Kavita Deepchand, Andrew Shaw, Julia Field
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SUMMARY
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People's health is affected greatly by what they eat. In Scotland, eating habits are the second major cause (after smoking) of poor health. The national diet contributes 'to a range of serious illnesses, which include coronary heart disease, certain cancers, strokes, osteoporosis and diabetes'.1
The Scottish Health Survey asked informants about their patterns of eating: what types of food they ate and, on average, how often. This provides indicators of the extent of healthy and unhealthy eating habits among the population. Trends in these indicators may show improvements or deterioration in diet. The 1998 survey reveals emerging trends for adults aged 16-64. For children and older adults (65-74), this survey provides for the first time data on eating habits. As with adults aged 16-64, it does not measure their consumption, since this requires a study dedicated to food and/or nutrition.4 However, the study does include some biological measurements linked to nutrition - total cholesterol, HDL cholesterol, ferritin, haemoglobin and vitamins -which are reported in Chapters 2, 13 and 14.
Sections 10.2 to 10.7 of this chapter describe informants' reported patterns of consumption of seven major food types: foods containing sugar (10.2), spreading and cooking fats and fried food (10.3), dairy produce (10.4), meat and poultry (10.5), fish (10.6), foods containing starch and fibre (10.7) and fresh fruit and vegetables (10.8). The two sections thereafter (10.9 and 10.10) report on the consumption of salt and dietary supplements. Variations in eating habits by social class and region are then explored (10.11 and 10.12), followed by trends since 1995 (10.13). Finally, the results for Scotland are compared with those from the Health Survey for England (10.14).
10.2 CONSUMPTION OF FOODS CONTAINING SUGAR
Sugar occurs naturally in many foods such as fruit, vegetables and milk. It is also used in many food products such as cakes and biscuits, sweets and soft drinks. While sugars are important in maintaining life and in providing energy, foods which are high in non-milk extrinsic (NME) sugar tend to contain few other nutrients. The dietary target is for there to be no increase in the intake of NME sugar. Informants were asked about consumption of several groups of foods containing sugar: tea and coffee with sugar; chocolates, crisps and biscuits; sweets and ice cream; cakes, scones, pastries and puddings; and soft drinks.
10.2.1 Sugar in tea and coffee
Adults
Among adults who drank tea at all (over ninety percent of all adults), almost twice the proportion of men as of women added sugar: 48% compared with 26%. Four adults in five reported drinking coffee, though this proportion was only two-thirds for 16-24 year olds. Among coffee drinkers, too, men were much more likely than women to add sugar: 55% compared with 32%. For both drinks and both sexes there was a decline with age in the proportions that added sugar. This was more marked for tea than for coffee, falling from 66% and 46% of young men and women to 39% and 21% respectively among the oldest age group.
Children
Overall, 62% of boys and 65% of girls drank tea; 25% of boys and 24% of girls drank coffee. The prevalence of both tea and coffee drinking increased substantially across age groups of children. For tea, the increase was from about half of those aged 2-3 to about three-quarters of those aged 14-15 (for boys and girls). For coffee it was from about two in ten to four in ten.
Among children who drank tea, 63% of boys and 54% of girls added sugar. The position was about the same for coffee: 60% of boys and 53% of girls added sugar. Prevalence of adding sugar tended to increase after the age of five. Around two-thirds of boys aged 10-15 who drank tea or coffee added sugar; among girls this proportion stabilised from as young as age six, at around six in ten.
10.2.2 Consumption of 'snacks': biscuits, cakes, confectionery and soft drinks
Adults
Just over half of men and women in Scotland ate chocolates, crisps or biscuits daily, including 20% of men and 17% of women who did so more than once a day. Younger men were the most likely to have eaten these foods more than once a day. One in ten men and women ate chocolates, crisps or biscuits less than once a week. However, this proportion varied substantially by age from just three or four per cent of young men and women to at least 15% among those aged 55 and over.
Far fewer adults - about one in eight - ate sweets or ice cream on a daily basis. Only 3% of men and 2% of women ate these foods more than once a day, while 10% of both sexes reported a consumption rate of once a day. Again, a notably higher proportion of 16-24 year old men (9%) ate sweets more than once a day.
