The influence of social and physical factors and out-of-home
eating on food consumption and nutrient intake in the
materially deprived older UK population
Final report to the WRVS
Bridget Holmes and Caireen Roberts
Submitted March 2009
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Acknowledgments The authors gratefully acknowledge WRVS for funding this secondary analysis and the
following for their contribution to the report: Ms Sam Clemens and Ms Heather Wardle from
the National Centre for Social Research, Dr Lisa Wilson from the Caroline Walker Trust, Mr
Mark Chatfield from the MRC Human Nutrition Research and Professor Judith Buttriss and
Ms Sara Stanner from the British Nutrition Foundation. LIDNS was funded by the Food
Standards Agency and carried out by the National Centre for Social Research, King’s
College London, and the Royal Free and University College London Medical School.
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Contents
1 BACKGROUND TO THE PROJECT..............................................................................................4
1.1 INTRODUCTION AND AIM .............................................................................................................4 1.2 THE LOW INCOME DIET AND NUTRITION SURVEY (LIDNS)...........................................................6
2 BACKGROUND TO THE ANALYSES ...........................................................................................7
2.1 DIETARY VARIABLES ..................................................................................................................7 2.2 NON-DIETARY VARIABLES...........................................................................................................7 2.3 EATING AT-HOME AND OUT-OF-HOME..........................................................................................7 2.4 DIETARY REFERENCE VALUES ...................................................................................................8 2.5 DATA ANALYSIS .........................................................................................................................9
3 RESULTS......................................................................................................................................11
3.1 BODY MASS INDEX ..................................................................................................................11 3.2 SOCIAL AND PHYSICAL FACTORS AND THEIR INFLUENCE ON FOOD AND NUTRIENT INTAKE .............11
3.2.1 Household type and social isolation..................................................................................11 3.2.2 Main food shop..................................................................................................................12 3.2.3 Cooking skills of the Main Food Provider (MFP)...............................................................12 3.2.4 Limiting physical factors ....................................................................................................13 3.2.5 Self-described appetite .....................................................................................................13 3.2.6 Self-reported oral health....................................................................................................14
3.3 REGRESSION FOR FOOD AND NUTRIENT INTAKE IN RELATION TO SOCIAL AND PHYSICAL FACTORS.14 3.4 EATING AT-HOME OR OUT-OF-HOME..........................................................................................16
4 DISCUSSION AND RECOMMENDATIONS ................................................................................18
REFERENCES......................................................................................................................................21
TABLES................................................................................................................................................24
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Summary There are many causes of less healthy eating patterns and nutritionally inadequate diets in
the older population, particularly among those living in poverty, and this means that
preventing, identifying and overcoming risk factors is often a complex issue. The present
analysis investigated factors for less healthy eating patterns, sub-optimal nutrient intakes
and the influence of the social setting (eating at-home or out-of-home) on diet quality in men
and women aged 65 and over from the national survey of low income households in the UK.
The analysis showed substantial evidence of nutritionally inadequate diets in both men and
women. Those limited by a long standing illness or disability generally had less healthy
eating patterns and lower nutrient intakes and this was most apparent for men aged 75 and
over. Men and women reporting a good appetite and no difficulty chewing were more likely
to have a healthier diet than those with an average or poor appetite or those who
experienced difficulty chewing.
Social isolation proved to be of particular concern with 72% of men and 58% of women
reporting that they did not eat out at least once a fortnight. Eating out-of-home appeared to
have a positive influence on diet, for men in particular, with higher energy intakes on ‘eating
out-of-home’ days compared with ‘eating at home’ days and generally higher nutrient
intakes. Men and women who ate alone (as opposed to eating with others) and those who
ate on their lap (as opposed to at a table) were more likely to have a nutritionally inadequate
diet. Older men living in households where the person responsible for shopping and
preparing food had less developed cooking skills, had a less healthy and nutritionally
adequate diet. Overall, our results indicated that older men were not only less likely to eat
out, but also less likely to cook when at home and would potentially benefit most from
support with food and cooking that extends beyond standard meals-on-wheels provision and
includes eating out more, ideally with others.
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1 Background to the project
1.1 Introduction and aim
Recent statistics show that for the first time, a higher proportion of the UK population is aged
over 60 than under 16 (ONS 2008). Those of pensionable age constitute nearly 20% of the
population, with those aged 80 years and over the fastest growing group. This age group
has increased between 1981 and 2007 from 2.8% to 4.5%, mainly as a result of
improvements in rates of mortality.
The prevalence of overweight is high in the older UK population, however a major concern is
that older people are not eating enough (Caroline Walker Trust 2004). Although as age
increases, energy requirements decrease with lessening activity, insufficient food intake
invariably results in a low intake of nutrients. It is estimated that 1 in 10 people aged over 65
and living in the community are experiencing some form of malnutrition (European Nutrition
for Health Alliance 2006). At its worst, malnutrition results in protein-energy malnutrition
which is associated with impaired muscle function, immune dysfunction, and poor wound
healing and delayed recovery from surgery (Domini et al 2003). More common in developed
countries such as the UK is a sub-optimal micronutrient intake from a nutritionally
inadequate diet. The level of risk of nutritional deficiency varies greatly within individuals as
the barriers to healthy eating are social, physical and psychological: they include underlying
disease, loss of appetite, decreased mobility, limited transport to local shops with healthy
affordable food and social isolation. Furthermore, older people are more likely to experience
food poverty and suffer the consequences of the widening gap in health inequalities in the
UK.
For many older people the problems of a nutritionally inadequate diet are linked to the ability
to shop and cook. The problem is exacerbated by factors which may lead to a lack of interest
in food such as bereavement, depression and ill health. Those who have spent their lives
cooking for a family or partner may lack the interest in cooking for themselves when alone
(Centre for Policy on Ageing 2002, Age Concern, 2006). Others may not know how to cook:
small studies have shown that men often struggle to cook for themselves when widowed
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(Howarth 1993) and their eating habits are positively influenced by a woman’s presence in
the household (Donkin et al. 1998).
Therefore, community meals, including meals delivered to the home and meals served at, for
example, day centres, have the potential to contribute greatly to the nutrient intake of
individuals who cannot shop, cook or provide a hot main meal for themselves. Home care
services including community meals therefore play a vital role in supporting older people to
remain in their own home where previously they would have gone into residential care. The
Caroline Walker Trust has issued nutritional guidelines to ensure community meals meet
minimum recommendations for older people for energy and other key nutrients (2004).
Additionally, oral heath plays a major part in food choice and diet quality in the older
population. Twenty percent of older people reported that poor oral health prevented them
from eating foods they would otherwise choose (Locker 1992) and dietary variety (a
measure of diet quality), is reportedly lower in subjects with fewer total teeth, fewer
functional teeth or ill-fitting dentures (Marshall et al 2002).
