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Nutrition Society
Food and nutrient intakes and compliance with recommendations in school-aged
children in Ireland: Findings from the National Children’s Food Survey II (2017-18)
and changes since 2003-04
Laura Kehoe1, Maria Buffini2, Breige A McNulty2, John Kearney3, Albert Flynn1 & Janette
Walton4
1School of Food and Nutritional Sciences, University College Cork, Ireland;
2UCD Institute of Food & Health, University College Dublin, Dublin, Ireland;
3School of Biological & Health Sciences, Technological University Dublin, Dublin, Ireland;
4Department of Biological Sciences, Munster Technological University, Cork, Ireland.
Corresponding author: Dr Laura Kehoe, Room 107, School of Food and Nutritional
Sciences, University College Cork, Ireland, Tel: +353 (0)21 490 3387, e-mail:
laura.kehoe@ucc.ie
Running title: Food and nutrient intakes in Irish children
Keywords: Food intake, nutrient adequacy, school-aged children, FBDG
https://doi.org/10.1017/S0007114522002781 Published online by Cambridge University Press
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Abstract
The childhood years represent a period of increased nutrient requirements during which a
balanced diet is important to ensure optimal growth and development. The aim of this study
was to examine food and nutrient intakes and compliance with recommendations in school-
aged children in Ireland and to examine changes over time. Analyses were based on two
National Children’s Food Surveys; NCFS (2003-04) (n 594) and NCFS II (2017-18) (n 600)
which estimated food and nutrient intakes in nationally representative samples of children (5-
12y) using weighed food records (NCFS: 7-d; NCFS II: 4-d). This study found that nutrient
intakes among school-aged children in Ireland are generally in compliance with
recommendations; however this population group have higher intakes of saturated fat, free
sugars and salt, and lower intakes of dietary fibre than recommended. Furthermore,
significant proportions have inadequate intakes of vitamin D, calcium, iron and folate. Some
of the key dietary changes that have occurred since the NCFS (2003-04) include decreased
intakes of sugar-sweetened beverages, fruit juice, milk and potatoes, and increased intakes of
wholemeal/brown bread, high fibre ready-to-eat breakfast cereals, porridge, pasta and whole
fruit. Future strategies to address the nutrient gaps identified among this population group
could include the continued promotion of healthy food choices (including education around
‘healthy’ lifestyles and food marketing restrictions); improvements of the food supply
through reformulation (fat, sugar, salt, dietary fibre); food fortification for micronutrients of
concern (voluntary or mandatory) and/or nutritional supplement recommendations (for
nutrients unlikely to be sufficient from food intake alone).
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Introduction
The childhood years represent a period of increased nutrient requirements during which a
balanced diet is important to ensure optimal growth and development. It is well established
that dietary habits and preferences are established early in life, thus appropriate diet and
lifestyle during this period can support optimal health and aid in the prevention of diet-related
chronic diseases (e.g. obesity and cardiovascular disease (CVD)) in later life(1-4). Regular
surveillance of the dietary and lifestyle habits of children can help to inform targeted public
health programmes to improve dietary patterns and adequacy during this critical period and
future life stages.
Data from national dietary surveys globally have shown that high proportions of school-aged
children (similar to other population groups) do not adhere to Food-Based Dietary Guidelines
(FBDG) with low intakes of fruit, vegetables, wholegrains and dairy, and high intakes of
animal proteins (particularly red & processed meat), discretionary foods and sugar-sweetened
beverages (SSBs) reported(5-8). Furthermore, a recent review of nutrient intakes from national
dietary surveys has highlighted high intakes of total fat, saturated fat, added sugars and salt
and low intakes of carbohydrate and dietary fibre in school-aged children with large
proportions of this population not meeting recommendations for vitamin D, folate and iron(9).
Time-trend analyses have shown that over time (approx. 6-20y) there have been reductions in
intakes of fruit juice, meat (particularly red & processed meat), potatoes, milk (particularly
whole milk) and SSBs and increases in intakes of whole fruit and low-calorie drinks among
children globally(10-16). While these changes have resulted in decreased intakes of total and
saturated fat, free sugars and sodium and increased intakes of dietary fibre and some key
micronutrients, for most nutrients, intakes are still not meeting recommendations among this
population group(10, 15, 17-19). While few national nutrition surveys have collected biomarkers
of nutritional status among children, data from the UK National Diet and Nutrition Survey
has reported low micronutrient status particularly with respect to vitamin D and folate among
school-aged children(20) while poor vitamin D status has also been reported in many
population groups across Europe(21).
In Ireland, the National Children’s Food Survey (2003-04) found that school-aged children
(5-12y) had an energy-dense diet with high intakes of fruit juice, confectionery, SSBs,
saturated fat and sodium and low intakes of fruit, vegetables, dietary fibre, vitamin A, vitamin
D, folate, riboflavin, calcium and iron(22-24). Furthermore, studies of children in Ireland have
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reported low vitamin D and iron status among children aged 2-14 years(25, 26). The current
FBDG for the population aged over 5 years in Ireland were published in 2011 (translated into
the visual representation of the Food Pyramid in 2016) and provide guidance on the
consumption of 6 core food groups; ‘vegetables, salad and fruit’, ‘wholemeal cereals and
breads, potatoes, pasta and rice’, ‘milk, yogurt and cheese’, ‘meat, poultry, fish, beans and
nuts’, ‘fats, spreads and oils’ and the ‘top-shelf’ which includes ‘foods and drinks high in fat,
sugar and salt’ (with only the first 5 food groups being recommended for good health)(27, 28).
However, with a global emphasis to incorporate environmental sustainability and
sociocultural factors in FBDG, it is necessary to have current information on dietary intakes
of population groups to inform the development of revised guidelines(29, 30). Updated food
consumption data have recently become available for school-aged children in Ireland through
the National Children’s Food Survey II (NCFS II) (2017-18) which utilised a similar
methodology to the NCFS and offers a unique opportunity to determine the current food and
nutrient intakes of this population group along with examining changes over time. Therefore,
the aim of this study was to examine food and nutrient intakes and compliance with
recommendations in school-aged children in Ireland from the NCFS II (2017-18) and to
examine changes since the previous NCFS (2003-04).
Experimental Methods
Study sample
Analyses were based on data from National Children’s Food Surveys in the Republic of
Ireland (ROI); the NCFS (2003-04) (n 594) and NCFS II (2017-18) (n 600), two cross-
sectional food consumption surveys conducted by the Irish Universities Nutrition Alliance
(IUNA) (www.iuna.net) to establish databases of habitual food and beverage consumption in
representative samples of school-aged children (5-12y). Both studies were conducted
according to the guidelines laid down in the Declaration of Helsinki and ethical approval was
obtained from St James’ Hospital and Federated Dublin Voluntary Hospitals Joint Research
Ethics Committee for the NCFS and the Clinical Research Ethics Committee of the Cork
Teaching Hospitals, University College Cork for the NCFS II. Written informed consent was
obtained from children and their parents/guardians in both surveys.
