National Diet And Nutrition Survey Research Articles

Association between an anti-inflammatory and anti-oxidant dietary pattern and diabetes in British adults: results from the national diet and nutrition survey rolling programme years 1–4

This study investigated the cross-sectional association between an anti-inflammatory and anti-oxidant dietary pattern and diabetes in the national diet and nutrition survey (NDNS) rolling programme years 1–4. A total of 1531 survey members provided dietary data. Reduced Rank Regression (RRR) was used to derive an anti-inflammatory and anti-oxidant dietary pattern. Serum C-reactive protein (CRP) and plasma carotenoids were selected as response variables and markers of inflammation and antioxidant status, respectively. Overall, 52 survey members had diabetes. The derived anti-inflammatory and anti-oxidant dietary pattern was inversely related to CRP and positively to carotenoids. It was associated with lower odds of diabetes (multivariate adjusted OR for highest compared with lowest quintile: 0.17; 95%CI: 0.04–0.73; p for linear trend = 0.013). In conclusion, an anti-inflammatory and anti-oxidant dietary pattern is inversely related to diabetes. Further research is required to understand the overall framework within which foods and nutrients interact to affect metabolic pathways related to diabetes risk.

Waist-to-height ratio as an indicator of ‘early health risk’: simpler and more predictive than using a ‘matrix’ based on BMI and waist circumference

ObjectivesThere is now good evidence that central obesity carries more health risks compared with total obesity assessed by body mass index (BMI). It has therefore been suggested that waist circumference...

Low Calorie Beverage Consumption Is Associated with Energy and Nutrient Intakes and Diet Quality in British Adults.

It is unclear whether consumption of low-calorie beverages (LCB) leads to compensatory consumption of sweet foods, thus reducing benefits for weight control or diet quality. This analysis investigated associations between beverage consumption and energy intake and diet quality of adults in the UK National Diet and Nutrition Survey (NDNS) (2008–2011; n = 1590), classified into: (a) non-consumers of soft drinks (NC); (b) LCB consumers; (c) sugar-sweetened beverage (SSB) consumers; or (d) consumers of both beverages (BB), based on 4-day dietary records. Within-person data on beverage consumption on different days assessed the impact on energy intake. LCB consumers and NC consumed less energy and non-milk extrinsic sugars than other groups. Micronutrient intakes and food choices suggested higher dietary quality in NC/LCB consumers compared with SSB/BB consumers. Within individuals on different days, consumption of SSB, milk, juice, and alcohol were all associated with increased energy intake, while LCB and tea, coffee or water were associated with no change; or reduced energy intake when substituted for caloric beverages. Results indicate that NC and LCB consumers tend to have higher quality diets compared with SSB or BB consumers and do not compensate for sugar or energy deficits by consuming more sugary foods.

The effect of snacking and eating frequency on dietary quality in British adolescents.

To describe the effects of number of eating occasions and snacks on dietary quality (DQ), defined as adherence to dietary recommendations. A sample of 884 adolescents (11-18years) in the UK National Diet and Nutrition Survey (NDNS) were included. The Diet Quality Index for Adolescents (DQI-A) was implemented. The total number of eating occasions and snacks was frequency of food or beverages consumed over 24h and frequency of foods or beverages consumed outside of the three mealtimes, respectively. Results were generated with and without low-energy food under 210kJ (50kcal). Regression models were generated with DQ score as the outcome variable and number of eating occasions and snacks as predictors. The mean (95% CI) DQ score was 31.1% (30.2, 32.0). The mean number of eating occasions and snacks was 7.5 (7.3, 7.7) and 2.6 (2.6, 2.7) times/day, respectively. When low-energy events were excluded, the mean number of eating occasions and snacks reduced to 6.2 (6.1, 6.4) and 2.0 (2.0, 2.1) times/day, respectively. DQ score increased by 0.74 points (0.42, 1.05; p<0.01) and 0.55 points (-0.08, 0.69; p=0.17) for total eating occasions and snacks, respectively. When low-energy events were excluded, DQ score increased by 0.30 points (-0.84, 0.69; p=0.13) for each eating occasion and decreased by 1.20 points (-2.1, -0.3; p<0.01) for each snack. Eating more frequently improves dietary quality especially if some eating occasions are low in energy. A focus on replacing high-energy snacks with low-energy alternatives rather than reducing the number of eating occasions may result in improved dietary quality in adolescents.

Modelling the Health Impact of an English Sugary Drinks Duty at National and Local Levels.

