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The continuing global increase in the prevalence of overweight and obesity, particularly amongst children, attracts widespread public and political attention. Obesity is a complex condition, with multi‐faceted determinants, and prevention strategies require consideration of dietary and lifestyle patterns alongside a range of environmental factors. Reduction in intake of sugar‐sweetened beverages and foods is advised around the world as part of healthier dietary patterns to help reduce energy intakes, obesity risk and obesity‐related disorders. Current intakes indicate that this is challenging and will likely require a concerted approach with a broad range of interventions including fiscal measures. In recent years, after some notable success with salt and trans fats, there has been considerable focus on food reformulation to support the reduction in population intakes of free sugars from manufactured foods, often without need for consumer behaviour change. In some products, particularly sugar‐sweetened beverages, reformulation is relatively easy and has been widely achieved, as the sweetness of sugars can be replaced with low‐calorie sweeteners. However, other products, in which sugar delivers a variety of functional properties, are more challenging to reformulate to maintain consumer acceptance and achieve a reduction in energy, alongside sugar, content. This paper will look at current definitions and recommendations for free (or added) sugars, as well as key dietary sources and trends in intakes, and explore various strategies to promote population reductions in intake of sugars for public health, including the opportunities and challenges presented by reformulation using low‐calorie sweeteners. Ultimately strategies to promote sugar reduction, including reformulation, should adopt a holistic approach that considers wider dietary recommendations. [ABSTRACT FROM AUTHOR]

Bread has been a widely consumed traditional staple food in the UK for centuries, although there has been a decrease in consumption over the past 50 years. This may reflect the increased availability and popularity of other starchy foods such as pasta and rice and potentially negative misconceptions around bread and health (e.g. weight gain and gastrointestinal symptoms). On average, in the UK, bread provides 11–12% of energy, 16–20% of carbohydrate, 10–12% of protein and 17–21% of fibre intakes across all age groups and is a key contributor to micronutrient intakes (9–14% of folate, 15–17% of iron, 12–17% of calcium, 12–13% of magnesium and 10–11% of zinc). White bread is the largest contributor to salt intakes in the UK, though average salt content has been declining, largely as a result of the government reformulation programme with the food industry, including the setting of salt reduction targets. The mandatory fortification of flour with folic acid, a strategy used successfully in >60 other countries as a means of reducing neural tube defects (NTDs), is currently being considered and may be an important public health initiative. The variety of fibre types in bread such as arabinoxylan, oligosaccharides and resistant starch, as well as other bioactives including polyphenols, are an area of emerging interest in relation to nutrition and health. This paper gives an overview of the current contribution of bread to nutrient intakes and considers trends which may change the role of bread in our diet going forward. [ABSTRACT FROM AUTHOR]

The development of crops that by harvest have accumulated higher amounts of a particular micronutrient than standard crops is known as biofortification. Biofortified staple crops such as provitamin A‐biofortified sweet potato ('orange sweet potato'), zinc‐biofortified rice ('zinc rice') and iron‐biofortified beans ('iron beans'), developed by selective breeding, have been introduced into developing countries with the goal of reducing micronutrient deficiencies. In these settings, micronutrient deficiencies caused by low dietary intakes and exacerbated by inflammation and infection result in considerable morbidity and mortality worldwide. The aim of this review is twofold: (1) to describe the impact of biofortified crops on micronutrient intake, nutritional status and other biological endpoints in developing countries and (2) to consider the relevance of these nutritional effects in other parts of the world such as Europe. Regular consumption of biofortified crops in developing countries where micronutrient deficiency is common has been shown to increase micronutrient intakes and thus help meet the World Health Organization's dietary recommendations. In terms of micronutrient status, most research has been conducted using provitamin A‐biofortified crops (particularly orange sweet potato), with large 2‐ to 3‐year studies indicating increases in plasma retinol, though additional studies measuring change in body stores would provide more definitive evidence. There is some evidence to suggest that iron‐biofortified crops can increase iron status (measured by serum ferritin and total body iron), but further studies are required to demonstrate the efficacy of zinc‐biofortified foods. Intakes of some micronutrients are low in some UK population subgroups (in particular adolescents and young adult women), with sizeable proportions having intakes below the lower reference nutrient intake. There is also evidence of low status for some nutrients (e.g. iron and in particular vitamin D), although the prevalence of iron deficiency is much less, and therefore the consequences less severe, than seen in the developing world. The final part of the paper describes strategies used to improve micronutrient intake in Europe, such as fortification of bread flour post‐harvest and supplementation with vitamin D and folic acid, and discusses whether there is a role for biofortified crops in the UK. [ABSTRACT FROM AUTHOR]