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Sampling and recruitment methodology
Eligible participants were children aged between 5-12 years, inclusive. A total sample of 594
participants (boys: 293, girls: 301) (NCFS) and 600 participants (boys: 300, girls: 300)
(NCFS II) were selected from databases of primary schools in the ROI provided by the
Department of Education and Skills (previously Department of Education and Science during
the NCFS). The databases were divided into: (i) small/medium/large schools; (ii) all boys/all
girls/mixed; (iii) disadvantaged/not disadvantaged; and (iv) urban/rural. A random sample
was selected so that, in the final sample, the proportions of children attending each of the
categories reflected that of the proportions according to the database. The principals of
selected schools were contacted with over 80% of those contacted (in both surveys) agreeing
to take part. Parents/guardians of children who were randomly selected from the school roll
were contacted with information on the survey and participation was invited (one child per
household only). Where families opted in, a researcher visited the home to explain the survey
in more detail and to obtain written consent from children and their parents/guardians. Data
collection was carried out from March 2003 to March 2004 for the NCFS and April 2017 to
May 2018 for the NCFS II, providing a seasonal balance for both surveys. The overall
response rates were 63% for the NCFS and 65% for the NCFS II.
Demographic analysis of both survey samples demonstrated that they were nationally
representative of children in Ireland with respect to age-group, sex and geographical location
when compared to the most recent Census data at that time(31, 32). While the NCFS was
representative with respect to social class, the NCFS II contained a higher proportion of
children of professional workers and a lower proportion of children of semi-skilled and
unskilled workers than the national population. Consequently, all data presented in this
manuscript with respect to the NCFS II were weighted to account for these differences.
Food intake assessment
Food and beverage intake data (including nutritional supplements) were collected at brand
level using a 7-d (NCFS) and 4-d (NCFS II) weighed food record (including at least one
weekend day for all participants). The researcher made a number of visits to the participant
and parents/guardians during the recording period: an initial training visit to demonstrate how
to complete the food record and use the portable scales provided (Soehnle Vita 8020, London
(NCFS) Tanita KD-400, Japan (NCFS II)), a second (and third for the NCFS) visit during the
recording period to review the food record, check for completeness and clarify details
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regarding food descriptors and quantities, and a final visit 1-2 days after the recording period
to review the final days of recording and to collect the food record. In both surveys,
participants were asked to collect and provide the packaging labels for all foods, beverages
and nutritional supplements consumed by the child over the recording period, to facilitate
quantification and coding of foods.
Food quantification
For both surveys, the majority of foods and beverages were weighed by the participant
directly on the portable scales (NCFS: 75%, NCFS II: 76%) and a further 11% of weights
(for both surveys) were derived from manufacturer’s information on product labels. The
remaining foods and beverages were quantified using photographic food atlases (NCFS: 5%,
NCFS II: 7%)(33, 34), standard portion sizes (NCFS: 4%, NCFS II: 3%)(35, 36), household
measures, (1% for both surveys) and estimates based on the child’s previous eating patterns
(used only when no other quantification method was appropriate) (NCFS: 3%, NCFS II: 2%).
For all methods of quantification, leftovers were accounted for, and the weight of the food
consumed was calculated.
Estimation of food intakes
Each food, beverage and nutritional supplement consumed in both surveys was assigned a
unique food code (at brand level) based on its descriptor and nutritional profile which was
used to enter data into nutrition analysis software packages: WISP© (Tinuviel Software,
Anglesey, UK) (NCFS) and Nutritics© (Nutritics, Dublin, Ireland) (NCFS II). Each food code
was then categorised into food groups and further subdivided into smaller food groups guided
by the FBDG for healthy eating in Ireland e.g. fruit & vegetables, breads (white/wholemeal),
cereals (low/high fibre), potatoes (fresh/processed), milks (whole/reduced fat/non-dairy
alternative), meats (fresh/processed), beverages (water/milk/soft drinks with added sugar/no
added sugar soft drinks) and ‘top-shelf foods/foods high in fat, salt and sugar e.g.
confectionery’ (Table 1). The mean daily intake (MDI) of each food group was calculated by
summing the total intake per person over the recording period and dividing by the total
number of recording days (NCFS: 7 days, NCFS II: 4 days). Consumers were defined as
those who consumed at least one food or beverage belonging to the food group during the
recording period.
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Estimation of nutrient intakes
Nutrient intakes were estimated using WISP© for the NCFS and Nutritics© for the NCFS II,
both of which use food composition data from McCance and Widdowson’s ‘The Composition
of Foods’; 6th Ed, 5th Ed and all nine supplemental volumes (NCFS) and the 7th Ed (and 6th Ed
for a small number of foods) (NCFS II)(37-39). During both surveys, modifications were made
to include recipes of composite dishes, nutritional supplements, fortified foods and generic
Irish foods that were commonly consumed. As ‘The Composition of Foods’ does not contain
values for some potentially important sources of dietary fibre (e.g. some fruits, vegetables
and cereal products) and vitamin D (e.g. white fish, salmon, processed meat (including ham),
mushrooms and milk), values were updated using data from published food composition
databases as appropriate(40-43) and as some nutrient values differ greatly by brand, food
packaging labels were used to update values for dietary fibre and sodium. Furthermore, the
fatty acid composition has been updated and is outlined elsewhere(44). Free sugar values were
assigned by adapting a systematic approach used to calculate added sugars content in foods
and beverages(45) and guidance from Public Health England on the calculation of free
sugars(46). The folic acid composition of fortified foods and nutritional supplements was
established from the food packaging labels or obtained directly from the manufacturer.
Dietary folate equivalents (DFE) were estimated as 1µg DFE = 1µg food folate + (1.7Xfolic
acid)(47).
Estimation of usual nutrient intakes
Usual intake distributions for energy and nutrients were estimated using the validated
National Cancer Institute (NCI)-method(48) which accounts for both inter- and intra-person
variance. The NCI-method has been implemented in SAS macros (version 2.1) which were
downloaded from www.riskfactor.cancer.gov/diet/usualintakes/macro.html (date of
download: July 2015). For these analyses, the covariates used were sex and age group (5-8y
and 9-12y).
Estimation of sodium intake from spot urine sample
For the NCFS II, sodium intakes were calculated by correcting the population mean sodium
values from spot urine samples for sex and age specific 24-hour urine output volumes
derived from a study on Australian children (in the absence of data for children in Ireland)(49).
Participants (95% of sample; n 572) provided a first void morning urine sample (~30ml)
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during the recording period. The sample was then sealed in the sterile container and stored in
in cool conditions (wrapped in an ice pack and kept in a thermal cooler bag) prior to same
day collection by the researcher. Once collected, the urine sample was stored on dry ice by
the researcher and transported to the university labs for storage at -20℃, until processing.
Urinary sodium was measured by Randox Laboratories using a Randox Rx Daytona with an
ion selective electrode. All samples were analysed in duplicate and the average of the two
readings was calculated. Interassay coefficient for sodium was <2.2%.