A further important factor to consider when looking at barriers to an adequate diet in the
older population is the social aspect of eating. A study investigating the nutritional needs of
older people living alone identified social and psychological factors that can increase
appetite and motivation to eat (Jones et al 2005). These included cooking or eating with
others, smelling food as it was being cooked and being involved in conversations around
food – activities in which many older people cannot or do not have the chance to participate
in. Getting out of the house and being active were also effective in stimulating a poor
appetite.
Recently published analysis on men aged 65 and over who participated in a national dietary
survey of low income households in the UK (LIDNS) identified those factors with the most
striking differences in terms of food consumption and nutrient intake to be level of cooking
skills, long standing illness or disability, poor oral health and smoking status (Holmes et al.
2008). The aim of the present analysis was to further investigate risk factors for less healthy
eating patterns and sub-optimal nutrient intakes in both men and women aged 65 and over
in LIDNS, exploring the influence of the social setting (eating at-home or out-of-home) on
diet quality. These results will feed into future primary research needs by identifying where
recommendations need to be focused to improve the diet of those at greatest risk.
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1.2 The Low Income Diet and Nutrition Survey (LIDNS)
The full LIDNS methodology is set out in the Main Report (Nelson et al. 2007). Briefly, an
index of material deprivation assessed via a doorstep screening questionnaire was used to
establish eligibility of households for inclusion in the survey with the aim of identifying the
bottom 15% of the population. In eligible households, up to two respondents were randomly
selected to take part; if children were present, one adult and one child were selected;
otherwise two adults were selected. The key stages of the survey, administered by trained
interviewers and nurses, involved a face-to-face interview and self-completion questionnaire,
dietary data collection, anthropometric measurements (which varied by age) and the
collection of blood samples (in those 8 years and over) to measure indices of nutritional
status.
The LIDNS dataset contained 3728 respondents (unweighted). Of these, 725 were aged 65
or over and living either on their own or with one or more adults, all of retirement age: 119
men and 227 women aged 65-74, and 115 men and 264 women aged 75 and over. This
group formed the basis for the analysis presented here. All LIDNS respondents were free
living.
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2 Background to the analyses
2.1 Dietary variables
Dietary data collection used the 24-hour recall ‘multiple pass’ method repeated on four non-
consecutive days based on the method used in the US (Moshfegh et al. 1999) but modified
for use in the Low Income Diet Methods Study (LIDMS) (Nelson et al. 2003) and again for
LIDNS (Nelson et al. 2007). Further details can be found in the Main Report (Nelson et al.
2007). Food consumption and energy and nutrient intakes are reported as measured i.e. no
adjustment has been made for physical activity or possible mis-reporting of dietary data.
Results should therefore be considered with this in mind.
2.2 Non-dietary variables
The face-to-face interview was completed with all selected respondents in the household.
Information was obtained on health (including oral health), appetite, smoking and where and
with whom respondents usually ate their meals. Additional questions were also asked of the
Main Food Provider (MFP) - the person in the household with the main responsibility for
shopping and preparing food if he or she was not one of the selected respondents. These
questions covered access to shops and cooking skills. Responses from the MFP interview
were applied to all individuals within the household at the analysis stage.
2.3 Eating at-home and out-of-home
For each eating or drinking occasion in the 24-hour recall, the respondent was asked to
select the place/source of consumption from a show card. This identified where the item was
consumed, for example at home, work or elsewhere and where the food came from, for
example home, work, takeaway outlet, or other retail outlet. Table 1 shows the place and
source codes used in the 24-hour recall.
At-home eating was defined to include consumption of all foods and drinks consumed at the
location coded as A in Table 1. Out-of-home eating was defined to include consumption of
all foods and drinks at any of the locations coded as B through to Q (inclusive) in Table 1,
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irrespective of the place of purchase or preparation. This definition has been used previously
(Orfanos et al. 2007).
Table 1. Place and source codes used in the 24-hour recall
Place A Home, own food supply B Home, take-away brought in C Home, other food brought in, paid for D Home, other food brought in, free E Friend's or Relative's house F Restaurant or Cafe G School (bought food or drink) H School (food or drink from home) I School (free/other) J Work (bought food or drink) K Work (food or drink from home) L Work (free/other) M Pub, bar, lounge, hotel, club N Take-away eaten away from home O Other place (bought food or drink) P Other place (food or drink from home) Q Other place (free/other)
To identify out-of-home eaters of substantial quantities, any days for which respondents
consumed 25% or more of their daily energy intake through eating out were classified as
eating out-of-home days (Orfanos et al. 2007). Any days for which respondents consumed
50% or more of their daily energy intake through missing place codes were removed from
the subsequent analyses. All remaining days were classified as eating-at-home days.
Mean food and nutrient values were calculated for each respondent according to whether
the days were ‘at-home’ or ‘out-of-home’. Only those respondents with days classified as ‘at-
home’ and ‘out-of-home’ were included in the analysis.
2.4 Dietary Reference Values
Mean nutrient intakes are expressed as a percentage of the relevant Dietary Reference
Value (DRV). DRVs comprise a series of estimates of the amount of energy and nutrients
needed by different groups of healthy people in the UK population.
Energy intake is expressed as a percentage of the Estimated Average Requirement (EAR).
For a given population group, it is expected that approximately 50% of each sex and age
group will have energy requirements above the EAR and 50% will have requirements below
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the EAR. The mean energy intake for a given group in which all members were meeting their
individual requirements would, therefore, be expected to be equal to the EAR.
Nutrient intakes for protein, total fat, saturated fat, total carbohydrate, non-milk extrinsic
sugars and alcohol were expressed as a percentage of energy. Non-milk extrinsic sugars
(NMES) include table sugars and added sugars (e.g. in soft drinks, cakes and confectionery)
as well as sugars in fruit juice.
Intakes of all other nutrients are expressed as a percentage of the Reference Nutrient Intake
(RNI). The RNI is the amount of that nutrient that is sufficient, or more than sufficient, for
about 97% of the people in the group for whom the RNI is defined. They are not minimum
targets. For further information see Department of Health (1991).
Energy intake as a percentage of the EAR and protein, vitamin and mineral intakes as a
percentage of the RNI were calculated for each respondent individually, using the EAR or
RNI appropriate for their sex and age.
