Diet and Nutrition Survey of Infants and Young Children in Scotland, 2011

A report providing detailed information of food consumption and nutrient intakes of infants and young children (4 to 18 months) in Scotland.


Chapter 6 Food consumption and nutrient intake

Summary of findings

  • Food consumption patterns and macro and micronutrient intakes were in general very similar in the Diet and Nutrition Survey of Infants and Young Children in Scotland (DNSIYCS) as for the UK sample. Comparisons to the UK sample have not been tested for statistical significance, unless specifically stated.
  • Nineteen per cent of children aged 4 to 6 months in DNSIYCS consumed breast milk during the four-day food diary period compared to 29% in the UK sample (not significantly different). Breast milk consumption decreased to 7% of those 12 to 18 months. No children were exclusively breastfed in DNSIYCS at the time of the survey.
  • Thirteen per cent of children aged 4 to 6 months consumed whole milk over the survey period this increased to 80% of those aged 12 to 18 months. 'Yoghurt, fromage frais and other dairy desserts' were consumed by 48% of children aged 4 to 6 months, rising to 82% of those aged 12 to 18 months.
  • The mean total fruit and vegetable consumption including contribution from mixed dishes ranged from 96g per day in the younger group to 169g per day in the older group. This is equivalent to one to two adult portions per day. When tested statistically results were similar to the UK sample with the exception of fruit consumption which was significantly higher in Scotland for children aged 4 to 11 months.
  • Commercial infant foods (meat, fish, fruit, dairy or cereal based) contributed 13% to 19% of daily energy intake for children aged 4 to 11 months, and 6% in children aged 12 to 18 months.
  • White bread was the most commonly consumed bread in children aged 7 to 18 months (consumed by 36% to 69% across the age groups). At least 27% of children in these age groups consumed wholemeal bread. Breakfast cereal consumption increased with age, so that over 80% of those aged 12 to 18 months had this in the four-day food diary period.
  • The proportion of children consuming biscuits, increased to 72% of those aged 12 to 18 months; 'buns, cakes, pastries and fruit pies', increased to 34%; savoury snacks to 42%; and 'sugar, preserves and confectionery' to 65% of children aged 12 to 18 months.
  • Mean consumption of beverages other than milk increased with age, with the most frequent consumption in older age groups, after milk and water, being low calorie soft drinks, consumed by 4% of those aged 4 to 6 months, rising to 51% of those aged 12 to 18 months. Fruit juice was consumed by 9% of children aged 4 to 6 months rising to 25% of those aged 12 to 18 months.
  • There were no statistically significant differences in intakes of energy and NMES between the Scotland and UK samples. Comparisons for intakes of other macronutrients were not tested for significance, but appeared similar between Scotland and the UK. All vitamins and minerals, with the exception of vitamin C intake which was significantly lower for children aged 12 to 18 months in Scotland were similar between DNSIYCS and the UK sample.
  • Mean daily intakes of all vitamins and minerals from all sources (including supplements), were above or close to the Reference Nutrient Intake (RNI) for all age groups with the exception of vitamin D for breastfed children (by any degree of breastfeeding) for all ages, and for non-breastfed children aged 12 to 18 months. It should be noted that these are underestimates as they do not include the contribution of breast milk to vitamin D intake.
  • The proportion of children with daily intakes of vitamins and minerals from all sources below the Lower Reference Nutrient Intake (LRNI) was low (8% or less for all age groups), except for iron for children aged over seven months and magnesium for infants aged 4 to 6 months.
  • Mean daily intakes of sodium were 79% of the RNI for children aged 4 to 6 months but increased to 203% for children aged 12 to 18 months, which equates to 2.5g salt per day, exceeding the recommendation for this age group.
  • Fruit consumption was significantly lower for children in receipt of Healthy Start vouchers in Scotland compared to the entire Scotland sample for both those aged 4 to 11 months and those 12 to 18 months. Vegetable consumption was significantly lower for children in receipt of Healthy Start vouchers compared to the entire Scotland sample for those aged 4 to 11 months.
  • Vitamin A intake was significantly lower for children in receipt of Healthy Start vouchers in Scotland compared to the entire Scotland sample for both those aged 4 to 11 months and those 12 to 18 months.

6.1. Introduction

The results presented in this chapter derive from the dietary assessment using the four-day food and drink diary and represent a daily average of the days assessed. The survey was designed to start on a random day, such that all days of the week would be equally represented. If the allocated day was inconvenient for parents of participants they were asked to start the following day and if this was not possible, then the next convenient day. This was to offer flexibility in order to maintain high response rates. As shown in Table 6.A, there was a greater proportion of Fridays, Saturdays and Sundays in the completed diary days for the Diet and Nutrition Survey of Infants and Young Children in Scotland (DNSIYCS), suggesting that there was a preference to complete diaries at the weekend. This pattern was also seen for the UK sample. In this age group, the type and quantity of foods eaten would not be expected to differ between week days and weekend days and hence the greater proportion of weekend days was not considered to have created bias in the data.

Table 6.A. Percentage of diary records by day of week

Day of Week Days Recorded % of total days
Monday 319 13.0
Tuesday 255 10.4
Wednesday 258 10.5
Thursday 342 14.0
Friday 409 16.7
Saturday 448 18.3
Sunday 417 17.0
All 2448 100

Mis-reporting of food consumption is known to be a problem in all dietary surveys, although it is generally considered to be less of an issue for younger children than adults. It is not known to what extent it is a problem for this age group. Biased estimates of intake can result from under- or over-reporting of actual intake or intake being modified during the recording period. In this age group there may be a particular risk of under or overestimating food wastage. There is also day-to-day variation in diet, making it difficult to capture habitual diet over the short assessment period of four days. The potential for some mis-reporting needs to be borne in mind when interpreting findings from this survey. Evidence suggests that some foods and nutrients may be under- or over-reported to a greater extent than others but there is no information available on the level to which different foods and nutrients are mis‑reported in the survey.

Items of policy interest have been statistically tested at the 95% significance level for two age groups, 4 to 11 months and 12 to 18 months; significant comparisons are discussed in the text. All other comparisons discussed have not been tested for significance and are therefore only observations.