Relatively few men (14%) and women (12%) reported that they ate cakes, scones, sweet pies, pastries or puddings on most days (5 or more times a week). One half of both men and women ate this type of food one to four times a week, while just over a third did so less than once a week. It was older rather than younger age groups that included higher numbers of frequent cake and pudding eaters (22% of men and 19% of women aged 65-75 reported five or more occasions a week).
On the consumption of (non-diet) soft drinks, for example squashes, fizzy drinks and mixers, there was an overall difference between men and women and sizeable age differences. A majority of women (57%) reported having soft drinks less than once a week, perhaps because diet or low-calorie options were excluded here. Thirteen per cent said they drank soft drinks once a day and 11% did so more than one. For men, these figures were 19% and 17% respectively, with less than a half (41%) stating they drank soft drinks less than once a week. However, many more young men _ indeed, a large majority of them - had either more than one (41%) or one (27%) occasion of having soft drinks each day. These percentages then fell sharply, such that by age 35-44 only 11% of men were consuming soft drinks more than once a day and 17% were doing so once. The pattern was the same among women, but in the younger age groups women were less likely than men to drink soft drinks more than once per day.
Children
Virtually all children ate chocolates, crisps or biscuits every week and most did so every day. Indeed, four in ten were eating these foods more than once a day. There was little variation by gender or age, though girls (37%) were less likely than boys (43%) to eat chocolates, crisps or biscuits more than once a day. Also, the youngest children (aged 2-3) had relatively low proportions within this category (27% of girls and 32% of boys).
In contrast, most children - 53% of boys and 56% of girls - did not eat sweets or ice cream every day. Nevertheless, a third did eat these foods once a day, while 13% of boys and 11% of girls were said to eat sweets or ice cream more than once a day. These figures were very similar across the age groups.
The most common rate of consumption of cakes, scones, sweet pies, pastries or puddings was clearly one to four times a week (56% of boys and 58% of girls). A quarter of both boys and girls ate these foods less frequently, while slightly fewer did so five or more times weekly (18% of boys and 15% of girls). Figures are, again, similar for boys and girls across the age range, though more teenage boys than girls ate cakes and puddings very frequently.
For just over half of children, drinking soft drinks was a daily event and many boys (37%) and girls (33%) consumed such drinks more than once a day. On the other hand a quarter of children reported having soft drinks less than once a week. Among boys there was a shift with increasing age towards more frequent consumption: just over a half of the youngest children but seven in ten 14-15 year olds had soft drinks at least once a day, while the proportion taking drinks less than once a week fell from 32% to 14%. There was an unusual age pattern among girls. The proportion consuming soft drinks daily showed no real change. Instead, the proportion having soft drinks one to six times a week rose from 10% to 23%, while that consuming less frequently fell from 35% to 22%. Teenage girls, therefore, were quite a bit more likely than boys not to have a (non-diet) soft drink every day.
10.3 CONSUMPTION OF SPREADING AND COOKING FATS AND FRIED FOOD
This section covers the use of fat spreads and of fat in frying as well as the frequency of eating fried foods. Fats are high in calories and are a concentrated source of energy. They also help in the absorption of key vitamins. However, too much fat in the diet, especially saturated fatty acids (SFA), is associated with raised plasma cholesterol levels and risk of heart disease. The Diet Action Plan targets are to reduce by 2005 the average intake of total fat as a proportion of food energy to 35% and to reduce intake of saturated fatty acids to 11%. Reducing consumption of butter and saturated fat margarines and spreads are components of these targets. Of course, total fat intake includes many sources in addition to these (covered in other sections, particularly sugary foods, 10.2; dairy produce, 10.4; and meat, 10.5).
10.3.1 Spreading fats
Adults
Only a small group of informants (6% of men and 8% of women) did not use a fat spread on bread or vegetables. The types of spread usually used by other informants were classified as either butter/margarine or low fat spread/half-fat butter. Equal numbers of men used the former (45%) and the latter (47%), while fewer women used butter/margarine (39% compared with 51% who used low fat spreads).5 Age differences were negligible except that more men aged 16-24 used butter/margarine (49%) than used a reduced fat spread (40%).
Among those who used butter/margarine, the average number of 'pats'6 used per day was 3.4 by men and 2.4 by women. Average use of reduced fat spreads was slightly lower at 2.9 pats per day for men and 2.1 for women. There were no marked differences by age.