BackgroundIncreasing evidence associates excess refined sugar intakes with obesity, Type 2 diabetes and heart disease. Worryingly, the estimated volume of sugary drinks purchased in the UK has more than doubled between 1975 and 2007, from 510ml to 1140ml per person per week. We aimed to estimate the potential impact of a duty on sugar sweetened beverages (SSBs) at a local level in England, hypothesising that a duty could reduce obesity and related diseases.Methods and FindingsWe modelled the potential impact of a 20% sugary drinks duty on local authorities in England between 2010 and 2030. We synthesised data obtained from the British National Diet and Nutrition Survey (NDNS), drinks manufacturers, Office for National Statistics, and from previous studies. This produced a modelled population of 41 million adults in 326 lower tier local authorities in England. This analysis suggests that a 20% SSB duty could result in approximately 2,400 fewer diabetes cases, 1,700 fewer stroke and coronary heart disease cases, 400 fewer cancer cases, and gain some 41,000 Quality Adjusted Life Years (QALYs) per year across England. The duty might have the biggest impact in urban areas with young populations.ConclusionsThis study adds to the growing body of evidence suggesting health benefits for a duty on sugary drinks. It might also usefully provide results at an area level to inform local price interventions in England.

Quantitative risk assessment of UK food products cross‐contaminated with allergens

Allergens in food pose a risk to allergic consumers, especially if they are present in food without declaration or warning. While there is EU regulation for allergens present as an ingredient, this is not the case for unintended allergen presence (UAP). Food companies use precautionary may contain labels to inform allergic individuals of a potential risk from UAPs. However, the use or absence of precautionary label has a limited correlation with the level of UAP and consequently the risk of an unexpected allergic reaction. Allergen risk assessment using probabilistic techniques enables estimation of the residual risk after the consumption of a product that unintendedly contains an allergen. Previously, the UAP was determined among 500 packaged food products from 12 food groups in the UK, either containing a precautionary label or not (FSA,UK). In the present study, the UAP results were combined with food consumption data from the National Diet and Nutrition Survey (NDNS) in the UK and the allergen-specific population threshold distribution in a probabilistic model. Data used for the threshold distributions were gathered during the scientific review of the VITAL® (Voluntary Incidental Trace Allergen Labelling). The allergens of interest were milk, wheat, peanut and hazelnut. The probabilistic model estimates the level of risk for objective allergic reactions posed to the allergic consumers in the UK and gives insight in the health implications of the measured unintended allergen levels. Also, the levels of UAP were compared to a product-specific action level (ppm) based on the reference doses as determined for VITAL® (mg protein) and the product specific consumption (kg). The results of this study will assess the public health risks posed by the levels of allergen cross-contamination found to be present in food in the UK retail market and will provide insight regarding the implications of the potential implementation of the VITAL® reference doses in evaluation of the use of advisory labeling in the UK.

The feasibility of meeting the WHO guidelines for sodium and potassium: a cross-national comparison study

ObjectiveTo determine joint compliance with the WHO sodium–potassium goals in four different countries, using data from nationally representative dietary surveys.SettingCompared to national and international recommendations and guidelines, the world's population...

Estimation of dietary iron bioavailability from food iron intake and iron status.

Currently there are no satisfactory methods for estimating dietary iron absorption (bioavailability) at a population level, but this is essential for deriving dietary reference values using the factorial approach. The aim of this work was to develop a novel approach for estimating dietary iron absorption using a population sample from a sub-section of the UK National Diet and Nutrition Survey (NDNS). Data were analyzed in 873 subjects from the 2000–2001 adult cohort of the NDNS, for whom both dietary intake data and hematological measures (hemoglobin and serum ferritin (SF) concentrations) were available. There were 495 men aged 19–64 y (mean age 42.7±12.1 y) and 378 pre-menopausal women (mean age 35.7±8.2 y). Individual dietary iron requirements were estimated using the Institute of Medicine calculations. A full probability approach was then applied to estimate the prevalence of dietary intakes that were insufficient to meet the needs of the men and women separately, based on their estimated daily iron intake and a series of absorption values ranging from 1–40%. The prevalence of SF concentrations below selected cut-off values (indicating that absorption was not high enough to maintain iron stores) was derived from individual SF concentrations. An estimate of dietary iron absorption required to maintain specified SF values was then calculated by matching the observed prevalence of insufficiency with the prevalence predicted for the series of absorption estimates. Mean daily dietary iron intakes were 13.5 mg for men and 9.8 mg for women. Mean calculated dietary absorption was 8% in men (50th percentile for SF 85 µg/L) and 17% in women (50th percentile for SF 38 µg/L). At a ferritin level of 45 µg/L estimated absorption was similar in men (14%) and women (13%). This new method can be used to calculate dietary iron absorption at a population level using data describing total iron intake and SF concentration.

