Dietary intake of older Victorians.

Abstract

Objectives: To describe the nutrient intake of Victorians aged 44 years and older and to compare this intake with recommended levels.

Design: Cluster stratified sampling was employed to enable recruitment of subjects by household census. Subjects were recruited and attended baseline examinations from 1992 to 1994 and were followed-up five years later. Dietary data were collected at follow-up using a four-page self-administered food frequency questionnaire.

Subjects: 3271 adults aged 40 years and older who were permanent Australian residents and lived in Victoria between 1992 and 1994. 3040 were alive for the five-year follow-up.

Setting: Data were collected from participants of the Melbourne Visual Impairment Project.

Main outcome measures: Dietary intake of vitamins A, B complex, C and E, and iron, calcium and zinc.

Statistical analysis: [chi square] analysis for categorical data and student's t-test for continuous data.

Results: Of the 3040 participants eligible to return for follow-up examinations, 2594 (85%) participated, 51 (2%) had moved interstate or overseas, 83 (3%) could not be located, and 312 (10%) refused to participate. The mean age of the participants examined at follow-up was 62.5 years (SD [+ or -] 10.9; range, 44-101) and 1421 (55%) were female. Nutrients for which more than half the population consumed less than the daily RDI included: vitamin A, vitamin B, calcium, magnesium, iron (women of child-bearing age only) and zinc. Intake of anti-oxidant supplements had very little influence on the percentage of participants who consumed less than the RDI. Ten per cent or fewer of the population had average daily intakes less than the RDI for the following nutrients: vitamin C, niacin, iron (all except younger females), and sodium. Sixty-nine per cent of the population had average daily fat intakes greater than the recommended limit of 30% of energy intake, while the mean saturated fat intake was greater than 12% for all ages.

Discussion: In conclusion, these population-based data have identified a number of nutrients for which the usual intake does not meet RDIs or national guidelines. Public health campaigns are warranted to increase the consumption of low fat foods high in calcium, iron, and anti-oxidants, and to decrease the daily intake of saturated fat.

(Nutr Diet 2092;59:12-17)

Key words: nutrient intake, adults, anti-oxidants

Introduction

Age- and gender-specific recommended dietary intakes (RDIs) have been produced and published by the National Health and Medical Research Council (1). They are set at levels that exceed the nutrient requirements for almost all healthy persons because they incorporate factors to accommodate variations in absorption and metabolism. The RDIs are updated periodically to reflect current scientific knowledge about nutrient intake and health and disease relationships. To assist people in food selection to meet the RDIs, and to promote health and prevent disease, the National Health and Medical Research Council has released dietary guidelines (2,3). Periocic surveys of dietary intake have been undertaken in Australia (4-8). Large differences in dietary intake by gender and ethnicity have been observed (9-12).

The purpose of this study was to quantify the dietary intake of Victorians aged 44 years and older and to compare their nutrient intake with RDIs.

Methods

The Melbourne Visual Impairment Project was a population-based epidemiologic study of eye disease (13). Random cluster sampling was employed to identify nine pairs of census collector districts within the Melbourne statistical division from which to recruit all permanent residents aged 40 years and older. A household census was employed to identify and recruit eligible residents. Eighty-three per cent of eligible residents (n = 3271) attended the baseline examinations, which were conducted from 1992 to 1994 (14). This cohort was shown to be representative of the Melbourne and Australian population aged 40 years and older (14). Five-year follow-up examinations of the surviving members of the cohort were conducted from 1997 to 1999. The protocol was approved by the Human Research and Ethics Committee of the Royal Victorian Eye and Ear Hospital.

At the initial household census, basic demographic information was collected from each participant including age, gender, country of birth, language spoken at home, education, and use of eye care services. At locally established test sites, participants underwent a standardised clinical eye examination and health interview that included questions on the use of medications and dietary anti-oxidant supplements. In relation to dietary antioxidant supplement use, people were asked to provide the name, frequency and duration of use for every supplement that they had ever taken on a regular basis (i.e. at least once per week for at least one month). Nutrient constituents of all products were obtained from supplement labels or from the manufacturers. The amount of the following anti-oxidants in each product was recorded: vitamin A, [beta]-carotene, vitamin C, vitamin E and zinc. Details about the use of dietary supplements other than these anti-oxidants was neither collected nor coded. Questions concerning the use of anti-oxidant supplements were repeated at the follow-up.