Children
Fewer children usually used butter/margarine (39% of boys, 41% of girls) than used reduced fat spreads (53% of both boys and girls). Among boys, but not girls, use of butter/margarine was slightly higher in the under eight age groups (over 40%) than among those aged eight and over (33%-36%).
The mean numbers of pats per day used by boys were 2.4 (butter/margarine) and 2.2 (reduced fat spread). For girls, consumption was slightly lower at 2.1 and 1.9 respectively. With both boys and girls and for both main types of spreads there was a modest increase with rising age in the amount used per day.
10.3.2 Cooking fats
Informants were asked what type of fat or oil they used when they had fried foods at home. The responses revealed that 78% of men and 77% of women used vegetable oil, while cooking fat, margarines and all other products together accounted for only 11% of men and 10% of women. A further 10% of men and 13% of women replied that they did not eat fried food, with this proportion rising to 20% among the oldest women (65-74).
As one might expect, the figures are similar for children. Even more boys and girls (82% and 84%) than adults had fried foods cooked in vegetable oil, while slightly fewer ate no fried food (8% of both boys and girls).
10.3.3 Fried food
Adults
Fried foods include fish, chips, cooked breakfasts and samosas. Few men (10%) and very few women (3%) ate this type of food every day. Most men (62%) and half of women (52%) ate fried food between once and six times a week. Nearly as many women (44%) were eating this food less often than weekly, though far fewer men (28%) were doing this.
There were sizeable age differences: at the extreme, 18% of men aged 16-24 ate fried food daily compared with 5% of men aged 65-74. Conversely, the proportion having fried food less than weekly rose from 13% in the youngest age group to 27% in the next group (25-34) and then to 37% in the oldest group. The pattern was the same among women, but the differences were substantially smaller. The net result was that very many more young women (38%) than young men (13%) were eating fried food less than once a week.
Children
This difference between men and women was not found between girls and boys. Well under one child in ten (7% of boys, 6% of girls) ate fried food daily, though the numbers reached one in ten among teenage boys. Six in ten boys and girls had fried food each week but not each day; a third had this type of food less often, though, among boys, this proportion tended to fall slightly with rising age (from 40% of those aged 2-5 to 21% of those aged 14-15).
10.4 CONSUMPTION OF DAIRY PRODUCE
10.4.1 Milk
Informants were asked both how much milk they had each day and what type they usually used (since the fat content varies considerably between whole or full cream, semi-skimmed and skimmed milk).
Adults
Over half of all adults usually used semi-skimmed milk (57% and 58% of men and women respectively). However, more men than women used whole milk: 32% of men compared with 26% of women. Use of semi-skimmed milk appeared to be slightly more widespread in the younger than in the older age groups of men.
Few adults did not have milk at all (3% to 4%). Among those who did have milk, on average, men consumed more milk per day than women: 30% of men had a pint or more per day compared with 17% of women, while 42% of women compared with 31% of men had a quarter pint or less. The proportion of men who had a pint or more of milk per day dropped sharply between the ages of 16 and 54: 45% of the youngest age group had this much compared with 19% of those aged 45-54. There was no clear age trend among women although a slightly higher proportion of those aged under 35 (21% or 22%) than of those aged 35 or over (14% to 17%) had at least a pint a day.
Children
Roughly half of all boys and all girls used whole milk and half used semi-skimmed, with under 5% using skimmed, other or no milk. However, these figures mask dramatic changes from whole milk to semi-skimmed with increasing age. Among boys aged 2-3, 74% used whole milk; by age 8-9 this was down to one half and by age 14-15, 32% had whole milk and 62% semi-skimmed. The same trend was evident for girls: at age 2-3, 70% usually had whole milk but at aged 14-15 only 32% did so, with 62% using semi-skimmed.
Approaching half of boys and a third of girls drank a pint or more of milk per day (44% and 31% respectively). A fifth of boys and a quarter of girls had a quarter pint or less per day. Among boys one observes no real change with age; among girls there appeared to be a gradual (but uneven) decrease in milk consumption with increasing age.
10.4.2 Cheese
Adults
Half the men and nearly half the women reported eating cheese 2-6 times a week (52% and 46% respectively, excluding cottage and other low fat cheeses). Most others ate cheese at lower frequencies but 16% of men and 14% of women reported daily consumption of cheese. While there were no marked differences by age in cheese consumption, there was a slight tendency towards reduced frequency with increasing age.
