7.1 New Zealand 2002 National Children’s Nutrition Survey data
FSANZ does not currently hold food consumption data for New Zealand children aged 2-14 years from the 2002 National Children’s Nutrition Survey (CNS). The New Zealand Food Safety Authority (NZFSA) commissioned the University of Otago (LINZ Research group) to undertake a dietary intake assessment for children aged 5-14 years, based on data from the 2002 New Zealand Children’s Nutrition Survey. The results for the proportion of children exceeding the upper level (UL) for folic acid for the proposed mandatory fortification of bread were submitted to the Ministerial Council in October 2006 at the same time as the FAR and were higher than those reported for Australian children at FAR for the same age group.
The level of folic acid fortification as proposed by FSANZ for FAR was 135 micrograms per 100 grams of bread and assessments for this analysis of New Zealand 2002 CNS are based on this scenario.
As part of the First Review, FSANZ assessed the difference between the proportion of New Zealand children and Australian children exceeding the upper limit. To do this FSANZ analysed the dietary intake data from LINZ, specifically:
1. the methodology;
2. folic acid concentrations; and 3. foods assumed to be fortified.
A summary of the methodologies used for the FSANZ and LINZ assessments for Australian and New Zealand children are outlined in Figure 9 below.
Research group)
Methodology 1. Single day un-adjusted model 2. Population weighted
1. Two day adjusted model 2. Not population weighted Folic acid concentrations Similar
Population group assessed 5-8 years for New Zealand, 2002 NNS
4-8 years for Australia, 1995 NNS
Other differences 1. Similar foods assumed to be fortified but foods coded slightly differently in the 2002 NZ survey compared to the 1995 NNS 2. Uptake of voluntary fortification permissions is different between
the countries.
3. Potentially different food consumption patterns between the two survey periods and/or countries.
Figure 9: Summary of the methodologies used for the FSANZ and LINZ Research Group assessments of folic acid intakes in children for Australia and New Zealand
In both the FSANZ and the LINZ Research group assessments, the mandatory folic acid fortification concentrations used and the foods assumed to be fortified were similar. The dietary intake assessments for Baseline were performed using analytical food composition data, where available, which take into account overages (overages were considered only where the information on folic acid content was taken from the claimed amount on the food label). The mean rather than maximum concentration of folic acid in foods reported was used to estimate dietary intakes of folic acid as this reflects the expected distribution of folic acid content in the food over time i.e. a single consumer would not be expected to consume a food with maximum levels of the nutrient every occasion of eating.
The methodologies for the FSANZ and the LINZ Research group assessments were different.
The methodology used by the University of Otago (LINZ Research group) was a single day un-adjusted method and the methodology used by FSANZ was a two-day adjusted method.
Using a single day of food consumption data can result in a broader distribution of folic acid intakes and, potentially, a higher estimated proportion of the population group with intakes above the UL which, in turn, overestimates the level of risk to the population group. Adjusted nutrient intakes better reflect ‘usual’ daily nutrient intakes (see Appendix 1: How were the estimated dietary intakes estimated in Attachment 7a of the FAR).
However, it is important to note that there are limitations in comparing the results from the FSANZ assessment and the LINZ assessment since different age groups were investigated (4- 8 years, for Australia; 5-8 years for New Zealand). FSANZ investigated whether using a single day un-adjusted modelling method for 4-8 year old Australian children would explain the difference between Australian and New Zealand children. These data are presented in Table 12 below. It was concluded that using a single day un-adjusted methodology may account for some of the differences in results as using for the second day adjustment for the Australian children decreased the proportion of children exceeding the UL from 9% to 3%.
In the 2002 New Zealand Children’s Nutrition Survey, there was over-sampling of the Maori and Pacific children. Population weighting was therefore used by the LINZ Research group in their assessment to make the survey sample better reflect the New Zealand children’s
population so that conclusions could be drawn about New Zealand children in general. The 1995 Australian National Nutrition Survey did not require weighting in order to make comments about the folic acid intakes of Australian children.
The impact of weighting is unknown but FSANZ has been advised by the NZFSA that weighting is not expected to be a major contributor to the reported differences in the proportion of children with intakes >UL. However, if the different groups of New Zealand children had different bread consumption patterns it may do so.
