1. © 2014 The British Nutrition Foundation Nutrition Update Sarah Coe, Nutrition Scientist British Nutrition Foundation 15 th November 2014

2. © 2014 The British Nutrition Foundation Outline The ‘5532-a-day’ toddler guide Vitamin D

3. © 2014 The British Nutrition Foundation Background No food-based guidance for parents of toddlers (1-3 years) available Guidance that children should ‘gradually move towards’ eating in line with the eatwell plate is confusing Health professionals wanted something age-specific

4. © 2014 The British Nutrition Foundation Nutrient requirements of toddlers Naturally active and growing rapidly – energy and nutrient requirements are high Nutrient-dense foods Regular drinks Establishing good dietary habits

5. © 2014 The British Nutrition Foundation Nutrient requirements of toddlers GroupNutrients providedRecommendationExamples of foods 1. Potatoes, bread, rice, pasta and other starchy foods Energy, some protein, fibre, vitamins and minerals 1 portion offered at each meal and at some snack times Breakfast cereals Bread sticks Rice cakes 2. Fruit and vegetables Vitamins and minerals, fibre, phytochemicals Serve at each meal and at some snack times Fresh/frozen/canned /dried 3. Milk and dairy foods Energy, protein, calcium, other vitamins and minerals Serve 3 times a day (whole milk/yogurt for under 2’s) Milk Yogurt Cheese 4. Meat, fish, eggs, beans and other non-dairy sources of protein Protein, energy, omega 3 fats, vitamins and minerals Serve 2-3 times a day (3 times for vegetarian toddlers) Fish – twice a week (one portion oil-rich) Meat Fish Eggs Nuts Pulses

6. Nutrient requirements of toddlers GroupNutrients provided RecommendationExamples of foods 5. Foods high in fat and/or sugar Energy, fat, vitamin A, E and D Offered only in addition to (not instead of) foods from the other food groups. Sugary foods should be kept to meal times and no more than 4 occasions a day Butter, margarine Cakes/biscuits Sweets Sweetened drinks © 2014 The British Nutrition Foundation

7. Key nutritional issues in 1-3 year-olds 1 in 5 overweight/obese when start primary school Type 2 diabetes Not enough… Iron Zinc Vitamin A Vitamin D Too much! Saturated fat Sugars Salt 12% of 3 year-olds have tooth decay Rickets

8. © 2014 The British Nutrition Foundation Developing the toddler guide Set up an advisory group to develop ideas and review the research Held focus groups with mums and health visitors

9. © 2014 The British Nutrition Foundation Key Messages

10. © 2014 The British Nutrition Foundation Not new but useful reminder Surprise at inclusion of ‘carbs’

11. TOO MUCH!! © 2014 The British Nutrition Foundation

12. Helps reinforce the breakdown of the food groups Memorable Needs careful communication of portion sizes

13. © 2014 The British Nutrition Foundation Design Routes

14. © 2014 The British Nutrition Foundation

18. And the winner was…

19. © 2014 The British Nutrition Foundation

23. Dissemination “I work with parents with young children and they have been crying out for this information re. portion guidance” Community & Health Coordinator, Co.Tyrone http://www.nutrition.org.uk/healthyliving/toddlers/5532 http://www.nutrition.org.uk/healthyliving/nutrition4baby

24. © 2014 The British Nutrition Foundation Vitamin D December 2014 www.blackwellpublishing.com/nbuwww.blackwellpublishing.com/nbu

25. © 2014 The British Nutrition Foundation Vitamin D Review to explore vitamin D status and intake in Europe Sources Vitamin D deficiency How much do we need? How much are we getting? Supplements and fortification

26. © 2014 The British Nutrition Foundation Why do we need vitamin D? Help us absorb calcium and phosphorus from the food we eat Healthy bones and teeth Severe lack of vitamin D = rickets and osteomalacia (soft and weak bones)

27. © 2014 The British Nutrition Foundation Sources of vitamin D Sunlight Natural food sources Fortified foods Diet Supplements

28. © 2014 The British Nutrition Foundation UK National Diet and Nutrition Survey (2008/09-2011/12) Sources of vitamin D Contribution of food groups to vitamin D intake in adults and children Adults aged 19 years and over Children aged 4- 18 years Children aged 1.5-3 years Meat and meat products 23-30%25-35%21% Fat spreads19%20-21%20% Cereals and cereal products 13%17-20%14% Fish17-23%8-9%8% Milk and milk products 5-6%6-13%24%

29. © 2014 The British Nutrition Foundation Vitamin D deficiency Increased risk if: Overuse sunscreen Have darker skin Low or no exposure to the sun Other population groups at risk: Pregnant or breastfeeding Teenagers and young women Babies and children under 5 years Older people aged 65 years and over

30. © 2014 The British Nutrition Foundation How much vitamin D do we need? Currently no agreement on what is the optimal amount of vitamin D Recommended intakes across Europe vary from 5-20 µg/day European average = 10 µg/day In the UK - there is no recommendation for vitamin D for those aged 4-65 years

31. © 2014 The British Nutrition Foundation How much vitamin D are we getting? Average intake from food for adults does not meet the recommendation: 4.8 μg/day (men), 3.3 μg/day (women) Most countries = 2-4 μg/day Lowest = Spain (<2 μg/day) Highest = Scandinavian countries

32. © 2014 The British Nutrition Foundation How much vitamin D are we getting? Average daily vitamin D intakes (μg/day) 1.5-3y4-10y11-18y19-64y65+y From food only1.92.02.12.83.3 From food + supplements 2.32.72.43.65.1 Source: NDNS 2008/09-2011/12

33. How much vitamin D are we getting? In UK, vitamin D deficiency is more common in winter than in the summer (39% vs. 8% adults) We can only make vitamin D from the sun between April and September Need to be out in the sun for few minutes between 11-3pm © 2014 The British Nutrition Foundation

34. How can vitamin D status be improved? Supplements Fortification Improve population’s diet and lifestyle © 2014 The British Nutrition Foundation

35. Supplements Pregnant and breastfeeding women More likely to be taken in Northern Europe and by women UK – Healthy Start scheme (low uptake) Will only work if they are taken! Vitamin D supplements (10 µg/day)

36. © 2014 The British Nutrition Foundation Fortification Varies throughout Europe Milk and milk products Finland (+ non-dairy alternatives e.g. soy, rice/oat drinks) Sweden (low fat) Margarine and fat spreads Finland (+ butter) Sweden UK (margarine) Breakfast cerealsInfant formula

37. Summary Healthy eating over the life course is important Some health issues e.g. low vitamin D might be more of a concern in some groups, but spans from young children to older adults Important to get diet right from the start © 2014 The British Nutrition Foundation

38. Thank you for listening www.nutrition.org.uk www.foodafactoflife.org.uk