Children
Overall, children's cheese consumption showed a very similar pattern to that of adults: 53% of boys and 54% of girls ate cheese 2-6 times a week; 18% of boys and girls ate it daily. There were no consistent patterns or differences across age groups.
10.5 CONSUMPTION OF MEAT AND POULTRY
10.5.1 Consumption of meat
In the early 1990s fat from meat accounted for around a quarter of the total fat intake of people in Scotland.7 A reduction in the consumption of red meat and meat products could therefore contribute to lowering total and saturated fat intakes. Informants were asked how often they ate meat such as beef, lamb and pork. Included within the definition were beefburgers, sausages, bacon, meat pies and processed meat. Poultry was excluded from this question.
Adults
Just over half of both men (54%) and women (52%) reported eating meat two to four times a week. However, 26% of men but only 14% of women reported eating meat at least five times a week. Conversely, 20% of men but 34% of women reported eating meat once a week or less often (including never).
Men in the youngest age group were distinguished by a high proportion of frequent meat eaters: 37% of those aged 16-24 said they ate meat at least five times a week compared with 21%-27% among other age groups. Women under 35 were the most likely (22%) to have eaten red meat less often than once a week.
Children
Overall, there was little difference between boys and girls in the frequency of eating meat: 19% of boys and 18% of girls ate meat five times a week or more; 58% and 55% reported eating meat two to four times weekly. A slightly higher proportion of all girls (13%) than of boys (10%) ate meat less than once a week because teenage girls were noticeably more likely (16%) than boys (6%-9%) to be in this category. Indeed overall consumption did appear to fall slightly among teenage girls, whereas any change among boys was in the opposite direction.
10.5.2 Consumption of poultry
Poultry was defined for informants as chicken or turkey including chicken or turkey in burgers, sausages, pies, mince and processed meat.
Adults
Overall, men reported eating poultry less frequently than meat. Only 7% ate poultry as much as five times a week (compared with 26% who ate meat this often) and 37% ate it once a week or less. For women, though, the figures for frequency of eating poultry were almost identical to those for meat (8% at least five times a week; 35% once a week or less). The result was similar rates of consumption of poultry by men and women.
Age differences in frequency of eating poultry were modest, though men and women aged 65-74 ate poultry less frequently than others (approaching half of these men and women ate poultry only once a week or less compared with around a third of other age groups).
Children
Overall, boys and girls were reported to eat poultry with about the same frequency: 58% of boys and 57% of girls ate it 2-4 times a week; 7% and 8% respectively ate it five or more times a week; 34% of boys and 35% of girls ate it once a week or less. For neither boys nor girls was there a discernible age trend in the frequency of eating poultry.
The Scottish Diet Action Plan notes that a diet that includes fish, especially oil-rich fish, is associated with low prevalence of cardiovascular disorders and helps to improve blood lipid profiles. In the Scottish Health Survey separate questions were asked about white fish and oil-rich fish, these being defined for informants as "white fish, such as cod, haddock, whiting or plaice" and "other fish, such as herring, tuna, mackerel, salmon or kippers".
10.6.1 White fish
Adults
Overall, 15% of both men and women reported eating white fish at least twice a week. A further 41% of men and 38% of women ate white fish at least once a week. Among both men and women there was a marked increase in consumption of white fish in the 55-74 age groups: 29% of men and 31% of women aged 65-74 ate white fish at least twice a week, as did 21% of men and 26% of women aged 55-64. This compares with between 6% and 15% in other age groups (men and women).
Across all age groups a higher proportion of women than of men reported eating white fish less often than once a month or never (18% of men overall; 25% of women). Among those aged 16-24, 32% of men and 44% of women reported this low frequency, but this proportion showed a reduction with age to 7% of men and 11% of women aged 65-74.
Children
Slightly lower proportions of children than of adults were reported to eat white fish at least twice a week: 11% of both boys and girls. A further 38% of boys and 35% of girls ate it once a week. Eating white fish at least twice a week declined slightly with age among both boys and girls, from 15% of both boys and girls at age 2-3 to 9% of both at age 14-15. Once a week eating of white fish also declined with age. By combining categories we find that at age 2-3, 52% of boys and 55% of girls were reported to eat white fish at least once a week, but at age 14-15 only 40% of boys and 34% of girls ate it this frequently. As a corollary, the proportions never or seldom (less often than once a month) eating white fish increased with age from a quarter of boys and girls at age 2-3 to 36% of boys and 42% of girls aged 14-15.