2.5 Data analysis
Comparisons of food consumption and nutrient intake between subgroups were carried out
using the statistical package SPSS version 15.0 (SPSS Inc 2006). Food group analysis is
based on all respondents i.e. both consumers and non-consumers of a food. Data presented
in the report are based on food only data i.e. not including supplements. All results are
based on weighted data so that the reported findings reflect the demographic characteristics
of the UK low income population as a whole. Comparisons between groups were made
using complex models unpaired t-tests or general linear models (ANOVA) unless otherwise
stated.
Multi-variable logistic regression was carried out using STATA/SE9.1 (StataCorp 2007) to
examine the non-dietary social and physical factors associated with foods and nutrients of
particular interest or policy relevance. The dependent variables investigated were
consumption of wholemeal bread, fruit and vegetables and intakes of vitamin C, iron, non-
starch polysaccharide (NSP) (often referred to as dietary fibre) and NMES. Binary variables
for wholemeal bread, fruit and vegetables were created according to sex specific weighted
median values for those aged 65 and over living alone or with one other retired adult from
LIDNS. The median is the middle of a distribution: half the values are above the median and
half are below. For example the median intake for portions of vegetables for men was 1.34.
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Binary variables for vitamin C and iron were created based on those who met or exceeded
the RNI and those who did not. Intakes of NSP were grouped according to whether or not
intakes had met the minimum recommended level of 12 grams per day, while intakes of
NMES were grouped according to whether or not more than 11% of food energy had been
derived from NMES.
The independent variables included in the models were the social and physical factors:
household type, who meals were eaten with at home on a weekday, main food shop,
cooking skills of the MFP, limited shopping and/or food preparation, self-described appetite
and chewing ability (see Table 3). In addition, age, current smoking status, main type of food
shop used, where meals were eaten at home on a weekday and if meals were eaten out at
least fortnightly were included. The variables were chosen specifically as they were identified
as factors likely to be associated with food consumption and nutrient intakes in people aged
65 and over.
Independent variables were entered into the model based on those most strongly associated
with each dependent variable according to Pearson correlation coefficients. Although the
models were run separately for men and women, factors of significance in the model for one
sex were included in both models.
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3 Results
3.1 Body Mass Index
Table 2 shows the distribution of the sample by Body Mass Index (BMI) (weight in kilograms
divided by height in metres squared). The categorization of BMI for adults used for this
report is based on that used in other surveys, such as the National Diet and Nutrition
Surveys (NDNS). Of the 662 respondents where BMI data was available, 71% of men and
74% of women were overweight or obese (BMI >25) and 2% of men and 1% of women were
classified as underweight (BMI ≤18).
3.2 Social and physical factors and their influence on food and
nutrient intake
3.2.1 Household type and social isolation
Table 3 shows the proportion of men and women who lived alone compared with those living
with other adults of retirement age. Men and women aged 75 and over were more likely to
be living on their own. Living alone was strongly associated with eating alone during the
week (chi squared p<0.001). Ninety-four percent of all respondents who lived alone usually
ate on their own on weekdays.
Overall those eating alone consumed significantly more fat spreads and less chips, fried and
roast potatoes than those who ate with others. Men eating alone consumed more white
bread and non diet soft drinks. For both men and women aged 75 and over, eating alone
meant a higher consumption of wholemeal bread compared with those eating with others.
There were very few consistent differences in terms of nutrient intakes.
Table 3 shows that 69% of men and 57% of women ate their meals at the table (as opposed
to on their lap or on the go) on weekdays. The main differences in food consumption
between the two groups indicated that women eating at the table had higher intakes of fruit
and vegetables though lower intakes of baked beans. These differences in food
consumption may account for the higher intakes of vitamin A, C and potassium. Lower
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intakes of sugar, preserves and confectionery were also seen in the women who ate their
meals at the table. Overall men and women who ate at the table consumed more meat and
meat dishes and had higher intakes of protein and iron than those who ate on their lap or on
the go.
Respondents were more likely to eat at the table regardless of whether they ate their meals
alone or with others: 57% of those who ate alone and 70% of those who ate with others ate
at the table (Fisher’s exact test p<0.05).
Respondents were also asked if they ate a meal out at least once a fortnight. Of the 516 who
responded, significantly more did not eat out at least once a fortnight (63%). Women were
more likely to eat out at least once a fortnight than men (42% compared with 28%). Eating
out was associated with a higher proportion of energy from total fat for men and a higher
intake of vitamin C for women.
Six percent of respondents consumed food at home that was classed as ‘other food brought
in, paid for’ on one or more of the days for which dietary data was collected (see Table 1).
This is likely to compose mainly of food supplied by meals on wheels. Small numbers meant
that analysis could not be undertaken separately on this group.
3.2.2 Main food shop
Respondents who lived in households in which the main shop used for purchasing food was
a large supermarket were compared with those that relied primarily on small supermarkets,
local/corner shops, garage forecourts or street markets. Few differences were seen in food
consumption patterns for men or women according to shopping practices. While men who
lived in households in which the main shop used for purchasing food was a large
supermarket consumed more dairy produce e.g. milk and cream and yoghurt, this pattern
was not generally observed in women.
3.2.3 Cooking skills of the Main Food Provider (MFP)
Table 3 shows that 25% of men lived in households where the MFP had ‘less developed’
cooking skills (better developed skills were defined as those able to prepare a main dish
from basic ingredients unaided; those unable to do this were defined as having less
developed skills) compared with 7% of women. The majority (93%) of men with less
developed cooking skills lived on their own.
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Men aged 75 and over living in households where the MFP had less developed cooking
skills consumed significantly lower amounts of vegetables, wholemeal bread, white fish and
fish dishes, chips, fried and roast potatoes, and other potatoes, and diet soft drinks than men
in households where the MFP had better developed cooking skills. This group of men were
particularly at risk of low intakes of energy and other nutrients (Figure 1).
3.2.4 Limiting physical factors
Twenty-seven percent of men and 36% of women reported that their food shopping and /or
food preparation was limited by a long standing illness or disability (Table 3). While few
significant differences were observed in the food consumption data for women, men aged 65
and over whose food shopping and/or preparation were not limited, consumed significantly
greater amounts of wholemeal bread, milk and cream and fruit. More differences and
differences of a greater magnitude were generally observed in men aged 75 and over.
While mean nutrient intakes were generally higher in men and women whose food shopping
and/or food preparation was not limited, very few of the differences were significant for
women. Table 4 presents the mean daily intake of nutrients as a percentage of the DRV and
as a percentage of energy from macronutrients for men aged 65-74 and 75 and over, by
whether or not their food shopping and/or preparation were limited. While differences for
men aged 65 and over were apparent (see Holmes et al, 2008), when this analysis was split
by age, it was the men aged 75 and over for whom the differences were significant. Men
aged 75 and over whose food shopping and/or food preparation was not limited had
significantly higher intakes for the majority of nutrients, and a lower percentage of their food
energy from NMES compared with those whose food shopping and/or food preparation was
limited. Very few differences in nutrient intake remained significant for men aged 65-74.
