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Key Features: • The National Diet and Nutrition Survey Rolling Programme (NDNS RP) is a cross-sectional, annual survey designed to collect detailed, quantitative information on food consumption, nutrient intake and nutritional status of the general United Kingdom (UK) population aged ≥ 1.5 years. • NDNS RP uses a stratified sampling design to generate a random sample of private UK households each year and nationally representative core sample of around 1000 participants (500 adults, 500 children) each year. Design provides for additional recruitment at country level. • Data/samples include: socio-demographic; dietary assessment; anthropometry; physical activity; energy expenditure; blood and urine samples for nutritional biomarker analysis; National Health Service (NHS) Central Registry and Cancer Registry linkage, contact for further research. • NDNS RP dataset (2008-2019) comprises: dietary data (7999 adults and 7656 children); blood biomarkers (4181 adults and 2014 children); spot urine (3246 adults and 2318 children); total energy expenditure (using doubly labelled water) (419 adults and 352 children). Results published and disseminated via UK Government; survey data accessible via UK Data Service. • Stored biological samples are accessible for further health related research in the public interest through the NDNS Bioresource. • NDNS RP data underpin monitoring and development of nutrition policy. Data are used for chemical exposure risk assessment and modelling for consumer safety.

Results of the National Diet and Nutrition Survey (NDNS) rolling programme for 2014 to 2015 and 2015 to 2016.

This report presents an overview of key findings for food consumption, nutrient intake and nutritional status for the UK in Years 5 and 6 (combined) (2012/13–2013/14) of the NDNS RP. The report also provides background information on the survey, including the sample and methodology. Urinary iodine measurement was introduced in Year 6 of the NDNS RP and is therefore presented for the first time in this report. The commentary in this report mainly discusses the descriptive statistics for Years 5 and 6 (combined). The report is supported by accompanying Excel tables providing data for Years 5 and 6 (combined) and the previous paired years (Years 1 and 2 combined; Years 3 and 4 combined).

National Diet and Nutrition Survey results from 2008 to 2017 assessing time and income trends for diet, nutrient intake and nutritional status for the UK

This report describes the changes in dietary methodology in the National Diet and Nutrition Survey rolling programme (NDNS RP) implemented from fieldwork year 12 (2019 to 2020), sets out the plan for evaluating the impact of the changes on participation in the survey and the resulting data, and presents findings from the first stage of this evaluation.

There is an established relationship between salt intake and risk of high blood pressure (hypertension), which is a risk factor in the development of cardiovascular disease (CVD), such as heart disease and stroke. 1,2,3,4,5 High blood pressure affects approximately 31% of adults in England. 6 Evidence has shown that a reduction in salt intake leads to a lowering of blood pressure, particularly in people with hypertension, and is associated with a decrease in the incidence of CVD. 7 The Scientific Advisory Committee on Nutrition (SACN) recommends a target reduction in the average salt intake of the UK population to a maximum of 6 g/day. 8 This level has been set as the UK government recommended maximum salt intake for adults and children aged 11 years and over. Following publication of the SACN Salt and Health report in 2003, the UK government began a programme of reformulation work with the food industry aimed at reducing the salt content of processed food products. Voluntary salt reduction targets were first set in 2006 for a range of food categories that contribute the most to the population’s salt intakes and further revised in 2009, 2011 and 2014. 9 In this 2018/19 survey, salt intake of adults aged 19 to 64 years in England was estimated from the measurement of 24-hour urinary sodium excretion. Urine samples were collected between November 2018 and May 2019 from 596 adults. Estimated salt intake was calculated based on 17.1 mmol of sodium equalling 1.0 g of salt and assumed all urinary sodium was derived from salt and 100% was excreted over 24 hours. Completeness of the urine collections was assessed using the paraaminobenzoic acid (PABA) method. The survey was powered to detect a 7% decrease in salt intake (equivalent to 0.5 g/day) between the most recent previous England Sodium Survey in 2014 and the current survey in 2018/19. This data helps to establish progress towards meeting the government recommendation8 and build on the series of previous surveys across the UK since 2005/06. 10,11,12,13,14,15,16,17,18 This report describes population mean estimated salt intake for adults aged 19 to 64 years in England in 2018/19 and provides a comparison with estimated population salt intakes assessed in the previous 2014 England Sodium Survey. 12 An updated analysis of the trend in estimated salt intake over time since 2005/06 is also provided.