6.2. Foods consumed

The commentary in this section excludes non-consumers unless otherwise stated (e.g. the results for disaggregated food groups are presented for the whole population i.e. consumers and non-consumers). This is because many foods were not consumed regularly by substantial proportions of the entire population. This is a different approach to the National Diet and Nutrition Survey (NDNS)[1] where the main focus is on mean intakes for the whole population. No statistical testing has been carried out between age groups for these reasons and therefore any differences between age groups are only observations.

Tables 6.1 and 6.2 report consumption of foods and drinks as they are reported (referred to as 'non-disaggregated') in the four-day food diary. However consumption of fruit and vegetables, and meat and fish, are also reported in table 6.3 including the contribution from composite dishes, but excluding other components of the dish such as pasta or pastry (referred to as 'disaggregated'). The methodology for this 'disaggregation' of composite dishes is provided in Appendix D.

It should be noted that the quantity and variety of different foods consumed was expected to increase with age across the age range of children in DNSIYCS due to the gradual introduction of complementary foods alongside breast milk and/or infant formula milk. It was also expected therefore that the contribution of these foods to nutrient intake would change with age.

Tables 6.1 and 6.2

6.2.1 Cereals and cereal products

Within the cereals category, the food group consumed by the greatest proportion of children was 'pasta, rice, pizza and other miscellaneous cereals', ranging from 10% of children aged 4 to 6 months increasing to 82% of children aged 12 to 18 months. Mean daily consumption among consumers ranged from 22g in the youngest age group up to 51g in the eldest age group.

White bread was the major type of bread consumed in all age groups. The proportion of children consuming white bread and the amount consumed increased with age. At least 27% of children aged 7 to 18 months consumed wholemeal bread.

The proportion of children consuming breakfast cereal increased with age from 25% of the youngest age group up to 83% in the eldest age group. Mean daily consumption among consumers ranged from 11g up to 24g across the age groups.

The proportion of children consuming the sub-food group biscuits increased with age to 72% of those aged 12 to 18 months; the proportion consuming 'buns, cakes, pastries and fruit pies' increased with age to 34%. Mean consumption of puddings ranged from 25g to 39g per day among consumers across the age groups. These patterns were all generally similar to those seen for the UK sample.

Tables 6.1 and 6.2

6.2.2 Milk and milk products

Results provided in this section do not include consumption of infant formula or breast milk. Whole milk was the most commonly consumed type of cow's milk for all age groups. The proportion of consumers increased with age, ranging from 13% of those aged 4 to 6 months up to 80% of those aged 12 to 18 months. Mean consumption ranged from 46g to 189g per day for consumers aged 4 to 11 months increasing to 326g per day for consumers aged 12 to 18 months. Children aged below 10 months consumed less than a quarter of a pint (146g) of whole milk per day. This is in keeping with the recommendation that cow's milk should only be used as a main drink after the age of one year[2]. Among consumers aged 10 to 11 months however consumption was greater at 189g per day. Four per cent of those aged 4 to 6 months, up to 12% of those aged 12 to 18 months consumed semi-skimmed milk over the survey period.

The proportion of children consuming the sub-food group 'yoghurt, fromage frais and other dairy desserts', ranged from 48% of those aged 4 to 6 months, up to 82% of children aged 12 to 18 months. Mean intakes ranged from 43g to 61g among consumers across the age groups. To help visualise portion sizes consumed, a typical child yoghurt pot weighs approximately 50g; consumers therefore ate about a children's pot of yoghurt per day. The proportion of children consuming cheese increased with age from 11% of the youngest age group to 66% of those aged 10 to 11 months and 65% of those aged 12 to 18 months. The mean daily intakes also increased with age among consumers, ranging from 4g to 12g per day. These patterns of consumption were similar to the UK sample although not tested for significance.

Tables 6.1 and 6.2

6.2.3 Eggs and egg dishes

The proportion of children consuming 'eggs and egg dishes' increased with age from 3% of those aged 4 to 6 months to 36% of those aged 12 to 18 months. The quantities for consumers ranged from 7g per day for those aged 4 to 6 months to 23g per day for those aged 12 to 18 months.

Tables 6.1 and 6.2

6.2.4 Fat spreads

Mean intakes of fat spreads including butter, ranged from 3g to 9g per day among consumers. Reduced and low fat spreads were the most commonly consumed, by 12% for those aged 4 to 6 months, rising to 61% for those aged 12 to 18 months. These patterns were also seen in the UK sample.

Tables 6.1 and 6.2

6.2.5 Meat and meat products

The proportion of infants and young children consuming commercially prepared 'red meat and dishes' (bacon, ham, beef, veal, lamb and pork) ranged from 1% of those aged 4 to 6 months to 8% of those aged 12 to 18 months. This contrasted with homemade 'red meat and dishes', where the proportion of consumers increased from 13% of those aged 4 to 6 months to up to 71% of those aged 12 to 18 months. Commercially prepared 'burgers, kebabs, sausages, meat pies and pastries' were not consumed by any children aged 4 to 6 months increasing to 20% for those aged 12 to 18 months, while homemade types were consumed by 1% of those aged 4 to 6 months, rising to 41% of those aged 12 to 18 months. These patterns were similar to those for the UK sample but there was an indication that those in Scotland consumed more burgers, both commercially prepared and homemade, and less 'chicken and dishes' than those in the UK sample although this was not tested for significance.

Tables 6.1 and 6.2

Estimates of meat consumption from all sources including composite dishes were calculated from disaggregated data. These estimates are much lower than those shown in Table 6.1 as the disaggregated estimates do not include the non-meat components of meat dishes e.g. the pasta and cheese in meat lasagne. Using the disaggregated data, each type of meat consumed was sub-categorised as red meat which included beef, lamb, pork, sausages, burgers and kebabs, or white meat, which included chicken and turkey.

Mean consumption of total meat for the whole population including non-consumers based on disaggregated data was estimated at 6g per day for children aged 4 to 6 months, up to 32g per day for those aged 12 to 18 months. This was around 25% less than non-disaggregated intakes (refer to Figure 6.A). Red meat comprised 50% total meat consumption for children aged 4 to 6 months increasing up to 72% for those aged 12 to 18 months, similar to the UK sample.

There was no statistically significant difference in meat consumption after disaggregation between DNSIYCS and the UK sample for the two age groups 4 to 11 months and 12 to 18 months.

