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UK women 'have poor diets'

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Millions of British women face health risks because they are “shunning nutritious foods”, says the Daily Mail.

The Daily Express says that the dangers of a love of junk food and obsession with “food fads” even affect their unborn babies.

These reports are based on research examining evidence on the quality of the diets of UK women throughout their lives. It found that, among most age groups, intakes of key micronutrients, particularly iron, vitamin D, calcium and folate, remain below recommended levels. Many women’s diets are also too high in saturated fat and salt, and low in fibre, oily fish and fruit and vegetables.

This narrative review was not a systematic analysis of research in this field, but its finding are in line with a body of quality evidence that suggests that many women (as well as men and children) are not consuming recommended levels of nutrients and, generally, do not have healthy diets. This is a serious, recognised issue that clearly needs to be addressed. However, while this study concludes that fortified foods or vitamin and mineral supplements may have a role to play in improving women’s nutrition, it is important to have a systematic approach to the evidence on supplementation and nutritional health.

Where did the story come from?

The review was carried out by Carrie Ruxton, a dietitian who runs a nutrition consultancy, and Emma Derbyshire, a researcher from Manchester Metropolitan University. The study was funded by the Health Supplements Information Service (HSIS), an online information programme funded by the Proprietary Association of Great Britain, which is the trade association for manufacturers of food supplements and over-the-counter medicines.

The study was published in Nutrition Bulletin, a publication of the British Nutrition Foundation, a registered charity.

The review’s overall finding that many women eat poorly was generally reported accurately, if somewhat sensationally, in the media. The Daily Telegraph’s headline about millions on “danger diets” and claims in the Daily Express about “food fads” are not borne out by the evidence presented in this study. The newspapers also failed to mention the fact that there is evidence for some improvements in dietary quality over the last few years. Stories in some papers used phrasing and quotes that were identical to those found in the press release on the review. The Daily Mail correctly pointed out (near the end of its report) that the study was industry-funded, but the Express incorrectly called HSIS an “independent body”.

What kind of research was this?

This was a non-systematic narrative review discussing women’s diets. It used supporting evidence from various studies of nutrition. It also referenced studies on the relationship between diet and health. It relied heavily on data from the main source of dietary information in the UK, the National Diet and Nutrition Survey (NDNS), as collated by the Scientific Advisory Committee on Nutrition (SACN). This evidence was supplemented by other studies of women’s diet. The government surveys of nutrition are reputable and generally thought to be accurate.

The study also describes evidence that a poor diet and high alcohol intake are both related to diseases such as cancer, cardiovascular disease, diabetes, osteoporosis and mental health problems. It does not systematically examine the quality of all this evidence, but uses some of it as part of an argument for the importance of improving women’s diets. Some research experts might describe this method for selecting evidence as ‘cherry picking’.

What did the research involve?

The review summarised over 100 studies addressing women’s diets and dietary deficiencies, and also how diet relates to other aspects of health. The review did not state how it identified and selected the studies to be included and, therefore, may not identify or include all relevant studies. The studies that were not included may not agree with the findings of studies that were included. Those studies that were included were summarised in a narrative way.

What were the basic results?

The review of UK dietary surveys broadly found that, while some improvements have occurred, intakes of key micronutrients, particularly iron, vitamin D, calcium and folate, remain below recommended levels across most age groups. Women’s diets are also too high in saturated fat and salt, and low in fibre, oily fish and fruit and vegetables.

The authors also make numerous specific observations on nutrition, such as:

Among girls of school age, 52% have low intakes of magnesium, 25% have low intakes of zinc and about a quarter have poor iron status.

Among women in their childbearing years 20% fail to meet the Lower Reference Nutrient Intake (LRNI) for iron and 83% eat more than the maximum recommended salt intake of 6g daily.

The authors also think vitamin D intake may be inadequate, although there is no consensus about recommended intake (the body can obtain vitamin D through either dietary intake of certain foods or by producing it when the skin is exposed to sunlight).

On average, pregnant women do not meet recommendations for vitamin D or folate.

Middle-aged women (aged 50-64) tend to eat better quality diets and meet recommended levels of most nutrients.

Older women (over 65 years) have low intakes of calcium, magnesium and zinc, and vitamin D status is poor.

The researchers also conclude that the evidence suggests that certain chronic conditions are influenced by dietary components. For example, they say that:

  • inadequate calcium and vitamin D intakes reduce bone density
  • salt and saturated fat increase cardiovascular disease risk
  • excessive alcohol intakes increase cancer risk
  • low intakes of long-chain n-3 fatty acids may adversely affect foetal development and mental health
  • adequate folic acid reduces the risk of birth defects

How did the researchers interpret the results?

The authors conclude that, although there have been positive changes in UK women’s diets, “there is still room for improvement”. High intakes of salt, saturated fat and alcohol remain a problem, as do low intakes of fibre, long-chain n-3 fatty acids, iron, calcium, folate and vitamin D. They say that women need to make better dietary choices in order to ensure adequate levels of micronutrients and, thus, safeguard health.