Modified home examinations were offered for homebound residents. Interpreters were offered for anyone who did not speak English as their first language. One field team member spoke Greek and one field team member spoke Italian.

At follow-up the participants were asked to complete a four-page, self-administered food frequency questionnaire that was developed by researchers at the Anti-Cancer Council of Victoria (15). These questionnaires were available in Greek and Italian as well as English. The completed questionnaires were checked to ensure that all questions were answered, and were then sent to the Anti-Cancer Council of Victoria for nutrient analysis. Daily intake of the following nutrients was quantified: total energy, protein, total carbohydrate, complex carbohydrate, simple carbohydrate, total fat, saturated fat, polyunsaturated fat, mono-unsaturated fat, cholesterol, alcohol, fibre, vitamin A, thiamin, riboflavin, vitamin C, vitamin F, niacin, folate, calcium, iron, potassium, magnesium, phosphorous, zinc and sodium. The percentage of energy from protein, fat, saturated fat, polyunsaturated fat and carbohydrate was calculated. Participants were also asked about their intake of supplemental anti-oxidants including vitamin A, vitamin C, vitamin E and zinc because antioxidants have been shown to be associated with a reduced risk of cataract (16) and age-related maculopathy (17). The percentage of participants with dietary intakes less than the RDI (1) were calculated. This percentage was recalculated with the addition of the supplementary intake.

Interview data were entered directly into a Paradox data entry program (Borland International, Scotts Valley, California) with in-built consistency checks. Demographic data were entered twice and verified. Data were analysed with the SAS statistical package (SAS Institute, Cary, North Carolina, SAS, version 6.10, 1999) Data were stratified by age and gender (44 to 64 years old and > 64 years old for males, and 44 to 54 years old and > 54 years old for females) to allow comparison with the RDIs. Analyses were also stratified by the major non-Australian-born ethnic groups represented in the cohort--Greek-born and Italian-born. Chi-squared analyses were used for categorical data and independent student's t-tests were used for continuous data. A P < 0.05 was considered statistically significant.

Results

Two hundred and thirty-one (7.1%) of the original 3271 participants died before the five-year follow-up examination. Of the remaining 3040 participants eligible to return for follow-up examinations, 2594 (85%) did participate, 51(2%) had moved interstate or overseas, 83 (3%) could not be located, and 312 (10%) refused to participate. Reasons for refusal were provided by 222 of the 312 refusals and included the following: not interested (33.8%), other or multiple answers (17.1%), too busy (12.2%), unhappy with drops from the previous examination (9.0%), illness (8.1%), personal (6.3%), apprehension (6.3%), disagree with the study (4.5%), and language (2.7%). The mean age of the participants examined at follow-up was 62.5 years (SD [+ or -] 10.9; range, 44-101) and 1421 (55%) were female.

The percentage of participants who reported taking any vitamin or mineral supplement was 20.3 (433/2133). Females were significantly more likely to report use of supplements (23.9% versus 16.2%, [chi square], ldf= 19.4, P <0.001). The percentage of participants who took various anti-oxidant supplements varied by age and gender (Figure 1). For all age groups, females were more likely to use supplements than males. Younger males and females were more likely to use anti-oxidant supplements, with the exception of vitamin A supplementation in females. Vitamin C was the most commonly used anti-oxidant, with 15.6% of the entire cohort reporting its use. The mean daily dietary intake of these four anti-oxidants was not significantly different between the users and non-users of the various anti-oxidants (data not shown).

The dietary intake of vitamins and minerals and percentage of participants with intakes less than the RDI are presented in Tables la and ib, stratified by age and gender. Nutrients for which more than half the population consumed less than the daily RDI included: vitamin A, vitamin E, calcium, magnesium, iron (women of childbearing age only) and zinc. Intake of anti-oxidant supplements did not change siguificantly the percentage of participants who consumed less than the RDI. Ten per cent or fewer of the population had average daily intakes less than the RDI for vitamin C, niacin, iron (all except younger females) and sodium.