Tables 6.1 to 6.4

Figure 6.A. Non-disaggregated and disaggregated meat (mean in grams) consumption for the entire population including non-consumers.

Figure 6.A. Non-disaggregated and disaggregated meat (mean in grams) consumption for the entire population including non-consumers.

6.2.6 Fish and fish dishes

The proportion of infants and young children consuming 'fish and fish products' increased with age from 13% of those aged 4 to 6 months up to 54% of those aged 12 to 18 months, similar to those for the UK sample. Mean daily intakes ranged from 11g at 4 to 6 months to 21g for those aged 12 to 18 months among consumers.

After disaggregation of composite dishes, mean consumption of fish from all sources for the entire population including non-consumers ranged from 1g per day for children aged 4 to 6 months to 7g per day for those aged 12 to 18 months. When disaggregated to exclude non-fish components for composite dishes, fish consumption was almost 50% lower for children aged 10 to 18 months than the non-disaggregated totals (refer to figure 6.B).This was similar to the UK sample and showed similar differences compared to non-disaggregated figures as seen for meat for children aged 10 to 18 months.

There was no statistically significant difference in fish consumption after disaggregation between DNSIYCS and the UK sample for the two age groups 4 to 11 months and 12 to 18 months.

Tables 6.1 to 6.4

Figure 6.B. Non-disaggregated and disaggregated fish (mean in grams) consumption for the entire population including non-consumers.

Figure 6.B. Non-disaggregated and disaggregated fish (mean in grams) consumption for the entire population including non-consumers.

6.2.7 Vegetables and fruit

Tables 6.1 and 6.2 provide results for fruit and vegetable consumption excluding the contribution from composite dishes. This section describes consumption of fruit and vegetables including the contribution from composite dishes.

Table 6.3 shows mean consumption of vegetables for the entire population including non-consumers based on disaggregated data, ranged from 48g per day for children aged 4 to 6 months, up to 72g per day for those aged 12 to 18 months. This is very similar to the consumption for the UK sample. Mean fruit consumption after disaggregation ranged from 48g per day for children aged 4 to 6 months up to 96g per day for those aged 12 to 18 months. These figures are considerably higher than those shown in Table 6.1 as the latter are based on fruit, salad and cooked vegetables consumed and reported as discrete items, and exclude fruit and vegetables in mixed dishes that are reported according to the main component of the dish. Taking vegetables from composite dishes into account (i.e. after disaggregation), vegetable consumption was over 100% higher for all age groups than the non-disaggregated totals (refer to Figure 6.C). Fruit consumption after disaggregation was 100% higher for those aged 4 to 6 months, decreasing to 23% higher for those aged 12 to 18 months (refer to Figure 6.D). The differences between estimates for non-disaggregated and disaggregated consumption are much greater than for older age groups as seen in NDNS (adults aged 19-64 years), probably due to the high number of commercial infant foods containing fruit or vegetables consumed by children in DNSIYC which are not included in the non-disaggregated vegetable and fruit totals.

Tables 6.1 to 6.3

Figure 6.C. Non-disaggregated and disaggregated vegetable (mean in grams) consumption for the entire population including non-consumers.

Figure 6.C. Non-disaggregated and disaggregated vegetable (mean in grams) consumption for the entire population including non-consumers.

When compared statistically, mean daily intake of fruit excluding fruit juice was significantly higher for children aged 4 to 11 months in DNSIYCS (78g) compared to children of the same age in the UK sample (70g). Mean consumption of total fruit and vegetables (excluding fruit juice) ranged from 96g per day for children aged 4 to 6 months, to 169g per day for those aged 12 to 18 months. These quantities are relatively high and were similar to the UK sample. For example, mean total fruit and vegetable consumption by those aged 12 to 18 months was similar to the mean consumption of total fruit and vegetables after disaggregation by those aged 11 to 18 years in NDNS (177g). Mean fruit consumption of children aged 7 to 18 months in DNSIYCS (80g to 96g) was higher than the 11 to 18 year age group in NDNS (62g). There is currently no recommendation for the number of portions of fruit and vegetables consumed per day or the recommended portion size for this age group. To put it into context adults are advised to consume five 80g portions of fruit and vegetables per day (400g), so children in DNSIYCS consumed about one to two adult portions a day, which is relatively high given their body size at this age.

Table 6.3 and 6.4

Figure 6.D. Non-disaggregated and disaggregated fruit (mean in grams) consumption for the entire population including non-consumers.

Figure 6.D. Non-disaggregated and disaggregated fruit (mean in grams) consumption for the entire population including non-consumers.

Fruit and vegetable consumption based on disaggregated data was compared statistically between the entire Scotland sample and the Healthy Start Scotland sample, for two age groups, 4 to 11 months and 12 to 18 months. For those aged 4 to 11 months, vegetable consumption was significantly lower for children receiving HS vouchers (51g per day) in Scotland than for all Scottish children (71g per day), while consumption of vegetables for those aged 12 to 18 months was similar. Children receiving HS vouchers consumed less fruit, both for those aged 4 to 11 months (41g per day compared to 78g per day for all Scottish children) and for those aged 12 to 18 months (69g per day compared to 96g per day for all Scottish children). Total fruit and vegetable consumption was significantly lower for children receiving HS vouchers aged 4 to 11 months (92g per day compared to 149g per day for all Scottish children) and aged 12 to 18 months (141g per day compared to 169g per day for all Scottish children).

Table 6.5

6.2.8 Savoury snacks, sugar and confectionery

Mean consumption of savoury snacks was 5g or less per day for consumers in all groups although the proportions of children consuming these foods increased with age from 0% of those aged 4 to 6 months to 42% of those aged 12 to 18 months. Hence although they ate small amounts, substantial proportions of older children were given these in the four-day food diary period. A higher proportion of children aged 4 to 6 months consumed savoury snacks in the UK (7%) compared to Scotland although this was not tested for significance.

Mean consumption of 'sugar, preserves and confectionery' ranged from 2g to 8g per day. However, like savoury snacks, the proportion having these foods increased with age, such that 65% of those aged 12 to 18 months were consuming these foods, similar to the UK sample.

Tables 6.1 and 6.2

6.2.9 Beverages

The proportion of children consuming water ranged from 61% of those aged 4 to 6 months and 67% or more for those aged 7 to 18 months. Mean daily consumption ranged from 52g among consumers aged 4 to 6 months up to 147g for those aged 12 to 18 months.