Comparison of energy and nutrient intakes with dietary reference values
Nutrient intakes were compared to the most recent Dietary Reference Values (DRVs)
available from the European Food Safety Authority (EFSA). The UK Department of Health
(DoH) or Scientific Committee on Nutrition (SACN) DRVs were used if they were not
superseded by updated DRVs from EFSA. Mean protein intake (g/kg bodyweight) was
compared to the age and sex specific average requirement (AR) and population reference
intake (PRI) set by EFSA(47). Mean intakes for carbohydrate and fat were compared to the
average population intake recommended by the UK SACN for carbohydrate (50% Energy
(%E))(46) and the UK DoH for total fat (<35%E)(50). Mean intakes of saturated fat,
monounsaturated fat (MUFA) and polyunsaturated fat (PUFA) were compared to the UK
DoH recommendations for a population mean intake <10%E for saturated fat and the
minimum average population intake recommendations of 12%E for MUFA and 6%E for
PUFA(50). Mean dietary fibre intakes were compared to the adequate intake (AI) from EFSA
(4-6y: 14g/d, 7-10y: 16g/d, 11-14y: 19g/d)(47). Mean intake of free sugars was compared to
the World Health Organisation (WHO) recommendation of <10%E for individuals and the
UK SACN recommendation for an average population intake <5%E(46, 51). Urinary salt
excretion was compared to the maximum population targets set by the Food Safety Authority
of Ireland (FSAI) (5-6y: 3g/d, 7-10y: 5g/d, 11-12y: 6g/d)(52).
Adequacy of micronutrient intakes
The prevalence of inadequate intakes of micronutrients were estimated using estimated
average requirements (EARs) as cut points. This method has been shown to be effective in
obtaining a realistic estimate of the prevalence of dietary inadequacy(53). EARs established by
the EFSA were used as cut-offs for assessing the prevalence of inadequate intakes of vitamin
A, thiamin, riboflavin, total niacin equivalents, vitamin B6, DFE, vitamin C, calcium, iron
and zinc(47). EARs established by the UK DoH were used for assessing the prevalence of
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inadequate intakes of thiamin, vitamin B12 and magnesium(50). The US Insitiute of Medicine
(IOM) EAR of 10µg/d and the Nordic EAR of 7.5µg/d were used to assess the prevalence of
inadequate vitamin D intakes(54, 55). As under-reporting of food consumption can result in an
overestimate of the prevalence of inadequacy in a population group(56), under-reporters (URs)
were identified and excluded from these analyses (NCFS: 32.5% of total sample, NCFS II:
19.5%). URs were identified in the NCFS as previously outlined(57) and in the NCFS II
using Goldberg’s cut-off2 criterion updated by Black (which evaluates the ratio of energy
intake to basal metabolic rate (EI:BMR) against age-specific energy cut offs based on
physical activity levels)(47, 58-60).
Risk of excessive intakes of micronutrients
The risk of excessive intake of micronutrients was evaluated using the tolerable upper intake
level (UL) as a reference value. The UL is defined as the maximum level of total chronic
daily intake of a nutrient (from all sources) judged to be unlikely to pose a risk of adverse
health effects to humans(61). ULs established by the EFSA/EU Scientific Committee for Food
were used for vitamin A (retinol), vitamin D, vitamin E, pre-formed niacin, vitamin B6, folic
acid, calcium, magnesium and zinc(61-63). ULs established by the US Food and Nutrition
Board (FNB) were used for iron and vitamin C(64, 65).
Percentage contribution of food groups to energy and nutrient intakes
The percent contribution of food groups to intakes of energy and nutrients from the NCFS II
were calculated by the mean proportion method(66) using SPSS© for Windows™ Version 26.0
and are presented in Supplementary Tables 1-3. This method provides information about
the sources that are contributing to the nutrient intake ‘per person’ and is the preferred
method when determining important food sources of a nutrient for individuals in the
population group as opposed to investigating the sources of a nutrient within the food supply.
Statistical analysis
Statistical analyses were carried out using SPSS© for Windows™ Version 26.0. Changes
between the two surveys were calculated by:
[(NCFS II value – NCFS value) / NCFS value] X 100 (in %)
Differences in intakes between the NCFS (2003-04) and NCFS II (2017-18) were assessed
using independent sample T-tests regardless of normality (due to the large sample size) for
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continuous variables and Chi-square tests for categorical variables. As sample size increases
so does the robustness of t-tests to identify deviations from normality, thus parametric tests
are recommended for large samples(67). To minimise type 1 errors (as a result of multiple
testing), the Bonferoni adjustment was used by dividing the alpha level (0.05) by the number
of comparisons. Therefore, intakes were considered to be significantly different from each
other if P<0.001. However, due to the large sample in this study even a small difference
between group means was highly statistically significant, thus greater emphasis was placed
on a descriptive, rather than a formal statistical analysis of the data.
Results
Table 1 presents the percent consumers and the mean daily intake (MDI) of food groups in
school-aged children (5-12years) in the NCFS (2003-04) and the NCFS II (2017-18) and the
changes in food group intakes between the two surveys. In the NCFS II, ‘breads’ were
consumed by 99% of children with a MDI of 85g (white bread 53g, wholemeal & brown
bread 25g, other breads 7g). The MDI of ‘breads’ is unchanged since the NCFS (2003-04)
(82g), however, there has been a decrease in the MDI of white bread (63 vs 53g) and an
increase in the MDI of wholemeal & brown bread (12 vs 25g). ‘Breakfast cereals’ were
consumed by 91% of children in the NCFS II with 85% consuming ready-to-eat breakfast
cereals (RTEBC) and 28% consuming ‘porridge & hot oat cereals’. The MDI of RTEBC was
28g (high fibre RTEBC: 16g, low fibre RTEBC: 13g) and the MDI of ‘porridge & hot oat
cereals’ was 25g. Since the NCFS (2003-04), there has been an increase in the MDI of high
fibre RTEBC (11 vs 16g) and ‘porridge & hot oat cereals’ (11 vs 25g) and a decrease in the
MDI of low fibre RTEBC (20 vs 13g).
In the NCFS II, ‘pasta, rice & savouries’ were consumed by 89% of children with a MDI of
72g (pasta 25g, rice 12g, pizza 19g, other cereals & savouries 16g). Overall, the MDI of
‘pasta, rice & savouries’ has increased since the NCFS (2003-04) (58 vs 72g) attributable to
an increase in the MDI of pasta (15 vs 25g). In the NCFS II, ‘potatoes & potato products’
were consumed by 92% of children with a MDI of 61g (boiled, baked & mashed potatoes
32g, chipped, fried and roasted potatoes 23g, processed & homemade potato products 6g).
Since the NCFS (2003-04), there has been a decrease in the MDI of ‘potatoes & potato
products’ (98 vs 61g) attributable to a decrease in the MDI of boiled, baked & mashed
potatoes (53 vs 32g) and chipped, fried & roasted potatoes (40 vs 23g).
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In the NCFS II, ‘milks’ were consumed by 91% of children with a MDI of 186g (whole milk
131g, reduced-fat milk 52g, non-dairy alternatives 3g). Approximately two-thirds of children
consumed yogurts & fromage frais (59%) and cheese (63%) with a MDI of 34 and 11g,
respectively. Since the NCFS (2003-04), there has been a decrease in the MDI of total milk
(258 vs 186g) and whole milk (232 vs 131g) and an increase in the MDI of reduced fat milk
(26 vs 52g). The MDI of cheese has also increased (8 vs 11g) while there has been a decrease
in the MDI of ‘creams, ice-creams & dairy desserts’ (18 vs 13g) and ‘butter & spreading fats’
(9 vs 7g).