10.6.2 Oil-rich fish
Adults
While the proportions who ate oil-rich fish at least twice a week were fairly similar to the proportions eating white fish this often _ 16% of men and 19% of women _ the proportions eating it once a week were much lower at 23% of men and 24% of women. A third of both men and women reported eating oil-rich fish less often than once a month or never. Young men and women were noticeably polarised on frequency of eating oily fish: 18% of men and 21% of women (aged 16-24) did so more than once a week but double that proportion did so less than once a month (44% of men and 41% of women).
Children
Slightly more children ate oil-rich fish than white fish at least twice a week: 16% of boys and 21% of girls. A further 19% of boys and 21% of girls ate oil-rich fish once a week. However, again compared with white fish, higher proportions seldom or never ate oil-rich fish: 47% of boys and 41% of girls.
There was no discernible pattern of differences by age for boys, other than that up to the age of five just over half the boys seldom or never ate oil-rich fish. Among girls this infrequent consumption fell from over 40% in the under eight age groups to below 40% in the eight and over age groups. Similarly, for girls, the proportions that ate oil-rich fish at least twice a week increased from well under to well over a fifth after age five (the extremes were 9% of girls aged 2-3 compared with 27% of those aged 10-11).
10.7 CONSUMPTION OF FOODS CONTAINING FIBRE AND STARCH
Questions on foods containing fibre and starch included the type of bread usually eaten and daily consumption; the type of breakfast cereal eaten and the frequency of eating; the frequency of eating potatoes, pasta or rice, and the frequency of eating pulses.
10.7.1 Bread
Wholemeal bread generally provides more fibre than white bread. The dietary target for Scotland is to raise the 1996 daily bread intake of 106 grams by 45% by the year 2005, mainly through greater eating of wholemeal and brown bread.
Adults
Sixty-one per cent of men and 50% of women said they usually ate white bread. Fewer men than women usually ate either wholemeal bread (10% compared with 16%) or brown/granary/wheatmeal bread (14% and 19%). Fourteen per cent of both sexes either ate another type of bread or had no usual type, implying that they at least sometimes ate wholemeal or brown bread. Only 1% of men and women said that they did not eat bread and there were no marked age trends in this.
Young adults were much more likely than older adults to eat white bread: 74% of men and 64% of women aged 16-24 usually ate white bread compared with 53% of men and 40% of women aged 65-74. Conversely the proportions that usually ate wholemeal or brown bread increased with age, among men from 13% in the youngest to 34% in the oldest group and among women from 24% to 45%.
However, the amount of bread eaten per day decreased considerably with age among men. For example, six or more slices a day were eaten by 34% of those aged 16-24, compared with just 11% of those aged 65-74. There was no real change with age for women, who ate less per day than men: 5% of women ate six or more slices compared with 24% of men; 72% of women ate three or fewer slices compared with 43% of men.
Children
Virtually all children ate bread. Three-quarters of them usually ate white bread (75% of boys; 77% of girls). Among both boys and girls, only 7% usually ate brown/granary/wheatmeal bread and 6% usually ate wholemeal bread. There were minimal differences across age groups in the type of bread usually eaten.
It was most common for children to eat two or three slices of bread a day: 49% of boys and 55% of girls. However 39% of boys ate more than this per day (4 or more slices), as did 29% of girls. Among boys, there was, as one might expect, a considerable increase in the quantity of bread eaten as they grew older. At age 2-3, for example, 5% of boys ate six or more slices a day and 29% ate one or less; at age 14-15 26% ate six or more slices daily and 7% ate one or less. Among girls there was a similar decrease in the numbers eating up to a slice a day (34% to 9%). The proportion eating as many as six slices a day did rise to one in ten teenage girls, but a bigger increase was seen in the 4 or 5 slices a day category, up from 10% of the 2-3 age group to 32% among those aged 14-15.