3.2.5 Self-described appetite
Respondents were asked to rate their appetite as good, average or poor for someone of
their age (see Table 3). Men and women with a good appetite (57% and 50% respectively)
were compared with those who reported having an average or poor appetite (42% and 50%
respectively). Men aged 65 and over with an average or poor appetite consumed more
alcoholic drinks compared with those with a good appetite. While men aged 65-74 with a
good appetite consumed significantly more vegetables than other men, men aged 75 and
over with a good appetite consumed significantly more fruit juice. A higher mean intake of
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vitamin C as a percentage of the RNI was observed in men aged 75 and over with a good
appetite.
Women aged 65 and over with a good appetite consumed significantly more meat and meat
dishes, vegetables and other potatoes (not chips, fried or roast) compared with those with an
average or poor appetite. These differences were observed in younger and older women but
differences were more apparent in the older group. Figure 2 presents intakes of selected
nutrients as a percentage of the DRV for women aged 65 and over, by appetite level.
Women with a good appetite had higher intakes for all nutrients compared with those with an
average or poor appetite. Additionally, women with an average or poor appetite derived a
higher percentage of their food energy from NMES and saturated fat and a lower percentage
from protein compared with those with a good appetite.
3.2.6 Self-reported oral health
Respondents were categorised into two groups – those who experienced no difficulty
chewing (70%) and those who experienced difficulty, either a little, some or a great amount
(30%) (Table 3). Chewing ability had an effect on consumption of vegetables for men and
women in both age groups, with those who had difficulty chewing consuming significantly
lower amounts. They also consumed less meat and meat dishes. Those aged 75 and over
with difficulty chewing consumed less wholemeal bread. The differences observed in food
consumption were reflected in generally lower nutrient intakes for those who experienced
difficulty chewing including protein, folate and potassium. This group also obtained higher
percent food energy from NMES and saturated fat.
3.3 Regression for food and nutrient intake in relation to
social and physical factors
Six separate logistic regression models are presented. For all models, the independent
variable is significantly associated with the outcome variable if p<0.05. Only variables that
were significant in the final model are presented in the table (although in some instances
results are presented for men or women where one or the other was significant). The odds
associated with the outcome variable are presented for each category of the independent
variable. Odds are expressed relative to a reference category, which is given the value of 1.
References groups were determined based on those most likely to have a positive outcome
in relation to food or nutrient intake. An odds ratio greater than 1 indicates higher odds, while
15
an odds ratio lower than 1 indicates lower odds. 95% confidence intervals are also shown for
each odds ratio. In some of the models, the number of available cases to analyse was small
and as a result the confidence intervals surrounding the odds ratios presented for some sub-
groups and categories are large.
Table 5 presents a model of the non-dietary factors associated with consuming the median
or above in number of portions of fruit for women. Women who did not eat out at least once
a fortnight were less likely to consume the median number of portions of fruit or above
compared with women who did eat out (odds ratio 0.4). Women who were current smokers
were less likely to consume the median number of portions of fruit or above compared to
those who did not smoke (odds ratio 0.5). No significant differences were observed for men.
Table 6 presents a model of the non-dietary factors associated with consuming the median
or above the median number of portions of vegetables. Women aged 75 and over, women
who had an average or poor appetite and women who experienced difficulty chewing were
less likely to consume the median number of portions of vegetables or above. For men,
ability to chew was the only significant predictor of a higher vegetable consumption. Men
who experienced difficulty chewing were more likely to consume above the median number
of portions of vegetables compared with men who had no difficulty but this result is most
likely due to very small numbers in one or more of the sub-groups.
Table 7 presents a model of the non-dietary factors associated with consuming the median
or above the median intake of wholemeal bread. For both men and women, those who
reported that their food shopping and /or preparation was limited by a long standing illness or
disability were less likely to be consuming the median intake or over for wholemeal bread
compared with those that reported no limitations (odds ratios 0.4 for men and 0.6 for
women). Also, men who experienced difficulty chewing were less likely to be consuming the
median intake or over the median intake of wholemeal bread compared with those who had
no difficulty (odds ratio 0.4).
Table 8 presents a model of the non-dietary factors associated with a vitamin C intake that
met or exceeded the RNI. Men living in households where the MFP had less developed
cooking skills were less likely to have a vitamin C intake that met the RNI compared to men
living in households where the MFP had better developed cooking skills. Women who were
current smokers were less likely to meet the RNI for vitamin C, a reflection of their
consumption of fewer portions of fruit, than women who were not current smokers. For both
16
men and women, those who reported having an average or poor appetite were less likely to
be meeting the RNI for vitamin C compared with those who reported having a good appetite.
Table 9 presents the only significantly associated non-dietary factor for deriving no more
than 11% of food energy from non-milk extrinsic sugars (NMES), by sex. Men and women
aged 75 years and over were more likely than those aged 65-74 years to derive more than
11% of food energy from NMES (odds ratios 0.5 for both men and women).
Table 10 presents a model of the non-dietary factors associated with consuming 12g or
more per day of NSP for women. Women aged 75 years and over, those who were current
smokers and those who ate their meals on their lap or on the go were less likely to consume
12g or more of NSP (age odds ratios 0.6, current smoker odds ratio 0.2, where eats odds
ratio 0.5). None of the non-dietary factors were significantly associated with NSP intake in
men.
3.4 Eating at-home or out-of-home
As described in the methods section, days of data were classified as either ‘eating at-home’
or ‘eating out-of-home’. Results presented within this section are separate to those
describing whether or not respondents ate out at least fortnightly. Table 11 shows the mean
daily consumption of foods by eating at-home or out-of-home. Consumption of biscuits, fruit
pies, buns, cakes and pastries, white fish and fish dishes, chips, fried and roast potatoes and
fried potato products was higher on days when men and women ate out-of-home (not always
significant). This was also the case for fruit juice (significant for women only, 42g vs 27g),
and alcoholic drinks, for which intake on out-of-home days was over double that on eating
at-home days (men 512g vs 216g, women 54g vs 17g).
Consumption of fat spreads and other potatoes (not chips, fried or roast) was lower on
eating out-of-home days in men and women. A lower consumption of fruit was also observed
on these days in both men (61g vs 77g) and women (74g vs 115g). Consumption of yoghurt,
fromage frais and dairy desserts was lower on eating out-of-home days but only for women.
Table 12 shows the mean nutrient intake as a percentage of the DRV by eating at-home or
out-of home. Generally higher nutrient intakes were seen on eating out-of-home days for
men, while the reverse was seen for women.