In the NCFS II, ‘meat & dishes’ were consumed by 98% of children with a MDI of 116g
(meat dishes 47g (of which fresh meat dishes 44g), processed meat 41g, fresh meat 28g).
Overall, the MDI of total meat, processed meat and fresh meat was unchanged since the
NCFS (2003-04), however, the MDI of meat dishes has increased (37 vs 47g). In the NCFS
II, ‘fish & fish dishes’ were consumed by 41% of children with a MDI of 13g (discrete fish
e.g. white/oily/other 10g, fish dishes 3g). Overall, the MDI of total fish is unchanged since
the NCFS (2003-04), however, there has been an increase in the MDI of discrete fish (6 vs
10g). In the NCFS II, 35% of children consumed ‘eggs & egg dishes’ with a MDI of 10g and
8% consumed ‘nuts & seeds’ with a MDI of <1g, both of which were similar to the previous
NCFS (2003-04).
In the NCFS II, ‘fruit & vegetables’ were consumed by all children (100%) with a MDI of
221g (discrete fruit 90g, fruit juice 38g, smoothies 11g, fruit in composite dishes 9g, discrete
vegetables 40g, vegetables in composite dishes 34g). Overall, the MDI of total fruit and
vegetables is unchanged since the NCFS (2003-04) (224g), however, there has been an
increase in the MDI of discrete fruit (59 vs 90g) and smoothies (<1 vs 11g) and a decrease in
the MDI of fruit juice (86 vs 38g). The proportion of consumers and the MDI of total
vegetables, discrete vegetables and vegetables from composite dishes is unchanged since the
NCFS (2003-04).
In the NCFS II, confectionery products (biscuits, cakes, confectionery & savoury snacks)
were consumed by 99% of children with a MDI of 76g, similar to that in the NCFS (2003-04)
(100% consumers and MDI of 85g). With regard to beverage intakes, water was the most
commonly consumed beverage in the NCFS II (95% consumers) with a MDI of 450g. Milk
was consumed as a beverage by 58% of children, with a MDI of 91g. Soft drinks were
consumed by 67% of children with a MDI of 160g (no added sugar variety 110g, sugar-
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sweetened 50g). Since the NCFS (2003-04), there has been a decrease in the MDI of total soft
drinks (331 vs 160g) and sugar-sweetened soft drinks (252 vs 50g) while the MDI of no
added sugar soft drinks is unchanged. ‘Teas & coffees’ and sweetened milk drinks were
consumed by 19% of children in the NCFS II with a MDI of 29 and 16g, respectively which
was similar to the previous NCFS (2003-04).
Table 2 presents the mean intake of energy and nutrients in school-aged children (5-12y) in
Ireland in the NCFS (2003-04) and the NCFS II (2017-18) and the changes in intakes
between the two surveys. The percent contribution of food groups to energy and nutrient
intakes (key sources) in the NCFS II are presented in Supplementary Tables 1-3. In the
NCFS II, the mean intake of energy was 6.3MJ with a decrease of approximately 200kcal
since the NCFS (2003-04) (7.0MJ). The mean intake of protein in the NCFS II was 2.0g/kg
bodyweight per day which is equivalent to over 2 times the PRI and no child had intakes
below the EAR (indicating that protein intakes are adequate among this population group).
The mean intake of protein has increased since the previous NCFS (1.8 vs 2.0g/kg
bodyweight). The mean intake of fat in the NCFS II was 33%E which is below the
recommendation of <35%E and is similar to that in the NCFS (34%E). The mean intake of
saturated fat in the NCFS II was 14%E and despite a decrease since the previous NCFS
(15%E), it is still above the recommendation of <10%E. The mean intakes of MUFA (14%E)
and PUFA (6%E) are in line with recommendations (MUFA ≥12%E, PUFA ≥6%E) and have
increased since the NCFS (MUFA 12%E, PUFA 5%E). The mean intake of carbohydrate in
the NCFS II was 50%E which meets the recommendation for an average population intake of
50%E but has decreased since the previous NCFS (52%E). The mean intake of free sugars in
the NCFS II was 9%E which is above the UK SACN recommendation for an average
population intake <5%E, with 40% of children having intakes above the WHO
recommendation of <10%E, however, there has been a notable decrease in the intake of free
sugars since the NCFS (16%E). The mean intake of dietary fibre in the NCFS II was 15g and
while intake has increased since the NCFS (12g) it is still below the AI for older children
(≥7y). There has been an increase in the mean intakes of vitamin D, vitamin E and zinc since
the NCFS (2003-04) while mean intakes of thiamin, riboflavin, vitamin B6, total folate, DFE,
vitamin C, potassium, calcium and copper have decreased. The mean intake of salt
(calculated as sodium equivalents) from food sources only (excluding discretionary salt) was
4g which has decreased since the NCFS (5g). However, the MDI of sodium from all sources
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(calculated from urinary output) was 5g and was above the FSAI maximum population
targets for older children (≥7y).
Table 3 presents the proportion of school-aged children (5-12y) in Ireland with micronutrient
intakes below the EAR in the NCFS (2003-04) and the NCFS II (2017-18). In the NCFS II, a
significant proportion of children had inadequate intakes of vitamin D (94%), calcium (37%),
zinc (24%), iron (20%), vitamin C (19%), magnesium (18%) and DFE (13%). The proportion
of children with inadequate intakes of vitamin D and zinc has decreased since the previous
NCFS (2003-04) while the proportion with inadequate intakes of vitamin B6 and calcium has
increased. The proportion of children with intakes exceeding the UL for retinol, vitamins D,
E, C, B6, preformed niacin, folic acid, calcium and iron was <0.5% in both surveys. In the
NCFS II, a very small proportion of children (2%) had zinc intakes exceeding the UL (<1%
in the NCFS (2003-04)).
Discussion
This study provides information on the current food and nutrient intakes and compliance with
recommendations in school-aged children (5-12y) in Ireland and is the first study to examine
changes over time among this population group. This study has found that while overall
intakes of macronutrients (protein, fat and carbohydrate) are generally sufficient for this
population group, intakes of saturated fat, free sugars and salt are higher, and intakes of
dietary fibre are lower than recommendations. Furthermore, a high prevalence of this
population group have inadequate intakes of key micronutrients including vitamin D,
calcium, iron and folate. Some of the key dietary changes that have occurred since the NCFS
(2003-04) include lower intakes of SSBs, fruit juice, milk and potatoes, and higher intakes of
wholemeal/brown bread, high fibre RTEBC, porridge, pasta and whole fruit. While these
changes have resulted in some improvements in nutrient intakes (i.e., decreased saturated fat,
free sugars and salt, and increased dietary fibre and some key micronutrients), gaps remain
with respect to recommendations for a number of nutrients which are discussed below in the
context of the literature and public health implications. As dietary patterns are mainly
developed at a young age and can track into adolescence and adulthood, it is important to
address these intakes in this population group to reduce the risk of development of chronic
diseases such as overweight/obesity, hypertension and CVD throughout the lifecycle(1-4, 68).