Results from a follow-up study of National Diet and Nutrition Survey (NDNS) participants for food consumption, nutrient intakes and physical activity.

Peer reviewed: True, Funder: Public Health England and the UK Food Standards Agency, The UK National Diet and Nutrition Survey rolling programme (NDNS RP) commenced in 2008 and moved in 2019 from a traditional paper food diary to a web-based 24 h recall, Intake24. This paper describes the approach to update and downsize the underlying UK Nutrient Databank (NDB) for efficient data management and integration into Intake24. Consumption data from the first 10 years (2008/2009 to 2017/2018) of NDNS RP informed decisions on whether foods from the extensive UK NDB were to be retained, excluded, revised or added to for creation of a rationalised NDB. Overall, 5933 food codes in the extensive NDB were reduced to 2481 food codes in the rationalised NDB. Impact on assessment of nutrient intakes was evaluated by re-coding NDNS 2017 data using the rationalised NDB. Small differences were observed between estimated intakes (Cohen's d ≤ 0.1) for all nutrients and there was a good level of agreement (Cohen's κ ≥ 0.6) between the extensive and rationalised NDBs. The evaluation provides confidence in dietary intake estimates for ongoing nutritional surveillance in the UK and strengthens the evidence of a good agreement between concise food databases and large food databases incorporated into web-based 24 h recalls for estimating nutrient intakes at the population level.

BACKGROUND: The measurement of micronutrient status is essential to understand the health of individuals and populations, but there are limited data on the stability of micronutrients in whole blood. OBJECTIVES: The objective was to investigate the effects of delayed processing of whole blood on the stability of 25 micronutrient and selected clinical biomarkers. METHODS: Blood from 16 healthy adults was collected into EDTA, lithium heparin (LH), or serum tubes. Samples were processed within 2 hours of collection ("2-hour processed") or mailed overnight (boxed with frozen cold packs) before processing ("24-hour processed"). Micronutrient and clinical biomarker concentrations were quantified with validated methods. The concentration percentage difference between the 2- and 24-hour processed samples was calculated and was compared against quality specifications determined from intra- and interindividual variations. RESULTS: All analytes had a sample type where the percentage difference concentration between 2-hour and 24-hour processed samples was ≤4% and was acceptable based on calculated limits, including for biomarkers of vitamin A, vitamin D, thiamin, folate, vitamin B-12, iron (ferritin), and zinc status and for selected clinical markers, C-reactive protein, HDL and total cholesterol, and triglycerides. EDTA plasma vitamin C was lower compared to the 2-hour processed sample (geometric mean, 43%; 95% CI: 36%-49%). Pyridoxal-5-phosphate (vitamin B-6 biomarker) decreased, with differences from the 2-hour processed samples of -8% (95% CI: -13% to -2%) and -14% (95% CI: -18% to -9%) in LH plasma and serum, respectively. CONCLUSIONS: In blood collected from adult participants, delayed processing of chilled whole blood for 24 hours did not materially affect the measured concentrations of the majority of micronutrients and selected clinical biomarkers. This suggests that for these analytes, adherence to a 2-hour processing protocol may be unnecessary. This knowledge is valuable and may help to simplify logistics for sample transport and processing of blood samples for micronutrient status assessment.