Fruit juice was consumed by 9% of children aged 4 to 6 months, rising to 25% for those aged 12 to 18 months, with mean daily intakes ranging from 7g for consumers aged 4 to 6 months to 63g per day for consumers aged 12 to 18 months.

To help visualise the quantities consumed, an individual carton of fruit juice typically weighs about 200g, so children in DNSIYCS were typically consuming between a quarter of a carton to two and a quarter cartons of fruit juice per week.

The proportion of children consuming soft drinks (not low calorie) (1% to 22%) was very similar to the proportion of children consuming juice (9% to 25%) across the age groups. However, the quantities of soft drinks (not low calorie) consumed were greater, with a mean daily consumption of 73g for consumers aged 4 to 6 months, increasing to 180g for those aged 12 to 18 months.

Somewhat higher proportions drank low calorie than non-low calorie soft drinks, particularly in the older age groups, with 51% of children aged 12 to 18 months consuming low calorie soft drinks compared to 22% consuming non-low calorie soft drinks. Quantities were also higher for low calorie soft drinks; mean consumption ranged from 21g per day for consumers aged 4 to 6 months, to 214g per day for consumers aged 12 to 18 months. These patterns of consumption were generally similar to the UK sample.

Tables 6.1 and 6.2

6.2.10 Breast milk and infant formula

Breast milk is the best form of nutrition for infants and exclusive breastfeeding is recommended for the first six months (26 weeks) of an infant's life[3],[4]. Infant formula milk is the only substitute for breast milk and although there are a variety of types available on the market, unless advised by a health professional 'first milk' is the only type of formula an infant requires until the age of 12 months when cow's milk can be introduced as a main drink into the diet. There are therefore no requirements for children to consume other types of formula including: 'hungrier babies milk' (also known as 'second milk'); follow-on formula; 'goodnight milk'; or 'growing up milk'. Follow-on formula and 'goodnight milk' are not recommended before six months and 'growing up milk' is not designed for children aged under 12 months. Complementary foods should be introduced at six months and breastfeeding (and/or infant formula, if used) should continue beyond this time alongside appropriate types and amounts of complementary foods[5].

Nineteen per cent of children aged 4 to 6 months consumed breast milk in the four‑day diary period, 22% of those aged 7 to 9 months, 17% of those aged 10 to 11 months and 7% of those aged 12 to 18 months. This was not significantly different to the UK.

Mean breast milk consumption estimated from the recorded feeding time and volumes (if expressed) for consumers decreased with age from 680g per day for those aged 4 to 6 months to 300g per day for those aged 12 to 18 months. There were no children aged 4 to 18 months who were exclusively breastfed at the time of the survey in DNSIYCS.

Forty seven per cent of children aged 4 to 6 months consumed 'first milk', decreasing to only 4% of those aged 12 to 18 months; similarly 20% of those aged 4 to 6 months consumed 'hungrier babies milk', again decreasing to only 2% of those aged 12 to 18 months. Twenty seven per cent of those aged 4 to 6 months consumed follow-on milk, rising to 40% of those aged 7 to 9 months, and 52% of those aged 10 to 11 months, but decreasing to 8% of those aged 12 to 18 months. There was little consumption of 'growing up milk', none up to age nine months, 3% of those aged 10 to 11 months and 14% of those aged 12 to 18 months. Very small proportions (0% to 4%) of children consumed soy or other infant specific milks. These patterns were similar to the UK sample, although the actual proportion varied in some cases.

The 27% of infants aged 4 to 6 months consuming follow-on milk may include some infants aged 4 or 5 months, i.e. younger than 6 months, not observing the recommendation that follow-on milk is not nutritionally necessary and not suitable at this age.

Tables 6.1 and 6.2

6.2.11 Commercial infant foods

'Commercial infant foods' were consumed mainly by children under the age of 12 months, with those aged 12 to 18 months more commonly consuming non-infant specific foods. Over 60% of children aged 4 months to 11 months consumed infant 'meat and fish based products and dishes' during the four-day food diary period, decreasing to 31% of those aged 12 to 18 months, and over 40% of those aged 4 months to 9 months had 'other savoury based foods and dishes', decreasing to 11% of those aged 12 to 18 months. 'Other savoury based foods and dishes', 'fruit based foods and dishes', 'dairy based foods and dishes', and 'cereal based foods and dishes' also showed similar patterns of consumption. The only type of 'commercial infant foods' for which there was an increase with age was for snacks, both sweet and savoury where 46% of children aged 4 to 6 months consumed these, rising to over 60% for those aged 7 to 11 months then falling to 37% of those aged 12 to 18 months. Mean consumption of infant specific snacks (sweet and savoury) ranged between 6g to 8g per day among consumers. These patterns of consumption of 'commercial infant foods' were largely similar to those seen for the UK sample.

Tables 6.1 and 6.2

6.3. Supplements

Information on consumption of dietary supplements was collected both in the four‑day food and drink diary and in the Computer Assisted Personal Interview (CAPI), which asks about consumption in the year before interview. Dietary supplements were defined for parents as products intended to provide additional nutrients or give health benefits and taken in liquid, powder, tablet or capsule form. In the CAPI, parents were asked to list any dietary supplements given to their children over the past year. In the diary parents wrote down the details of any supplements they gave to their children on each diary recording day. Statistical tests were carried out to compare supplement intakes in DNSIYCS compared to the entire UK sample.

Six per cent of children aged 4 to 6 months, 9% of those aged 7 to 9 months, 3% of those aged 10 to 11 months and 7% of those aged 12 to 18 months were given at least one supplement during the four-day food diary recording period. The main supplement given to children during the four-day food diary was a multi-vitamin supplement.

When compared statistically for age groups 4 to 11 months and 12 to 18 months, supplement consumption during diary recording period was similar for DNSIYCS and the UK sample. Only the consumption of other nutrient supplements was significantly different, being 1% in DNSIYCS compared to 4% for the UK sample.

Tables 6.6a and 6.7a

A higher proportion of parents reported having given at least one supplement to their children during the previous year than had done so in the four-day food diary period. Five per cent of children aged 4 to 6 months, 11% of those aged 7 to 9 months, 9% of children aged 10 to 11 months and 15% of those aged 12 to 18 months had been given a supplement in the past year. The main supplement given to children in the past year was a multi-vitamin supplement.