The percentage of participants who consumed less then the RDI daily for various nutrients was evaluated separately for the two ethnic groups with sufficient numbers to allow relatively precise stratified analyses, i.e. Greek-born and Italian-born (Table 2). The nutrients that were consumed at an average level less than the RDI by 50% or more of the population were: vitamin A, riboflavin (younger Greek males), vitamin E, folate (older Italians), calcium, iron (Italian women of child-bearing age), potassium (older Italian men), magnesium, phosphorous (all Italian women and older Italian men), and zinc. Again, anti-oxidant supplement intake did not improve significantly the percentage of people consuming less than the RDI for those anti-oxidants.

The mean and range of daily intake of macronutrients in the population are summarised in Table 3. The mean percentage of energy derived from the various sources, as calculated in the lower section of Table 3, was nearly identical between the genders and age groups. The percentage of men with greater than 8% of their energy intake from saturated fats was 92.6%, compared with 87.3% for women ([chi square], ldf= 17.4, P < 0.001). Eight per cent of men and 9% of women had daily alcohol intakes that exceeded the guidelines from the National Health and Medical Research Council (i.e. no more than 40 g for men and no more than 20 g for women) (2).

Discussion

These data provide population-based information about the nutrient intake profile of a random sample of Melbourne residents aged 44 years and older. They indicate a number of nutrients for which a public health campaign is warranted to encourage increased intake to promote health and prevent disease. The only sub-group of the population that should be specifically targeted separately is women, due to their low iron intake relative to the RDI. These dietary data could provide baseline information to assess the impact of any public health campaigns implemented.

The strengths of this study include the cluster sampling and relatively high response rate that resulted in a study sample that has been shown to be representative of the Melbourne statistical division and Australia in general (14). The relatively large number of Italian-born and Greek-born participants allowed us to provide precise estimates of dietary intakes in these two subgroups of the population. The weakness of this study is that detailed information about nutrient supplement intake was only available for selected anti-oxidants, and not for all possible nutrients. Also, differential mortality by nutritional status could have affected the estimates of population dietary intakes in this follow-up study.

The National Health and Medical Research Council has specific guidelines related to calcium intake, 'Eat foods containing calcium' (2) for all Australians and specifically for older Australians, 'Include foods high in calcium' (3). As estimated from food consumption data from 1985 to 1991, calcium was consistently the least available nutrient in Australia (7). Data collected in elderly South Australians (5) in the 1980s and in a Victorian survey (4) in 1985 and 1990 revealed that more than half of the population had intakes of calcium less than the RDI. Data from the national food consumption survey (18) and the national nutrition survey (19) reveal that calcium has consistently been shown to be consumed at a level less than the RDI and that this figure has not changed significantly over time. Our data, collected from 1997 to 1999, confirmed that calcium continues to be a problem nutrient, with the majority of adults failing to meet the daily RDI. Similar to the previous Victorian survey (4), we found that more women than men have diets deficient in calcium and that the older age groups are more deficient in calcium intakes than the younger age groups. The percentage of women aged 54 years or older in our study who had daily calcium intakes less than the RDI (82%) was considerably higher than the percentage of women aged 60 years or older reported in the 1985 (75%) and 1990 (50%) Victorian nutrition surveys with deficient calcium intakes. The subgroup of our study population with the lowest intake of calcium in relation to the RDI was Italian women. These findings highlight the need to educate the public to increase their intake of low-fat foods high in calcium to decrease their risk of osteoporosis (2). This is especially important as the number of elderly persons is increasing (20) and bone density decreases with age (2), thus predisposing people to osteoporosis. In addition to dairy foods as a generally well known source of calcium, tinned salmon, sardines and shellfish are also good sources (21).

A nutrient of particular concern to women of childbearing age is iron. The National Health and Medical Research Council has a specific guideline for Australians that reads, 'Eat foods containing iron' (2). In our study, the majority of women aged 44 to 64 years did not consume the RDI for iron. Again, this was higher than was reported in the 1985 and 1990 Victorian Nutrition Surveys (4) and could indicate that dietary iron intake has decreased in the past decade, perhaps as people eat less meat in an attempt to decrease their total fat intake. Foods high in iron include red meats, silver beet and spinach (20).