There is evidence from the dietary modelling conducted by FSANZ using the 1995 and 1997 NNSs that New Zealand estimated dietary folic acid intakes for adults were lower than those for Australia. This difference could be due to different food consumption patterns, seasonality of consumption and/or lower levels of uptake of voluntary fortification permissions. It would be expected that similar food consumption patterns to adults would be found for the younger children in New Zealand, however it is possible that changes in food consumption in the 7 year period from 1995 through to 2002 may account for some differences in the estimated folic acid intakes. FSANZ will be in a position to use the 2002 CNS data in DIAMOND later in 2007, so can rerun these estimates at that time.
Table 12: Comparison between proportion of Australian children aged 4-8 years and New Zealand children aged 5-8 years exceeding the UL using different dietary intake methodologies (single day unadjusted versus two day adjusted models) for the FAR Mandatory fortification scenario of 135 àg folic acid /100 g bread
Gender
% above UL New Zealand
(LINZ data)
Australia (FSANZ FAR)
Australia (FSANZ FAR) Single day un-adjusted
model Two day adjusted model
Single day un-adjusted model
5-8 yrs 4-8 yrs 4-8 yrs
All 3 9
Males 13.8 5 7
Females 8.2 <1 2
FSANZ has used the best available food consumption data available for the folic acid intake assessments (1995 and 1997 NNSs) and validated these with more up-to-date studies that assessed bread consumption in the Australian and New Zealand populations. Results were published in the FAR.
7.2 Mandatory fortification and the national nutrition guidelines
7.2.1 Contributions of high fat and/or high sugar breads to estimated folic acid intakes The First Review request indicated that the mandatory fortification of all bread products with folic acid may contravene national nutrition policies as the definition of bread included sweet buns and other bread products to which fat and/or sugar may be added pre-baking. Also, breads to which fat and/or sugar are added after baking would also be fortified with folic acid i.e. buns filled or topped with cream and jam and coffee scrolls topped with icing. The First Review request questioned whether it would be appropriate to apply qualifying or
disqualifying criteria for bread to be fortified.
To determine the impact of fortifying breads with added fat and/or sugar with folic acid, the proportion of fat and sugar in bread products and their contribution to folic acid intakes was investigated as follows:
• Determining the proportion of fat and sugar in sweet fancy buns and other bread
products to which fat and/or sugar may be added pre- and post-baking was compared to
‘standard’ breads i.e. white, wholemeal, grain.
• Calculating the contribution of sweet fancy buns and other bread products to which fat and/or sugar may be added pre- and post-baking to total folic acid intakes was
compared to ‘standard’ plain breads i.e. white, wholemeal, grain.
7.2.1.1 Proportion of fat and sugar in bread products
The proportion of fat and sugar in bread products is shown in Table 13. Bread products have been separated into three categories: (1) plain bread and rolls; (2) flat breads and English-style muffins; and (3) fancy breads with added fat and/or sugar. The latter category includes those products that conform to the criteria outlined in the First Review request i.e. fat and/or sugar added pre- or post-baking.
Table 13: Proportion of fat and sugar in bread products (%) in Australia and New Zealand (range)
Proportion of fat in bread
(% range) Proportion of sugar in bread (% range)
Australia New Zealand Australia New Zealand
Plain bread and rolls 1 – 5 <1 – 3 2 – 7 <1 – 6
White bread and rolls 1 – 5 <1 – 3 2 – 7 2 – 3
Fibre-increased bread and rolls 3 – 4 <1 2 – 4 2 - 4
Wholemeal bread and rolls 1 – 5 1 – 2 2 – 6 1 – 2
Mixed grain bread and rolls 3 – 4 <1 – 2 2 – 4 1 – 2
Rye bread and rolls 1 – 4 <1 – 3 3 – 5 <1 – 6
Flat breads and English-style muffins 1 – 12 <1 – 8 <1 – 8 <1 – 14
Flat breads 2 – 122 <1 – 83 3 – 84 <1 – 65
English-style muffins 1 – 4 2 – 8 <1 – 2 2 – 146
Fancy breads with added fat and/or
sugar 3 – 14 <1 – 28 2 – 22 1 – 28
Fruit 3 – 5 3 – 6 2 – 21 11 – 19
Garlic 13 – 14 28 4 2
Cheese topped 3 – 7 3 – 5 2 – 4 2
Flavoured1 3 – 6 <1 – 6 2 – 3 1 – 2
Buns and yeast-based products 4 – 14 <1 – 9 8 – 22 4 – 28
1 Includes focaccia.
2 Upper figure is for Naan. Next highest figure is 3% (wholemeal, toasted).
3 Upper figure is for Naan. Next highest figures are 4% (Chinese bread); and 2% (wholemeal (toasted).
4 Upper figure is for Naan. Next highest figure is 4% (white, toasted).
5 Upper figure is for Chinese bread. Next highest figures are: 4% (Naan); 3% (takakau); and 2% (wholemeal, toasted).
6 Upper figure is for muffin split, with fruit.
7.2.1.1.1 Proportion of fat in bread products
In Australia, the proportion of fat in plain bread and rolls ranged from 1% to 5%. The proportion of fat in fancy breads with added fat and/or sugar ranges from 3% to 14%. The breads containing the highest proportion of fat were garlic bread and buns and yeast-based products (up to 14%).