When compared statistically, supplement consumption over the past year was similar for DNSIYCS and the UK sample for those aged 4 to 11 months. For those aged 12 to 18 months, both consumption of other nutrient supplements (5% for DNSIYCS compared to 8% for the UK sample) and any type of supplement (15% for DNSIYCS compared to 20% for the UK sample) were significantly higher for the UK sample than for DNSIYCS.

Tables 6.6b and 6.7b

6.4. Nutrient intakes

This section presents daily intakes of energy, macronutrients (protein, fat, carbohydrate, sugars and non-starch polysaccharides) and micronutrients (vitamins and minerals) for the entire population estimated from the food consumption data, including from the consumption of supplements. It also shows the percentage contribution of the major food types to intake of each nutrient for the entire population, including non-consumers. This analysis has been carried out using the food groups generally used in Department of Health (DH) dietary surveys and not disaggregated food groups.

Dietary Reference Values (DRVs) for food energy and nutrients provide a best estimate of the requirements of the UK population and its subgroups, and present criteria against which to judge the adequacy of their intake[6]. These DRVs apply to groups of people in health and are not appropriate for the definition of requirements for individuals. The DRV for food energy is defined as the Estimated Average Requirement (EAR), that is, the average energy requirement for any population group. During infancy and childhood, the energy requirement has to meet the needs for healthy growth and development.

In this report, average daily intakes of total energy[7] for boys and girls were compared to age and sex specific UK reference values taken from the Scientific Advisory Committee on Nutrition (SACN) energy report[8] by calculating the EAR for each child in DNSIYC based on their body weight. For children aged under 12 months, figures were used for mixed or unknown feeding i.e. it was assumed the proportions of breast milk and formula milk substitute used were not known. The median physical activity level (PAL)[9] value adjusted for growth was used for children aged over 12 months. Macronutrients and micronutrients for children were compared to the 1991 COMA report on Dietary Reference Values for Food Energy and Nutrients for the United Kingdom[10]. The only macronutrient, other than energy, for which DRVs are set for this age group is protein.

Where the UK Reference Nutrient Intakes (RNIs) and Lower Reference Nutrient Intakes (LRNIs) have been published for this age group[6], intakes as a proportion of the RNI and the proportion with intakes below the LRNI are given. The RNI for a vitamin or mineral is the amount of the nutrient that is sufficient for about 97.5% of people in the population. If the average intake of a sample is at the RNI, then the risk of deficiency in the sample is judged to be very small. The inadequacy of vitamin or mineral intake can be expressed as the proportion of individuals with intakes below the LRNI. The LRNI for a vitamin or mineral is set at the level of intake considered likely to be sufficient to meet the needs of only 2.5% of the population. However, it should be noted that DRV's for some micronutrients such as magnesium, potassium, selenium and zinc are based on very limited data so caution should be used when assessing adequacy of intake using the LRNI.

Intakes of vitamins and minerals are reported in two ways: 1) intakes from all sources, that is, including supplements as recorded in the four-day food diary; and 2) for recommended vitamins (A, C and D), intakes from food sources only. The proportion of children taking supplements was small, as reported in section 6.3. The percentage contribution of the major food types to selected vitamins and minerals are shown in Tables 6.25 to 6.27 and 6.32 to 6.35.

Other than for energy, DRVs have not been set for exclusively breastfed infants as breast milk is recommended to provide the best nutrition for infants. DRVs are set only for infants whose nutrient intakes are dependent on the composition of breast milk substitutes (i.e. infant formula) being offered. The vitamin D content of breast milk is not known (see Annexe D of the UK report). In DNSIYC the contribution of breast milk to vitamin D intakes for breastfed infants has therefore been excluded, however this provides an underestimation of vitamin D intake for breastfed infants[10].

The commentary in this section refers to mean intakes for the total population. Statistical testing has been carried out in this section for energy and specific nutrients for two age groups, 4 to 11 months and 12 to 18 months; any differences noted between age groups and other statements comparing DNSIYCS to the entire UK sample are only observations.

Wherever they exist, the DRVs (that is the EARs, RNIs and LRNIs) are provided in tables.

6.4.1 Energy

The mean daily intakes of total energy[7] for children aged 4 to 6 months was 2.83 MJ (674 kcal), 3.28 MJ (780 kcal) for children aged 7 to 9 months, 3.70 MJ (879 kcal) for children aged 10 to 11 months and 4.11 MJ (977 kcal) for children aged 12 to 18 months. There were no statistically significant differences in energy intake between DNSIYCS and the UK sample for either those aged 4 to 11 months or those aged 12 to 18 months.

Table 6.8

The percentage of children calculated as exceeding the age and sex specific EAR for energy[9] (calculated for the individual based on body weight) was similar for boys and for girls, 77% and 74% respectively. The percentage of boys exceeding the EAR was 50% for children aged 4 to 6 months, 81% for those aged 7 to 9 months, 71% for those aged 10 to 11 months and 85% for children aged 12 to 18 months. For girls the percentage exceeding the EAR increased with age, from 45% for children aged 4 to 6 months, 52% for those aged 7 to 9 months, 70% for those aged 10 to 11 months and up to 92% for children aged 12 to 18 months, providing evidence that energy intakes increase with age following the introduction of complementary foods. It should be noted that 50% of the population are expected to have requirements exceeding the EAR.

Tables 6.9a and 6.9b

Infant formula was the main source of energy for children aged 4 to 11 months while for children aged 12 to 18 months, the food group 'milk and milk products' was the main source of energy (26%) followed by the food group 'cereals and cereal products' (25%).

In general, infant formula, breast milk and the food group 'commercial infant foods' contributed decreasing proportions of energy with age. For example, the contribution of infant formula decreased from 57% for children aged 4 to 6 months to 8% for children aged 12 to 18 months. Breast milk consumption followed a similar pattern contributing 12% for children aged 4 to 6 months down to 2% for children aged 12 to 18 months and 'commercial infant foods' contributing 18% for children aged 4 to 6 months decreasing to 6% for those aged 12 to 18 months. In contrast, the contribution of non-infant specific foods increased with age. For example, the food group 'cereals and cereal products' increased from 2% for children aged 4 to 6 months to 25% for those aged 12 to 18 months.