10.7.2 Breakfast cereals
Breakfast cereals were classified as high fibre or 'other'. High fibre included bran, wheat or oat based cereals and porridge; 'others' included cornflakes, Rice Krispies and similar types. Apart from variation in fibre content, breakfast cereals provide other important nutrients (minerals and vitamins). The dietary target is for a daily intake of cereals of 34 grams by the year 2005.
Adults
Substantial numbers of adults said they never ate breakfast cereals: 30% of men and 27% of women. Roughly a third of men and women (32% and 38% respectively) usually had high fibre cereals. The choice of high fibre increased substantially with age: only a quarter of all young men and women (16-24) usually ate a high fibre cereal compared with a half of the oldest age group (65-74). Also the proportions who reported not eating cereal at all decreased slightly in the older age groups, from around a third of men and women aged 16-54 to around a quarter of those aged 55-74.
Among adults who ate breakfast cereals at all, half did so daily (54% of men and 52% of women) and a third ate cereal two to six times a week (34% of men and 35% of women). More of those in older age groups ate cereal daily (for example, 71% of men and 69% of women aged 65-74 who ate cereal at all did so daily).
Children
Few children never had breakfast cereals (6% of boys; 8% of girls). A majority of both sexes at all ages ate non-high fibre cereals (59% of all boys; 62% of all girls). Not eating cereal at all increased among teenage boys and, especially, girls, while high fibre as the usual type decreased somewhat, from 30% of boys and girls aged 2-3 to 20% of boys and girls aged 14-15.
Based on those who had breakfast cereals at all, overall 77% of the boys and 69% of the girls ate this food daily. However, there was a sharp decline across age groups in daily eating of cereal by girls (85% at age 2-3 to 53% at age 14-15). There was only a small decline among boys (from 81% at age 2-3 to 71% at age 14-15).
10.7.3 Potatoes, pasta and rice
Potatoes, pasta and rice contain non-sugar complex carbohydrates and are an appropriate substitute for calories derived from fat. While these items are already an important component of diets, targets are further to increase intake of complex carbohydrates through increased consumption of these products (as well as others such as bread, breakfast cereals, fruit and vegetables).
Adults
Eating potatoes, pasta or rice at least once a day was reported by 49% of men and 54% of women. Young men (16-24) included fewer daily eaters of these foods: 36%. In all age groups very few were not eating even one of these items at least once a week (overall, 5% of both men and women).
Children
As with adults, half of all children ate potatoes, pasta or rice daily (51% of boys; 53% of girls) and few (6% of boys, 5% of girls) ate one of these no more than once a week. There were no noteworthy differences with age.
10.7.4 Pulses
Adults
Many pulses, such as baked beans, dried beans, peas8 and lentils, have a high fibre and starch content. More than four in five adults ate pulses at least once a week, including 67% of men and 58% of women who did so at least twice a week. Only 5% of men and 8% of women ate pulses less than once a month (including never). There were no marked differences according to age.
Children
The figures for children are similar to those for adults, with a majority of boys (70%) and girls (65%) eating pulses at least twice a week. However, slightly more children than adults ate pulses less than once a month or never (11% of boys and 12% of girls). There were no apparent age trends for either boys or girls.
10.8 CONSUMPTION OF FRESH FRUIT AND VEGETABLES
The dietary target for Scotland is for consumption of fruit and vegetables to reach an average of 400 grams per day by 2005. Three portions a day are recommended for young adults. The nutrients in fruit and vegetables are increasingly recognised as protective of good health, and high intakes help to reduce the risk of ischaemic heart disease, intestinal disorders and some cancers.
Informants were asked how often they usually ate fresh fruit, fresh fruit juice, cooked green vegetables, cooked root vegetables and raw vegetables or salad.
10.8.1 Fresh fruit and fruit juice
Adults
Nearly half the men and over half the women reported eating fresh fruit at least daily (46% and 59%). On the other hand 29% of men and 19% of women ate fresh fruit only once a week or less often. Younger adults ate fruit with slightly lower frequency than older adults.
Twenty-six per cent of men and 32% of women had fresh fruit juice at least daily. Around half of both men and women had fruit juice once a week or less often. The consumption rate of fruit juice declined with age, with young women (16-24) having the highest proportion of daily fruit juice drinkers (37%).
