Time to address the double inequality of differences in dietary intake between Scotland and England

Geographical disparities in health outcomes have been evident across the UK for decades. There is limited recent analysis on the dietary differences between Scotland and England that might go some way to explain these health differences. This study aimed to assess whether, and to what degree, aspects of diet and nutrition differ between Scottish and English populations, specifically between those with similar household incomes. Twelve years of UK food purchase data (2001-2012) were pooled and used to estimate household level consumption data for Scotland and England. Population mean food consumption and nutrient intakes were estimated, adjusting for known confounders (year, age of household reference person, age they left full-time education and income). Comparison was also made within equivalised income quintiles. Analysis showed that the foods and nutrients that should be increased in the diet (highlighted in the Scottish Dietary Goals) were lower in Scotland than England (e.g. fruit and vegetables 267g/day (99%CI 259-274g/day) vs. 298g/day (99%CI 296-301g/day), P<0.001). Likewise, foods and drinks linked with poor health outcomes were higher in Scotland. These regional inequalities in diet were even more pronounced in the lower income groups (e.g. red and processed meat consumption in the lowest income quintile was 65g/day (99% CI 61-69g/day) in Scotland vs. 58g/day (99% CI 57-60g/day) in England, P<0.001, but similar in the highest income quintile (58g/day (99%CI 54-61 g/day) vs. 59g/day (99% CI 58-60 g/day) respectively). A poorer diet in Scotland compared to England, particularly among disadvantaged groups, may contribute to differences in excess mortality between countries

Sustainable diets in the UK—developing a systematic framework to assess the environmental Impact, cost and nutritional quality of household food purchases

Sustainable diets should not only respect the environment but also be healthy and affordable. However, there has been little work to assess whether real diets can encompass all three aspects. The aim of this study was to develop a framework to quantify actual diet records for health, affordability and environmental sustainability and apply this to UK food purchase survey data. We applied a Life Cycle Assessment (LCA) approach to detailed food composition data where purchased food items were disaggregated into their components with traceable environmental impact data. This novel approach is an improvement to earlier studies in which sustainability assessments were based on a limited number of “food groups”, with a potentially high variation of actual food items within each group. Living Costs and Food Survey data for 2012, 2013 and 2014 were mapped into published figures for greenhouse gas emissions (GHGE, taking into account processing, transport and cooking) and land use, a diet quality index (DQI) based on dietary guidelines and food cost, all standardised per household member. Households were classified as having a ‘more sustainable’ diet based on GHGE, cost and land use being less than the median and DQI being higher than the median. Only 16.6% of households could be described as more sustainable; this rose to 22% for those in the lowest income quintile. Increasing the DQI criteria to >80% resulted in only 100 households being selected, representing 0.8% of the sample. The framework enabled identification of more sustainable households, providing evidence of how we can move toward better diets in terms of the environment, health, and costs

Identifying dietary differences between Scotland and England:a rapid review of the literature

Rates of premature mortality have been higher in Scotland than in England since the 1970s. Given the known association of diet with chronic disease, the study objective was to identify and synthesise evidence on current and historical differences in food and nutrient intakes in Scotland and England.A rapid review of the peer-reviewed and grey literature was carried out. After an initial scoping search, Medline, CINAHL, Embase and Web of Science were searched. Relevant grey literature was also included. Inclusion criteria were: any date; measures of dietary intake; representative populations; cross-sectional or observational cohort studies; and English-language publications. Study quality was assessed using the Quality Assessment Tool for Observational Cohort and Cross-sectional Studies. A narrative synthesis of extracted information was conducted.Fifty publications and reports were included in the review. Results indicated that children and adults in Scotland had lower intakes of vegetables and vitamins compared with those living in England. Higher intakes of salt in Scotland were also identified. Data were limited by small Scottish samples, difficulty in finding England-level data, lack of statistical testing and adjustment for key confounders.Further investigation of adequately powered and analysed surveys is required to examine more fully dietary differences between Scotland and England. This would provide greater insight into potential causes of excess mortality in Scotland compared with England and suitable policy recommendations to address these inequalities