This paper updates a British Nutrition Foundation ( BNF) Briefing Paper on this topic, published in 2011. Healthy eating and being physically active are particularly important for children and adolescents. This is because their nutrition and lifestyle influence their wellbeing, growth and development. There remains considerable room for improvement in the diets of British schoolchildren, according to findings of the government's National Diet and Nutrition Surveys ( NDNS), but some improvements have been made in the past decade. Although intakes of saturated fatty acids and non-milk extrinsic sugars have decreased in recent years, on average, they are still above recommended upper levels. Average contribution of fat to total energy intake has dropped below the recommended upper level of 35%, but fibre intakes remain low. With regard to micronutrients, many teenage girls are consuming low amounts of iron, but there is also evidence of low intakes of vitamin A, riboflavin, calcium, magnesium, potassium, selenium, iodine and zinc. New data on micronutrient status is now available for 11-18 year-olds, and reveals low levels of vitamin D, riboflavin and iron (mainly in girls). Low vitamin D intake and status is a particular problem in some ethnic minority groups, especially South Asian children. There is also some evidence of socio-economic inequalities; for example, children from families with higher incomes tend to have higher intakes of fruits and vegetables compared with children from families with lower incomes. This paper also discusses how dietary patterns can influence the micronutrient intake and status of schoolchildren, as well as the risk of overweight and obesity. Since publication of the Briefing Paper in 2011, new physical activity guidelines have been published and, for the first time, these are UK-wide guidelines. Also for the first time, UK-wide data on physical activity levels in schoolchildren are available (for 7-year-old children). Physical activity levels vary little between the UK regions, with the exception of Northern Ireland where fewer children meet the UK recommendations than in other regions. The data highlight significant differences between boys and girls (with girls generally being less active) and significant differences between ethnic groups. In particular, children from the Bangladeshi, Indian and Pakistani ethnic groups are less likely to meet the recommended levels of physical activity compared with other children. Obesity remains a major problem among British schoolchildren and there is a stark socio-economic gradient, with levels of obesity being highest in the most socially deprived children. This paper also discusses various health issues in children, including iron deficiency anaemia, oral health, bone development, food allergy and intolerance, and cognitive function in children, updating the previous paper with the latest statistics and evidence. The findings of the NDNS serve to emphasise the importance of a whole school approach to good nutrition embracing the school curriculum as well as the food and drink available in schools (as highlighted in the recently published School Food Plan). School food provision has seen many changes over recent years, with school food standards now in place in all UK regions, most recently Wales. Various evaluations of the impact of school food standards, mainly in England, have highlighted improvements in the diets of schoolchildren, not only in the school setting but in their diets overall. However, there remains room for improvement. This paper also briefly describes a selection of initiatives and organisations of relevance to child nutrition. [ABSTRACT FROM AUTHOR]

The Scientific Advisory Committee on Nutrition ( SACN) recently published its draft report on Carbohydrates and Health, in which new recommended intakes for fibre were proposed for children and adults, following an in-depth review of the scientific evidence base. The recommendation for the adult population of 30 g/day, measured by the Association of Official Analytical Chemists' ( AOAC) method, is somewhat higher than current recommendation and, according to intakes reported in the recent National Diet and Nutrition Survey, would require men to increase their fibre intakes by around 50% and women by 75%. This paper discusses current fibre intakes in the UK and describes the main contributors of fibre to the diet. Simple dietary modelling was carried out to investigate the feasibility of the recommendation by SACN in the context of other nutrient recommendations and food-based guidelines. This demonstrated that it is possible to consume 30 g of AOAC fibre a day in the context of a healthy diet that meets other dietary recommendations if all meals are based on starchy foods (including mainly wholegrain options and potatoes with their skins), high fibre snacks are selected and the diet is rich in fruit and vegetables (around 8 portions daily). Barriers to meeting the recommendation are considered, including the negative consumer perceptions of starchy foods and a lack of awareness regarding the health benefits of fibre, particularly those beyond bowel health. Labelling regulations may pose further challenges, as there is not an agreed definition for 'wholegrain' and the European Food Safety Authority (EFSA) has concluded that there is, as yet, insufficient evidence to warrant an official health claim for dietary fibre (as a general food ingredient). Although feasible in the context of other dietary guidelines, the required dietary pattern to achieve 30 g of AOAC fibre a day is not reflective of average diets in the UK. Achieving this population recommendation will therefore be a considerable challenge. Co-operation and collaboration is likely to be required from a number of stakeholders including the food industry, health professionals and regulatory bodies to raise awareness of the benefits of dietary fibre and encourage greater consumption of higher fibre foods. Innovative high fibre ingredients may also be needed to make it easier for consumers to boost their fibre intakes. [ABSTRACT FROM AUTHOR]

