Who needs supplements? Why are they necessary?

Transcription

1 Who needs supplements? Why are they necessary? Dr Carrie Ruxton RD Supported by

2 Key points today 1. If we all ate a healthy balanced diet, we could get all the nutrients we need 2. Many people do not currently eat a healthy balanced diet 3. Vulnerable groups have increased needs for specific nutrients 4. This is why supplements are necessary in certain cases.

3 THE GREAT BRITISH DIET

4 1/3 of calories from nutrient-poor foods and drinks NDNS (2014) years

5 Comparison with targets: 19-64y Area Current intakes Target Fruit & veg 4.1 portions/day 5 portions/day Dietary fibre 13.7 grams/day 18 grams/day Salt 7-8 grams/day 6 grams/day Total fat 32.9% energy 35% energy Saturated fat 12.0% energy 10% energy Trans fats 0.6% energy < 2% energy NME sugars 11.5% energy 5% energy* NDNS (2014); 30% achieve 5-a-day; * new 2015 guideline

6 Comparison with targets: 11-18y Area Current intakes Target Fruit & veg 2.9 portions/day 5 portions/day Dietary fibre 11.8 grams/day 18 grams/day Salt 7-8 grams/day 6 grams/day Total fat 33.7% energy 35% energy Saturated fat 12.4% energy 10% energy Trans fats 0.6% energy <2% energy NME sugars 15.4% energy 5% energy* NDNS (2014); 9% achieve 5-a-day; * new 2015 guideline

7 Fruit and vegetable intakes flat lining % achieving 5-a-day Men Women Children NDNS various years

8 Grams per week Oily fish consumption poor y 4-10y 11-18y 19-24y 25-34y Target 2 portions/wk % consumers: 1.5-3y = 10% 4-10y = 11% 11-18y = 8% 19-24y = 18% 25-34y = 33% Total fish/wk Oily fish/wk Bates et al. (2012) NDNS

9 Sugar falling but not enough Guideline 5% total energy NDNS various years; 2000 was the adult survey

10 NUTRIENT GAPS

11 Vitamin & mineral DRVs LRNI EAR RNI % population needs met by each rec. RNI = 97.5% EAR = 50% LRNI = 2.5% Message: It s bad to have intakes below the LRNI COMA report 1991

12 Average intakes fine Source: NDNS (2010) Adults

13 NDNS (2014) But.. hide at risk groups

14 NDNS (2014) Lowest intakes in teenage girls

15 Nutrients of concern Iron Folate Vitamin D Long-chain omega-3 fatty acids

16 Iron More than 20% of women and 40% of girls have inadequate intakes < LRNI 10% of women have low haemoglobin 30% of girls have low ferritin Probably due to low intakes of red meat and fortified breakfast cereals Low iron levels cause tiredness, and may impact on immune function

17 Folate Prevents neural tube defects (75% reduced risk in suppl. takers) 400 mcg recommended pre-pregnancy and for first trimester (4 mg in at risk ) 2/3 women do not take a supplement prior to becoming pregnant (RCOG) Food fortification being debated in UK.

18 Poor folate status in UK women PHE (2015)

19 Vitamin D Normal teeth, bones, immune function Low vitamin D during pregnancy linked with higher risk of child type 1 diabetes Higher risk of deficiency in people from lower socio-economic groups and those living in Scotland 10 mcg/day supplement recommended during pregnancy & lactation.

20 Widespread deficiency in UK Average vitamin D status (25 hydroxyvitamin D) nmol/l Male Female Teens Adults Women Girls Men Boys % < 25nmol/L NDNS (2012)

21 Limitations of sources 90% vitamin D from sun exposure but you would need 9-25 min* daily midday sun (shorts & t-shirt) from March-Sept to ensure adequate status 10% from foods but limited natural sources and oily fish/egg intakes low Current mean daily intakes of 2-4 mcg are well below draft DRV of 10 mcg.* *SACN (2015) draft report on vitamin D

22 LC omega-3 fatty acids Important for normal brain and eye development during pregnancy at intakes of mg daily (esp DHA) Population recommendation of 400 mg EPA+DHA per day in UK* Intakes are around half of this in women of child-bearing age. SACN/COT (2004) Report on fish

23 New review article Encouraging data on giving omega-3s during pregnancy for cognitive and eye development but more RCT needed Barriers to oily fish consumption are driving poor intakes in UK 29% adults surveyed took oily fish supplements. Ruxton C (2015) Complete Nutrition; September issue

24 Premature birth Women consuming less than 150 mg of omega-3 fatty acids a day (ie less than 3.5 oz [90g] of fish weekly) were at the highest risk of delivering prematurely 1 Fish Oil Trials in Pregnancy study (n=232) found fish oil supplementation reduced risk of recurrent preterm birth by 46% Greenberg JA et al. (2008) Rev Obstet Gynecol 1: Olsen SF et al. (2000) BJOG 107:

25 Benefits during lactation Lactating women given 200 mg/d DHA for 4 months had infants who performed significantly better on the Bayley Psychomotor Development Index compared with vegetable oil control Fish oil supplementation during pregnancy and lactation resulted in a decreased risk of infant allergies. Coletta JM et al. (2010) Obstet Gynecol 3: REVIEW

26 IMPACT OF SUPPLEMENTS

27 % below LRNI Fewer have inadequate intakes when supplements taken year olds < LRNI Supplements No supplements NDNS 2014

28 Compliance with folate advice improves status Survey of 296 pregnant Irish women Only 19% complied with advice to take 400 mcg folic acid prior to becoming pregnant Red cell folate status was signif. higher in supplement takers McNulty B et al. (2011) Women's compliance with current folic acid recommendations and achievement of optimal vitamin status for preventing neural tube defects. Hum Reprod 26:

29 Fish oil supplementation Improves omega-3 status in women and their offspring 1 May lower risk of some atopic conditions e.g. eczema, egg allergy 2 May improve infant cognitive function but depends on baseline status 3 Free from heavy metals. 1. Carlson SE et al (2013) Am J Clin Nutr 97: Cochrane Database Syst Rev 7: CD Gould JF et al. (2013) Am J Clin Nutr 97:

30 Conclusions In an ideal world, we wouldn t need nutritional supplements The reality is that poor diets are common in women and girls Nutrients of concern include iron, folate, vitamin D and LC omega-3 fatty acids So, what can HCPs advise?

31 Population advice Healthy balanced diet is the cornerstone Daily multinutrient supplement can help bridge the gap between intakes and recommendations Folic acid pre- and during pregnancy* Vitamin D (10mcg) during pregnancy and lactation* Daily omega-3fish oil supplement in women who don t eat enough oily fish (140g portion/wk). * Already Govt advice

32 Thank you