Tables 6.10 and 6.11

6.4.2. Protein

Mean protein intakes were well above the RNI in all age groups (the RNI for protein ranges from 12.7g to 14.5g per day for the DNSIYCS age range)[6]. Protein provided 10% of total energy for children aged 4 to 6 months increasing to 16% for children aged 12 to 18 months.

Table 6.8

For children aged 4 to 9 months, infant formula was the largest contributor to protein intake, providing 49% of intake for children aged 4 to 6 months and 29% for children aged 7 to 9 months; the food group 'commercial infant foods' was the second largest contributor (22% for both). For children aged 10 to 18 months, the food group 'milk and milk products' was the largest contributor to protein intake providing 21% for children aged 10 to 11 months and 34% for those aged 12 to 18 months. The second largest contributor to protein intake for children aged 10 to 11 months was infant formula (providing 19%) and for children aged 12 to 18 months was the food group 'cereals and cereal products' (19%).

In general, the contribution of the food group 'meat and meat products and dishes' to protein intake increased with age, from 3% for children aged 4 to 6 months to 17% for those aged 12 to 18 months. A similar pattern was seen for the intake of the food groups 'cereals and cereal products' and 'milk and milk products', rising from 2% to 19% and 8% to 34% respectively for children aged 4 to 6 months to children aged 12 to 18 months. This is as expected as the variety of complementary foods introduced increases with age.

Table 6.12

6.4.3. Total fat

It should be noted that the maximum dietary recommendations regarding the proportion of energy intake as fat for the general population do not apply for children aged under five years. This is due to the importance of dietary fat in achieving energy requirements for this age group while consuming a manageable volume of food.

Total fat provided an average of 40% of total energy for children aged 4 to 6 months, 36% for those aged 7 to 11 months and 35% for children aged 12 to 18 months.

Table 6.8

The major contributor to total fat intake for children aged 4 to 11 months was infant formula, with the contribution highest in children aged 4 to 6 months at 68%, 51% for children aged 7 to 9 months and 37% for children aged 10 to 11 months. For children aged 4 to 6 months, the second largest contributor to total fat intake was breast milk, providing 14% and for children aged 7 to 9 was 'commercial infant foods', providing 11%. For children aged 10 to 11 months, the second largest contributor was the food group 'milk and milk products' (18%). For children aged 12 to 18 months, the main contributor was 'milk and milk products' (36%) followed by the food group 'cereals and cereal products' (14%).

Table 6.13

6.4.3.1. Saturated fatty acids

Saturated fatty acids provided an average of 16% to 18% of total energy across all age groups.

The main source of saturated fatty acids for children aged 4 to 11 months was infant formula, providing an average of 69% of saturated fat intake for children aged 4 to 6 months, 51% for 7 to 9 months and 37% for 10 to 11 months. The second largest contributor was breast milk for children aged 4 to 6 months (15%) and both breast milk and the food group 'milk and milk products' for children aged 7 to 9 months (both 11%). The food group 'milk and milk products' (24%) was the second largest contributor for children aged 10 to 11 months. For children aged 12 to 18 months, 'milk and milk products' (47%), particularly whole milk (32%), was the main source of saturated fatty acids with the food group 'cereals and cereal products' the second largest contributor (12%).

Tables 6.8 and 6.14

6.4.3.2. Trans fatty acids

Trans fatty acids are derived from two sources in the diet: those that occur naturally in meat and dairy products of ruminant animals, and those produced artificially through food processing. Trans fatty acids provided an average of 0.5% or less of total energy across all age groups. The main source of trans fatty acids were natural sources, as the food group 'milk and milk products' was one of the largest contributors (31% to 52%) for all age groups. The food group 'commercial infant foods' contributed 46% of trans fatty acid intake for children aged 4 to 6 months. For children aged 7 to 18 months, the contributions to trans fatty acid intake from other sources, such as the food groups 'commercial infant foods' (5% to 30%), fat spreads (3% to 8%) and 'cereals and cereal products' (1% to 11%) were smaller.

Tables 6.8 and 6.15

6.4.4. Carbohydrate

Total carbohydrate provided an average of 50% of total energy intake for children aged 4 to 6 months, 52% for children aged 7 to 9 months, 50% for children aged 10 to 11 months and 49% for children aged 12 to 18 months.

The major contributor to carbohydrate intake for children aged 4 to 11 months was infant formula (51% for those aged 4 to 6 months; 34% for those aged 7 to 9 months; and 26% for those aged 10 to 11 months). The second largest contributor to carbohydrate intake for children aged 4 to 9 months was the food group 'commercial infant foods' (at least 23%), while for children aged 10 to 11 months, it was the food group 'cereals and cereal products' (21%). For children aged 12 to 18 months the major contributor to carbohydrate intake was 'cereals and cereal products' (35%) followed by the food group 'milk and milk products' (17%, with whole milk providing 10%).

Overall, the contribution from infant formula, breast milk and the food group 'commercial infant foods' to carbohydrate intake decreased with age, as expected, from 85% for children aged 4 to 6 months to 16% for children aged 12 to 18 months.

Tables 6.8 and 6.16

6.4.4.1. Total sugars

Sugars provided an average of 40% of total energy for children aged 4 to 6 months, 34% for those aged 7 to 9 months, 30% for those aged 10 to 11 months and 25% for children aged 12 to 18 months.

The main contributor to total sugars intake for children aged 4 to 11 months was infant formula (60%, 46% and 37% for children aged 4 to 6 months, 7 to 9 months and 10 to 11 months respectively). The second largest contributor was the food group 'commercial infant foods' for children aged 4 to 6 months (14%) and 7 to 9 months (16%), and the food group 'milk and milk products' (16%) for those aged 10 to 11 months. For children aged 12 to 18 months, 'milk and milk products' was the main source of total sugars (32%) followed by fruit (20%). The contribution of milk to total sugars was mainly due to the presence of milk sugars, especially lactose.

Tables 6.8 and 6.17

6.4.4.2. Non-milk extrinsic sugars (NMES)

Non-milk extrinsic sugars (NMES) intakes increased with age, providing between 5% of total energy for children aged 4 to 6 months and 8% for children aged 12 to 18 months. There were no statistically significant differences in NMES intake (g per day or % energy) between DNSIYCS and the UK sample for either those aged 4 to 11 months or those aged 12 to 18 months.