Children
Slightly higher proportions of children than of adults were reported to have fresh fruit at least daily: 54% of boys and 62% of girls. While fairly small minorities overall (19% of boys and 12% of girls) usually had fresh fruit as little as once a week, there was a marked increase in this with age. Among boys aged 2-3, 9% had fresh fruit once a week of less often, compared with 28% of boys aged 14-15. The equivalent figures for girls were 6% and 19%.
Fresh fruit juice was drunk daily by 31% of boys and 35% of girls; 44% and 42% respectively had it at only once a week or less often. There was little change across age groups.
10.8.2 Raw and cooked vegetables
Three questions were asked about frequency of eating vegetables. In each case, examples were given:
Adults
Cooked green vegetables were eaten more frequently than either root or raw vegetables. Among men the proportions eating each of these at least five time a week were 39%, 22% and 11% respectively. Among women the levels were slightly higher at 44%, 27% and 20%. Substantial proportions of informants, particularly men, ate each type of cooked vegetable only once a week or less often (among men, 24% for green vegetables and 34% for root vegetables, among women, 17% and 29% respectively). Furthermore 33% of men and 23% of women had raw vegetables or salad not even once a week.
There were substantial age differences. For instance, 45% of young men and 30% of young women ate green vegetables once a week or less often, compared with 10% to 17% among men and women in the age groups from 45 upwards. However, this did not apply to raw vegetables or salad, for which there was little change with age among men but a modest decline in frequent consumption among women.
Children
In general, girls ate vegetables with slightly greater frequency than did boys. Consumption of cooked green vegetables at least five times a week was reported by 27% of boys and 31% of girls; cooked root vegetables by 17% of boys and girls; raw vegetables or salad by 10% of boys and 16% of girls. Frequencies of once a week or less were widespread: between 40% and 44% for boys for cooked vegetables, and 35% and 41% for girls. Forty-five per cent of boys and 35% of girls ate raw vegetables or salad not even once a week
There were no clear or marked trends across age groups except that frequent eating of raw vegetables or salad among girls increased with age.
High levels of salt - sodium chloride - in the diet are associated with high blood pressure. A small amount is necessary (it is present in all body fluids), but it is not naturally present in high concentrations in food. Most salt in food is added either in manufacture or in the home. The target for year 2005 is for a reduction in average sodium intake to 100mmol per day. Survey informants were asked only about adding salt to food at the table.
Adults
Five in ten men and four in ten women said they usually add salt to food at the table, either before or after tasting the food (35% of men and 25% of women without tasting the food). Rather more women than men rarely or never added salt at the table (39% compared with 31%). There was negligible age variation, except that young men (37%) and women (47%) were the most likely not to add salt.
Children
Overall, 56% of boys and 58% of girls rarely or never added salt to food at the table, while far fewer boys (27%) and girls (25%) generally did so. However, these figures mask very large increases with age in salt use. For example, among boys, salt was added without tasting the food for 5% of the 2-3 age group compared with 32% of the 14-15 age group. Among girls the equivalent figures were 5% and 28%. Conversely, the proportions who rarely or never added salt at the table decreased sharply, from 85% of boys and 83% of girls aged 2-3 to 34% of boys and 45% of girls aged 14-15.
Vitamins are needed in small quantities for growth and metabolism. They cannot be synthesised in the body (apart from vitamin D) and are therefore needed in the diet. For normal functioning of the body various minerals (such as calcium, phosphorus, iron, potassium, sodium, chlorine and magnesium) are also essential dietary needs in small amounts. A varied diet will normally provide the recommended daily intake of all necessary vitamins and minerals. However dietary supplements can be important for people who do not have a sufficiently varied diet or who have greater needs, for whatever reasons.
During the nurse visit, informants were asked whether they took any vitamin or mineral supplements or anything else to supplement their diet or improve their health (other than anything prescribed by a doctor).
Adults
In total, 17% of men and 27% of women reported taking any dietary supplement(s). This was mainly in form of vitamins (10% of men, 16% of women) and fish oils (7% of men, 9% of women). There were slight increases in taking dietary supplements with age, though, for women the peak age groups were 45-54 and 55-64, among whom 35% and 34% respectively were taking some dietary supplement(s).
Children
The same proportion of boys and girls (15%) took dietary supplements, mostly in the form of vitamins. There was variation with age about these overall figures, but not with a clear pattern.
