Food and Nutrition Monitoring Report 2006

Food and Nutrition Monitoring Report 2006

Food and Nutrition Monitoring Report 2006

Public Health Intelligence
Monitoring Report 9

This report was written by Maria Turley, Senior Advisor (Epidemiology/Nutrition), Public Health Intelligence, Ministry of Health.

Citation: Ministry of Health. 2006. Food and Nutrition Monitoring Report 2006. Wellington: Ministry of Health.

Published in October 2006 by the
Ministry of Health
PO Box 5013, Wellington, New Zealand

ISBN 0-478-30042-5 (Book)
ISBN 0-478-30046-8 (Internet)
HP 4292

This document is available on the Ministry of Health’s website:

Foreword

Poor diet is the leading cause of death in New Zealand, and contributed to an estimated 8500 deaths in 1997. The monitoring of all aspects of food and nutrition, from food supply to health status, is a critical component in the prevention and control of nutrition-related illness and premature death.

Public Health Intelligence (PHI), the epidemiology group of the Ministry of Health, carries out the Ministry’s statutory responsibility to monitor and report on the state of New Zealanders' health. PHI first produced a report on food and nutrition monitoring in 2003. The report provided a detailed overview of food and nutrition monitoring information domains, data sources and information gaps, but no data. This 2006 report updates and extends the earlier report by summarising the most up-to-date and readily available monitoring data and outlining new monitoring activities, and will itself be updated on a regular basis.

Although this report provides a comprehensive overview of data for key food and nutrition indicators, it was not intended to be exhaustive. This report has a national focus and information on socio-demographic and regional inequalities are not included. However, where possible, inequalities in food and nutrition indicators will be the focus of future reports in this series.

The strength of this PHI monitoring report is twofold. Firstly, by synthesising information from multiple sources, it provides a readily accessible one-stop shop for professionals and agencies working across the spectrum of nutrition and health policy and service provision. Secondly, it identifies areas where our monitoring system can be further enhanced and expanded, and so should contribute to progressive improvement in the quality, timeliness and coverage of food and nutrition information – and so to evidence-based policy making and service delivery.

Relevant, reliable and timely food and nutrition monitoring data are essential for the development and monitoring of food and nutrition-related policies, such as Healthy Eating – Healthy Action,the Ministry of Health’s action planto achieve the New Zealand Health Strategyobjectives of improving nutrition, increasing physical activity and reducing obesity. However, monitoring data alone are insufficient to evaluate specific interventions under this plan and therefore there is also a need for research and evaluation.

Comments about the report and suggestions for future reports in this series are welcome and should be sent to Public Health Intelligence, Public Health Directorate, Ministry of Health, PO Box 5013, Wellington.

Dr Barry Borman

Manager (Epidemiologist)

Public Health Intelligence

Ministry of Health

Acknowledgements

The author is grateful to the following people for peer reviewing this report and providing valuable feedback: Dr Martin Tobias and Dr Niki Stefanogiannis (Public Health Intelligence), Mary-Louise Hannah and Elizabeth Aitken (Non-communicable Disease Policy, Ministry of Health), Dr Nick Wilson (Wellington School of Medicine, University of Otago), and Dr Cliona Ni Mhurchu (Clinical Trials Research Unit, Auckland University). Many thanks also to Belinda Allan (Consumers’ Institute) for providing nutrient data for breakfast cereals.