This study found that the mean intake of saturated fat among school-aged children in Ireland
in 2017-18 (14%E) has decreased since 2003-04 (15%E) but still exceeds recommendations
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(<10%E), which is consistent with findings from other national dietary surveys of children
where intakes of saturated fat have also decreased over time but are still too high(10, 15, 17). The
decrease of saturated fat in this study may be partly explained by the reduction in milk intake
between 2017-18 and 2003-04 as the intake of other key sources of saturated fat (meats and
biscuits & confectionery) were unchanged (Supplementary Table 1). A decrease in milk
intake has also been observed in other studies of children but in contrast to our findings, the
intake of meat (particularly processed meat) has also decreased (10-16). There is currently a
growing body of evidence suggesting that the dairy food matrix (in addition to providing key
nutrients such as calcium and iodine) may be beneficial in terms of cardiovascular health(69)
and that the consumption of ultra-processed foods (e.g. SSBs, confectionery products,
processed meats) are associated with poor nutritional quality and an increased risk of
negative health outcomes in populations(70). Therefore public health efforts to reduce
saturated fat intakes for health should focus on reducing the consumption of low nutrient
dense foods such as processed meat and ‘top-shelf’ foods including confectionery.
Despite a notable decrease in free sugars intake observed in this study between 2017-18 and
2003-04 (9 vs 16%E), intakes are still above the SACN recommendation for a maximum
population intake of <5%E and 40% of school-aged children in Ireland have intakes above
the WHO recommendation of <10%E(46, 51). Data from the UK and Germany have also shown
that despite reductions in free sugar intakes among children over time, intakes still exceed
recommendations(10, 15). The decrease in free sugars intake noted in children in Ireland since
2003-04 can be explained by the decreased intake of fruit juices and SSBs (as intakes of other
sources including biscuits & confectionery, breakfast cereals and yogurts were unchanged
(Supplementary Table 1)). Similarly, intakes of fruit juice and SSBs have decreased over
time among children in Australia, Canada, the UK and the USA(11-13, 15, 16). While many
countries have implemented strategies to reduce sugar intake including sugar tax policies,
reformulation initiatives and education policies (with some successes), further research is
needed to determine the long-term impact of these policies on actual sugar intakes and health
outcomes of populations(71).
Dietary fibre intake increased in school-aged children in Ireland between 2017-18 and 2003-
04 (15 vs 12g), however, intakes among children ≥7 years are still below the AI set by EFSA
for normal bowel function(47). Similarly, despite increases over time, dietary fibre intakes are
still below recommendations for children in Germany, the UK and the USA(10, 15, 18). The
modest increase in dietary fibre intake since 2003-04 may be explained by the increase in
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Accepted manuscript
intake of wholemeal/brown bread, high fibre RTEBC and whole fruit. Notably, the increased
contributions to dietary fibre intake from high fibre RTEBCs is likely to be due to
reformulation rather than active decisions/behaviour change as a direct comparison of brands
between the two surveys in this study found that some were previously categorised as low
fibre (<6g/100g) in 2003-04. Studies from Australia, Canada, Germany, the Netherlands and
the USA have also shown increases in intakes of wholemeal/brown cereals and fruit among
children over time(10, 11, 13, 14, 16).
This study found that salt intakes in school-aged children in Ireland generally exceeded
recommendations set by the FSAI. However, sodium intakes (from food sources only) were
found to have decreased by approximately 1g since 2003-04 which may be attributable to the
FSAI’s salt reduction programme (implemented in 2003) which has resulted in significant
reductions in the salt content of a number of foods, particularly breads and processed
meats(72) (key sources of salt among this population group (Supplementary Table 3)).
Similar salt reduction programmes have been implemented in other European countries
which have also resulted in significant reductions in sodium intakes in populations including
children(15, 73). As high blood pressure in childhood has been shown to be associated with
high BP and subsequent CVD risk in later life, early intervention is crucial to ensure the
development of appropriate dietary patterns for optimal lifelong health(4). However, as this
study has found that intakes of breads and processed meats are generally stable over time,
further reformulation efforts in conjunction with dietary strategies will be needed if target salt
recommendations are to be met.
With regard to micronutrient intakes, this study found that a significant proportion of school-
aged children in the NCFS II (2017-18) had inadequate intakes of vitamin D (94%), calcium
(37%), zinc (29%), iron (20%), vitamin C (19%), magnesium (18%) and DFE (13%) which
are important for lifelong bone health, cognitive and behavioural development, and general
immune health(47, 50, 74). Adequate intakes of calcium, vitamin D and magnesium are essential
during childhood for lifelong bone health (peak bone mass developed in the first ~25 years of
life is an important determinant of osteoporosis in later life). While this study found that the
intake of vitamin D in 2017-18 has increased since 2003-04 (4.2 vs 2.5µg), almost all
children (94%) still have inadequate intakes (based on adequate serum 25(OH)D status
deemed to be adequate for bone health)(54). The increase in vitamin D intake may be partly
explained by the increased contribution of vitamin D fortified RTEBC in the NCFS II
(0.93µg/d) compared to the NCFS (0.24µg/d). The intake of calcium in 2017-18 has
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decreased since 2003-04 (partly explained by the reduction in milk intake) and the MDI of
dairy is well below the recommended 3-5 servings/day for this age group (~1.6 servings/day)
resulting in 37% of children having inadequate intakes of calcium. While a proportion of
children in this study were also found to have low magnesium intakes this may be due to the
DRV used as there is currently no clinical evidence of low magnesium intakes in EU
populations and EFSA have called for further research to support the evidence base for
setting DRVs for magnesium(75, 76). Low intakes of vitamin D (along with insufficient
biochemical status), calcium and magnesium have also been reported in other dietary surveys
of children with reductions in milk & dairy products also reported over time(10-13, 15, 16, 19, 77).
As there are few natural sources of vitamin D, food-based strategies (e.g. fortification) and
nutritional supplement recommendations/policies may be necessary to meet requirements
(particularly for populations at northerly latitudes or those with limited time outdoors)(78). In
Ireland, the FSAI recommend a 10µg/d vitamin D supplement for all ages (particularly in
winter), but this recommendation has not yet been implemented into policy for school-aged
children and is not widely adhered to with just 19% of children in the NCFS II taking a
supplement containing vitamin D (with <3% taking >10µg/d)(79).
This study found that 20% of school-aged children in Ireland have inadequate intakes of iron
which is similar to findings from other countries where low iron intakes have been noted in
children(10, 15, 80). Furthermore, data from the UK National Diet Nutrition Survey (NDNS) has
shown that 6% of boys and 13% of girls (4-10y) have low iron stores with approximately 5%
showing evidence of anaemia(20). Addressing the low intakes in this population group is
necessary to promote cognitive and behavioural development and is of particular importance
for older girls due to the onset of menstruation, which may elevate the risk of low iron stores
and iron deficiency anaemia(81). The mean intake of iron was similar in 2017-18 compared to
2003-04 which may be explained by the relatively stable consumption of the key sources of
iron including fortified RTEBCs breads and meat (Supplementary Table 3).
