Thursday, July 28, 2011

A comparison of the 1995 NNS and 2007 NCNPAS

Are Australian children eating healthier?

Australian National dietary survey’s are few and far between. These large and expensive Australian representative surveys are invaluable for understanding Australian’s food intake and nutrition status and the results provide the evidence base for public health, marketing and policy decisions. With 1 in 4 of Australian children overweight or obese, regular monitoring of the dietary intakes of children is essential.

Australia's most recent National Nutrition Survey was conducted in 1995 (NNS 95), and the 2011-13 Australian Health Survey is currently in field now. In 2007, a National Children’s Nutrition and Physical Activity Survey (NCNPAS07) was completed to understand what Australian Children were eating and their physical activity habits. A group of respected Australian researchers has just published their findings of the nutritional comparison of both surveys, to determine whether there was a change in core food intakes among Australian children between 1995 and 2007, and to review trends over this 12 year period.

The authors analysed the 24 hour recall data from the NNS95 with almost 2500 participants, and the NCNPAS07, with almost 5000 participants aged between 2-16 years. The researchers compared the differences between how many children were consuming each food group, the amounts consumed and the contribution of these foods to energy intake. Based on the Australian Guide to Healthy Eating, core foods were identified as: breads and cereals, meat and alternatives, milk and alternatives, fruit, and vegetables.

The consumption of core foods increased significantly between the 1995 and 2007 surveys by per-capita consumption and percent energy contribution. Core foods contributed 59% of energy intake in 1995 and 65% in 2007. The types of core foods also moved to more healthy choices. In the breads and cereals group there was a significant increase in the percent of children consuming wholemeal and fibre-increased bread, high-fibre breakfast cereal, pasta, noodles and rice. Total breads and cereals consumption remained largely unchanged, but still provided the largest energy contribution of all the core food groups. There were significant increases in per capita consumption of wholemeal bread, pasta, noodles, and high fibre breakfast cereals, along with decreases in white bread. Children in the older age groups were more likely to consume bread as white bread (69%), while younger children consumed a greater proportion as wholemeal (51%). Sales of wholegrain, wholemeal and artisan types of breads have also increased over recent years. The Go Grains Health & Nutrition '4+ serves a day' message, which actively promotes the health and nutrition benefits of grain-based foods, preferably wholegrain, along with increased marketing of wholegrains on pack may have prompted the growing interest in wholegrains.

Overall the authors concluded there appears to have been some notable improvements in the diets of Australian children since 1995. There was an increase in the consumption of healthier food choices, accompanied by decreases in the consumption of unhealthier food choices in 2007.

Breads and cereals remain the most important contributors to the core food intakes of Australian children and since 1995 there has been a trend to healthier wholemeal and high-fibre choices.

New Australian Food Consumption Data

Grain food and legume intakes from 2009 – 2011

A new national consumption tracking study commissioned by Go Grains Health & Nutrition has just been completed by research group Colmar Brunton, comparing grain food and legume consumption from 2009 to 2011. A 2-day food diary was kept by over 1200 participants in 2011 and over 1700 participants in 2009, followed by a series of online questions to understand consumption, awareness and attitudes towards grain foods and legumes.

The study concluded Australians are not eating enough legumes or core (staple) grain foods such as bread, breakfast cereal, rice, pasta and noodles for health and wellbeing as recommended by Australian Dietary Guidelines. Australians are not meeting the recommended minimum ‘4 serves a day’ of core grain foods, with the average intake only 3.2 serves in the 2011 survey compared with 4.1 serves in 2009. For females and children the picture is even worse with neither subgroups reaching above 3 serves of core grain foods a day on average, significantly lower than 2009.

There was a decrease in bread (15.3 to 11.9 serves/wk), equal to almost 1 slice a day, breakfast cereals (3.8 to 2.99 serves/wk), pasta/noodles (0.27 to 0.21 serves/wk) and rice (0.21 to 0.17 serves/wk) consumption over the 2 years. One serve is equivalent to approximately 2 slices of bread, 1 cup of breakfast cereal/ pasta/ rice/ noodles as described in the Australian Guide to Healthy Eating.

In 2011, there was a significant increase in takeaway/mixed meals (1.2 to 0.9 serves/wk) compared to 2009. Over a quarter (28%) of grain-based food intake came from non-core (“extra’s”) foods like cakes, biscuits, pastries and takeaway foods (like hamburgers, hot dogs and pizza), which has significantly increased from 2009. This indicates that Australians need to swap non-core grain-based foods for core grains with an emphasis on wholegrain, high fibre and low GI grain types.

The study estimates that Australians are eating just over 1 serve of wholegrains a day, less than 1.4 serves in 2009 and a long way from the Go Grains recommendation of at least 48g of wholegrains a day for good health (equivalent to approximately 2 serves, or ½ grain intake as wholegrain). This is consistent with the recently launched 2010 Dietary Guidelines for Americans which recommend half of grain intake as wholegrain (equivalent to 1.5 serves ‘Australian’ serves).

Declining consumption appears to be as a result of misperceptions and lack of understanding about the importance of grain foods in the diet. The study indicates there is a lack of awareness of the health benefits of grains and poor understanding of the recommended amount that should be consumed per day. When asked how many serves would fall with dietary recommendations, only 15% of participants correctly answered 4 or more, as per the Australian Guide to Healthy Eating. Of concern, 42% of females thought “4+ serves a day” is too many serves of grain foods.

There is also lack of knowledge about the foods that contain wholegrains. 9-17% of people surveyed thought vegetables, brown sugar, white rice were wholegrain, and only half thought oats/porridge was wholegrain. The study found people may also limit grain foods as they are concerned about weight management or dietary intolerance.

The findings are a major concern for public health and require supportive action from policy makers to address the issue of declining core grain food consumption. In the 1995 National Nutrition Survey, breads and cereals were the leading source of fibre, thiamin, magnesium and iron and secondary source of folate, niacin, zinc and protein in the diets of Australians. Go Grains is concerned that many Australians may be missing out on these essential nutrients as a results of declining consumption across 2009-2011. We look forward to the results of the Australian Health Survey expected in 2013, however there is a need for realistic quantitative recommendations for the proportion of wholegrains and refined core grain foods in a healthy diet in the upcoming review of the Dietary Guidelines to ensure communication is clear and consistent amongst health care professionals and manufacturers. Helping consumers identify core grain foods will reduce confusion between the nutritious refined grain foods like white rice, white bread, white pasta and lower fibre breakfast cereals and non-core refined grain foods like cakes, biscuits and pastries and takeaway foods with significant amounts of added fat, sugar and salt.

Go Grains recommends an evidence-based guideline: “Eat “4+ serves a day” of grain foods (including breads, rice, pasta, breakfast cereals and noodles), with at least ½ wholegrain”.

Australians need to eat more core grain foods and include more wholegrain and high fibre foods in the diet. Australians should limit their intake of non-core refined grain-based foods such as cakes, pastries, biscuits and takeaway foods.