Update of the vitamin D content of fortified foods and supplements in the UK National Diet and Nutrition Survey Nutrient Databank

Food composition tables require updating regularly to keep abreast of the periodic reformulation of fortified foods and dietary supplements. This paper describes a process undertaken to update the vitamin D content of fortified foods and supplements consumed in the UK, and the impact this may have on reported vitamin D intake. In 2011, the vitamin D content of the 289 vitamin D fortified foods and vitamin D containing supplements recorded in the National Diet and Nutrition Survey (NDNS) Nutrient Databank (last updated in 2008) was compared to data from industry websites, trade associations and manufacturers, and nutrition labelling on pack. Typical ‘overages’ (the additional amount added to account for any processing loss or degradation) applied during vitamin D fortification were also obtained. This information was used to update the NDNS Nutrient Databank, and applied to NDNS food consumption data (2008/2010) to determine the impact of the composition update on reported population vitamin D intakes. Up-to-date vitamin D values were obtained for 257 (89%) of the 289 items in the NDNS databank; the remainder were no longer available on the market. The vitamin D content of 31 (11%) of the items had changed, and these were most commonly breakfast cereals, fat spreads and powdered malt drinks. A further eight food items were identified as newly fortified with vitamin D. Calculation of mean vitamin D intakes using updated data identified that use of out-of-date food composition data may lead to an underestimation of UK vitamin D intakes of around 3% (0.1 μg/day). When a blanket 12.5% ‘overage’ was applied to all items, this underestimate increased to 6% (0.2 μg/day). Even though the absolute impact of updating the vitamin D content of fortified foods and supplements on population mean intakes is relatively small, our analysis suggests it is important that nutrient databases are regularly updated. The new estimates of the vitamin D content of foods and supplements should be used for future estimates of vitamin D intake in the UK until a further periodic update is conducted.

Phytonutrient intakes in relation to European fruit and vegetable consumption patterns observed in different food surveys.

Fruit and vegetables make an important contribution to health, partly due to the composition of phytonutrients, such as carotenoids and polyphenols. The aim of the present study was to quantify the intake of fruit and vegetables across different European countries using food consumption data of increasing complexity: food balance sheets (FBS); the European Food Safety Authority (EFSA) Comprehensive Database; individual food consumption data from the UK National Diet and Nutrition Survey (NDNS). Across Europe, the average consumption of fruit and vegetables ranged from 192 to 824g/d (FBS data). Based on EFSA data, nine out of fourteen countries consumed <400g/d (recommended by the WHO), although even in the highest-consuming countries such as Spain, 36% did not reach the target intake. In the UK, the average consumption of fruit and vegetables was 310g/d (NDNS data). Generally, phytonutrient intake increased in accordance with fruit and vegetable intake across all European countries with the exception of lycopene (from tomatoes), which appeared to be higher in some countries that consumed less fruit and vegetables. There were little differences in the average intake of flavanols, flavonols and lycopene in those who did or did not meet the 400g/d recommendation in the UK. However, average intakes of carotenoid, flavanone, anthocyanidin and ellagic acid were higher in those who consumed >400g/d of fruit and vegetables compared with those who did not. Overall, intakes of phytonutrients are highly variable, suggesting that while some individuals obtain healthful amounts, there may be others who do not gain all the potential benefits associated with phytonutrients in the diet.

Socioeconomic inequality in salt intake in Britain 10 years after a national salt reduction programme

ObjectivesThe impact of the national salt reduction programme in the UK on social inequalities is unknown. We examined spatial and socioeconomic variations in salt intake in the 2008–2011 British National...