Folate intake (measured by DFE) decreased modestly between 2017-18 and 2003-04 with
13% of school-aged children in Ireland in the NCFS II having inadequate intakes for normal
cell development and growth. While data from other countries has shown similar or slightly
increased folate intakes over time, intakes are still below recommendations in children(10, 15).
Biochemical status data from the UK NDNS has reported that 4% of children (4-10y) had red
blood cell folate below the threshold for folate deficiency and 17% below the threshold for
serum folate indicating possible deficiency(20). Key sources of DFE in the NCFS II were folic
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acid fortified RTEBC, breads, milks, fruit and vegetables (Supplementary Table 2) and as
intakes of milk, fruit and vegetables were below recommendations among children in Ireland,
continued promotion of healthy food choices in line with FBDG guidelines (along with
fortified foods) may help to improve intakes of folate in this population group.
The current study also found that a proportion of school-aged children in Ireland have low
intakes of vitamin C and zinc (important for normal immune function), however, these DRVs
have been set based on evidence in adults and extrapolated to children and so should be
interpreted with caution as there is currently no evidence of clinical manifestations for low
vitamin C and zinc intakes in EU populations(75). Additionally, EFSA have stated that further
research is required to investigate vitamin C and zinc homeostasis in children to further
strengthen the evidence base for these recommendations and so while there is currently no
evidence of deficiency, it is important to continue to monitor intakes among this population
group.
This study has highlighted poor compliance with nutrient goals among school-aged children
in Ireland which can be largely attributed to low compliance with the FBDG; including low
consumption of wholemeal/high fibre breads and cereals, fruit and vegetables and dairy foods
and widespread consumption of SSBs, confectionery and processed meats, which are not
necessary for health and are recommended to be consumed less frequently and in small
amounts. As the dietary patterns developed at this young age have been shown to track into
later life it is important to address the challenges identified in this population group to reduce
the prevalence of chronic diseases throughout the lifecycle. Examination of other health
determinant parameters among this population group highlight other challenges which need
to be addressed for optimal lifestyle patterns for good health in children in Ireland. While the
prevalence of overweight and obesity has plateaued since the previous NCFS rates remain
high (16%)(82) and while a high proportion of this population group are meeting physical
activity recommendations (69%) there is still a need to reduce time spent in sedentary
behaviours(83). Furthermore, while over 78% of parents felt their child’s diet could be
healthier they highlighted a number of barriers to implementing this including convenience
and food advertising(83). These findings suggest that there is a need for intersectoral policies
and cross-collaboration between public health agencies for improving the dietary intakes of
children in Ireland. Examples of these may include further investments in education around
‘healthy’ lifestyle patterns for all ages, food marketing restrictions (particularly related to
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advertisements targeted for young children) and policies for improvement of the food supply
e.g. reformulation and fortification.
Strengths and limitations
This is the first study to investigate changes in food and nutrient intakes in nationally
representative samples of school-aged children in Ireland over a 15-year period. The main
strengths of this study are the detailed dietary intake data (including brand level detail on
fortified foods and nutritional supplements and customised recipes) and the use of nationally
representative data for estimating food and nutrient intakes and adequacy. The use of
statistical modelling to estimate usual intakes accounts for day-to-day intra-person variation
and results in a better estimate of the true distribution of nutrient intakes. It also improves the
estimates of the proportions of the population with intakes above or below particular
reference values (e.g. UL, EAR) which otherwise would be overestimated. While the food
record completion time (7- vs 4-days) differed between the two surveys, this is unlikely to
impact on mean intakes of foods or nutrients, however, any changes in the proportion of
consumers should be interpreted with caution (particularly for foods consumed less
frequently). As with all self-reported data under- or over-reporting of food intake data may be
sources of bias. This issue was minimised by a high level of researcher-participant interaction
(3-4 visits over the recording period). Additionally, nutrient intakes were expressed as a
percentage of energy intake (where appropriate) which partially corrects this bias and the
removal of URs from estimates of the prevalence of inadequacy provides a better
representation of the scale of nutrient inadequacy.
Conclusion
In summary, while there have been some changes in the dietary intakes of school-aged
children in Ireland over a 15-year period, including decreased intakes of SSBs, fruit juice,
milk and potatoes, and increased intakes of wholemeal/brown bread, high fibre RTEBC,
porridge, pasta and whole fruit, this population group still have higher intakes of saturated
fat, free sugar and salt, and lower intakes of dietary fibre, vitamin D, calcium, iron and folate
compared to recommendations. Future strategies to address the nutrient gaps identified
among this population group could include the continued promotion of healthy food choices
(including education around ‘healthy’ lifestyles and food marketing restrictions);
improvements of the food supply through reformulation (fat, sugar, salt, dietary fibre); food
fortification for micronutrients of concern (voluntary or mandatory) and/or nutritional
https://doi.org/10.1017/S0007114522002781 Published online by Cambridge University Press
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supplement recommendations (for nutrients unlikely to be sufficient from food intake alone).
These strategies will require careful monitoring to ensure effectiveness; for example
reformulation and/or fortification of the food supply should be monitored to ensure sufficient
bioavailability of nutrients and that these practices do not encourage consumption of ‘less
healthy’ foods. With a global emphasis to update FBDG to incorporate environmental
sustainability and sociocultural factors, the current study provides valuable information on
the baseline/current dietary patterns of school-aged children in Ireland.
Financial support: Both the NCFS and NCFS II were funded by the Irish Department of
Agriculture, Food and the Marine (DAFM) under the National Development Plan 2000-2006
for the NCFS (2003-04) and the 2015 Food Institutional Research Measure (FIRM) awards
for the NCFS II (2017-18).
Conflicts of Interest: The authors declare that they have no conflicts of interest.
Author’s Contributions: JK, BAMcN, AF and JW were involved in the conception of the
work and are grant holders; LK, MB, JK, BAMcN, AF and JW contributed to the design and
execution of the study and provided expert advice throughout; LK carried out the data
analyses and wrote the first draft. All authors contributed to the writing of the final
manuscript.