In New Zealand, the proportion of fat in plain bread and rolls ranged from less than 1% to 3%. The proportion of fat in fancy breads with added fat and/or sugar ranged from less than 1% to 28%. Garlic bread contained the highest proportion of fat at 28%.
7.2.1.1.2 Proportion of sugar in bread products
In Australia, the proportion of sugar in plain bread and rolls ranged from 2% to 7%. The proportion of fat in fancy breads with added fat and/or sugar ranged from 2% to 22%. The breads containing the highest proportion of sugar were fruit bread (up to 21%) and buns and yeast-based products (up to 22%).
In New Zealand, the proportion of sugar in plain bread and rolls ranged from less than 1% to 6%. The proportion of sugar in fancy breads with added fat and/or sugar ranged from 1% to 28%. The breads containing the highest proportion of sugar were buns and yeast-based products (up to 28%).
7.2.1.2 Contribution of bread products to folic acid intakes
The contribution of bread products to folic acid intakes for various Australian and New Zealand population groups is shown in Table 14. Bread products have been separated into three categories: (1) plain breads; (2) sweet breads; and (3) fancy breads with added fat and/or sugar.
7.2.1.3 Risk characterisation
In Australia, garlic bread and buns and yeast-based products were identified as containing the highest proportion of fat (14%), whilst fruit bread, and buns and yeast-based products were identified as containing the highest proportion of sugar (21% and 22% respectively). These products were included in the ‘fancy breads with added fat and/or sugar’ category that made a minor contribution to folic acid intakes (between 1% and 4% for the three population groups examined).
In New Zealand, garlic bread was identified as containing the highest proportion of fat (28%), whilst buns and yeast-based products were identified as containing the highest proportion of sugar (28%). These products were included in the ‘fancy breads with added fat and/or sugar’
category that made a minor contribution to folic acid intakes (approximately 6% for both population groups examined).
7.2.1.4 Conclusions
Whilst sweet buns and other fancy bread products to which fat and/or sugar may be added pre-baking and fancy breads to which fat and/or sugar are added after baking contain a varying proportions of fat and sugar, their contribution to folic acid intake for the target population group (Australian and New Zealand females aged 16-44 years), Australians aged 2-3 years and 2 years and above, and New Zealanders aged 15 years and above was minimal.
The highest contribution of fancy breads with added fat and/or sugar to folic acid intakes was approximately 6% for the New Zealand population.
Table 14: Contribution of bread products to folic acid intakes (%) for various Australian and New Zealand population groups
Bread product
Contribution to folic acid intake (%)
Australia New Zealand
2-3 years Females 16-
44 years 2 years and
above Females 16-
44 years 15 years and above
Plain bread and rolls 41 44 45 56 57
White bread and rolls 28 29 29 33 29
Fibre-increased bread and rolls 4 2 2 3 3
Wholemeal bread and rolls 7 9 10 9 12
Mixed grain bread and rolls 2 4 4 7 9
Rye bread and rolls <1 <1 <1 4 4
Flat breads and English-style muffins <1 2 1 2 <1
Flat breads <1 1 <1 <1 <1
English-style muffins <1 <1 <1 <1 <1
Fancy breads with added fat and/or
sugar 1 4 3 6 6
Fancy bread1 <1 3 2 4 4
Buns and yeast-based products <1 1 1 2 2
1 Fruit, garlic, cheese-topped, flavoured.
In Australia, plain bread and rolls contributed between 41% and 45% to folic acid intakes.
White bread and rolls made the largest contribution to folic acid intakes (28% to 29%), followed by wholemeal bread and rolls (7% to 10%). Fancy breads with added fat and/or sugar contributed between 1% and 4% to folic acid intakes.
In New Zealand, plain bread and rolls contributed 56% and 57% to folic acid intakes. As with Australia, white bread and rolls made the largest contribution to folic acid intakes (29% to 33%), followed by wholemeal bread and rolls (9% to 12%). Fancy breads with added fat and/or sugar contributed approximately 6% to folic acid intakes.