The dietary intakes of anti-oxidant vitamin A, vitamin B and zinc were all identified in the current study to be deficient in the majority of adults. Similar to a study of Victorians conducted in 1985, we found no consistent relationship between the intake of these anti-oxidants and age (9). It has been suggested that low anti-oxidant intake may be related to cancer (9), cataract (16) and age-related macular degeneration (17). Low fat food sources of many of these anti-oxidants include apricots, mangoes, rock melon, cabbage, carrot, capsicum, pumpkin, spinach, sweet potato and silver beet (21). Nuts arid seeds are good sources of vitamin E in addition to oils.

For all of these deficient nutrients, the difference between the mean intake in the population and the RDI for that nutrient is the equivalent of one serving of food high in that particular vitamin or mineral. For example, a 100 g edible portion of raw spinach contains 53 mg of calcium, 390 [micro]g of retinol (vitamin A) equivalents, 68 mg of magnesium, and 3.2 mg of iron (21). This one food could supply sufficient amounts of nearly all of the nutrients that are deficient in the diets of Victorians. The addition of oil and vinegar dressing would supply the necessary vitamin E to meet all of the deficient needs.

The National Health and Medical Research Council advises that Australians should 'Eat a diet low in fat and, in particular, low in saturated fat' (2) and that older Australians should 'Eat a diet low in saturated fat' (3) because of epidemiologic evidence linking high fat intake with cancer and heart disease. The National Heart Foundation recommends that trans fatty acids and saturated fatty acids together should contribute no more than 8% of total energy intake (22). In the current study, the mean intake of saturated fatty acids was 12%, well above recommendations, and the vast majority of the population had intakes exceeding recommendations. However, the data do support a trend towards a decrease in percentage of total energy from saturated fat as was observed between the 1985 and 1990 Victorian nutrition surveys for both genders and all ages (6). For both males and females, the calculated saturated fat intake was about 1% less in the current study than was calculated in 1990, which was approximately 1% le ss than was calculated in 1985. The Victorian data mirror the overall national trends for fat consumption that have been documented in the national food consumption survey (18) and the national nutrition survey (19). It appears that public health programs to decrease fat intake are resulting in positive dietary changes and should continue to be supported.

The National Health and Medical Research Council recommends to Australians that, 'If you drink alcohol, limit your intake' because excess alcohol intake is associated with increased morbidity and mortality (2,3). Slightly less than 10% of the population had average daily alcohol intakes that exceed recommendations (no more than 40 g or approximately four standard drinks per day for men and no more than 20 g or approximately two standard drinks per day for women).

In conclusion, these population-based data for older Australians have identified a number of nutrients for which the usual intake does not meet RDIs or national guidelines. Public health campaigns are warranted to increase the consumption of low fat foods that are high in calcium, iron, and anti-oxidants, and to decrease the daily intake of saturated fat. Public health messages to encourage increased intake of fresh green leafy vegetables, low fat meat and low fat dairy products would assist the community in meeting the RDIs and guidelines that are currently not met. Improved nutritional intake could decrease nutrition-related morbidity and mortality.

Figure 1. Percentage of participants who took anti-oxidant supplements
by age and gender

                Vitamin A  Vitamin C    Vitamin E     Zinc

Males 44-64        7.9        5.7          9.7        10.6
Males >64         15.6        9.5         20.9        16.4
Females 44-54     12.5        6.5         19.1        15.6
Females >54        7.6        4.2         11.5         9.2

Note: Table made from bar graph
Table 1a. Mean, median and range of average daily intake of vitamins by
age and gender

                                           Males

                      Age                    5th-95th             <RDI
Vitamin               (years)  Mean  Median  percentile  RDI (1)  (%)