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Table 1. Distribution of food group intakes (g/d) in school-aged children (5-12 years) in Ireland, for the total population and percent consumers in the NCFS II and NCFS and the change (%)
in intake (g/d) and consumers (%) between the NCFS and NCFS II
Food groups
NCFS (2003-04) (n 594)
NCFS II (2017-18) (n 600)
Change (%)
Mean
SD
Median
Percentiles
%
Consumers
Mean
SD
Median
Percentiles
%
Consumers
Mean
(g/d)
%
Consumers
5th
95th
5th
95th
g/d
g/d
Breads
82
39
76
29
153
100
85
45
78
22
179
99
+4.2
-1
of which
White bread
63
37
57
11
128
98
53
42
48
0
128
89
-15.3*
-9*
Wholemeal & brown bread
12
24
0
0
61
40
25
36
9
0
97
54
+110*
+36*
Other breads
7
13
0
0
36
38
7
17
0
0
42
27
-1.4
-29*
Breakfast cereals
42
40
32
0
118
94
53
53
38
0
170
91
+26.8*
-3
of which
Ready-to-eat breakfast cereals
31
24
27
0
81
93
28
23
25
0
73
85
-8.5
-8*
High fibre cereals (≥6g/100g)
11
17
3
0
42
54
16
20
9
0
60
59
+44.2*
+9
Low fibre cereals (˂6g/100g)
20
21
15
0
61
79
13
17
5
0
48
54
-37.1*
-31*
Porridge & hot oats cereals (made up)
11
36
0
0
84
17
25
51
0
0
148
28
+122*
+62*
Pasta, rice & savouries
58
50
47
0
152
89
72
61
57
0
197
89
+24.6*
0
of which
Pasta
15
24
0
0
63
46
25
35
11
0
93
53
+63.7*
+16
Rice
10
19
0
0
46
36
12
23
0
0
57
32
+18.2
-12
Pizza
15
23
4
0
60
51
19
33
0
0
88
37
+27.5
-27*
Other cereals & savouries
18
29
0
0
78
50
16
33
0
0
80
38
-8.2
-23*
Potatoes & potato products
98
57
88
26
200
100
61
49
51
0
152
92
-38.0*
-8*
of which
Boiled, baked & mashed potatoes
53
49
41
0
144
88
32
36
23
0
107
65
-40.1*
-26*
Chipped, fried & roasted potatoes
40
32
33
0
101
89
23
29
16
0
79
65
-41.8*
-27*
Processed & homemade potato products
6
15
0
0
26
28
6
20
0
0
38
18
+8.4
-35*
Milks
258
185
224
11
615
96
186
156
155
0
479
91
-28.0*
-6*
of which
Whole milk
232
186
203
0
590
90
131
154
91
0
430
68
-43.3*
-25*
Reduced fat milk
26
86
0
0
174
17
52
110
0
0
298
31
+99.1*
+79*
Non-dairy alternatives
0.2
4
0
0
0
0.5
3
19
0
0
0
3
+1115
+494
Yogurts & fromage frais
39
43
26
0
128
71
34
43
21
0
120
59
-12.2
-17*
Cheeses
8
10
4
0
28
59
11
13
6
0
38
63
+38.9*
+6
Creams, ice creams & dairy desserts
18
23
11
0
65
69
13
27
0
0
62
45
-27.1*
-35*
Butter & spreading fats
9
8
8
0
21
93
7
7
5
0
19
87
-23.9*
-7*
https://doi.org/10.1017/S0007114522002781 Published online by Cambridge University Press
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Table 1 continued.
Food groups
NCFS (2003-04) (n 594)
NCFS II (2017-18) (n 600)
Change (%)
Mean
SD
Median
Percentiles
%
Consumers
Mean
SD
Median
Percentiles
%
Consumers
Mean
(g/d)
%
Consumers
5th
95th
5th
95th
g/d
g/d
Meat & meat dishes
105
55
102
30
202
98
116
69
105
26
252
98
+10.5
0
of which
Meat dishes
37
40
26
0
114
71
47
58
30
0
158
64
+28.5*
-10
Processed meat
46
30
41
3
104
95
41
36
34
0
105
91
-9.9
-5
Fresh meat
23
22
16
0
64
86
28
31
20
0
85
73
+22.5
-15*
Fish & fish dishes
9
14
0
0
34
48
13
29
0
0
56
41
+47.3
-15
of which
White/oily/other fish
6
9
0
0
26
40
10
25
0
0
42
37
+77.2*
-7
Fish dishes
1
8
0
0
0
4
3
14
0
0
15
7
+103
+59
Eggs & egg dishes
8
13
0
0
36
42
10
17
0
0
47
35
+23.9
-17
Nuts & seeds
0.4
2
0
0
4
8
0.7
4
0
0
5
8
+64.3
-1
Fruit & vegetables
224
153
186
35
525
100
221
129
201
53
444
100
-1.0
0
Fruit & fruit juices
155
133
123
7
427
98
147
115
125
10
349
97
-4.8
-1
of which
Discrete fruit
59
53
46
0
161
85
90
70
78
0
229
92
+53.1*
+8*
Fruit in composite dishes
9
11
6
0
28
94
9
14
5
0
31
84
-2.8
-10*
Fruit juice (100% fruit)
86
113
46
0
314
67
38
75
0
0
161
40
-56.3*
-40*
Smoothies
0.6
6
0
0
0
2
11
36
0
0
90
12
+1715*
606*
Vegetables
69
52
58
6
165
98
74
49
67
12
165
99
+7.4
+1
of which
Discrete vegetables
39
35
31
0
104
92
40
38
30
0
111
85
+4.1
-7
Vegetables in composite dishes
30
28
23
1
83
97
34
32
25
0
96
95
+11.5
-2
Confectionery
85
42
79
28
161
100
76
48
67
17
162
99
-10.1
-1
Water as a beverage
-
-
-
-
-
-
450
315
405
22
1037
95
Soft drinks†
331
285
276
18
821
95
160
221
83
0
595
67
-51.7*
-29*
of which
Soft drinks, no added sugar
78
206
0
0
433
40
110
201
0
0
483
47
+40.3
+16
Soft drinks, added sugar
252
227
194
0
677
93
50
93
0
0
217
40
-80.2*
-57*
Milk as a beverage
-
-
-
-
-
-
91
127
47
0
357
58
Teas & coffees
36
72
0
0
179
42
29
81
0
0
203
19
-21.4
-55*
Sweetened milk drinks
15
36
0
0
79
23
16
43
0
0
89
19
+8.8
-17
†carbonated beverages, fruit juice drinks, squashes & cordials, *Denotes statistical differences (p <0.001) between the NCFS and NCFS II via Independent Samples T Test and adjusted for
multiple testing
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Accepted manuscript
Table 2. Distribution of energy, macronutrients, dietary fibre, vitamin and mineral intakes in school-aged children (5-12 years)
in Ireland in the NCFS II and NCFS and the change in intakes between the NCFS and NCFS II
NCFS (2003-04) (n 594)
NCFS II (2017-18) (n 600)
Change
Percentiles