Food composition tables require updating regularly to keep abreast of the periodic reformulation of fortified foods and dietary supplements. This paper describes a process undertaken to update the vitamin D content of fortified foods and supplements consumed in the UK, and the impact this may have on reported vitamin D intake. In 2011, the vitamin D content of the 289 vitamin D fortified foods and vitamin D containing supplements recorded in the N ational D iet and N utrition S urvey ( NDNS) Nutrient Databank (last updated in 2008) was compared to data from industry websites, trade associations and manufacturers, and nutrition labelling on pack. Typical 'overages' (the additional amount added to account for any processing loss or degradation) applied during vitamin D fortification were also obtained. This information was used to update the NDNS Nutrient Databank, and applied to NDNS food consumption data (2008/2010) to determine the impact of the composition update on reported population vitamin D intakes. Up-to-date vitamin D values were obtained for 257 (89%) of the 289 items in the NDNS databank; the remainder were no longer available on the market. The vitamin D content of 31 (11%) of the items had changed, and these were most commonly breakfast cereals, fat spreads and powdered malt drinks. A further eight food items were identified as newly fortified with vitamin D. Calculation of mean vitamin D intakes using updated data identified that use of out-of-date food composition data may lead to an underestimation of UK vitamin D intakes of around 3% (0.1 μg/day). When a blanket 12.5% 'overage' was applied to all items, this underestimate increased to 6% (0.2 μg/day). Even though the absolute impact of updating the vitamin D content of fortified foods and supplements on population mean intakes is relatively small, our analysis suggests it is important that nutrient databases are regularly updated. The new estimates of the vitamin D content of foods and supplements should be used for future estimates of vitamin D intake in the UK until a further periodic update is conducted. [ABSTRACT FROM AUTHOR]