Contents

Foreword

Acknowledgements

Executive Summary

Introduction

Purpose and scope

Food and Nutrition Monitoring Overview

Information domains

Data sources

Food and Nutrition Policies and Guidelines

Policies and strategies

Guidelines

Reference values

Food Supply and Purchasing

Food balance sheets

Food outlets

Supermarket sales

Household food expenditure

Meals prepared away from home

Food Composition

New Zealand Food Composition Database

Dietary Supplements Database

Manufactured Food Database

Other sources of food composition data

Food Intake

Vegetables and fruit

Meat and poultry

Milk and milk products

Biscuits and snack foods

Beverages

Breastfeeding

Dietary supplements

Nutrient Intake

Energy and macronutrients

Micronutrients

Sodium

Nutritional Status

Body size

Overweight and obesity

Underweight

Blood pressure

Blood lipids

Iron status

Zinc status

Selenium status

Iodine status

Vitamin D status

Folate status

Health Status

Prevalence rates

Mortality rates

Mortality associated with nutrition risk factors

Non-fatal disease burden associated with obesity

Factors Influencing Dietary Intake

Social and cultural factors

Food security

Food pricing

Food marketing

Settings

Conclusions and Future Activities

References

Appendix: Nutrition Surveys

List of Tables

Table 1:Users and uses of food and nutrition monitoring data

Table 2:Summary of food and nutrition monitoring domains and data sources

Table 3:Per capita supply of energy, 1961–63 versus 2000–02

Table 4:Number of food outlets, 2000 to 2005

Table 5:Food outlet revenue ($000), 2000 to 2005

Table 6:Household expenditure on key food groups, 2003/04

Table 7:Household expenditure on selected foods, 2000/01 and 2003/04

Table 8:Mean (range) nutrient composition of breakfast cereals per 100g, 2006

Table 9:Average nutrient composition of breakfast cereals available in both 2003 and 2006

Table 10:Average nutrient composition of deleted (2003) and new (2006) breakfast cereals

Table 11:Proportion (percent) of adults (2002/03) and children (2002) meeting the guidelines for vegetable and fruit intake

Table 12:Proportion (percent) of infants exclusively or fully breastfed, 2000 to 2004

Table 13:Median energy and macronutrient intakes for adults (1997) and children (2002)

Table 14:Median micronutrient intakes for adults (1997) and children (2002)

Table 15:Mean 24-hour urinary sodium excretion and estimated salt intake in adults

Table 16:Mean body size measurements in adults (2002/03) and children (2002)

Table 17:Prevalence (percent) of overweight and obesity in adults (2002/03) and children (2002)

Table 18:Prevalence (percent) of diagnosed high blood pressure in adults, 2002/03

Table 19:Mean serum total and HDL cholesterol in adults (1997) and children (2002)

Table 20:Prevalence (percent) of diagnosed high blood cholesterol in adults, 2002/03

Table 21:Iron deficiency (percent) in adults (1997) and children (2002)

Table 22:Mean serum zinc concentration and prevalence of low zinc status in children, 2002

Table 23:Median urinary iodine concentration and prevalence of low iodine status in children, 2002

Table 24:Mean 25-hydroxyvitamin D concentration and prevalence of vitamin D deficiency and insufficiency in adults (1997) and children (2002)

Table 25:Prevalence (percent) of nutrition-related chronic diseases in adults, 2002/03

Table 26:Age-standardised mortality rate (per 100,000) for selected nutrition-related chronic diseases, 2001–02

Table 27:Prevalence (percent) of household food security over the last year in adults (1997) and children (2002)

Table 28:Estimated weekly family food costs ($), by life-cycle stage, 2000 and 2003

Table 29:Advertising expenditure ($000) by selected fast-food chains, 2000 to 2005

Table 30:Advertising expenditure ($000) for selected food and beverage categories, 2000 to 2005

Table 31:Summary of national nutrition surveys in New Zealand

List of Figures

Figure 1:Food and nutrition monitoring domains

Figure 2:Per capita supply of vegetables and fruit (g/day), 1961–63 to 2000–2002

Figure 3:Per capita supply of meat, poultry and fish (g/day), 1961–63 to 2000–2002

Figure 4:Per capita supply of butter and cream (g/day), 1961–63 to 2000–2002

Figure 5:Per capita supply of sugar and sweeteners (g/day), 1961–63 to 2000–2002

Figure 6:Per capita supply of alcoholic beverages (g/day), 1961–63 to 2000–2002

Figure 7:Per capita supply of energy (kJ/day), 1961–63 to 2000–2002

Figure 8:Per capita supply of macronutrients (percent energy), 1961–63 to 2000–2002

Figure 9:Per capita supply of fat (g/day), 1961–63 to 2000–2002

Figure 10:Per capita supply of fat (percent total fat), 1961–63 and 2000–02

Figure 11:Average weekly household expenditure on food, by household income, 2003/04

Figure 12:Number and type of breakfast cereals available in Wellington supermarkets, 2003 and 2006

Figure 13:Prevalence of overweight and obesity in adults, 1977 to 2003

Figure 14:Mortality attributable to nutrition risk factors, 1997

Figure 15:Potentially avoidable mortality, 2011

Figure 16:Disease risk associated with BMI  35 versus BMI 18.5–24.9, 2002/03

Figure 17:Home environment, 1975 to 2005

Figure 18:Average daily minutes spent viewing live television, 1996 to 2005

Executive Summary

Food and nutrition monitoring involves the routine and ongoing collection, analysis and reporting of data on all aspects of food and nutrition, from food supply and purchasing patterns to nutritional and health status. Relevant, reliable and timely food and nutrition monitoring data provide a basis for informed decision-making and are essential for the development and monitoring of effective food and nutrition-related policies, programmes and services. The ultimate goal of food and nutrition monitoring is to inform policies for the prevention and control of nutrition-related illness and premature death.