Percentiles
Mean
(%)
Mean
SD
Median
5th
95th
Mean
SD
Median
5th
95th
Macronutrients & Fibre
Energy (MJ)
7.0
1.4
7.0
4.9
9.4
6.3
1.2
6.2
4.5
8.3
-10.8*
Energy (kcal)
1667
323
1653
1166
2229
1487
275
1469
1067
1969
-10.8*
Protein (g)
56.6
13.4
55.8
36.4
80.5
59.6
14.1
58.0
39.2
85.3
+5.2*
Protein (g/kg bodyweight)
1.8
0.7
1.7
0.8
3.1
2.0
0.6
2.0
1.1
3.1
11.7*
%E from protein
13.7
1.8
13.7
10.9
16.9
16.2
2.1
16.0
13.0
19.9
+17.7*
Total fat (g)
63.1
14.2
62.2
41.4
88.1
55.8
12.7
54.8
36.8
78.5
-11.5*
%E from total fat
33.7
3.6
33.7
27.8
39.6
33.3
3.8
33.3
27.0
39.6
-1.2
Saturated fat (g)
27.3
6.7
26.8
17.1
39.1
23.4
5.6
23.0
15.0
33.4
-14.1*
%E from saturated fat
14.5
2.1
14.5
11.0
18.1
14.0
2.2
14.0
10.6
17.7
-3.5*
Monounsaturated fat (g)
21.5
5.1
21.2
13.9
30.5
22.9
5.6
22.4
14.7
32.9
+6.2*
%E from MUFA
11.5
1.5
11.5
9.1
14.0
13.6
1.8
13.6
10.7
16.6
+18.1*
Polyunsaturated fat (g)
9.2
2.8
8.9
5.3
14.2
9.3
2.5
9.0
5.8
13.8
+1.2
%E from PUFA
4.9
1.0
4.8
3.4
6.7
5.5
1.0
5.5
4.1
7.3
+13.4*
Carbohydrate (g)
231
47
228
158
313
197
38.3
195
138
264
-14.6*
%E from carbohydrate
52.1
4.2
52.1
45.2
59.0
50.0
4.3
50.1
42.8
57.0
-4.0*
Total sugars (g)
107
29.3
104
62.9
159
73.7
19.4
72.3
44.4
108
-30.8*
%E from total sugars
23.9
4.7
23.7
16.5
32.1
18.7
4.0
18.5
12.5
25.6
-21.7*
Free sugars (g)
73.4
26.2
70.7
35.7
121
38.4
14.9
36.6
17.4
65.6
-47.7*
%E from free sugars
16.3
5.0
16.0
8.8
25.2
9.5
3.4
9.2
4.5
15.6
-41.9*
Dietary fibre (g)
12.4
3.5
12.1
7.3
18.8
15.1
3.6
14.8
9.8
21.6
+21.9*
Dietary fibre (g/10MJ)
17.9
3.7
17.7
12.3
24.4
24.7
4.5
24.4
17.9
32.6
+37.8*
Vitamins†
Total Vitamin A (µg)
700
414
613
217
1507
666
307
613
274
1243
-5.0
Retinol (µg)
347
237
293
77
811
292
146
268
101
565
-15.8*
Carotene (µg)
2130
1688
1683
496
5368
2397
1828
1920
600
5823
+12.5*
Vitamin D (µg)
2.5
1.8
2.1
0.5
6.0
4.2
3.1
3.5
0.9
10.1
+68.5*
Vitamin E (mg)
6.3
3.2
5.8
2.2
12.3
6.9
2.9
6.5
3.0
12.4
+9.9*
Thiamin (mg)
1.5
0.5
1.4
0.8
2.5
1.4
0.4
1.4
0.8
2.2
-6.9*
Riboflavin (mg)
1.8
0.8
1.7
0.8
3.3
1.6
0.6
1.5
0.8
2.6
-13.4*
Total Niacin (mg)
28.5
7.8
27.8
17.0
42.5
28.8
7.5
28.0
18.2
42.5
+1.3
Vitamin B6 (mg)
2.0
0.7
1.9
1.0
3.4
1.5
0.5
1.4
0.8
2.5
-24.7*
Vitamin B12 (µg)
4.4
1.9
4.2
1.8
7.9
4.6
1.8
4.4
2.1
8.0
+5.1
Total folate (µg)
224
82
214
108
377
211
65
204
117
330
-6.0*
DFE (µg)
268
109
253
119
473
253
97
238
122
432
-5.6*
Biotin (µg)
24.8
12.9
22.2
9.3
49.8
25.3
11.2
23.3
10.9
46.4
+2.0
Pantothenate (mg)
5.3
2.0
5.1
2.6
9.1
5.3
1.8
5.1
2.8
8.8
+0.4
Vitamin C (mg)
86
50
76
25
182
73
42
65
22
154
-15.0*
Minerals†
Sodium (mg)
2081
506
2047
1317
2981
1657
365
1627
1114
2310
-20.4*
Potassium (mg)
2190
502
2164
1418
3073
2019
486
1980
1296
2891
-7.8*
Calcium (mg)
862
264
841
470
1337
791
241
767
438
1224
-8.2*
Iron (mg)
9.4
3.0
9.0
5.1
14.8
9.0
2.4
8.7
5.4
13.4
-4.2
Magnesium (mg)
194
47
191
122
277
194
47
190
124
279
+0.3
Zinc (mg)
6.6
1.8
6.4
4.0
10.0
7.8
2.1
7.5
4.8
11.6
+17.6*
Copper (mg)
0.8
0.3
0.8
0.4
1.3
0.8
0.2
0.7
0.5
1.1
-5.6*
Phosphorus (mg)
1024
258
1008
630
1481
1008
256
986
628
1467
-1.5
MUFA, monounsaturated fat; PUFA, polyunsaturated fat. †All sources including nutritional supplements. *Denotes statistical
differences (p <0.001) between the NCFS and NCFS II via Independent Samples T Test and adjusted for multiple testing
https://doi.org/10.1017/S0007114522002781 Published online by Cambridge University Press
Accepted manuscript
Table 3. Proportion of school-aged children (5-12 years) in Ireland with micronutrient intakes below the
Estimated Average Requirement (EAR) (excluding under-reporters) in the NCFS II and NCFS
Estimated Average Requirement
% < EAR
NCFS
(2003-04)
NCFS II
(2017-18)
Vitamin A
245µg/d (4-6y)
320µg/d (7-10y) (47)
480µg/d (11-14y) (47)
13
8.9
Vitamin D
10µg/d (54)
100
94*
7.5µg/d (55)
100
86*
Thiamin
0.072mg/MJ (47)
0
0
Riboflavin
0.6mg/d (4-6y) (47)
0.8mg/d (7-10y) (47)
1.1mg/d (11-14y) (47)
3
5
Total Niacin Equivalents
1.3mg NE/MJ (47)
0
0
Vitamin B6
0.6mg/d (4-6y) (47)
0.9mg/d (7-10y) (47)
1.2mg/d (11-14y) (47)
2
8*
Vitamin B12
0.7µg/d (4-6y) (50)
0.8µg/d (7-10y) (50)
1.0µg/d (11-14y) (50)
0
0
Dietary Folate Equivalents
110µg/d (4-6y) (47)
160µg/d (7-10y) (47)
210µg/d (11-14y) (47)
11
13
Vitamin C
25mg/d (4-6y) (47)
40mg/d (7-10y) (47)
60mg/d (11-14y) (47)
13
19
Calcium
680mg/d (4-10y) (47)
960mg/d (11-17y) (47)
24
37*
Iron
5mg/d (1-6y) (47)
8mg/d (7-11y) (47)
8mg/d (boys, 12y) (47)
7mg/d (girls, 12y) (47)
20
20
Magnesium
90mg/d (4-6y) (50)
150mg/d (7-10y) (50)
230mg/d (11-14y) (50)
18
18
Zinc
4.6mg/d (4-6y) (47)
6.2mg/d (7-10y) (47)
8.9mg/d (11-14y) (47)
36
24*
*Denotes statistical differences (p <0.001) between the NCFS and NCFS II via Chi-square Test and adjusted for
multiple testing
https://doi.org/10.1017/S0007114522002781 Published online by Cambridge University Press
Accepted manuscript
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