74 year age group. There were no changes in other age groups. Over 11 years since 2008 there was little change in intakes.

3.8 Fibre

Mean intakes of fibre were below recommendations in all age groups. In adults mean intakes were 19.7, 19.7 and 17.3g per day in the 19 to 64, 65 to 74 and 75 years and over age groups respectively, below the recommendation of 30g. Nine per cent of the 19 to 64 and 65 to 74 year age groups and 3% of the 75 years and over age group met the recommendation. In children mean intakes were 10.4g, 14.3g, and 16g per day in children aged 1.5 to 3 years, 4 to 10 years and 11 to 18 years respectively, also below the age adjusted recommendations for each age group. Twelve percent, 14% and 4% respectively met the recommendations.

For boys aged 4 to 10 years there was an increase of 7 percentage points in the proportion meeting the fibre recommendation between 2014 to 2016 and 2016 to 2019, and in girls 11 to 18 years mean fibre intake was 1.3g per day higher in 2016 to 2019 than in 2014 to 2016, but there were no changes in other age or sex groups. Changes over the 11 years since 2008 were small and inconsistent in direction between age groups.

4. Micronutrients and blood or urine analytes

4.1 Vitamin A

Mean vitamin A intakes met the Reference Nutrient Intake (RNI) in all age or sex groups except for children aged 11 to 18 years (90% of RNI). Nine per cent of children aged 1 and a half to 3 years, 11% of the 4 to 10 year age group, 18% of the 11 to 18 year age group, 10% of adults 19 to 64 years and 8% of older adults (65 years and over) had intakes below the Lower Reference Nutrient Intake (LRNI). Over the 11 years since 2008 there was a fall in vitamin A intakes in all age groups equivalent to a 23%, 23% and 21% reduction for children aged 1 and a half to 3 years, 4 to 10 years and 11 to 18 years respectively and a 13% reduction in adults 19 to 64 years and 29% reduction in adults aged 65 years and over. There were corresponding increases in the percentage below the LRNI in most age groups.

4.2 Vitamin D

There was evidence of low vitamin D status (as indicated by low plasma 25-hydroxy vitamin D (25-OHD) concentrations in blood) in all age groups. Sixteen per cent of adults aged 19 to 64 years, 13% of adults aged 65 years and over, 19% of children aged 11 to 18 years and 2% of children 4 to 10 years had low vitamin D status (taking account of seasonal variation). For children aged 4 to 10 years mean 25-OH D concentration was higher in 2016 to 2019 than in 2014 to 2016 and the percentage with low status had fallen from 10% to 2%. There were no changes in other age groups. Over the 11 years since 2008 there were increases in 25-OHD concentrations in children aged 4 to 10 years and older adults but not in other age groups.

Mean vitamin D intakes from food sources were below the RNI of 10µg per day in all age groups, at around a fifth to a quarter of the RNI in children and a quarter to a third in adults. When intakes of vitamin D from supplements were taken into account mean intakes increased to around 29-40% of the RNI for children and 54% for adults 19 to 64 years, 91% for 65 to 74 years and 60% for adults aged 75 years and over. Mean vitamin D intake from food and supplements for women aged 65 to 74 years met the RNI (101%). Seventeen per cent of adults aged 19 to 64 years, 34% aged 65 to 74 years and 28% aged 75 years and over reported taking vitamin D supplements during the 4-day dietary recording period.

4.3 Folate

There was evidence of low red blood cell folate (RBC) concentrations indicating risk of anaemia in 18% of girls aged 11 to 18 years, 16% of boys aged 11 to 18 years 13% of adults 19 to 64 years and 11% of adults aged 65 years and over. Mean RBC folate concentration was 16% lower for women aged 65 years and over in 2016 to 2019 compared with 2014 to 2016. There were no changes in other age groups. In the 11 years since 2008 there was a 25 to 28% decline in RBC folate concentration in all age groups and a corresponding increase in the percentage below the threshold for anaemia.

Eighty-nine per cent of women of childbearing age (defined as 16 to 49 years) had a RBC folate concentration below the threshold indicating elevated risk of neural tube defects (NTD) in the developing foetus. In the 11 years since 2008 there has been a 31% reduction in RBC folate concentrations in women of childbearing age, a 16 percentage point increase in the proportion below the threshold for anaemia and a 20% increase in the proportion below the threshold for increased NTD risk.

Serum folate concentrations show a similar picture to RBC folate. Nine per cent of children aged 11 to 18 years and 11% and 7% of adults aged 19 to 64 years and 65 years and over had serum folate levels indicating deficiency, and 53%, 52% and 34% respectively had blood concentrations indicating possible deficiency. Time trend data over 11 years showed a reduction in serum folate concentrations over time in adults and children from 4 years.