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Higher energy intakes as a percentage of the EAR were observed in men and women on
eating out-of-home days (significant for men only). On eating out-of-home days, intakes of
vitamin B6, folate, magnesium and iodine were significantly higher in men and the
percentage of food energy from saturated fat was lower.
For women, significantly lower intakes of protein, riboflavin and vitamin B6 were seen on
eating out-of-home days. They also had a lower percentage of food energy from protein and
a higher percentage from NMES and total fat on eating out-of-home days.
For both men and women, alcohol contributed twice as much to their energy intake on eating
out-of-home days.
Days for which respondents consumed 25% or more of their daily energy intake through
eating out were classified as eating out-of-home days, in line with the literature (Orfanos et al
2007). This classification system is arbitrary to some extent and it is assumed that eating
out-of-home days are correlated with eating out-of-home in general. Additionally, out-of-
home eating was defined according to the place of consumption, irrespective of the place of
purchase or preparation, and therefore some misclassification may have resulted.
Our analysis included only those respondents who had days classified as ‘at-home’ and ‘out-
of-home’ so therefore in some cases data may be based on only one day for any one
individual. Mean values are not likely to be affected although corresponding standard
deviations will tend to increase (Willet, 1998).
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4 Discussion and Recommendations
In the older population there are many causes of less healthy eating patterns and
nutritionally inadequate diets, particularly among those living in poverty, and this means that
preventing, identifying and overcoming risk factors is often complex.
Results from this analysis show that levels of underweight in the low income older population
who live at home are low, with 2% of men and 1% of women classified as underweight.
Equivalent figures reported in the National Diet and Nutrition Survey of people aged 65 years
and over were 3% for men and 6% for women, while figures for those in residential care
were higher, 16% and 15% respectively (Finch et al 1998). Our results showed large
proportions of the group were classified as overweight or obese (71% of men and 74% of
women) and there was substantial evidence of nutritionally inadequate diets.
Social isolation proved to be of particular concern in our sample, with low levels of eating out
recorded, particularly for men: 72% of men and 58% of women reported that they did not eat
out at least once a fortnight. The positive contribution eating out makes to overall diet is
shown by the higher energy intakes on ‘eating out-of-home’ days compared with ‘eating at
home’ days for men and women, and generally higher nutrient intakes as a percentage of
the DRV for men. Eating out of home has previously been linked to a sedentary lifestyle and
higher energy intakes in adults aged 35 – 74 years (Orfanos et al 2007). Our results suggest
that eating out generally had a positive influence on nutritional intake in older people,
especially in men who are less likely to cook meals at home, but that healthy food choices
and advice on healthy eating should be made available to consumers.
In terms of the eating environment at home, the food consumption data suggested that those
who ate alone may be substituting a cooked meal or hot meal for food that can be easily
prepared such as sandwiches. Those who ate alone and those who ate on their lap (as
opposed to at a table) appeared to be most likely to have a nutritionally inadequate diet.
Older people living in households where the MFP had less developed cooking skills
generally had a less healthy and nutritionally adequate diet and this was particularly
noticeable in the older men. Overall, our results indicated that older men were not only less
likely to eat out, but also less likely to cook when at home.
19
While the type of shop that men and women used to purchase their food didn’t seem to
influence food and nutrient intake, how easy it was for a person to get to the shop to
purchase food did. Older people who were limited by a long standing illness or disability
generally had less healthy eating patterns and lower nutrient intakes. Again this result was
most apparent for men, but particularly so for men aged 75 and over. These results are in
line with those reported elsewhere which suggest that older people who experience the
greatest difficulties in food shopping are considered to be at the greatest nutritional risk
(Herne 1995; McKie 1999).
Nutritional adequacy of older people’s diet according to level of appetite indicated that men
and women reporting a good appetite were more likely to have a healthier diet than those
with an average or poor appetite. Interpretation of appetite as an influencing factor on dietary
intake is problematic since it is linked to other factors such as long standing illness or
disability limiting food preparation, poor oral heath and ability to chew, social isolation and
current smoking status. Additionally appetite is difficult to measure and self-reporting may
introduce bias into the results. Oral health played an important role in food consumption and
nutrient intake with those older people who had poor chewing ability generally consuming
lower amounts of vegetables and having lower nutrient intakes, with higher intakes of NMES.
The Caroline Walker Trust (2004) stresses that it is not just a case of improving what older
people eat but also how much they eat. It suggests the importance of stimulating appetite in
older people and suggests that snacks should be provided in between more formal
mealtimes or, in the case of community meals, be delivered with the main meal, thereby
ensuring that, if they wish, older people can eat a little at a time, but more frequently.
Relationships between intakes in terms of our cut-offs i.e. intakes at or above the median
(for foods) or DRVs (for nutrients) and our social and physical factors varied for men and
women. Associations were generally in the direction that would be expected, for example,
those with average or poor chewing ability were less likely to consume the median intake of
vegetables. It should be noted that often median intakes were still very low, for example
median intakes of fruit and vegetables were still well below the Department of Health’s
recommendation of at least five portions per day. Social and physical factors that appeared
to be consistently linked to less healthy food consumption patterns and lower nutrient intakes
were having an average or poor appetite, poor chewing ability, shopping and/or food
preparation being limited by long standing illness or disability, and factors relating to social
isolation including eating out at least once a fortnight, eating alone and eating on one’s lap.
20
These results reinforce the importance of the social aspects of eating for older people. Men
seem to be at particular risk and would benefit from learning how to eat better at home but
also to eat more meals with others outside the home. Projects such as ‘Recipe for Life’ aim
to help older people who live alone to eat well by developing innovative ways of providing
support with food and eating that maintain the positive social and psychological benefits
associated with food that may be lost with conventional community meals (Jones et al 2005).
Eating with familiar others has been shown to increase food intake by 60% in healthy older
adults (McAlpine et al 2003) so advantage should be taken of any opportunities for social
eating. The Caroline Walker Trust Expert Working Group has recommended that lunch clubs
should be developed for older people in any setting where it is already the custom for older
people to gather (Caroline Walker Trust, 2004). In addition, research in the US has shown
that by expanding community meals-on-wheels to include breakfast, energy and nutrient
intakes could be improved and depressive symptoms reduced. The researchers
recommended that the addition of a breakfast service to traditional home delivered meals
services could be of great benefit to the older population living at home (Gollub et al 2004).
We suggest that this should be done in conjunction with other measures that support social
eating.
21
References
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on healthy lifestyle choice and older people’, Age Concern Reports.