However, they suggest that attaining optimal levels of some vitamins and minerals from food sources may be “challenging” for some groups of women and, therefore, fortified foods and supplements should continue to play a role in public health campaigns. They argue that, because of insufficient year-round exposure to sunlight and because few foods are naturally rich in vitamin D, vitamin supplements play an important role in helping vulnerable groups achieve acceptable vitamin D status.

Conclusion

This review does not tell us anything new, but it does highlight the worrying fact that many women in the UK of all ages have poor diets. Diet and food choices are complex issues and are also influenced by many environmental factors such as income, lifestyle and access to cheap, nutritious food, some of which are not entirely within an individual’s control.

Sticking to a healthy diet is easier said than done, but it’s important to try to make healthy choices. The current advice is to:

  • Eat a variety of food, including plenty of fruit, vegetables and starchy foods, such as wholemeal bread and wholegrain cereals; some protein-rich foods, such as meat, fish, eggs and lentils; and some milk and dairy foods.
  • Eat more fish, including one portion of oily fish a week.
  • Cut down on sugar and saturated fats (found in butter, cream, cheese and many processed foods).
  • Eat less salt (no more than 6g a day).

As a review of nutrition, the authors do not pay much attention to sunlight as a source of vitamin D.

While some groups may benefit from vitamin supplements (women who are pregnant or planning to be for example, are advised to take supplements of folic acid and vitamin D), it is not clear from this report which subgroups of women can get nutrients from eating a healthy diet and who may need supplementation.

It is worth considering the commercially-affiliated funding source of this review and the choice of evidence presented before deciding what role vitamins, mineral supplements or fortified foods may have in improving the health of women.

Links to the headlines

Millions of British women on danger diets. The Daily Telegraph, June 1 2010

Too much alcohol and not enough vitamins: How poor diet is putting women of all ages at risk. Daily Mail, June 1 2010

Food fads that are putting women’s health in danger. Daily Express, June 1 2010

Links to the science

Ruxton CHS and Derbyshire E et al. Women’s diet quality in the UK. Nutrition Bulletin, Volume 35 Issue 2, Pages 126-137 [Published Online May 20 2010]

  • 3 Comments

Readers' comments (3)

  • uk women are so careless about their diet, health and looks it is hardly surprising. good diet is commonsense and everyone is responsible for themselves and their families not the nhs. nor should they need educating, there is plenty of information out there for the less well-informed. bad eating is merely sloppy habit and laziness and nothing else although the food industry and especially the supermarkets do absolutely nothing to help. compare them to those in other well-off European countries where food on the shelves of supermarkets is displayed in a colourful, attractive and tempting manner also designed to increase their sales and known as marketing psychology. Wonderful displays of a huge variety of excellent quality fruit and vegetables well arranged at the entrance of a supermarket is used to enhance mood and stimulate purchase instead of the scruffy motheaten looking fruit on many of the english shelves carelessly left in their wooden boxes and half of them lacking any price tags makes shopping a chore to be got over fast instead of making all the rich choices of healthy foods a pleasure and social occasion where there is plenty of room to push around trolleys and stop for the odd chat.

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  • It's true! in Britiain we don't have an idea what good healthy natural food is. Our taste buds have been brainwashed by the media and advertising. If it comes from Mark's & Spencers or sainsbury's then it has to be good of course, whereas if it's from Tesco or asda it's considered inferior. It makes me laugh how British women have put a vogue slant on food, just to listen to them conversing on the subject is short of farcical. I lived in Italy for thirteen years where even children understand the importance of good nutrition. I have now returned to the UK and it amazes me what women regularly stuff their faces with, then complain that they're overweight. If it says it on the packet then they believe it is good for us, worse still I was shocked to see what they feed their kids on. Don't get me wrong I'm all for the occasional burger, and the rare bottle of coca cola but keep it in context. British people have no connection with the land, climate and diet as they do on the continent. We used to but unfortunately the Supermarket culture in this country, imported from the states is so well developed and powerful that it has successfully crushed small scale food producers. The government has also permitted this and closed a blind eye to the truth. Thank god for people like the SOIL ASSOCIATION. The good news is that this immoral behaviour is now backfiring on itself and we appear to be returning to traditional farmers markets, local produce and people even growing their own fruit and veg. which is wonderful news. My children's primary school have a veg plot and the kids get to bring home what they've grown. They start with a compost bin and learn everything involved in food production right up to harvesting it. It helps them to understand the great circle of life.

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  • if I remember rightly, Michele Obama set an excellent example by showing kids how and helping them plant foodstuffs in the White House garden. I agree most of what was said above although I am not too impressed with all the packages sold in Sainsburys and M&S either but wouldn't dream of going to the other two above mentioned stores. The most reasonable for choice and attractive presentation and better quality I have seen so far is Waitrose but this may also be slightly more expensive. However, I am sure that anything that comes out of a packet must be more expensive than fresh food and far less nutritious. Also fresh food doesn't always take any longer to prepare and fresh fruit is ready to eat anyway if people can be bothered to wash it!

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