The aims of the National Diet and Nutrition Survey series are summarized, and the new National Diet and Nutrition Survey of people aged 65 years and over is explored, with particular emphasis on micronutrient intakes and status indices. Mean nutrient intakes were generally satisfactory for most micronutrients, but intakes of vitamin D, Mg, K and Cu were low. Intakes of vitamin D were far below the reference nutrient intake for people aged 65 years and over, and there was also biochemical evidence of vitamin D deficiency, for 8 % of free-living and 37 % of institution participants, attributed partly to limited exposure to sunlight. A substantial proportion of people living in institutions had inadequate biochemical status indices, notably for vitamin C, Fe and folate. Relationships between intake and status were close for vitamins. Mineral intakes did not correlate well with currently used status indices. Some intakes and indices, especially those of vitamin C, carotenoids, Na and K, were strongly correlated with socio-economic status and with north-south gradients in Britain. Future research challenges should address the functional and health significance of low intakes and sub-optimal biochemical indices for certain micronutrients, especially for people living in institutions; the shortcomings of mineral status indices especially as indicators of mineral intake; the social and geographical inequalities of micronutrient intakes and status, and why micronutrient status deteriorates with increasing age. The answers to these questions will help to define the characteristics of nutritional risk for older people in Britain, and to clarify future needs for education and intervention. Micronutrients: National Diet and Nutrition Survey: ElderlyThe purpose of the present paper is to draw attention to the British Government's National Diet and Nutrition Survey of people aged 65 years and over, and the reports derived from it Steele et al. 1998). It also considers some of the problems of interpretation and research challenges of this large dataset in order to encourage other researchers to continue this investigation. The primary data from the survey will be lodged with the

Results: Vitamin D status is highly dependent on season: moreover, the relation between vitamin D intake and status is also seasonally dependent, being strong in the winter and negligible in the summer. During the winter, those children who had relatively low 25OH-D concentrations generally were those not receiving vitamin D supplements. Vitamin D intakes and supplement use were lower in the north than in the south of Britain. Conclusions: For British preschool children, dietary vitamin D is of much greater importance in the winter than in the summer. There is evidence of regional inequality, with lesser use of supplements in the north. Supplements are needed in the winter, to achieve satisfactory vitamin D status and minimise the risk of rickets and of poor bone health, especially in high-risk groups.

Objective: To compare the evidence derived from blood biochemical status indices with the evidence from a questionnaire and from a 4-day weighed dietary record of micronutrient supplement use in the British National Diet and Nutrition Survey (NDNS) of People Aged 65 Years and Over; to resolve some apparent incompatibility between nutrient intake and status estimates, and to recommend an approach towards supplement recording that should improve accuracy. Design: The survey procedures described in the National Diet and Nutrition Survey Report (1998) included a health-and-lifestyle questionnaire, a 4-day weighed diet record, and fasting blood and urine sample for biochemical indices, including a wide range of micronutrients. Setting: Eighty randomly selected postcode sectors from mainland Britain during 1994±1995. Subjects: Of 2060 people interviewed, 1467 provided a blood sample and 1217 provided both a blood sample, and a complete 4-day diet record. About 20% were living in institutions such as nursing homes, and the remainder were living in private households. Results: After assigning the subjects to four categories by the use of dietary supplements (A, those not taking supplements (by questionnaire or by the 4-day record); B, those taking supplements (excluding prescribed ones) by questionnaire only; C, those taking supplements by 4-day record only; and D, those taking supplements by both questionnaire and 4-day record), these categories were then compared with respect to estimated total nutrient intakes and blood biochemical indices. Those in category B had estimated (4-day) nutrient intakes (from foods and supplements) that were indistinguishable from those in category A, but had biochemical indices that indicated signi®cantly higher dietary intakes of several vitamins. Conclusions and recommendation: The 4-day weighed intake record may not have identi®ed all of the subjects who were regularly taking micronutrient supplements in amounts suf®cient to improve their biochemical status. Because survey respondents may use supplements irregularly or change their usual patterns of supplement use during a period of intensive diet-recording, it is important to design a dietary instrument that will minimise this potential source of inaccuracy. We therefore recommend that population surveys in which an accurate estimate of micronutrient intakes is required, from supplements as well as from food, should record supplement use for a period longer than 4-days. It is likely that a better estimate of long-term intakes can be achieved by combining a 4-day weighed diet record with a structured recall or several weeks of diary records, which focus speci®cally on the use of supplements.

SUMMARY The water-soluble (BI, B2, B6, C, folic acid) and fat-soluble vitamin (A, carotene, E, and D) status of 36 patients with cystic fibrosis was assessed and compared with a control group of 21 age-matched normal children. Twenty-seven of the patients were receiving vitamin supplements (except folic acid and vitamin E) at the time of investigation. Vitamin BI, B2, and B6 status was adequate in all patients, and there was little evidence of folic acid deficiency. Vitamin C stores might not have been adequate in some of these patients, despite daily supplements with 50 mg of the vitamin. Steatorrhoea, often severe, was present in most of them. Serum carotene and vitamin E concentrations were low in over 90 % of patients and were related to the severity of steatorrhoea. Vitamin A was low in over 40% of the patients despite daily vitamin supplements of 4000 IU and correlated with the serum retinol-binding protein level. Serum 25-OH cholecalciferol was low in some patients whether or not they were receiving a daily supplement of 400 IU vitamin D. In a short-term supplementation trial with water-miscible preparations of vitamins A and E in 14 patients, the serum levels of both vitamins responded well to 2 weeks of treatment with 50 mg vitamin E and 4000 IU vitamin A. Except for serum vitamin A, which was lowest in patients with the poorest clinical grading, the other vitamins were not influenced by the clinical grade of the patients.

Commissioned by the Ministry of Agriculture, Fisheries and Food, the Department of Health and carried out by Social and Community Planning Research and MRC Dunn Nutrition Unit, the dental hospitals of the Universities of Newcastle and Birmingham and the Department of Epidemiology of the University of London, this research forms part of the National Diet and Nutrition Survey. Set up in 1992 the surveys cover representative groups of the population and examine the diet of the over-65s in terms of actual dietary intake, habits, energy and nutrient intakes, physical measurements. Regional and socioeconomic comparisons are made.