“I think there is no doubt that our biggest public health problem is obesity so it’s understandable that for some time we’ve been focusing on macronutrients and obviously for the last year or so the focus has all been on sugars which clearly we do need to reduce,” Sara Stanner, science director for the British charity, told NutraIngredients.
“But I think it has kind of tipped the balance a bit because consumers are very unaware that actually there are things in our diet that we’re not getting enough of and there are a number of vulnerable groups particularly teenagers and younger people where there are a number of micronutrients that are lacking in the diet. So it’s important to have a conversation about those things simultaneously.”
She said among young people in particular concerns around weight had meant foods like meat, dairy and bread were being cut out to reduce calories of carbohydrates and fats, but this meant cutting out micronutrients too.
A more complex conversation was needed, she said, along with investment in research and support from healthcare professionals and food fortification policies.
The review, published in Nutrition Bulletin, said greater focus was needed on folate, vitamin D, calcium, iron and iodine in particular, which were micronutrients of concern for some groups in the UK population like adolescents, ethnic minorities and people from lower socio-economic backgrounds.
At least one in ten teenagers are falling short on key micronutrients, including vitamin A, iron and calcium, the report said.
"Teenage girls and women of childbearing age are of particular concern because of their high requirements for some micronutrients and the impact poor micronutrient intakes can have on the health of their offspring,” wrote Stanner and co-authors BNF nutrition scientist Dr Rosalind Miller and senior nutrition scientist Ayela Spiro.
“Yet, compared to other food concerns, relatively little importance seems to be given by consumers to the micronutrient density of food.”
A continuation of current dietary trends could see further decreases in iron and calcium intakes, the report warned; adding that environmental-motivation for dietary changes should also be taken into consideration.
The fat and the famine
The UK has the third highest level of obese and overweight people in western Europe behind Iceland and Malta.
A 2014 study published in The Lancet calculated that 67% of men and 57% of women in the UK are either overweight or obese.
Meanwhile one in five people in the UK have a sub-optimal vitamin D status, 19% of females aged 11–18 years have inadequate calcium levels and 46% of females aged 11–18 years and 23% aged 19–64 years have low iron intakes.
“Unfortunately it’s a dual problem and it is very complicated because obviously we are trying to give consumers simple messages but actually as nutritionists looking at it, the message isn’t that simple because there are lots of issues that are ongoing and discussions even with the macronutrients about what the right proportion of carbohydrates to fats is for example,” Stanner said.
This idea of a double nutrition burden went beyond the UK, with regions like Latin America and Africa shifting focus from under to over nourishment in recent years.
Speaking with NutraIngredients in December, director of nutrition for the UN’s Food and Agriculture Organisation (FAO) said Africa was now facing up to its own double burden of malnutrition and obesity, which was occurring side-by-side in the same countries, communities and even households.
In 2014, over 1.9 billion adults aged 18 years and older were overweight – that’s 39% of the world’s adult population. Of these over 600 million – 13% of the world’s adult population – were obese, according to the World Health Organisation (WHO).
“It is a neglected issue and something we tried at the conference [FAO’s Second International Conference on Nutrition in Rome] last year to bring up – that we should not close our eyes to that [obesity] problem as we are looking at the undernutrition problem, we should really tackle the two so we don’t create another problem,” said Anna Lartey.
Like the BNF, she said what was now needed was a full "food systems approach" to tackle the issue of malnutrition in all its forms simultaneously.
Throwing the baby out with the bathwater
Fruit juices have also come under fire in the UK in the so called ‘war on sugar’ of recent years, which Stanner said was a concern given these drinks were also a source of vitamin C.
A list of foods that contained sugars did not go deep enough as guidance for the public, she said.
The challenge was getting the message out when health care professionals within the UK’s resource-strapped National Health Service (NHS) were already over-burdened with priority public health messages to push.
The review also highlighted changing dietary habits motivated by global food security issues and climate change.
“There is clearly a global move to promote more sustainable plant-based diets worldwide to reduce the burden on the environment but such diets may invoke nutritional challenges for the future.
“The task ahead is to identify dietary patterns that provide us with the vitamins and minerals we need for health, in appropriate amounts, that are also equitable, affordable and sustainable,” the report said.
A fortified future?
The report said fortification of foods was making an important contribution in tackling deficiencies.
Movement on mandatory fortification of things like folic acid and flour has been slow, however, with prolonged discussions on possible risks of systematically upping intakes.
“It has been relatively slow and I think it’s just the priorities. The priorities has been focused – particularly with PHE [Public Health England] – on sugar reduction,” Stanner said.
Source: Nutrition Bulletin
Published online ahead of print, doi: 10.1111/nbu.12187
“Micronutrient status and intake in the UK – where might we be in 10 years' time?”
Authors: R. Miller, A. Spiro, and S. Stanner