Diet, nutrition and schoolchildren: An update

SummaryThis paper updates a British Nutrition Foundation (BNF) Briefing Paper on this topic, published in 2011. Healthy eating and being physically active are particularly important for children and adolescents. This is because their nutrition and lifestyle influence their wellbeing, growth and development. There remains considerable room for improvement in the diets of British schoolchildren, according to findings of the government's National Diet and Nutrition Surveys (NDNS), but some improvements have been made in the past decade. Although intakes of saturated fatty acids and non‐milk extrinsic sugars have decreased in recent years, on average, they are still above recommended upper levels. Average contribution of fat to total energy intake has dropped below the recommended upper level of 35%, but fibre intakes remain low. With regard to micronutrients, many teenage girls are consuming low amounts of iron, but there is also evidence of low intakes of vitamin A, riboflavin, calcium, magnesium, potassium, selenium, iodine and zinc. New data on micronutrient status is now available for 11–18 year‐olds, and reveals low levels of vitamin D, riboflavin and iron (mainly in girls). Low vitamin D intake and status is a particular problem in some ethnic minority groups, especially South Asian children. There is also some evidence of socio‐economic inequalities; for example, children from families with higher incomes tend to have higher intakes of fruits and vegetables compared with children from families with lower incomes. This paper also discusses how dietary patterns can influence the micronutrient intake and status of schoolchildren, as well as the risk of overweight and obesity.Since publication of the Briefing Paper in 2011, new physical activity guidelines have been published and, for the first time, these are UK‐wide guidelines. Also for the first time, UK‐wide data on physical activity levels in schoolchildren are available (for 7‐year‐old children). Physical activity levels vary little between the UK regions, with the exception of Northern Ireland where fewer children meet the UK recommendations than in other regions. The data highlight significant differences between boys and girls (with girls generally being less active) and significant differences between ethnic groups. In particular, children from the Bangladeshi, Indian and Pakistani ethnic groups are less likely to meet the recommended levels of physical activity compared with other children.Obesity remains a major problem among British schoolchildren and there is a stark socio‐economic gradient, with levels of obesity being highest in the most socially deprived children.This paper also discusses various health issues in children, including iron deficiency anaemia, oral health, bone development, food allergy and intolerance, and cognitive function in children, updating the previous paper with the latest statistics and evidence.The findings of the NDNS serve to emphasise the importance of a whole school approach to good nutrition embracing the school curriculum as well as the food and drink available in schools (as highlighted in the recently published School Food Plan). School food provision has seen many changes over recent years, with school food standards now in place in all UK regions, most recently Wales. Various evaluations of the impact of school food standards, mainly in England, have highlighted improvements in the diets of schoolchildren, not only in the school setting but in their diets overall. However, there remains room for improvement. This paper also briefly describes a selection of initiatives and organisations of relevance to child nutrition.

Estimates of dietary exposure to bisphenol A (BPA) from light metal packaging using food consumption and packaging usage data: a refined deterministic approach and a fully probabilistic (FACET) approach

The FACET tool is a probabilistic model to estimate exposure to chemicals in foodstuffs, originating from flavours, additives and food contact materials. This paper demonstrates the use of the FACET tool to estimate exposure to BPA (bisphenol A) from light metal packaging. For exposure to migrants from food packaging, FACET uses industry-supplied data on the occurrence of substances in the packaging, their concentrations and construction of the packaging, which were combined with data from a market research organisation and food consumption data supplied by national database managers. To illustrate the principles, UK packaging data were used together with consumption data from the UK National Diet and Nutrition Survey (NDNS) dietary survey for 19–64 year olds for a refined deterministic verification. The UK data were chosen mainly because the consumption surveys are detailed, data for UK packaging at a detailed level were available and, arguably, the UK population is composed of high consumers of packaged foodstuffs. Exposures were run for each food category that could give rise to BPA from light metal packaging. Consumer loyalty to a particular type of packaging, commonly referred to as packaging loyalty, was set. The BPA extraction levels used for the 15 types of coating chemistries that could release BPA were in the range of 0.00005–0.012 mg dm–2. The estimates of exposure to BPA using FACET for the total diet were 0.0098 (mean) and 0.0466 (97.5th percentile) mg/person/day, corresponding to 0.00013 (mean) and 0.00059 (97.5th percentile) mg kg–1 body weight day–1 for consumers of foods packed in light metal packaging. This is well below the current EFSA (and other recognised bodies) TDI of 0.05 mg kg–1 body weight day–1. These probabilistic estimates were compared with estimates using a refined deterministic approach drawing on the same input data. The results from FACET for the mean, 95th and 97.5th percentile exposures to BPA lay between the lowest and the highest estimates from the refined deterministic calculations. Since this should be the case, for a fully probabilistic compared with a deterministic approach, it is concluded that the FACET tool has been verified in this example. A recent EFSA draft opinion on exposure to BPA from different sources showed that canned foods were a major contributor and compared results from various models, including those from FACET. The results from FACET were overall conservative.