Additional file 1. systematic review of reviews search algorithm. This is an example of a search run in Ovid MEDLINE(R). The search was initially conducted in May/June 2015, then updated in October 2016, and was restricted to reviews published between January 2000 and October 2016. (DOCX 12 kb)

Background: Dietary assessment is complex, and strategies to select the most appropriate dietary assessment tool (DAT) in epidemiological research are needed. The DIETary Assessment Tool NETwork (DIET@NET) aimed to establish expert consensus on Best Practice Guidelines (BPGs) for dietary assessment using self-report. Methods: The BPGs were developed using the Delphi technique. Two Delphi rounds were conducted. A total of 131 experts were invited, and of these 65 accepted, with 48 completing Delphi round I and 51 completing Delphi round II. In all, a total of 57 experts from North America, Europe, Asia and Australia commented on the 47 suggested guidelines. Results: Forty-three guidelines were generated, grouped into the following four stages: Stage I. Define what is to be measured in terms of dietary intake (what? who? and when?); Stage II. Investigate different types of DATs; Stage III. Evaluate existing tools to select the most appropriate DAT by evaluating published validation studies; Stage IV. Think through the implementation of the chosen DAT and consider sources of potential biases. Conclusions: The Delphi technique consolidated expert views on best practice in assessing dietary intake. The BPGs provide a valuable guide for health researchers to choose the most appropriate dietary assessment method for their studies. These guidelines will be accessible through the Nutritools website, www.nutritools.org.

BACKGROUND: Where children eat has been linked to variations in diet quality, including the consumption of low-nutrient, energy-dense food, a recognized risk factor for obesity. OBJECTIVE: The aim of this study was to provide a comprehensive analysis of consumption patterns and nutritional intake by eating location in British children with the use of a nationally representative survey. DESIGN: Cross-sectional data from 4636 children (80,075 eating occasions) aged 1.5-18 y from the UK National Diet and Nutrition Survey Rolling Program (2008-2014) were analyzed. Eating locations were categorized as home, school, work, leisure places, food outlets, and "on the go." Foods were classified into core (considered important or acceptable within a healthy diet) and noncore (all other foods). Other variables included the percentage of meals eaten at home, sex, ethnicity, body mass index, income, frequency of eating out, takeaway meal consumption, alcohol consumption, and smoking. RESULTS: The main eating location across all age groups was at home (69-79% of eating occasions), with the highest energy intakes. One-third of children from the least-affluent families consumed ≤25% of meals at home. Eating more at home was associated with less sugar and takeaway food consumption. Eating occasions in leisure places, food outlets, and "on the go" combined increased with age, from 5% (1.5-3 y) to 7% (11-18 y), with higher energy intakes from noncore foods in these locations. The school environment was associated with higher intakes of core foods and reduced intakes of noncore foods in children aged 4-10 y who ate school-sourced foods. CONCLUSIONS: Home and school eating are associated with better food choices, whereas other locations are associated with poor food choices. Effective, sustained initiatives targeted at behaviors and improving access to healthy foods in leisure centers and food outlets, including food sold to eat "on the go," may improve food choices. Home remains an important target for intervention through family and nutrition education, outreach, and social marketing campaigns. This trial was registered with the ISRTCN registry (https://www.isrctn.com) as ISRCTN17261407.

Eating location has been linked with variations in diet quality including the consumption of low-nutrient energy-dense food, which is a recognised risk factor for obesity. Cross-sectional data from 4736 adults aged 19 years and over from Years 1-6 of the UK National Diet and Nutrition Survey (NDNS) Rolling Programme (RP) (2008-2014) were used to explore food consumption patterns by eating location. Eating location was categorized as home, work, leisure places, food outlets and "on the go". Foods were classified into two groups: core (included in the principal food groups and considered important/acceptable within a healthy diet) and non-core (all other foods). Out of 97,748 eating occasions reported, the most common was home (67-90% of eating occasions). Leisure places, food outlets and "on the go" combined contributed more energy from non-core (30%) than from core food (18%). Analyses of modulating factors revealed that sex, income, frequency of eating out and frequency of drinking were significant factors affecting consumption patterns (p < 0.01). Our study provides evidence that eating patterns, behaviours and resulting diet quality vary by location. Public health interventions should focus on availability and access to healthy foods, promotion of healthy food choices and behaviours across multiple locations, environments and contexts for food consumption.