An Analysis of the Consumption of Sausages in Scotland using Supermarket Data

This paper addresses consumers’ choices by looking into: current food choices made by different socio-economic groups; price barriers for diet improvement; and ways in which marketing may affect product choice. The study seeks: first, to analyze the differences in consumption of sausages of different nutritional composition among different socio-demographic and lifestage groups; and second, to measure whether it is possible to improve diet quality without affecting household expenditure. Sausages represent a relatively high proportion of red and processed meat purchases in Scotland, contributing significantly to the fat and sodium in the Scottish diet. The data used consisted of two-years of weekly information from a top-4, UK supermarket. The results suggest that it is possible to purchase similar quantities of a lower saturated fat or lower sodium sausage for the same price as a higher saturated fat or sodium sausage. However, it would cost more for some the groups to replace both a lower saturated fat and a lower sodium sausage in the household’s food basket.Scotland, saturated fats, sodium, consumer choices, sausages consumption, Food Consumption/Nutrition/Food Safety, D1,

An Analysis of the Consumption of Sausages in Scotland using Supermarket Data

This paper addresses consumers’ choices by looking into: current food choices made by different socio-economic groups; price barriers for diet improvement; and ways in which marketing may affect product choice. The study seeks: first, to analyze the differences in consumption of sausages of different nutritional composition among different socio-demographic and lifestage groups; and second, to measure whether it is possible to improve diet quality without affecting household expenditure. Sausages represent a relatively high proportion of red and processed meat purchases in Scotland, contributing significantly to the fat and sodium in the Scottish diet. The data used consisted of two-years of weekly information from a top-4, UK supermarket. The results suggest that it is possible to purchase similar quantities of a lower saturated fat or lower sodium sausage for the same price as a higher saturated fat or sodium sausage. However, it would cost more for some the groups to replace both a lower saturated fat and a lower sodium sausage in the household’s food basket.Scotland, saturated fats, sodium, consumer choices, sausages consumption, Food Consumption/Nutrition/Food Safety,

Frequency of eating home cooked meals and potential benefits for diet and health: cross-sectional analysis of a population-based cohort study

BACKGROUND: Reported associations between preparing and eating home cooked food, and both diet and health, are inconsistent. Most previous research has focused on preparing, rather than eating, home cooked food; used small, non-population based samples; and studied markers of nutrient intake, rather than overall diet quality or health. We aimed to assess whether frequency of consuming home cooked meals was cross-sectionally associated with diet quality and cardio-metabolic health. METHODS: We used baseline data from a United Kingdom population-based cohort study of adults aged 29 to 64 years (n=11,396). Participants self-reported frequency of consuming home cooked main meals. Diet quality was assessed using the Mediterranean Diet Score, Dietary Approaches to Stop Hypertension (DASH) score, fruit and vegetable intake calculated from a 130-item food frequency questionnaire, and plasma vitamin C. Markers of cardio-metabolic health were researcher-measured body mass index (BMI), percentage body fat, haemoglobin A1c (HbA1c), cholesterol and hypertension. Differences across the three exposure categories were assessed using linear regression (diet variables) and logistic regression (health variables). RESULTS: Eating home cooked meals more frequently was associated with greater adherence to DASH and Mediterranean diets, greater fruit and vegetable intakes and higher plasma vitamin C, in adjusted models. Those eating home cooked meals more than five times, compared with less than three times per week, consumed 62.3 grams more fruit (99%CI 43.2 to 81.5) and 97.8 grams more vegetables (99%CI 84.4 to 111.2) daily. More frequent consumption of home cooked meals was associated with greater likelihood of having normal range BMI and normal percentage body fat. Associations with HbA1c, cholesterol and hypertension were not significant in adjusted models. Those consuming home cooked meals more than five times, compared with less than three times per week, were 28% less likely to have overweight BMI (99%CI 8 to 43%), and 24% less likely to have excess percentage body fat (99%CI 5 to 40%). CONCLUSIONS: In a large population-based cohort study, eating home cooked meals more frequently was associated with better dietary quality and lower adiposity. Further prospective research is required to identify whether consumption of home cooked meals has causal effects on diet and health.The Fenland Study is funded by the Wellcome Trust and the Medical Research Council. Support from Medical Research Council programmes MC_UU_12015/1 and MC_UU_12015/5 is acknowledged. This report is independent research arising from a Doctoral Research Fellowship Grant DRF-2014-07-020 for the lead author (SM), supported by the National Institute for Health Research. JA and MW received funding from the Centre for Diet and Activity Research (CEDAR), a UK Clinical Research Collaboration (UKCRC) Public Health Research Centre of Excellence. HB and SM are members of Fuse, also a UKCRC Public Health Research Centre of Excellence. Grant reference number is MR/K02325X/1. Funding for CEDAR and for Fuse from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research and the Wellcome Trust, under the auspices of the UKCRC, is gratefully acknowledged. The views expressed in this publication are those of the authors and not necessarily those of the National Health Service, the Department of Health, the funders or UKCRC. The funders had no role in the study design; in the collection, analysis and interpretation of data; nor in the writing of the report and the decision to submit for publication