4.4 Iron

Mean iron intakes for girls aged 11 to 18 years and women aged 19 to 64 years were below the RNI (56% and 76% of the RNI respectively). Forty-nine per cent of girls aged 11 to 18 years and 25% of women aged 19 to 64 years had low iron intakes (below the LRNI). There was evidence of both iron-deficiency anaemia (as indicated by low haemoglobin levels) and low iron stores (plasma ferritin) in 9% of older girls, 5% of adult women and 2% of older women. Over the 11 years since 2008 there was a 0.7 to 1.1mg reduction in iron intake for children and older adults.

4.5 Iodine

Analysis of urinary iodine concentrations showed that all age or sex groups except for women aged 16-49 years (childbearing age) met the World Health Organization (WHO) criteria for adequate iodine status, that is median urinary iodine concentrations between 100 and 199µg/l and fewer than 20% of the population below 50µg/l. For women aged 16 to 49 years median urinary iodine concentration was 98µg/l and 21% were below 50µg/l.

4.6 Calcium

Mean calcium intakes were above the RNI for all age or sex groups except for children aged 11 to 18 years (84% and 82% of the RNI for boys and girls respectively in this age group). Fifteen per cent of children aged 11 to 18 years and 9%, 9% and 4% of women aged 19 to 64, 65 to 74 and 75 years and over respectively had calcium intakes below the LRNI.