Vitamin A ([micro]g)  44-64    728   689     312-223     750      58
(diet alone)          >64      729   721     279-268     750      54
Vitamin A ([micro]g)  44-64    728   689     312-223     750      58
(incl supplement)     >64      729   721     279-268     750      54
Vitamin E (mg)        44-64    6.45  6.1     3.1-0.7     10       92
(diet alone)          >64      6     5.7     2.6-0.5     10       93
Vitamin E (mg)        44-64    29    6.6     3.2-105     10       82
(incl supplement)     >64      15    5.8     2.6-16.1    10       88
Vitamin C (mg)        44-64    120   109     48-227      40       1.8
(diet alone)          >64      124   111     41-274      40       4.3
Vitamin C (mg)        44-64    192   117     49-678      40       1.6
(incl supplement)     >64      163   116     41-554      40       4.1
Thiamin (mg)          44-64    1.6   1.5     0.7-2.8     1.1      22
                      >64      1.54  1.4     0.6-2.8     0.9      13
Riboflavin (mg)       44-64    2.18  2       0.9-4.1     1.7      36
                      >64      2.06  1.9     0.8-3.9     1.3      20
Niacin (mg            44-64    38.6  36      18-71       19       5
equivalent)           >64      35.1  33      17-65       16       3
Folate ([micro]g)     44-64    275   254     136-470     200      24
                      >64      274   260     120-485     200      26

                                         Females

                      Age                    5th-95th             <RDI
Vitamin               (years)  Mean  Median  percentile  RDI (1)  (%)

Vitamin A ([micro]g)  44-54    638   613     259-1092    750      70
(diet alone)          >54      663   632     287-111     750      66
Vitamin A ([micro]g)  44-54    638   613     259-1092    750      70
(incl supplement)     >54      664   632     287-1111    750      66
Vitamin E (mg)        44-54    5.46  5.2     2.8-9.0     7        80
(diet alone)          >54      5.45  5.2     2.5-9.0     7        81
Vitamin E (mg)        44-54    28.1  5.6     2.8-102     7        67
(incl supplement)     >54      29.4  5.6     2.6-126     7        70
Vitamin C (mg)        44-54    116   103     44-227      30       0.54
(diet alone)          >54      116   104     44-234      30       1.22
Vitamin C (mg)        44-54    208   119     48-751      30       0.54
(incl supplement)     >54      192   116     44-650      30       1
Thiamin (mg)          44-54    1.37  1.3     0.6-2.5     0.8      9.8
                      >54      1.38  1.3     0.6-2.4     0.7      5.2
Riboflavin (mg)       44-54    1.98  1.9     0.8-3.7     1.2      17
                      >54      2     1.9     0.8-3.5     1        17
Niacin (mg            44-54    32.6  29      16-59       13       1.9
equivalent)           >54      31.1  29      15-53       11       0.89
Folate ([micro]g)     44-54    242   225     116-428     200      37
                      >54      245   228     119-416     200      37
Table 1b. Mean, median and range of average daily intake of minerals by
age and gender

                                        Males

                   Age                    5th-95th               <RDI
Mineral            (years)  Mean  Median  percentile  RDI (1)    (%)

Calcium (mg)       44-64    767   718     334-1355    800        60
                   >64      729   694     353-1266    800        65
Phosphorus (mg)    44-64    1432  1350    758-2419    1000       19
                   >64      1307  1234    703-2202    1000       27
Magnesium (mg)     44-64    302   285     158-505     320        64
                   >64      290   277     150-494     320        68
Iron (mg)          44-64    13.3  12.2    6.4-24.2    7          7.3
                   >64      12.6  11.6    5.5-23.7    7          10.7
Zinc (mg)          44-64    11.4  10.6    5.7-19.5    12         64
(diet alone)       >64      10.2  9.3     4.7-18.1    12         74
Zinc (mg)          44-64    12    10.8    5.8-23.2    12         62
(incl supplement)  >64      10.4  9.4     4.7-18.7    12         72
Potassium (mg)     44-64    2840  2705    1566-4378   1950-5460  14.2
                   >64      2768  2689    1544-4367   1950-5460  18.5
Sodium (mg)        44-64    2556  2396    1255-4404   920-2300   0.98
                   >64      2295  2187    1125-3882   920-2300   2.51

                                       Females

                   Age                    5th-95th               <RDI
Mineral            (years)  Mean  Median  percentile  RDI (1)    (%)