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guidelines for food in residential and nursing homes and for community meals. 2nd ed. CWT:
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Centre for Policy on Ageing (2002) ‘Hard Times – A Study of Pensioner Poverty, CPA &
Nestle Family Monitor.
Department of Health (1991) Report on Health and Social Subjects, No 41. Dietary
Reference Values for Food Energy and Nutrients for the United Kingdom. Report of the
Committee on Medical Aspects of Food Policy. HMSO: London.
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fruit and vegetable consumption among elderly living at home in Nottingham. Appetite, 30:
39-51.
European Nutrition for Health Alliance (2006) Malnutrition among Older People in the
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London
Finch S, Doyle W, Lowe C et al. (1998) National Diet and Nutrition Survey: people aged 65
years and over. Volume 1: Report of the diet and nutrition survey. TSO: London.
Gollub EA, Weddle DO (2004) Improvements in nutritional intake and quality of life among
frail homebound older adults receiving home delivered breakfast and lunch. J Am Diet
Assoc, 104: 1227-1235.
Herne S. (1995) Research on food choice and nutritional status in elderly people: a review.
British Food Journal, 97 (9): 12-29.
22
Holmes B, Roberts C, Nelson M. (2008) How access, isolation and other factors may
influence food consumption and nutrient intake in materially deprived older men in the UK.
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independence and life (eds S Arber & M Evandrou). Jessica Kingsley: London
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Margaret University College: Edinburgh.
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Marshall TA, Warren JJ, Hand JS et al. (2002) Oral health, nutrient intake and dietary quality
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McAlpine S J, Harper J, McMurdo M E et al. (2003) Nutritional supplementation in older
adults: pleasantness, preference and selection of sipfeeds. British Journal of Health
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McKee L. (1999) Older people and food: Independence, locality and diet. British Food
Journal, 101 (7): 528-537.
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Nelson M, Dick K, Holmes B et al. (2003) Low Income Diet Methods Study. Food Standards
Agency: London.
Nelson M, Erens B, Bates B et al. (2007) Low Income Diet and Nutrition Survey. TSO:
London. Available from: http://www.food.gov.uk
23
Orfanos P, Naska A, Trichopoulos D et al. (2007) Eating out of home and its correlates in 10
European countries. The European Prospective Investigation into Cancer and Nutrition
(EPIC) study. Public Health Nutrition, 10(12): 1515-1525.
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StataCorp. Stata Statistical Software: Release 9. College Station, Texas: Stata Corporation.
2007. Willet WC (1998) Nutritional epidemiology, 2nd ed. New York: Oxford University Press.
24
Table 2. Distribution of sample, by sex, age and body mass index (BMI (kg/m2))
BMI Men Women Total 65-74 years 75+ years 65+ years 65-74 years 75+ years 65+ years 65+ years % % % % % % %
Underweight (≤18.5) - 3 2 1 2 1 1 Normal weight (>18.5, ≤25) 27 29 28 20 28 24 26 Overweight (>25, ≤30) 43 41 42 32 41 37 39 Obese (>30, ≤40) 27 26 27 41 29 34 32 Morbidly obese (>40) 2 1 2 6 0 3 2
Base (unweighted) 114 108 222 212 228 440 662 - No observations
25
Table 3. Distribution of sample, by sex, age and social and physical factors
Social and physical factor Men Women Total 65-74 years 75+ years 65+ years 65-74 years 75+ years 65+ years 65+ years % % % % % % % Household type Living alone 46 70 59 75 84 80 74 Living with other(s)
54 30 41 25 16 20 26
Who meals are eaten with at home on a weekday
Alone 51 62 58 72 82 78 71
With others
49 38 42 28 18 22 29
Where meals are eaten at home on a weekday
At the table 58 77 69 57 58 57 61
On lap or on the go
42 23 31 43 42 43 39
Main food shopping Large supermarket 83 68 74 81 82 82 79 Small supermarket
17 32 26 19 18 18 21
Cooking skills of MFP Better developed 84 68 75 96 92 93 87 Less developed
16 32 25 4 8 7 13
Long standing illness or disability limiting shopping and/or food preparation
No 74 72 73 66 63 64 67
Yes
26 28 27 34 37 36 33
Self-described appetite Good 54 60 57 55 46 50 52
Average or poor
46 40 42 45 54 50 48
Chewing ability No difficulty 73 70 72 72 68 70 70 Difficulty experienced
27 30 28 28 32 30 30
Base (unweighted)* 119 115 234 227 264 491 725 MFP, Main Food Provider - the person in the household with the main responsibility for shopping and preparing food. * Bases apply to household type, main food shopping, limited shopping and/or food preparation and chewing ability and vary slightly for all other characteristics.
26
Figure 1. Mean daily intake of nutrients as a percentage of the Dietary Reference Value (DRV) (Estimated Average Requirement or Reference Nutrient Intake) for men aged 75 and over, by cooking skills of main food provider (selected significant differences) (n=115)
0
20
40
60
80
100
120
140
160
Energ
y
Prote
in
Folat
e
Potas
sium
Magne
sium
Copp
er Zinc
Iron
Iodin
e
Per
cent
age
of t
he D
RV
Better cooking skills
Less cooking skills
27
Table 4. Mean daily intake of nutrients as a percentage of the Dietary Reference Value (DRV) and as a percentage of energy from macronutrients, by sex and whether or not shopping, food preparation or both are limited by a long standing illness or disability
Nutrient Men 65-74 years Men 75 years and over Not limited Limited Not limited Limited Mean Mean P Mean Mean P Percentage of DRV Energy (% EAR) 81 74 88 79 * Protein (% RNI) 139 128 134 114 **
Vitamin A (% RNI) 152 126 191 150 Vitamin D (% RNI) 34 31 36 38 Thiamin (% RNI) 171 160 185 141 ** Riboflavin (% RNI) 137 118 146 111 ** Niacin equivalent (% RNI) 215 196 216 179 ** Vitamin C (% RNI) 166 143 165 134 Vitamin B6 (% RNI) 157 137 157 122 ** Vitamin B12 (% RNI) 404 378 455 337 Folate (% RNI) 135 117 * 137 102 ** Potassium (% RNI) 79 72 78 62 ** Calcium (% RNI) 129 113 126 98 ** Magnesium (% RNI) 81 72 80 64 ** Phosphorus (% RNI) 226 202 222 175 ** Iron (% RNI) 119 115 127 101 ** Copper (% RNI) 94 75 ** 100 82 Zinc (% RNI) 92 85 91 70 ** Iodine (% RNI) 140 130 140 106 ** Percentage of energy % food energy from total carbohydrate 46.6 47.5 47.3 48.8 % food energy from non-milk extrinsic sugars 11.5 13.2 13.2 16.1 * % food energy from protein 17.0 16.7 16.5 15.8 % food energy from total fat 36.5 35.7 36.2 35.4 % food energy from saturated fat 14.3 14.5 14.7 14.2 % energy from alcohol 4.4 3.3 4.0 5.4 Base (unweighted) 87 32 84 31 * P<0.05, ** P<0.01 EAR Estimated Average Requirement RNI Reference Nutrient Intake
28
Figure 2. Mean daily intake of nutrients as a percentage of the Dietary Reference Value (DRV) for women aged 65 and over, by appetite level (selected significant differences) (n=491)
0
50
100
150
200
250
Prote
in
Vitam
in C
Vitam
in D
Folat
e
Potas
sium
Magne
sium
Phos
phor
us Iron
Zinc
Per
cen
tag
e o
f th
e D
RV
Good appetite
Average or poor appetite
29
Table 5. Estimated odds ratios for consuming above the median daily intake for fruit (portions)a for women, by associated non-dietary factors Variable Base
(unweighted) Odds ratio 95% CI P
Eats out fortnightly Eats out at least fortnightly 130 1 Does not eat out at least fortnightly
208 0.4 0.26 - 0.74 0.002
Question not answered 153 0.9 0.49 - 1.67 Current smoker No 188 1 Yes 87 0.5 0.25 - 0.93 0.029 Question not answered/never smoked
216 0.9 0.56 - 1.60
491
a Median portions of fruit (this includes a maximum of one portion fruit juice) per day was 1.1 for women.