Detailed assessment of nutritional status and eating patterns in children with gastrointestinal diseases attending an outpatients clinic and contemporary healthy controls

In the era of modern multidisciplinary clinical management, very little is known about the prevalence and presentation of malnutrition in children with gastrointestinal disorders (GastroD) particularly employing composite, global measures of nutritional status. Anthropometry, body composition, dietary intake, eating habits and grip strength were assessed with bedside methods in 168 patients from outpatient gastroenterology clinics (n, median (IQR) years; Crohn's disease (CD): n=53, 14.2 (11.6:15.4); ulcerative colitis (UC): n=27, 12.2 (10.7:14.2); coeliac disease: n=31, 9.3 (7.5:13.6); other GastroD: n=57, 9.8 (7.2:13.8)) and compared with 62 contemporary healthy controls (n, median (IQR): 9.8 (6.9:13.8)) and the results of the recent UK, National Diet and Nutritional Survey (NDNS). Children with CD had lower BMI z-scores than controls (median (IQR): -0.3 (-0.9:0.4) vs 0.3 (-0.6:1.4); P=0.02) but only 2% were classified as thin (BMI z-score <-2 s.d.). The prevalence of obesity in children with UC was 19%, 6% in CD, 11% in children with other GastroD and 15% in controls. No difference was found in grip strength measurement between groups. Except for CD children, the proportion of patients with suboptimal micronutrient intake was similar to that of controls and the cohort of children from the latest NDNS. A higher proportion of children with CD had suboptimal intake for riboflavin, vitamin B6 and calcium and consumed significantly more meat products, juices (including carbonated drinks), spreads/jams and crisps and savoury snacks and significantly fewer portions of dairy, fish, fruits and vegetables compared with healthy controls. GastroD affect children's body composition, growth, strength, dietary intake and eating habits, particularly CD, but to a lesser extent than expected.

Biomarkers of diabetes risk in the National Diet and Nutrition Survey rolling programme (2008–2011)

This study describes the distribution of glycosylated haemoglobin (HbA1c) and glucose concentrations in the combined year 1 (2008–2009), year 2 (2009–2010) and year 3 (2010–2011) of the National Diet and...

Innovations in national nutrition surveys

The aim of this paper is to describe innovations taking place in national nutrition surveys in the UK and the challenges of undertaking innovations in such settings. National nutrition surveys must be representative of the overall population in characteristics such as socio-economic circumstances, age, sex and region. High response rates are critical. Dietary assessment innovations must therefore be suitable for all types of individuals, from the very young to the very old, for variable literacy and/or technical skills, different ethnic backgrounds and life circumstances, such as multiple carers and frequent travel. At the same time, national surveys need details on foods consumed. Current advances in dietary assessment use either technological innovations or simplified methods; neither lend themselves to national surveys. The National Diet and Nutrition Survey (NDNS) rolling programme, and the Diet and Nutrition Survey of Infants and Young Children (DNSIYC), currently use the 4-d estimated diary, a compromise for detail and respondent burden. Collection of food packaging enables identification of specific products. Providing space for location of eating, others eating, the television being on and eating at a table, adds to eating context information. Disaggregation of mixed dishes enables determination of true intakes of meat and fruit and vegetables. Measurement of nutritional status requires blood sampling and processing in DNSIYC clinics throughout the country and mobile units were used to optimise response. Hence, innovations in national surveys can and are being made but must take into account the paramount concerns of detail and response rate.

Is there an association between adolescents' high caloric food portion size and body mass index?

The trend of consuming large food portion sizes has occurred simultaneously with the rise in obesity prevalence, and therefore it is worth examining food portion size as a potential contributing risk factor for weight gain. However, limited studies have investigated this relationship particularly among adolescents. This study aims to investigate the association between food portion size for the top fifteen high energy dense-foods and body mass index (BMI), among British adolescents (aged 11–18 years), using the National Diet and Nutrition Survey (NDNS) 3 years combined from 2008 to 2011 (1) . Food portion sizes were estimated for all adolescents who had consumed the food at least once. Regression models with BMI as outcome were adjusted for age, sex and misreporting. Misreporting of energy intake (EI) was calculated based on Torun cut-off points (2) . There was a positive relationship between total EI in megajoule (MJ) and BMI (Coef. = 0.45, 95 % CI 0.24 to 0.66, P < 0.001) for the entire sample, even after stratifying it by misreporting. Larger portions of cream, biscuits, breakfast cereals, and buns, cakes & pastries were positively associated with higher BMI in adolescents, particularly among normal reporters. Biscuits were the highest contributors to adolescents daily EI with 4 %, followed by crisps 3.8%, chocolate 3.6% and fat at 3.5%. These findings highlight the need to increase adolescents’ awareness regarding portion size and energy-dense foods in order to improve their food choice and future health outcomes.