Calcium (mg)       44-54    731   689     311-1234    800        62
                   >54      748   732     317-1272    1000       82
Phosphorus (mg)    44-54    1268  1186    669-2270    1000       31
                   >54      1235  1168    622-1991    1000       33
Magnesium (mg)     44-54    264   253     146-440     270        58
                   >54      264   249     136-426     270        60
Iron (mg)          44-54    11.3  10.4    5.6-20.0    12-16      65
                   >54      11    10.1    5.3-19.7    5-7        3.5
Zinc (mg)          44-54    9.47  8.5     4.7-16.6    12         81
(diet alone)       >54      9.09  8.5     4.5-15.7    12         85
Zinc (mg)          44-54    10.1  8.9     4.7-19.0    12         76
(incl supplement)  >54      9.8   8.7     4.5-18.0    12         81
Potassium (mg)     44-54    2566  2436    1550-4075   1950-5460  23
                   >54      2595  2500    1435-3936   1950-5460  21
Sodium (mg)        44-54    2024  1924    1051-3368   920-2300   3.8
                   >54      1967  1818    979-3334    920-2300   3.5
Table 2. Percentage of Greek-born and Italian-born participants who had
dietary intakes less than the recommended dietary intake (1), by age and
gender

                                                Males (a)
                                  Age group
Vitamins and minerals             (years)    Greek-born  Italian-born

Vitamin A (diet alone)            44-64      63          73
                                  >64        54          69
Vitamin A (including supplement)  44-64      63          73
                                  >64        54          69
Thiamin                           44-64      18          24
                                  >64        8           27
Riboflavin                        44-64      57          49
                                  >64        13          49
Vitamin C (diet alone)            44-64      4           7
                                  >64        4           12
Vitamin C (including supplement)  44-64      4           7
                                  >64        4           12
Vitamin E (diet alone)            44-64      90          93
                                  >64        96          94
Vitamin E (including supplement)  44-64      86          89
                                  >64        96          94
Niacin (mg equivalents)           44-64      6           13
                                  >64        4           6
Folate                            44-64      27          38
                                  >64        21          57
Calcium                           44-64      69          73
                                  >64        71          78
Iron                              44-64      8           15
                                  >64        4           25
Potassium                         44-64      16          22
                                  >64        4           53
Magnesium                         44-64      71          76
                                  >64        75          84
Phosphorus                        44-64      20          27
                                  >64        17          59
Zinc (diet alone)                 44-64      57          66
                                  >64        58          82
Zinc (including supplement)       44-64      57          66
                                  >64        58          80
Sodium                            44-64      0           2
                                  >64        0           2

                                               Females (b)
                                  Age group
Vitamins and minerals             (years)    Greek-born  Italian-born

Vitamin A (diet alone)            44-54      71          68
                                  >54        72          72
Vitamin A (including supplement)  44-54      71          68
                                  >54        72          72
Thiamin                           44-54      5           12
                                  >54        11          11
Riboflavin                        44-54      14          40
                                  >54        20          44
Vitamin C (diet alone)            44-54      0           4
                                  >54        0           0
Vitamin C (including supplement)  44-54      0           4
                                  >54        0           0
Vitamin E (diet alone)            44-54      76          88
                                  >54        75          85
Vitamin E (including supplement)  44-54      71          88
                                  >54        72          80
Niacin (mg equivalents)           44-54      0           4
                                  >54        0           1
Folate                            44-54      24          48
                                  >54        43          59
Calcium                           44-54      76          84
                                  >54        88          88
Iron                              44-54      48          68
                                  >54        9           12
Potassium                         44-54      24          44
                                  >54        25          45
Magnesium                         44-54      52          64
                                  >54        65          76
Phosphorus                        44-54      29          52
                                  >54        39          53
Zinc (diet alone)                 44-54      67          80
                                  >54        82          87
Zinc (including supplement)       44-54      67          80
                                  >54        82          85
Sodium                            44-54      5           12
                                  >54        9           5

(a) Number of men in each group: 49 Greek men aged 44 to 64 years old,
24 Greek men aged>64 years old, 55 Italian men aged 44 to 64 years old,
49 Italian men aged >64 years old.