This report is a synthesis of the most up-to-date and readily available food and nutrition monitoring data for New Zealand. This report has a national focus and information on socio-demographic and regional inequalities are not included. However, where possible, inequalities in food and nutrition indicators will be the focus of future reports in this series. Where data have been collected consistently over time and are available in a standardised format, trends have been included.

Food supply and purchasing

Monitoring trends in the food supply is important because food supply influences food consumption patterns, which influence nutrient intake and nutritional status.

Food balance sheet data are available for New Zealand from 1961 to 2003. These data provide an estimate of per capita food and nutrient supply. Following are some of the key changes in per capita food and nutrient supply from 1961–63 to 2000–02.

  • The vegetable supply (excluding starchy root vegetables such as potatoes) increased from 250 to 380 g/day.
  • The fruit supply increased from about 200 to 300 g/day.
  • The red meat supply decreased from about 300 to 200 g/day, with most of the decrease being due to declines in beef and sheep meat.
  • The poultry meat supply increased from less than 10 to 80 g/day, and the fish supply increased from 50 to 70 g/day.
  • The butter supply decreased by half, from approximately 50 to 25 g/day.
  • The supply of sugar and sweeteners increased slightly, from about 140 to 160 g/day.
  • The supply of energy increased by 9 percent from 12,300 to 13,400 kJ/day.
  • The proportion of energy from fat peaked at 36 percent in the early 1980s and then declined to 32percent.
  • The proportion of energy from protein declined slightly from 13 to 12 percent.
  • Sources of fat changed considerably, with declines in animal fats (including butter and milk products) offset by increases in vegetable oils.

Data on the number (density) and sales revenue for retail food outlets were derived from the Retail Trade Survey. Following are some of the key trends from 2000 to 2005.

  • The total number of retail food outlets selling food as their predominant activity increased by 18 percent.
  • The total sales revenue for retail food outlets increased by 38 percent.
  • The takeaway food outlet sales revenue increased by 67 percent.

Data on household food expenditure were derived from the Household Economic Survey. Following are some of the key results from the 2000/01 and 2003/04 surveys.

  • The average weekly household expenditure on food was $142.50 in 2003/04 (average household 2.7 people), which is 16 percent of total household expenditure.
  • The greatest increase in household food expenditure from 2000/01 to 2003/04 was on meals away from home ($13.80 to $19.20, or 10.9 to 13.5 percent of food expenditure).
  • In 2003/04, average weekly household food expenditure on confectionery ($6.50) was greater than expenditure on fresh fruit ($5.90).

Food composition

Up-to-date information on the nutrient composition of foods and dietary supplements is essential for several purposes, including calculating reliable estimates of nutrient intake from food consumption data. Key sources of food composition data in New Zealand are outlined below.

  • New Zealand Food Composition Database – includes nutrient data for 50 core nutrients for approximately 2700 commonly consumed foods (mostly generic foods rather than branded foods).
  • Manufactured Food Database – includes information on food additives (including fortificants) and some nutrients for up to 6000 branded foods.
  • Dietary Supplements Database – contains data for 700 dietary supplements and will be updated for the 2007/08 New Zealand Adult Nutrition Survey.
  • Consumers’ Institute – collate nutrition label data for selected foods.

Following are some of the findings from a preliminary assessment of Consumers’ Institute nutrient data for breakfast cereals purchased in 2003 and 2006.

  • The total number of breakfast cereals available increased by 10 percent from 2003 to 2006, but the turnover of products was nearly 50 percent in this three-year period.
  • Among breakfast cereals available in both 2003 and 2006, there was no real change in the average nutrient composition in this three-year period.
  • Compared to 2003 breakfast cereals no longer on the market, new breakfast cereals in 2006 had on average 10 percent more fibre, 20 percent more saturated fat, 29percent more sugar and 23 percent less sodium.

Food intake

Data on usual food intake were derived from the 1997 National Nutrition Survey, 2002 National Children’s Nutrition Survey and 2002/03 New Zealand Health Survey. Data on breastfeeding were obtained from Plunket. Following are some of the key findings.