Fish plays a useful role in a healthy and balanced diet, and its consumption has long been associated with several health benefits. Fish provides a variety of nutrients, including protein and long-chain omega-3 polyunsaturated fatty acids ( n-3 PUFAs), as well as micronutrients including selenium, iodine, potassium, vitamin D and B-vitamins. Intakes of some of these micronutrients, including iodine and vitamin D, are low in some population groups in the UK, which makes fish a valuable contributor to intakes of these. The long-chain n-3 PUFA eicosapentaenoic acid ( EPA) and docosahexaenoic acid ( DHA), present in oil-rich fish and fish oil, have been suggested to be associated with beneficial health outcomes. In this paper, we review the evidence associating fish and long-chain n-3 PUFAs with various health outcomes. Evidence from observational studies shows a protective effect of fish intake on risk of cardiovascular disease ( CVD; including stroke). Eating at least two portions of fish per week has been associated with a 23-25% lower risk of death from coronary heart disease ( CHD) compared with those eating no or very little fish; eating fish once a week has been associated with a 15% lower risk of CHD death. Fish intake seems only moderately associated with lower risk of stroke, with results from meta-analyses showing a risk reduction of between 6% and 18% in those eating fish 2-4 times per week compared with those eating none. There have been some inconsistencies in study findings relating to fish intake and risk of CVD. Differences in habitual fish intakes of the study populations may account for some of this inconsistency. Evidence from randomised controlled trials ( RCTs) on the effect of long-chain n-3 PUFA supplementation on CVD risk has come mainly from secondary prevention studies and is inconsistent. While early studies support a protective effect, recent studies do not support the hypothesis that long-chain n-3 PUFA supplementation is beneficial in secondary prevention of CVD. Different study outcomes have been influenced by variations in study design and the characteristics of the study populations. Furthermore, the increased use of modern treatments for cardiovascular risk factors ( e.g. statins) may not have been sufficiently controlled for in more recent studies. Treatment doses of long-chain n-3 PUFA also varied substantially between studies, ranging from 0.3 to 6.9 g/day. Current evidence suggests that there is no association between fish consumption and risk of type 2 diabetes. We also found no evidence to suggest that fish intake has a protective effect on several types of cancer (pancreas, prostate, bladder, stomach and ovaries). However, studies do suggest that maternal fish intake during pregnancy may reduce the risk of eczema and asthma in her baby, the evidence being somewhat more consistent for eczema. There may also be a link between fish intake during infancy and childhood and the risk of developing asthma and eczema later in childhood, although the evidence is inconsistent and more studies are needed to clarify the situation. The long-chain fatty acid DHA is crucial for development of the brain and the central nervous system in early life. While studies suggest that fish intake in early life contributes to cognitive development, supplementation with EPA and DHA does not seem to have a beneficial effect on cognitive function in childhood. The European Food Safety Authority ( EFSA) suggests that pregnant and breastfeeding women increase their intake of preformed DHA by 100-200 g/day in addition to the suggested average intake level of long-chain n-3 PUFA for adults (250 mg EPA + DHA combined). EFSA proposes that an intake of 1-2 portions of oil-rich fish per week should be compatible with an adequate DHA supply during pregnancy and lactation. There is some evidence to suggest that higher fish intake, dietary DHA intake and DHA levels in the blood among older adults may be positively associated with a lower risk of dementia and Alzheimer's disease ( AD). In some prospective studies, risk of AD and dementia in those having the highest fish intake, or the highest blood DHA levels, was about half that of those who ate a little or no fish or had a low blood DHA level. In one prospective study, eating fish once a week was associated with a 60% lower risk of AD compared with those who rarely or never ate fish. However, some studies have found no association, and more evidence will be needed to draw reliable conclusions. Fish intake may be associated with slower cognitive decline, but the evidence is very limited and more studies are needed. Data from RCTs do not suggest that long-chain n-3 PUFA supplements are effective in preventing cognitive decline. There is some evidence from cohort and cross-sectional studies that fish intake may be associated with better bone health, but not all studies have found such an association. Oil-rich fish, in particular, is an important dietary source of vitamin D, which is important for bone health, and fish consumed with soft bones are a good source of calcium, which is the most abundant mineral in the skeleton. When making recommendations on fish intake, consideration has to be given to the sustainability of fish supplies. Much work has been done already to ensure that fish stocks are not depleted and more efforts will be required to ensure supplies of fish for future generations. Overall, it is evident that including fish in the diet is associated with several health benefits. The extent to which long-chain n-3 PUFA per se contributes to these various effects has yet to be established. It is likely that other components in fish, such as selenium, potassium, vitamin D or B-vitamins, and other dietary aspects ( i.e. foods typically eaten with fish or foods displaced by fish) contribute to the positive health effects. [ABSTRACT FROM AUTHOR]

Despite efforts to promote the consumption of starchy foods, UK consumers are not meeting the recommended proportion of energy from starch for the population. Awareness of the nutritional benefits of starchy foods is poor and consumers tend to have highly divergent attitudes to, and beliefs about, these foods - although starchy foods are generally viewed as good for health, they are also often described as 'fattening' and avoided by those trying to lose weight. Concern about wheat allergy and other gastrointestinal problems commonly associated with bread in particular are also barriers to it being perceived as a 'healthy food'. There is therefore clearly a mismatch between consumers' perceptions of starchy foods and current nutritional guidelines. This paper considers the evidence for and against the most common consumer perceptions around the health effects of bread and the possible impact of reduced levels of consumption on the nutrient intake of individuals. [ABSTRACT FROM AUTHOR]