Table 6.8 and 6.11

The main contributor to NMES for children aged 4 to 6 months and 7 to 9 months was the food group 'commercial infant foods' (51% and 36% respectively), particularly 'fruit based foods and dishes' and 'cereal based foods and dishes'. For children aged 10 to 18 months, the main contributor to NMES was the food group 'milk and milk products'; 29% for children aged 10 to 11 months and 24% for children aged 12 to 18 months. This came almost entirely from 'yoghurt, fromage frais and other dairy desserts'.

Other contributors to NMES, in smaller proportions, were the food groups 'cereals and cereal products' (1% for children aged 4 to 6 months rising to 24% for children aged 12 to 18 months), 'sugars, preserves and confectionery' (0% for children aged 4 to 6 months increasing to 14% for children aged 12 to 18 months) and beverages (1% for children aged 4 to 6 months increasing to 10% for children aged 12 to 18 months). It should be noted that all sugars in fruit juice are NMES, as are half the sugars in pureed fruit. These foods, particularly pureed fruit, make a major contribution to NMES intakes in this age group.

Tables 6.11 and 6.18

6.4.4.3. Intrinsic and milk sugars (IMS)

Intrinsic and milk sugars (IMS) provided an average of 35% of total energy for children aged 4 to 6 months, 27% for those aged 7 to 9 months, 23% for those aged 10 to 11 months and 18% for children aged 12 to 18 months.

Infant formula was the largest contributor to IMS for children aged 4 to 11 months, with 68% for children aged 4 to 6 months, 54% for those aged 7 to 9 months and 42% for children aged 10 to 11 months. The second largest contributors to IMS intake were breast milk for those aged 4 to 6 months (14%), the food group 'commercial infant foods' for children aged 7 to 9 months (14%) and fruit for those aged 10 to 11 months (18%). For children aged 12 to 18 months, the largest contributor to IMS intake was the food group 'milk and milk products' (37%) followed by fruit (26%).

Tables 6.8 and 6.19

6.4.4.4. Starch

Starch provided an average of 10% of total energy for children aged 4 to 6 months, 18% for children aged 7 to 9 months, 20% for children aged 10 to 11 months and 24% for children aged 12 to 18 months.

For children aged 4 to 6 months and 7 to 9 months, the main contributor to starch intake was the food group 'commercial infant foods' (64% and 44% respectively), and in particular 'cereal based foods and dishes' (25% and 16%) and 'meat and fish based products and dishes' (15% and 14%). For children aged 4 to 6 months the second largest source of starch was infant formula (13%) and for those aged 7 to 9 months, was the food group 'cereals and cereal products' (31%). For children aged 10 to 11 months and 12 to 18 months, the main source of starch was 'cereals and cereal products', providing 44% and 59% respectively. The second largest contributor for children aged 10 to 11 months was 'commercial infant foods' (25%) and was the food group 'vegetables and potatoes' (14%) for children aged 12 to 18 months.

Tables 6.8 and 6.20

6.4.5. Non-starch polysaccharides (NSP)

Mean daily intakes of non-starch polysaccharides (NSP) were 4.3g for all children aged 4 to 6 months, 6.2g for those aged 7 to 9 months, 6.7g for those aged 10 to 11 months and 7.3g for those aged 12 to 18 months. The main contributor to NSP intake for children aged 4 to 6 months was the food group 'commercial infant foods' (41%), followed by the food group infant formula (29%). For children aged 7 to 9 months, the main contributor was 'commercial infant foods' (35%) followed by infant formula (19%). The major contributor to NSP for children aged 10 to 11 months was the food group 'cereals and cereal products' (24%) followed by 'commercial infant foods' (23%) and, for children aged 12 to 18 months, 'cereals and cereal products' (37%) followed by the food group 'vegetables and potatoes' (19%). 'Vegetables and potatoes' contributed 12% to 19% to NSP intakes across the age groups and fruit contributed 10% to 14%.

Tables 6.8 and 6.21

6.4.6. Vitamins

In this section breastfeeding status is denoted by the presence or absence of breast milk in the four‑day food diary. The vitamin D content of breast milk is not known (see Annexe D of the UK report), therefore the results for vitamin D intake are presented in two ways: 1) for children who were not breastfed; and 2) for children who were breastfed, excluding the contribution from breast milk, this is therefore an underestimation of vitamin D intake.

Mean daily intakes of vitamins from all sources (including supplements), with the exception of vitamin D, were above the RNI for all age groups. Mean intakes of vitamin D were below the RNI for non-breastfed children aged 12 to 18 months (48% of the RNI), although this is an underestimation of vitamin D intake for this group. Mean intakes of vitamin D (excluding the contribution from breast milk) were below the RNI across the age groups for children who were breastfed (by any degree of breastfeeding) at the time that the food diary was completed (ranging from 45% to 55% of the RNI). The proportion of children below the LRNI for most vitamins from all sources were very small (0% to 3%), with 6% and 8% of children aged 4 to 6 months and below the LRNI for vitamin B6 and vitamin B12 respectively. There is no LRNI set for vitamin D.

Tables 6.22 to 6.25

There was little change in the mean intakes of vitamins A, C and D from food sources only (i.e. excluding supplements) compared to mean intakes from all sources with age. For those children who were breastfed the average intake of vitamin D from food sources as a percentage of the RNI ranged from 18% of the RNI to 50% of the RNI, slightly lower than the percentage meeting the RNI from all sources. Dietary supplements providing vitamins A and C had no effect on the proportions with intakes meeting the RNI and below the LRNI.

When tested statistically, there was a lower average vitamin C intake for children aged 12 to 18 months in DNSIYCS than in the UK sample. There were no significant differences in intakes of any other vitamins between DNSIYCS and the UK sample for either those aged 4 to 11 months or those aged 12 to 18 months.