(b) Number of women in each group: 21 Greek women aged 44 to 54 years
old, 65 Greek women aged >54 years old, 25 Italian women aged 44 to 54
years old, 75 Italian women aged >54 years old.
Table 3. Mean average daily intake of macronutrients by age and gender

                                               Males

                             44-64 years, n = 615   >64 years, n = 439

                                       5th-95th               5th-95th
Macronutrient                Mean      percentile  Mean       percentile

Energy (keal)                1912      1017-3180   1747       882-2820
Protein (g)                  87        45-149      77         40-135
Carbohydrate (g)             203       106-339     194        103-226
Complex carbohydrate(g)      126       60-218      115        51-194
Simple carbohydrate (g)      76        32-134      77         32-139
Total fat (g)                72        30-126      65         24-118
Saturated fatty acids (g)    28        11-53       25         9-48
Polyunsaturated fatty        13        4-24        12         3-23
acids (g)
Mono-unsaturated fatty       25        10-46       22         8-42
acids (g)
Cholesterol (g)              199       79-385      174        63-337
Alcohol (g)                  16        0-52        12         0-47
Fibre (g)                    24        12-39       23         11-40

Percentage of energy as

Protein                       18.2      13.6-24.2   17.7       13.3-23.6
Fat                           33.3      21.6-43.1   32.8       21.4-42.5
Saturated fatty acids         12.7       7.4-18.7   12.8        7.3-19.8
Polyunsaturated fatty acids    5.9       2.8-9.9     5.9        2.6-10.6
Total carbohydrate            43.1      32.3-54.2   44.8       33.6-56.9
Sugars                        16.4       8.1-26.4   18          8.8-29.2
Starches                      26.4      18.5-34.5   26.5       18.7-35.8

                                              Females

                             44-54 years, n = 367  >54 years, n = 903

                                       5th-95th               5th-95th
Macronutrient                Mean      percentile  Mean       percentile

Energy (keal)                1522      859-2519    1485       804-2346
Protein (g)                  74        37-135      70         36-123
Carbohydrate (g)             172       96-264      171        90-267
Complex carbohydrate(g)      100       49-168      95         45-160
Simple carbohydrate (g)      70        33-114      74         33-119
Total fat (g)                55        22-102      54         22-94
Saturated fatty acids (g)    21        8-45        21         7-41
Polyunsaturated fatty        10        3-19        10         3-20
acids (g)
Mono-unsaturated fatty       19        7-35        18         7-33
acids (g)
Cholesterol (g)              161       62-330      151        56-298
Alcohol (g)                  7         0-29        6          0-24
Fibre (g)                    21        12-37       22         11-35

Percentage of energy as

Protein                       19.2      13.6-25.6   18.8       13.8-25.2
Fat                           31.7      19.7-42.0   32.3       19.7-42.2
Saturated fatty acids         11.9       6.8-18.2   12.3        6.8-19.0
Polyunsaturated fatty acids    5.6       2.6-10.0    5.9        2.5-10.4
Total carbohydrate            45.9      34.7-58.4   46.5       34.8-58.7
Sugars                        19.1      10.5-30.9   20.5       11.1-31.3
Starches                      26.4      17.8-36.8   25.7       17.4-35.2

References

(1.) National Health and Medical Research Council. Recommended dietary intakes for use in Australia. Canberra: Australian Government Publishing Service; 1990.

(2.) National Health and Medical Research Council. Dietary guidelines for Australians. Canberra: Australian Government Publishing Service; 1992.

(3.) National Health and Medical Research Council. Dietary guidelines for older Australians. Canberra: Australian Government Publishing Service; 1999.

(4.) Baghurst K, Crawford D, Record S, Worsley A, Baghurst P, Syrette J. The Victorian nutrition survey. Part 2. Nutrient intakes by age, sex, area of residence and occupational status. Adelaide: CSIRO Division of Human Nutrition; 1987.

(5.) Baghurst KI, Record SJ. The vitamin and mineral intake of a free-living young elderly Australian population in relation to total diet and supplementation practices. Hum Nutr Appl Nutr 1987;41A:327-37.

(6.) CSIRO Division of Human Nutrition. What are Australians eating? Results from the 1985 and 1990 Victorian nutrition surveys. Adelaide: CSIRO Division of Human Nutrition; 1993.

