Eatwell Guide: reflections and challenges (dairy)

Eatwell Guide: reflections and challenges (dairy) Anne Mullen, BSc, PhD, FHEA, RD Director of Nutrition at The Dairy Council April 2016 Email: a.mullen@dairycouncil.org.uk Tel: 020 7025 0560 Web: www.milk.co.uk Twitter: TheDairyCouncil 210 High Holborn, London WC1V 7EP

Who we are Non- profit making organisation with a remit to address human health and disease issues relating to dairy Staffed by registered dietitians and registered nutritionists Provide information on the health benefits of dairy to consumers, healthcare professionals, media and industry Engage with opinion formers in clinical and public health Liaise with international health and nutrition bodies Facilitate dairy and human nutrition research in partnership with other organisations [cardiovascular disease, obesity, hormones, healthy ageing, environmental sustainability]

Overview Dairy is nutrient- rich, nutrient- dense and integral to the UK diet How much dairy is recommended? Public health nutrition guidance internationally and nationally Eatwell Guide: micronutrients Eatwell Guide: cardiometabolic health and obesity

Composition per 100g Whole Semi- skimmed Milk Yogurt Cheese Skimmed Plain Plain low- fat Fromage frais Cheddar Cottage cheese Energy (kcal) 63 46 34 79 57 99 416 103 237 Protein (g) 3.4 3.5 3.5 5.7 4.8 5.8 25.4 9.4 11.3 Carbohydrate (g) 4.6 4.7 4.8 7.8 7.8 13.2 0.1 3.1 6.5 Fat (g) 3.6 1.7 0.3 3.0 1.0 2.9 34.9 6.0 18.6 Sat Fat (g) 2.3 1.1 0.1 1.9 0.7 1.9 21.7 3.2 12.9 Sodium (mg) 42 43 44 80 63 60 723 250 730 Potassium (mg) 157 156 162 280 228 143 75 161 219 Calcium (mg) 120 120 125 200 162 140 739 127 498 Phosphorus (mg) 96 94 96 170 143 123 505 171 835 Iodine (µg) 31 30 30 63 34 17 30 24 29 Thiamin (mg) 0.03 0.03 0.03 0.06 0.12 0.11 0.03 0.05 0.05 Riboflavin (mg) 023 0.24 0.22 0.27 0.22 0.29 0.39 0.24 0.36 Cheese spread McCance and Widdowson s The Composition of Foods 7 th Edition (2015)

Composition High in Vitamin A, Vitamin B12 and Zinc per 100g Whole Semi- skimmed Milk Yogurt Cheese Skimmed Plain Plain low- fat Fromage frais Cheddar Cottage cheese Energy (kcal) 63 46 34 79 57 99 416 103 237 Protein (g) 3.4 3.5 3.5 5.7 4.8 5.8 25.4 9.4 11.3 Carbohydrate (g) 4.6 4.7 4.8 7.8 7.8 13.2 0.1 3.1 6.5 Fat (g) 3.6 1.7 0.3 3.0 1.0 2.9 34.9 6.0 18.6 Sat Fat (g) 2.3 1.1 0.1 1.9 0.7 1.9 21.7 3.2 12.9 Sodium (mg) 42 43 44 80 63 60 723 250 730 Potassium (mg) 157 156 162 280 228 143 75 161 219 Calcium (mg) 120 120 125 200 162 140 739 127 498 Phosphorus (mg) 96 94 96 170 143 123 505 171 835 Iodine (µg) 31 30 30 63 34 17 30 24 29 Thiamin (mg) 0.03 0.03 0.03 0.06 0.12 0.11 0.03 0.05 0.05 Riboflavin (mg) 023 0.24 0.22 0.27 0.22 0.29 0.39 0.24 0.36 Cheese spread McCance and Widdowson s The Composition of Foods 7 th Edition (2015)

Contribution to UK diet Milk and Milk Products 1.5-3 yrs 4-10 yrs 11-18 yrs 19-64 yrs 65+ yrs Energy 25% 15% 9% 9% 12% Protein 34% 21% 14% 13% 17% Fat 34% 20% 13% 13% 16% NMES 18% 12% 7% 6% 8% Calcium 61% 45% 35% 36% 42% Iodine 64% 51% 40% 33% 37% Riboflavin 55% 41% 29% 28% 34% Vitamin B12 63% 49% 36% 33% 35% Sodium 18% 11% 8% 9% 11% NDNS Years 1 to 4 rolling programme 2008/2009 2011/2012(2014)

Contribution to UK diet Milk and Milk Products 1.5-3 yrs 4-10 yrs 11-18 yrs 19-64 yrs 65+ yrs Energy 25% 15% 9% 9% 12% Protein 34% 21% 14% 13% 17% Fat 34% 20% 13% 13% 16% NMES 18% 12% 7% 6% 8% Calcium 61% 45% 35% 36% 42% Iodine 64% 51% 40% 33% 37% Riboflavin 55% 41% 29% 28% 34% Vitamin B12 63% 49% 36% 33% 35% Sodium 18% 11% 8% 9% 11% Milk and milk products are nutritious foods integral to the nation s diet NDNS Years 1 to 4 rolling programme 2008/2009 2011/2012(2014)