  • In 2002/03, 69 percent of adults and 57 percent of children consumed the recommended three or more servings of vegetables per day.
  • In 2002/03, 55 percent of adults and 43 percent of children consumed the recommended two or more servings of fruit per day.
  • Full fat milk is the most common milk used by adults (60 percent in 1997) and children (74 percent in 2002).
  • In 2004, the proportion of infants exclusively or fully breastfed at six weeks, three months and six months was 67 percent, 56 percent and 25 percent, respectively.

Nutrient intake

Data on nutrient intake were derived from the 1997 National Nutrition Survey and 2002 National Children’s Nutrition Survey. Following are some of the key findings.

  • Total fat provided 35 percent of energy in adults in 1997 and 33 percent of energy in children in 2002.
  • In both adults and children, saturated fat was the predominant fat (14–15 percent of total energy), followed by monounsaturated fat (11 percent) and polyunsaturated fat (4 percent).
  • Carbohydrates provided a greater proportion of energy in children (54 percent) than in adults (46 percent), partly because alcohol also contributed to energy intake in some adults.
  • Micronutrient intakes were generally adequate for adults (1997) and children (2002), although intakes of folate and iron were estimated to be inadequate for some females aged 11–44 years, and calcium intakes were estimated to be inadequate for some males aged 11–24 years and some females aged 7 years and over.

Nutritional status

Data on nutritional status were derived from the 1997 National Nutrition Survey, 2002 National Children’s Nutrition Survey and 2002/03 New Zealand Health Survey. Following are some of the key findings.

  • In 2002/03, 35 percent of adults aged 15 years and over were overweight and a further 21 percent were obese.
  • In 2002, 21 percent of children aged 5–14 years were overweight and a further 10percent were obese.
  • The prevalence of obesity in adults doubled from 1977 to 2002/03, from 9 to 20 percent in males and from 11 to 22 percent in females.
  • In 2002/03, the prevalence of self-reported diagnosed high blood pressure among adults was 21 percent.
  • Mean total cholesterol concentrations were 5.7 mmol/L in adults in 1997 and 4.4mmol/L in children in 2002.
  • The prevalence of iron deficiency and iron deficiency anaemia was low (<2percent) in both adults in 1997 and children in 2002.
  • In 2002, 16 percent of children had low serum zinc concentrations.
  • Twenty-eight percent of children had low urinary iodine concentrations in 2002, which indicates mild iodine deficiency.
  • The prevalence of vitamin D deficiency was 3 percent in adults (1997) and 4 percent in children (2002), and the prevalence of vitamin D insufficiency was 28 percent in adults and 31 percent in children.

Health status

Data on nutrition-related health status were derived from New Zealand Health Information Service data collections and secondary analyses of the 1997 National Nutrition Survey and 2002/03 New Zealand Health Survey. Following are some of the key results.

  • In 2002/03, the prevalence of diagnosed heart disease and diabetes in adults aged 15years and over was 10.4 and 4.3 percent, respectively.
  • Ischaemic heart disease is the leading cause of death in New Zealand and accounted for 22 percent of all deaths in 2001.
  • Stroke accounted for 10 percent of all deaths in 2001.
  • In 1997, an estimated 8500 deaths were due to the combined effects of poor diet (higher than optimal blood cholesterol, blood pressure and BMI, and inadequate vegetable and fruit intake).
  • In 2002/03, high BMI and waist circumference in adults were associated with a significantly increased risk of many common chronic health conditions, particularly diabetes and high blood pressure.

Factors influencing dietary intake

Factors influencing dietary intake include food security, food price and food marketing. Following are some of the key findings.

  • Approximately 15–20 percent of households cannot always afford to eat properly.
  • In 2005, advertising expenditure on chocolate, confectionery and aerated drinks was $57,289,000, which is over nine times the amount spent on advertising vegetables and fruit ($6,215,000).
  • In 2005, total advertising expenditure on all fast-food chains, restaurants and cafes was $67,352,000, and McDonald’s accounted for a third of all expenditure in this category ($21,420,000).
  • Several New Zealand studies show that most foods advertised on television during children’s viewing times are unhealthy.
  • New Zealand research shows that school sponsorship and fundraising activities tend to promote unhealthy foods, and the most commonly available foods in school tuck shops are unhealthy.

Conclusions and future activities

New Zealand has a range of data useful for monitoring all aspects of food and nutrition, from food supply and purchasing patterns to nutritional and health status. Although there are no major gaps in monitoring of core food and nutrition information domains, monitoring could be enhanced by establishing better systems for monitoring the food supply and food environment, identifying additional sources of data useful for monitoring, and further integration and analysis of existing data. Key areas of focus for the next one to two years include:

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