Tables 6.26 to 6.31

As the vitamin D content of breast milk is not known the results for the percentage contribution of foods to vitamin D are presented only for children who were not breastfed at the time that the food and drink diary was completed. The major contributor to vitamin D intake from food for all age groups of children not receiving any breast milk was infant formula, providing 85% for children aged 4 to 6 months, 80% for those aged 7 to 9 months, 70% for those aged 10 to 11 months and 23% for children aged 12 to 18 months. The second largest contributor for children aged 4 to 11 months was the food group 'commercial infant foods' (12% to 13%), particularly 'cereal based foods and dishes' (7% to 9%) which are often fortified. For those aged 12 to 18 months the second largest contributor to vitamin D intake was the food group 'meat and meat products and dishes' (18%). It is difficult to get enough vitamin D through food alone and the main source of vitamin D is direct sunlight on the skin, although this will vary by the degree of exposure of the child's skin to summer sunshine.

Table 6.28

Infant formula was the main contributor to folate intakes for children aged 4 to 6 months, 7 to 9 months and 10 to 11 months (59%, 43% and 32% respectively) followed by the food group 'commercial infant foods' for the two younger age groups (17% and 19% respectively) and the food group 'cereals and cereal products' (14%) for those aged 10 to 11 months. For those aged 12 to 18 months, the food groups 'cereals and cereal products' (26%) and 'milk and milk products' (22%) were the main sources of folate.

Table 6.29

Infant formula was also the largest contributor to vitamin A intake for the three youngest age groups (45%, 35% and 29% respectively) followed by the food group 'commercial infant foods' (25%, 29% and 23% respectively). For children aged 12 to 18 months, the food group 'milk and milk products' (26%) was the largest contributor to vitamin A intake followed by the food group 'vegetables and potatoes' (15%). Breast milk contributed smaller proportions, from 10% for children aged 4 to 6 months decreasing to 2% for children aged 12 to 18 months.

Table 6.30

Intakes of vitamins A, C and D (from all sources) were compared statistically between children in receipt of Healthy Start vouchers in Scotland and the entire Scottish sample for two age groups, 4 to 11 months and 12 to 18 months. Because of a very small number of breastfed children receiving HS vouchers, the vitamin D comparison was limited to the non-breastfed children. Children receiving HS vouchers had significantly lower vitamin A intakes, both for those aged 4 to 11 months (840µg per day for children receiving HS vouchers and 942µg per day for all Scottish children) and for those aged 12 to 18 months (565µg per day for children receiving HS vouchers and 663µg per day for all Scottish children). There were no significant differences in vitamin C or D intakes between children receiving HS vouchers and the Scotland sample for either age group.

Table 6.32

6.4.7. Minerals

Average daily intakes of minerals from all sources (including supplements) were above the RNI for most age groups[6]. Mean iron intakes were below the RNI for children aged 7 to 9 months (89% of the RNI), and were close to the RNI for those aged 10 to 11 months (97% of the RNI) and for those aged 12 to 18 months (92% of the RNI). Children aged 4 to 6 months had mean calcium intakes close to the RNI (96% of the RNI). The proportion of children with daily intakes of minerals from all sources below the LRNI was low (≤6%) for most minerals, except for iron where 8% to 17% had intakes below the LRNI across all age groups. Eleven per cent of children aged 4 to 6 months had magnesium intakes below the LRNI.

Tables 6.33 to 6.36

Mean sodium intakes for children aged 4 to 6 months were below the RNI at 79%, but increased to 203% for children aged 12 to 18 months, which equates to 2.5g salt per day. Twelve per cent and 9% of children aged 4 to 6 months and 7 to 9 months respectively were below the LRNI for sodium. It should be noted that the DRVs set for sodium are based on physiological requirements for children, the RNI for sodium ranges from 280mg to 500mg per day and the LRNI ranges from 140mg to 200mg per day for children aged 4 to 18 months. The Scottish Government recommends less than 400mg sodium (1g salt) per day for children aged 0 to 12 months and less than 800mg sodium (2g salt) per day for children aged 1 to 3 years[11]. Mean sodium intakes for children aged 12 to 18 months therefore exceeded the recommendation for this age group. The most reliable estimates of sodium intake are obtained from chemical urinary analysis as estimates derived from patterns of food consumption cannot consider salt added during food preparation.

There were no statistically significant differences in intakes of iron, calcium, magnesium, potassium, zinc, copper, selenium, iodine and sodium between DNSIYCS and the UK sample for either those aged 4 to 11 months or those aged 12 to 18 months.

Tables 6.33, 6.36 and 6.37

The major contributor to iron intake for children aged 4 to 6 months, 7 to 9 months and 10 to 11 months was infant formula (providing 59%, 47% and 40% respectively) followed by the food group 'commercial infant foods' (both 22%) for children aged 4 to 6 months and 7 to 9 months respectively and the food group 'cereals and cereal products' (20%) for those aged 10 to 11 months. For children aged 12 to 18 months, the main contributor was 'cereals and cereal products' (44%) followed by infant formula (13%).

Table 6.38

Infant formula was the main contributor to zinc intake for children aged 4 to 6 months, 7 to 9 months and 10 to 11 months (64%, 48% and 39% respectively) followed by the food group 'commercial infant foods' (15% and 17% respectively) for children aged 4 to 6 and 7 to 9 months and the food group 'milk and milk products' (15%) for children aged 10 to 11 months. For children aged 12 to 18 months, the main contributor was 'milk and milk products' (31%) followed by the food group 'cereals and cereal products' (20%).

Table 6.39

The main contributor to calcium intake was infant formula for children aged 4 to 6 months and 7 to 9 months, at 59% and 44% respectively. The second largest contributor to calcium intake was the food group 'commercial infant foods' (17%) for children aged 4 to 6 months, while for children aged 7 to 9 months, it was the food groups 'milk and milk products' and 'commercial infant foods' (both 17%). For children aged 10 to 11 months, the main contributor was infant formula (34%) followed by 'milk and milk products' (31%). For children aged 12 to 18 months, the main contributor was 'milk and milk products' (54%) followed by the food group 'cereals and cereal products' (18%).

Table 6.40

Infant formula was the main contributor to sodium intake for children aged 4 to 6 months (50%) and 7 to 9 months (26%) followed by the food group 'commercial infant foods' (18%) for children aged 4 to 6 months and 'cereals and cereal products' for children aged 7 to 9 months (18%). The food group 'cereals and cereal products' was the main contributor for children aged 10 to 11 months (24%) and children aged 12 to 18 months (31%). The second largest contributor to sodium intake was the food group 'milk and milk products' for children aged 10 to 11 months (15%) and 12 to 18 months (20%).

Table 6.41

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Email: Julie Ramsay

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