Healthy Eating Guidelines in Ireland, 2012 Milk, Yoghurt & Cheese Food Safety Authority of Ireland (2011)

Dutch Dietary Guidelines, 2016 Dairy, Nuts, Fish, Legumes, Meat & Eggs Health Council of Netherlands (2015)

Dietary Guideline for Americans, 2015-2020 USDA (2015)

Eating Well with Canada s Food Guide, 2007

Eatwell Guide, 2016 PHE (2016)

Eatwell Guide, 2016 1. Renamed Eatwell Guide 2. Removal of knife and fork 3. Drawn images instead of photographs 4. Updated segment names 5. Food group segments resized 6. Purple section contains only oils and spreads 7. HFSS foods removed from purple section 8. Inclusion of a hydration message 9. Additional messages for further guidance 10. Inclusion of energy requirements 11. Inclusion of front- of- pack nutrition label 12. Fruit juice removed from F&V section PHE (2016)

PHE (2015)

some dairy Source reported as PHE (2016) by Daily Mail, 17 th March 2016

some dairy Dairy 150ml semi-skimmed milk 30ml semi-skimmed milk 60ml semi-skimmed milk Source reported as PHE (2016) by Daily Mail, 17 th March 2016

some dairy Dairy 150ml semi-skimmed milk 30ml semi-skimmed milk 60ml semi-skimmed milk Fruit & Veg 160g orange 100g salad 100g banana 190g carrot & coriander soup 80g broccoli 80g sweetcorn 30g chopped apricot 90g vegetable crudites Source reported as PHE (2016) by Daily Mail, 17 th March 2016

some dairy Dairy 150ml semi-skimmed milk 30ml semi-skimmed milk 60ml semi-skimmed milk Fruit & Veg 160g orange 100g salad 100g banana 190g carrot & coriander soup 80g broccoli 80g sweetcorn 30g chopped apricot 90g vegetable crudites 4 other such menus Range from 185mls milk (Plan 2) to 215mls milk + 25g cheese + 80g yogurt (Plan 4) Portion sizes not always standard

Our analysis Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Energy (kcal) 1919 2135 2213 2264 2174 Carbohydrate (g) 305 295 351 346 373 Protein (g) 109 99 90 125 94 Fat (g) 37 70 61 54 45 Fibre (g) 45 35 41 41 32 Sugars (g) 102 108 104 117 97 Free Sugars (g) 17.2 18 29 8 29 Saturated fat (g) 10.6 16.3 19.5 15.6 10.7 Calcium (mg) 888 946 1191 1154 1156 Iodine (µg) 145 136 136 149 129

Micronutrients Age (yrs) 1-3 350 4-6 450 7-10 550 11-18 male 1000 Calcium RNI (mg/day) 11-18 female 800 (+550 breastfeeding) 19+ 700 (+550 breastfeeding) 1 in 5 adolescent girls are not reaching their requirement & 13% of teenage boys are not reaching their requirement Age (yrs) 1-3 70 4-6 100 7-10 110 11-14 130 15-18 140 19+ 140 Iodine RNI (µg/day) 1 in 5 adolescent girls and 10% of women have iodine below the LRNI WHO has defined problem as mild to moderate severity WHO recommends 250µg/day for pregnant and breastfeeding women

Cardiometabolic disease

Seven Countries Study Kromhaut (1999)

Saturated Fat, CHD/Stroke CHD & SFA RR 1.07 no association Stroke & SFA RR 0.81 no association Siri-Tarino et al (2010)

Coronary outcomes and. SFA: no association MUFA: no association n-3 LC PUFA: -ve association n-6 PUFA: no association TFA: +ve association Chowdhury et al (2014)

De Souza et al (2015)

not all saturated fatty acids are created equal Chowdhury et al (2014)

Milk and CVD RR 0.94 association Soedamah-Muthu et al (2011)

Milk and CHD RR 1.00 no association Soedamah-Muthu et al (2011)

Milk and Stroke RR 0.87 no significant association Soedamah-Muthu et al (2011)

Dairy and Hypertension RR 0.97 association Soedamah-Muthu et al (2012)

Dairy and Body Weight no energy restriction change 0.39kg no association energy restriction change -0.79kg association Chen et al (2012)

Dairy and Body Fat change -0.45kg association Chen et al (2012)

A YOGHURT A DAY KEEPS DIABETES AWAY, SAY SCIENTISTS NHS: 121,700 females;; 7841 incident cases of T2DM (30yrs f/up) NHS II: 116,671 females;; 3951 incident cases of T2DM (16yrs f/up) HPFS: 51,529 males;; 3634 incident cases of T2DM (24ys f/up) Pooled Chen et al (2014)

Chen et al (2014)

always consider heterogeneity Chen et al (2014)

Conclusions Milk and dairy foods are nutrient- rich and nutrient- dense; they have an established and integral place on dietary guidelines internationally and nationally Refreshed Eatwell Guide appears to have reduced the amount of milk and dairy We believe this has implications for micronutrient intakes particularly calcium and iodine We also believe the approach of the analysis behind the guide should be food- based rather than nutrient- based particularly with respect to cardiometabolic health and obesity References available on request