Dietary value for money? Investigating how the monetary value of diets in the National Diet and Nutrition Survey (NDNS) relate to dietary energy density

Estimating the monetary value of individuals’ diets allows investigation into how costs relate to dietary quality. A number of studies(1–2), including one in Scotland(3), have reported a strong negative relationship between diet costs and energy density. Most studies of this type neglect to address the issue of mathematical coupling, where energy is both the numerator in the energy density variable (kJ/g) and the denominator in energy-adjusted diet cost (e.g. E/10 MJ). As a result, the findings could be reflecting a mathematical relationship(4). This study investigated how estimated diet costs of NDNS adults relate to dietary energy density using the ‘residuals’ regressionmethod to account for energy. Diet diary information from 2008–2010 was matched to an in-house database of national average (2004) food prices (the DANTE cost database) to assign a cost to each food and non-alcoholic beverage consumed. Mean daily diet costs and costs per 10 MJ were calculated for each participant. Energy density (g/kJ) was derived from foods and milk. The sample median diet cost was £2.84 per day (IQR £2.27, £3.64), or £4.05 per 10MJ (£3.45, £4.82). Values for energy density, food energy, and diet costs by quintiles of dietary energy density (1 = least energy dense) are presented in the table. Adjusted linear regression found a strong negative relationship: additional standard deviation above the diet cost expected for a given energy intake (the residual), there was an associated decrease in energy density of 0.46kJ/g (95% CI - 0.53, - 0.38, p<0.001). This is the first time individual-level diet costs have been characterized for a representative British population. These diet costs represent the inherent value of the diet, and are not comparable to UK expenditure data. The analyses confirm a diet cost-energy density link that is not due to mathematical artefact, and suggest that those consuming more energy-dense diets are achieving more kilojoules for their money.

Reflections on dietary guidance and the status of carbohydrate on both sides of the Atlantic

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Achieving eatwell plate recommendations: is this a route to improving both sustainability and healthy eating?

SummaryBy using data from the National Diet and Nutrition Survey (NDNS) rolling programme, the objective was to determine the extent to which consumers meet the nutrition guidelines implicit in the eatwell plate; to profile those eating healthily and gain insight on how they achieved the recommendations and whether in doing so, their eating pattern was also potentially more sustainable.Only 4% of adults simultaneously met five targets related to fat, saturated fatty acids (SFA), 5 A DAY fruit and vegetables, fibre (non‐starch polysaccharide; NSP) and protein intake and, with the exception of target protein intake, the majority of people (51%) achieved none of the guidelines. The addition of the oil‐rich fish recommendation reduces those meeting all six targets to 1%. Just 12% of the population (n = 94) met the three targets for fat, SFA and fruit and vegetable intake. These were designated achievers, who tended to be older by 5 years and to have a degree (P &lt; 0.05), while non‐achievers were more likely to smoke (P &lt; 0.05). Energy intakes were slightly lower in achievers (non‐significant), who had significantly lower fat and SFA intakes and higher intakes of protein. Intakes of NSP were significantly higher among achievers, who on average met the dietary reference value for NSP. The main NDNS food groups with a significantly higher intake in achievers were skimmed milks, chicken and turkey dishes, white fish (not fried) and shellfish and wholemeal breads, while non‐achievers consumed more coated chicken, meat pies and pastries, cheese, whole milks and white bread. It appears that the achievers have reduced the fat content of their diet by focussing on lower fat/higher fibre alternatives within the same category of foods rather than introducing more plant foods such as legumes, nuts and seeds.There is growing interest in the future sustainability of current dietary patterns in light of expected climate change and an expanding global population. Although only one facet of a very complex picture, plant foods are typically associated with fewer greenhouse gas (GHG) emissions than those of animal origin. On this limited basis, achievers were not necessarily eating more sustainably. It is suggested, by reference to literature values (primarily for potential GHG emissions of food production), that with some rebalancing and through the inclusion in current UK dietary patterns of more plant foods, particularly more plant proteins and starchy foods, the existing eatwell plate could not only provide the basis of a cost‐effective healthy diet, but also a potentially more sustainable one too. However, in order to meet these joint objectives, improved consumer understanding and practical advice on how to use the eatwell plate in this way is clearly required.