Despite being a staple food in the UK for centuries, bread consumption has fallen steadily over the last few decades. Average consumption now equates to only around 2-3 slices of bread a day. As well as providing energy, mainly in the form of starch, bread contains dietary fibre and a range of vitamins and minerals. The National Diet and Nutrition Survey (NDNS) of adults suggests that it still contributes more than 10% of our daily intake of protein, thiamine, niacin, folate, iron, zinc, copper and magnesium; one-fifth of our fibre and calcium intakes; and more than one-quarter of our manganese intake. Therefore, eating bread can help consumers to meet their daily requirements for many nutrients, including micronutrients for which there is evidence of low intake in some groups in the UK, such as zinc and calcium. This paper gives an overview of the role of bread in the UK diet, its contribution to nutrient intakes and current consumption patterns in different population groups. [ABSTRACT FROM AUTHOR]

SummaryIntroduction1Definitions of ethnic groups and demographics of minority ethnic groups in the UK○ 1.1 Definitions of 'ethnic groups' and 'ethnicity'○ 1.2 Demographics and characteristics of minority ethnic groups in the UK– Countries of origin– Age/sex distribution and life expectancy– Geographical distribution and size of household– Religious beliefs– Education and employment patternsKey points2Overview of the health profile and dietary habits of minority ethnic groups in the UK○ 2.1 Available surveys○ 2.2 Overview of the health profiles among adults from minority ethnic groups– Overall health– Cardiovascular disease (CVD)– Coronary heart disease (CHD)– Stroke– Type 2 diabetes– Obesity○ 2.3 Possible causes of increased disease risk among minority ethnic groups○ 2.4 Smoking, drinking and physical activity habits○ 2.5 Dietary habits and nutritional status○ 2.6 Overview of the health profiles and dietary and health behaviour patterns of children from minority ethnic groups– Overall health– Diet and health behaviour patterns○ 2.7 Gaps in data availabilityKey points3Factors affecting food choice– Income and socio‐economic status– Food availability and access– Awareness of healthy eating– Religious beliefs– Food beliefs– Time and cooking skills– Generation and genderKey points4Traditional diets of minority ethnic groups○ 4.1 Overview of traditional diets of minority ethic groups– South Asians– African‐Caribbeans– Chinese○ 4.2 Dietary acculturation○ 4.3 Nutritional composition of ethnic‐style cuisineKey points5Nutritional interventions and health promotion among minority ethnic groups○ 5.1 Effective nutritional interventions○ 5.2 Health promotion interventions to prevent problems associated with fasting○ 5.3 Priorities for nutritional interventions and health promotion○ 5.4 Using behaviour change models○ 5.5 Current community initiatives○ 5.6 Catering for institutionalised individuals○ 5.7 Recommendations for future research, policy and practiceKey points6Conclusion• Acknowledgements• References Summary: According to the latest census, non‐white minority ethnic groups made up 7.9% of the UK's population in 2001. The largest of these groups were South Asians, Black African‐Caribbeans and Chinese. Studies have shown that some minority ethnic groups are more likely to experience poorer health outcomes compared with the mainstream population. These include higher rates of cardiovascular disease (CVD), type 2 diabetes and obesity. The differences in health outcomes may reflect interactions between diet and other health behaviours, genetic predisposition and developmental programming, all of which vary across different groups. As is the case for the rest of the population, the dietary habits of minority ethnic groups are affected by a wide variety of factors, but acquiring a better understanding of these can help health professionals and educationalists to recognise the needs of these groups and help them to make healthier food choices. Unfortunately, to date, there have been few tailored, well‐designed and evaluated nutritional interventions in the UK targeting minority ethnic population groups. Further needs assessment and better evaluation of nutritional interventions have been recommended to enhance the understanding of the effectiveness of different approaches amongst minority ethnic groups. This briefing paper will provide an overview of the health profile, dietary habits and other health behaviours of the three largest non‐white minority ethnic groups in the UK, explore the factors affecting their food choices, provide a summary of their traditional diets and review the evidence base to identify the factors that support successful nutrition interventions in these groups. [ABSTRACT FROM AUTHOR]

This paper provides an update of a previous review ' Red Meat in the Diet' published in the Nutrition Bulletin in 2005. An update on red meat consumption levels in the UK and other countries is provided, and a summary of the nutritional content of red meat in the diet is given. Current evidence on dietary and lifestyle factors associated with red meat consumption and the effects of red meat intake on health and chronic disease outcomes are discussed. As there is now continued debate about the environmental impact of different aspects of our diet, sustainability issues regarding red meat were also discussed. [ABSTRACT FROM AUTHOR]