Sociodemographic characteristics and frequency of consuming home-cooked meals and meals from out-of-home sources: cross-sectional analysis of a population-based cohort study.

OBJECTIVE: To identify sociodemographic characteristics associated with frequency of consuming home-cooked meals and meals from out-of-home sources. DESIGN: Cross-sectional analysis of a population-based cohort study. Frequency of consuming home-cooked meals, ready meals, takeaways and meals out were derived from a participant questionnaire. Sociodemographic characteristics regarding sex, age, ethnicity, working overtime and socio-economic status (SES; measured by household income, educational attainment, occupational status and employment status) were self-reported. Sociodemographic differences in higher v. lower meal consumption frequency were explored using logistic regression, adjusted for other key sociodemographic variables. SETTING: Cambridgeshire, UK. SUBJECTS: Fenland Study participants (n 11 326), aged 29-64 years at baseline. RESULTS: Eating home-cooked meals more frequently was associated with being female, older, of higher SES (measured by greater educational attainment and household income) and not working overtime. Being male was associated with a higher frequency of consumption for all out-of-home meal types. Consuming takeaways more frequently was associated with lower SES (measured by lower educational attainment and household income), whereas eating out more frequently was associated with higher SES (measured by greater educational attainment and household income) and working overtime. CONCLUSIONS: Sociodemographic characteristics associated with frequency of eating meals from different out-of-home sources varied according to meal source. Findings may be used to target public health policies and interventions for promoting healthier diets and dietary-related health towards people consuming home-cooked meals less frequently, such as men, those with lower educational attainment and household income, and overtime workers

What can secondary data tell us about household food insecurity in a high-income country context?

In the absence of routinely collected household food insecurity data, this study investigated what could be determined about the nature and prevalence of household food insecurity in Scotland from secondary data. Secondary analysis of the Living Costs and Food Survey (2007–2012) was conducted to calculate weekly food expenditure and its ratio to equivalised income for households below average income (HBAI) and above average income (non-HBAI). Diet Quality Index (DQI) scores were calculated for this survey and the Scottish Health Survey (SHeS, 2008 and 2012). Secondary data provided a partial picture of food insecurity prevalence in Scotland, and a limited picture of differences in diet quality. In 2012, HBAI spent significantly less in absolute terms per week on food and non-alcoholic drinks (£53.85) compared to non-HBAI (£86.73), but proportionately more of their income (29% and 15% respectively). Poorer households were less likely to achieve recommended fruit and vegetable intakes than were more affluent households. The mean DQI score (SHeS data) of HBAI fell between 2008 and 2012, and was significantly lower than the mean score for non-HBAI in 2012. Secondary data are insufficient to generate the robust and comprehensive picture needed to monitor the incidence and prevalence of food insecurity in Scotland.</p