Additional file 2. UK validation study results for dietary assessment tools by nutrient in children/adolescents (0 to 18 years). This table provides the numerical values from the published validation studies of dietary assessment tools in children/adolescents which are included in the summary plots. (DOCX 29 kb)

Additional file 2. UK validation study results for dietary assessment tools by nutrient in children/adolescents (0 to 18 years). This table provides the numerical values from the published validation studies of dietary assessment tools in children/adolescents which are included in the summary plots. (DOCX 29 kb)

ContextOverestimation or underestimation of portion size leads to measurement error during dietary assessment.ObjectiveTo identify portion size estimation elements (PSEEs) and evaluate their relative efficacy in relation to dietary assessment, and assess the quality of studies validating PSEEs.Data Selection and ExtractionElectronic databases, internet sites, and cross-references of published records were searched, generating 16 801 initial records, from which 334 records were reviewed and 542 PSEEs were identified, comprising 5% 1-dimensional tools (eg, food guides), 46% 2-dimensional tools (eg, photographic atlases), and 49% 3-dimensional tools (eg, household utensils). Out of 334 studies, 21 validated a PSEE (compared PSEE to actual food amounts) and 13 compared PSEEs with other PSEEs.ConclusionQuality assessment showed that only a few validation studies were of high quality. According to the findings of validation and comparison studies, food image–based PSEEs were more accurate than food models and household utensils. Key factors to consider when selecting a PSEE include efficiency of the PSEE and its applicability to targeted settings and populations.

BackgroundLittle is known about population levels of energy expenditure, as national surveillance systems typically employ only crude measures. The National Diet and Nutrition Survey (NDNS) in the UK measured energy expenditure in a 10% subsample by gold-standard doubly labelled water (DLW).MethodsDLW-subsample participants from the NDNS (383 males, 387 females) aged 4–91 years were recruited between 2008 and 2015 (rolling programme). Height and weight were measured and body-fat percentage estimated by deuterium dilution.ResultsAbsolute total energy expenditure (TEE) increased steadily throughout childhood, ranging from 6.2 and 7.2 MJ/day in 4- to 7-year-olds to 9.7 and 11.7 MJ/day for 14- to 16-year-old girls and boys, respectively. TEE peaked in 17- to 27-year-old women (10.7 MJ/day) and 28- to 43-year-old men (14.4 MJ/day), before decreasing gradually in old age. Physical-activity energy expenditure (PAEE) declined steadily with age from childhood (87 kJ/day/kg in 4- to 7-year-olds) through to old age (38 kJ/day/kg in 71- to 91-year-olds). No differences were observed by time, region and macronutrient composition. Body-fat percentage was strongly inversely associated with PAEE throughout life, irrespective of expressing PAEE relative to body mass or fat-free mass. Compared with females with 40% recorded 29 kJ/day/kg body mass and 18 kJ/day/kg fat-free mass less PAEE in analyses adjusted for age, geographical region and time of assessment. Similarly, compared with males with 35% recorded 26 kJ/day/kg body mass and 10 kJ/day/kg fat-free mass less PAEE.ConclusionsThis first nationally representative study reports levels of human-energy expenditure as measured by gold-standard methodology; values may serve as a reference for other population studies. Age, sex and body composition are the main determinants of energy expenditure.Key Messages This is the first nationally representative study of human energy expenditure, covering the UK in the period 2008-2015. Total energy expenditure (MJ/day) increases steadily with age throughout childhood and adolescence, peaks in the 3rd decade of life in women and 4th decade of life in men, before decreasing gradually in old age. Physical activity energy expenditure (kJ/day/kg or kJ/day/kg fat-free mass) declines steadily with age from childhood to old age, more steeply so in males. Body-fat percentage is strongly inversely associated with physical activity energy expenditure. We found little evidence that energy expenditure varied by geographical region, over time, or by dietary macronutrient composition.