30
Table 6. Estimated odds ratios for consuming above the median daily intake for vegetables (portions)a, by associated non-dietary factors and sex Variable Base
(unweighted) Odds ratio 95% CI P Base
(unweighted) Odds ratio 95% CI P
Men Women Age Age 65 - 74 years 119 1 65 - 74 years 227 1 75 years and over 115 1.2 0.65 - 2.38 0.515 75 years and over 264 0.5 0.33 - 0.87 0.011 Appetite Appetite A good appetite 128 1 A good appetite 243 1 An average or poor appetite for someone their age
105 0.6 0.28 - 1.18 0.131 An average or poor appetite for someone their age
248 0.3 0.19 - 0.50 0.000
Question not answered 1 - - Ability to chew Ability to chew No difficulty 168 1 No difficulty 334 1 Difficulty experienced (little, fair or great)
66 0.3 0.14 - 0.77 0.011 Difficulty experienced (little, fair or great)
156 0.5 0.33 - 0.79 0.003
Question not answered 1 - - 234 491 a Median portions of vegetables (this includes a maximum of one portion of beans and pulses) per day was 1.3 for men and 1.4 for women
31
Table 7. Estimated odds ratios for consuming above the median daily intake for wholemeal bread (grams)a, by associated non-dietary factors and sex Variable Base
(unweighted) Odds ratio 95% CI P Base
(unweighted) Odds ratio 95% CI P
Men Women Limited shopping and/or food preparation
Limited shopping and/or food preparation
Not limited 171 1 Not limited 317 1 Limited 63 0.4 0.14 - 0.91 0.030 Limited 174 0.6 0.37 - 0.95 0.030 Ability to chew Ability to chew No difficulty 168 1 No difficulty 334 1 Difficulty experienced (little, fair or great)
66 0.4 0.17 - 0.95 0.037 Difficulty experienced (little, fair or great)
156 1.03 0.67 - 1.59 0.879
Question not answered 1 - - 234 491 a Median daily intake of wholemeal bread was 0.0g for men and women
32
Table 8. Estimated odds ratios for meeting or exceeding the Dietary Reference Value (DRV) for vitamin C intake, by associated non-dietary factors and sex Variable Base
(unweighted) Odds ratio 95% CI P Base
(unweighted) Odds ratio 95% CI P
Men Women Cooking skills Cooking skills Better developed 183 1 Better developed 454 1 Less developed 51 0.4 0.18 - 0.91 0.029 Less developed 35 0.4 0.14 - 1.27 0.129 Question not answered 2 0.3 0.01 - 8.72
Appetite Appetite A good appetite 128 1 A good appetite 243 1 An average or poor appetite for someone their age
105 0.3 0.17 - 0.64 0.001 An average or poor appetite for someone their age
248 0.6 0.34 - 0.92 0.022
Question not answered 1 - - Eats out fortnightly Eats out fortnightly Eats out at least fortnightly 50 1 Eats out at least fortnightly 130 1 Does not eat out at least fortnightly
128 1.8 0.74 - 4.33 0.193 Does not eat out at least fortnightly
208 0.6 0.35 - 1.07 0.082
Question not answered 56 5.3 1.85 - 15.15 Question not answered 153 1.3 0.65 - 2.47 Current smoker Current smoker No 128 1 No 188 1 Yes 54 0.4 0.18 - 1.10 0.079 Yes 87 0.4 0.22 - 0.84 0.014 Question not answered/never smoked
52 0.9 0.41 - 2.16 Question not answered/never smoked
216 1.0 0.59 - 1.78
234 491
33
Table 9. Estimated odds ratios for deriving no more than 11% of food energy from Non-milk extrinsic sugars (NMES), by associated non-dietary factors and sex Variable Base
(unweighted) Odds ratio 95% CI P Base
(unweighted) Odds ratio 95% CI P
Men Women Age Age 65 - 74 years 119 1 65 - 74 years 227 1 75 years and over 115 0.5 0.26 - 0.91 0.024 75 years and over 264 0.5 0.34 - 0.84 0.007 234 491
34
Table 10. Estimated odds ratios for consuming 12g or more per daya of non-starch polysaccharides (NSPs) for women, by associated non-dietary factors Variable Base
(unweighted) Odds ratio 95% CI P
Age 65 - 74 years 227 1 75 years and over 264 0.6 0.37 - 0.96 0.035
Current smoker No 188 1 Yes 87 0.2 0.11 - 0.53 0.000 Question not answered/never smoked
216 0.9 0.53 - 1.46
Where eats on a weekday At the table 279 1 On lap or on the go 209 0.5 0.28 - 0.73 0.001 Question not answered 3 8.2 0.42 -159.89 491 a 12grams is the minimum recommended daily intake of NSP.