5. Background notes

1. The NDNS rolling programme is commissioned as a continuous survey but is retendered at regular intervals. The contract under which this report was produced runs from 2018 to 2023 (fieldwork years 11 to 14) and is held by NatCen Social Research working with the National Institute of Health Research Cambridge Biomedical Research Centre (NIHR BRC, Cambridge).
2. The report presents new estimates for food consumption, nutrient intakes and nutritional status based on data collected over 3 years from April 2016 to March 2019. For selected variables of particular public health importance, the new estimates are compared with previous estimates based on data collected from April 2014 to March 2016 and the long term trend since 2008 is assessed by regression analysis.
3. All differences highlighted in this summary are statistically significant at the 95% level unless otherwise stated.
4. ‘Percentage consumers’ refers to the percentage who consumed during the 4-day dietary recording period and not the percentage who ever consumed.
5. The Government recommends an intake of at least 5 portions of fruit and vegetables per person per day. The Health Survey for England (HSE) is used to monitor ‘5 A Day’ in England. HSE estimates of fruit and vegetable consumption are based on a recall of consumption over the previous 24 hours and are therefore different from NDNS estimates, which are based on a 4-day diary. NDNS estimates are higher than HSE, at least in part, because NDNS captures the contribution from composite dishes containing fruit and vegetables.
6. Government recommendations for energy and nutrient intakes for males and females aged 1 to 18 years and 19+ years are summarised in Government Dietary Recommendations. These are based on recommendations from the Scientific Advisory Committee on Nutrition (SACN) and its predecessor the Committee on Medical Aspects of Food and Nutrition Policy (COMA).
7. Recommendations for macronutrient intakes were originally set by COMA in its 1991 report on Dietary Reference Values, both as a percentage of total dietary energy (which includes any intake from alcohol) and corresponding figures as a percentage of food energy (which excludes any energy from alcohol). The DRVs for total fat were set at 33% of total energy (35% food energy) and for saturated fat 10% total energy (11% food energy). The 1994 COMA report on cardiovascular disease confirmed the recommendations on the basis of percentage of total energy and noted that the precision of the recommendations did not warrant a distinction between total and food energy. In 2015 and 2019 respectively SACN set recommendations for carbohydrates and confirmed the recommendation for saturated fat as a percentage of total dietary energy. Until recently the convention in NDNS had been to report intakes in relation to the percentage of food energy recommendation but this has now changed to percentage of total energy. It should be noted that for children in age groups where alcohol consumption is zero or almost zero, macronutrient intakes expressed as a percentage of food energy and total energy are the same. This means that using recommendations expressed as percentage of total energy results in intakes being more likely to exceed the recommendation.
8. Saturated fat is the kind of fat found in animal foods such as butter and lard, fatty cuts of meat, sausages and bacon, cheese and cream and foods containing them such as pies, cakes and biscuits. Consuming high levels of saturated fat can lead to raised blood cholesterol levels, which are associated with greater risk of developing heart disease.
9. Trans fats are formed when liquid vegetable oils are turned into solid or semi-solid fats through a process of hydrogenation. The main sources of trans fats in the diet are from partially hydrogenated vegetable oils (PHVOs), dairy and meat from ruminant animals. Hydrogenated vegetable oils can be used as ingredients in products such as biscuits, cakes and desserts and are also used as cooking and ingredient oils. Naturally occurring trans fats are found in dairy produce and the flesh of ruminant animals, for example beef and lamb. Trans fats raise the levels of the type of cholesterol in the blood, which may increase the risk of heart disease.
10. In 2015, SACN recommended that a new definition of free sugars should be adopted in the UK and the population average intake of free sugars should not exceed 5% of total energy for adults and children aged 2 years and over. The definition of free sugars includes: all added sugars in any form including honey and syrups; all sugars naturally present in fruit and vegetable juices, spreads, purees and pastes, and similar products in which the structure has been broken down; all naturally occurring sugars in drinks (except for dairy-based drinks) and lactose and galactose added as ingredients. The sugars naturally present in milk and dairy products, fresh and most types of processed fruit and vegetables and in cereal grains, nuts and seeds are excluded from the definition.
11. This report does not include results for salt intake based on 24-hour urinary sodium. The latest results for salt intake for adults aged 19 to 64 years in England were published in March 2020.
12. Sodium intake estimates are based on the sodium content of foods consumed. They do not fully take account of salt added during cooking and exclude salt added at the table by participants.
13. The RNI for a vitamin or mineral is the amount of the nutrient that is sufficient for 97.5% of people in the group. If the average intake of the group is at the RNI, then the risk of deficiency in the group is judged to be very small. However, if the average intake is lower than the RNI then it is more likely that some of the group will have an intake below their requirement.
14. The adequacy of vitamin or mineral intake can be expressed as the proportion of individuals with intakes below the LRNI. The LRNI for a vitamin or mineral is set at the level of intake considered likely to be sufficient to meet the needs of only 2.5% of the population. An intake below the LRNI is only considered a problem if sustained over a period of time.
15. Nutritional status means the level of nutrients available to the body (after absorption) for use in metabolic processes. For some micronutrients, status can be assessed by directly measuring the level of the nutrient in blood, while for others it is assessed by a functional measure such as the activity of vitamin-dependent enzymes.
16. Severe vitamin D deficiency causes rickets in children and osteomalacia in adults - this is a condition characterised by pain, muscle weakness and bone fractures. Both conditions are rare in the UK although there is evidence of significant incidence in South Asian and Afro-Caribbean groups. In 2016, SACN published an evidence review of vitamin D and health and set a RNI of 10μg per day for adults and children of all ages. Government advice recommends that in the summer months the majority of adults and children aged 5 years and older will probably obtain sufficient vitamin D from sunshine when they are outdoors, and by following a healthy, balanced diet. However, because it is difficult to get enough vitamin D from food alone, everyone over the age of 5 years should consider taking a daily supplement containing 10μg vitamin D during the autumn and winter months. People who have no or very little sunshine exposure such as those living in an institution (for example, a care home) or who are not often outdoors or who cover their skin when outdoors, should take a daily supplement containing 10μg vitamin D throughout the year. People from minority ethnic groups with dark skin, such as those of African, African Caribbean or South Asian origin, might not get enough vitamin D from sunlight, so should consider taking a vitamin D supplement throughout the year. Children aged 1 to 4 years should be given a daily supplement containing 10μg vitamin D throughout the year. Infants from birth up to 1 year of age should also be given a daily supplement containing 8.5-10μg vitamin D unless they are receiving at least 500ml of infant formula per day.
17. Folate status is assessed against the clinical thresholds for risk of anaemia, based on RBC folate (305nmol/L) and serum folate (7nmol/L - deficiency’ 13nmol/L – possible deficiency). For women of childbearing age, folate status is also assessed against the RBC folate concentration below which indicates elevated risk of neural tube defects (748nmol/L). RBC folate is usually a better indicator of long-term status than plasma or serum folate because it reflects longer term body stores whereas serum folate concentrations respond rapidly to changes in dietary intake.
18. Folate in the diet comes from naturally occurring folates in foods and folic acid from fortified foods such as some breakfast cereals and from dietary supplements. Low folate status of women of childbearing age (16 to 49 years) is a particular public health concern. Increased folic acid intake through supplementation has been shown to reduce the risk of NTDs such as spina bifida if taken in the periconceptional period. It is recommended that women who are pregnant or who could become pregnant take a 400μg folic acid supplement daily until the 12th week of pregnancy. This is to help prevent birth defects of the central nervous system, such as spina bifida, in the baby.