10.11 SOCIAL CLASS VARIATIONS IN EATING HABITS
Adults
A 22-item summary table of adults' diets demonstrates (through age-standardised figures) that consumption of healthy foods was a good deal more prevalent among informants in Social Classes I and II than it was among those in Classes IV and V. For instance, one half of men and women in Classes I and II ate green vegetables five or more times a week compared with around one third of those in Classes IV and V. Similar differences were apparent for using semi-skimmed or skimmed milk and eating oily fish, wholemeal bread, fruit and raw vegetables.
Men and women in Classes IV and V were the most likely to eat fried foods twice or more a week and add sugar to hot drinks. However, differences in the proportions who ate chocolates, biscuits or crisps every day, ate cheese twice or more a week or used butter or margarine were small or negligible.
Children
Social class differences were also evident among boys and girls. For instance, half (or more) of boys in Social Classes IV and V added sugar to tea and ate fried food at least twice a week. In contrast, a third or less of boys in Classes I and II reported these eating habits. Two-thirds of boys in the latter social classes ate fruit daily, compared with a half or less among other social classes. The differences among girls for these foods were of a very similar scale.
10.12 REGIONAL VARIATIONS IN EATING HABITS
Adults
Regional variations among men and women were very modest compared with social class differences. Typically there were either no real regional differences or one or two regions differed to some extent from the rest. For instance, somewhat above average proportions of men and women in Lanarkshire, Ayrshire & Arran ate fried food at least twice a week. Poultry and raw vegetables were consumed at least twice a week by fewer informants in the Highland & Islands, but men and women in this region were clearly the most likely to eat potatoes, pasta or rice at least five times a week. Men and women in Greater Glasgow had relatively low rates of eating green and root vegetables.
Children
As one might expect, children's eating habits largely replicate the regional pattern of little variation found among adults. However, the modest samples of children in the geographically distant regions of Highland & Islands and Borders, Dumfries & Galloway showed some distinctive features. Boys and girls in Highland & Islands were the most likely to have eaten green vegetables five or more times a week and were among the least likely to have been frequent eaters of fried food or usually to have added salt at the table. Those in Borders, Dumfries & Galloway were the most likely to add sugar to tea and coffee and the least likely to have had wholemeal bread or to have eaten white fish every week.
10.13 TRENDS OVER TIME IN ADULTS' EATING HABITS
It would be surprising if eating habits had changed greatly between 1995 and 1998. Table 10.23 demonstrates much stability in patterns of consumption, but with some subtle shifts. Most notable was the increase in the proportion of men and women who ate potatoes, pasta or rice at least five times a week: among men it increased from 53% in 1995 to 63% in 1998; among women the increase was from 59% to 68%.
Consumption of fresh fruit had increased, with 45% of men and 58% of women eating fruit at least once a day in 1998 compared with 39% and 52% respectively in 1995. The rate of consumption of soft drinks had risen, especially among men, while fewer people were eating wholemeal bread (though minor changes to the questions on these foods may have contributed to the differences recorded).
Nearly all the changes were found among both sexes and both the 16-44 and 45-64 age groups. However, there were small signs of growing differences between men and women in the younger (16-44) age group: still under half of the men in this age group (43% in 1998; 42% in 1995) ate raw vegetables or salad twice weekly or more compared with well over half of the younger women (60% in 1998, 54% in 1995). (Comparisons for meat, poultry, pulses and butter/margarine are not shown because of changes in the survey questions.)
Changes within social classes and regions rarely deviated greatly from overall changes.
10.14 COMPARISONS BETWEEN SCOTLAND AND ENGLAND
The overall pattern of food consumption was broadly similar in Scotland and England, though with modest differences for a number of foods. Wholemeal bread was eaten by 10% of men and 16% of women in Scotland compared with 17% and 22% respectively in England. Men and women in Scotland were less likely to have eaten high fibre cereal and to have been users of (semi-)skimmed milk and of butter or margarine and more likely to have eaten fried food and chocolate, crisps or biscuits at least once a week.
Compared with their counterparts from the 1997 Health Survey for England (the most recent data), boys and girls in Scotland were more likely to have eaten fruit daily (55% and 62% compared with 47% and 54%). However, they were hugely more likely to have used butter or margarine (38%/39% compared with 16%/17%) and somewhat less likely to have eaten a high fibre cereal. These differences applied across the age range.