35
Table 11. Mean daily consumption of food (grams) (including non-consumers), by sex and eating at-home or out-of-home
Men Women All Food group At-
home Out-of-home
P At-home
Out-of-home
P At-home
Out-of-home
P
Pasta, rice, pizza and other cereals Mean (g) 8 19 19 19 16 19 % consumer 17 20 28 25 25 24 White and other bread Mean (g) 90 85 52 50 63 60 % consumer 88 82 87 75 88 77 Wholemeal bread Mean (g) 19 18 16 14 17 15 % consumer 23 21 29 24 28 23 Wholegrain and high fibre cereals Mean (g) 44 34 27 29 32 30 % consumer 44 40 49 43 47 42 Other breakfast cereals Mean (g) 6 8 6 6 6 6 % consumer 23 24 26 21 25 22 Biscuits, fruit pies, buns, cakes and pastries Mean (g) 36 45 * 38 45 38 45 * % consumer 70 68 83 75 80 73 Puddings including ice cream Mean (g) 44 37 31 42 35 41 % consumer 39 32 39 43 39 39 Milk and cream Mean (g) 203 200 225 213 * 219 209 % consumer 93 94 100 100 98 98 Cheese Mean (g) 10 7 9 9 9 9 % consumer 31 22 41 29 38 27 Yoghurt, fromage frais and dairy desserts Mean (g) 10 11 27 13 ** 23 12 ** % consumer 13 8 28 14 24 12 Eggs and egg dishes Mean (g) 29 19 14 13 18 15 % consumer 48 35 37 27 40 29 Fat spreads Mean (g) 25 22 * 18 15 ** 20 17 ** % consumer 94 91 94 84 94 86 Meats and meat dishes, excluding processed meat
Mean (g) 140 120 111 92 119 100 *
% consumer 88 86 89 78 89 81 Processed meat including sausages, burgers, coated chicken
Mean (g) 34 37 23 21 27 26
% consumer 53 35 40 28 44 30 White fish and fish dishes Mean (g) 17 42 * 17 36 ** 17 38 ** % consumer 20 36 30 31 27 32 Oily fish and dishes Mean (g) 10 4 8 3 * 8 3 ** % consumer 22 8 19 6 20 6 Vegetables exc potatoes and baked beans Mean (g) 118 110 114 106 115 108 % consumer 84 76 87 80 86 79 Baked beans Mean (g) 17 6 6 6 9 6 % consumer 15 6 10 5 11 6 Chips, fried and roast potatoes and fried potato products
Mean (g) 15 59 ** 17 47 ** 16 51 **
% consumer 29 53 31 51 31 52 Other potatoes, potato salads and dishes, potato products cooked without fat
Mean (g) 92 55 * 78 55 ** 82 55 **
% consumer 66 38 68 49 68 46 Crisps and savoury snacks Mean (g) 6 3 2 2 3 2 % consumer 22 14 12 10 15 11 Fruit, excluding fruit juice Mean (g) 77 61 115 74 ** 104 70 ** % consumer 56 45 72 57 67 54 Sugar, preserves and confectionery Mean (g) 30 33 22 23 24 26 % consumer 83 83 70 67 74 72 Fruit juice Mean (g) 13 18 27 42 * 23 35 * % consumer 13 12 21 22 19 19 Soft drinks, not diet Mean (g) 53 83 49 56 50 64 % consumer 26 27 29 25 29 26 Soft drinks, diet Mean (g) 22 14 37 37 33 30 % consumer 10 8 15 14 13 13 Alcoholic drinks, including low alcohol Mean (g) 216 512 ** 17 54 ** 74 186 ** % consumer 38 50 18 25 23 32 Tea, coffee and water Mean (g) 1068 1120 1162 1154 1135 1144 % consumer 100 100 100 100 100 100 Beverages (dry wt), soups and sauces Mean (g) 58 54 72 45 * 68 48 * % consumer 64 70 79 68 75 69 Base (unweighted)† 100 100 248 248 348 348
* P<0.05, ** P<0.01 † Only those respondents with days classified as ‘at-home’ and ‘out-of-home’ were included in the analysis.
36
Table 12. Mean daily intake of nutrients as a percentage of the Dietary Reference Value (DRV) and as a percentage of energy from macronutrients, by sex and eating at-home or out-of-home Men Women All Nutrient At-
home Out-of-home
P At-home
Out-of-home
P At-home
Out-of-home
P
Mean Mean Mean Mean Mean Mean Percentage of DRV Energy (% EAR) 83 91 ** 79 82 81 84 * Protein (% RNI) 133 135 131 125 * 132 128 Vitamin A (% RNI) 128 135 201 188 180 173 Vitamin D (% RNI) 39 35 28 24 * 31 27 ** Thiamin (% RNI) 177 171 180 166 ** 179 168 * Riboflavin (% RNI) 129 136 148 138 * 143 138 Niacin equivalent (% RNI) 205 221 241 227 231 225 Vitamin C (% RNI) 153 150 181 163 173 159 Vitamin B6 (% RNI) 144 165 ** 153 143 * 150 149 Vitamin B12 (% RNI) 387 374 341 319 354 335 Folate (% RNI) 126 143 * 116 115 119 123 Potassium (% RNI) 74 78 68 67 70 70 Calcium (% RNI) 116 117 107 106 109 109 Magnesium (% RNI) 76 84 * 72 71 73 75 Phosphorus (% RNI) 211 223 185 182 193 194 Iron (% RNI) 121 117 107 104 111 108 Copper (% RNI) 82 91 ** 73 74 75 79 Zinc (% RNI) 88 86 104 96 * 99 93 * Iodine (% RNI) 132 154 * 116 116 121 127 Percentage of energy % food energy from total carbohydrate
47.2 47.4 47.6 47.2 47.5 47.2
% food energy from non-milk extrinsic sugars
12.8 13.6 11.6 12.6 * 12.0 12.9 *
% food energy from protein 16.5 16.7 17.2 16.1 ** 17.0 16.3 * % food energy from total fat 36.4 35.8 35.2 36.7 * 35.5 36.5 % food energy from saturated fat 14.4 13.3 ** 14.4 14.7 14.4 14.3 % energy from alcohol 3.6 6.8 ** 0.9 2.0 ** 1.7 3.4 ** Base (unweighted)† 100 100 248 248 348 348
* P<0.05, ** P<0.01 † Only those respondents with days classified as ‘at-home’ and ‘out-of-home’ were included in the analysis. EAR Estimated Average Requirement RNI Reference Nutrient Intake
37
Contacts
Dr Bridget Holmes Nutritional Sciences Division
King’s College London
150 Stamford Street
London
SE1 9NH
United Kingdom
Tel: + 44 (0)20 7848 3360
Email: [email protected]
Ms Caireen Roberts National Centre for Social Research
35 Northampton Square
London
EC1V 0AX
United Kingdom
Tel: + 44 (0)20 7549 7063
Email: [email protected]
WRVS Garden House
Milton Hill
Steventon
Abingdon
OX13 6AD
United Kingdom
Email: [email protected]
38