(7.) Australian Bureau of Statistics. Apparent consumption of foodstuffs and nutrients. Australia 1990-91. ABS catalogue No. 4306.0. Canberra: Commonwealth of Australia; 1993.

(8.) Lester IH. Australia's food & nutrition. Canberra: Australian Government Publishing Service; 1994.

(9.) Baghurst KI, Record SJ, Baghurst PA, Syrette JA, Crawford D, Worsley A. Sociodemographic determinants in Australia of the intake of food and nutrients implicated in cancer aetiology. Med J Aust 1990;153:444-52.

(10.) Guest CS, O'Dea K. Food habits in Aborigines and persons of European descent in southeastern Australia. Aust J Public Health 1993;17:321-4.

(11.) Hsu-Hage BHH, Ibiebele T, Wahlqvist ML. Food intakes of adult Melbourne Chinese. Aust J Public Health 1995;19:623-8.

(12.) Kouris-Blazos A, Wahlqvist ML, Trichopoulou A, Polychronopoulos E, Trichopoulos D. Health and nutritional status of elderly Greek migrants to Melbourne, Australia. Age Ageing 1996;25:177-89.

(13.) Livingston PM, Carson CA, Stanislavsky YL, Lee SE, Guest CS, Taylor HR. Methods for a population-based study of eye disease: the Melbourne visual impairment project. Ophthalmic Epidemiol 1994;l:139-48.

(14.) Livingston PM, Lee SE, McCarty CA, Taylor HR. A comparison of participants with non-participants in a population-based epidemiologic study: the Melbourne visual impairment project. Ophthalmic Epidemiol 1997;4:73-81.

(15.) Hodge A, Patterson AJ, Brown WJ, Ireland P, Giles G. The Anti Cancer Council of Victoria FFQ: relative validity of nutrient intakes compared with weighed food records in young to middle-aged women in a study of iron supplementation. Aust N Z J Public Health 2000;24:576-83.

(16.) Taylor A, Jacques PF, Epstein EM. Relations among aging, antioxidant status, and cataract. Am J Clin Nutr 1995;62 Suppl: 1439S-1447S.

(17.) Snodderly DM. Evidence for protection against age-related macular degeneration by carotenoids and antioxidant vitamins. Am J Clin Nutr 1995;62 Suppl:14485-1461S.

(18.) Apparent consumption of foodstuffs and nutrients, Australia 1990-91. ABS Catalogue No. 4306.0. Canberra: Australian Bureau of Statistics; 1993.

(19.) National nutrition survey: selected highlights, Australia. ABS Catalogue No. 4802.0. Canberra: Australian Bureau of Statistics; 1995.

(20.) Population Projections 1991 to 2051. ABS catalogue No. 3222.0. Canberra: Australian Bureau of Statistics; 1998.

(21.) English R, Lewis J. Nutritional values of Australian Foods. Canberra: Australian Government Publishing Service;1991.

(22.) National Heart Foundation of Australia. A review of the relationship between dietary fat and cardiovascular disease. Aust J Nutr Diet 1999;56(4 Suppl):S5-522.

The Melbourne Visual Impairment Project was funded in parts by grants from the National Health and Medical Research Council, the Victorian Health Promotion Foundation, the Ansell Ophthalmology Foundation, the estate of the late Dorothy Edols, the Jack Brookhoff Foundation, the Eye Ear Nose and Throat Research Institute, the Appel Family Bequest and the Hugh Williamson Foundation. Dr McCarty was the recipient of the Wagstaff Fellowship in Ophthalmology from the Royal Victorian Eye and Ear Hospital.

Centre for Eye Research Australia, University of Melbourne 

C.A. McCarty, PhD, MPH, RD, formerly, Associate Professor (currently Senior Research Scientist, Marshfield Medical Research and Education Foundation, Marshfield, WI, USA)

M.B. Nanjan, PhD, Research Fellow

H.R. Taylor, MD, FRACO, Ringland Anderson Professor

Correspondence: C. McCarty, Marshfield Medical Research and Education Foundation, Marshfield Clinic, 1000 N. Oak Avenue (ML2), Marshfield, WI 54449, USA. Email: [e-mail]