The main aim of DNFCS 2019-2021 was to gain insights into the diet of children and adults aged 1-79 living in the Netherlands and to establish:
•    The consumption of food groups;
•    The use of dietary supplements;
•    The percentage of adults that met the 2015 Dutch food-based dietary guidelines;
•    The intake of energy and nutrients from food and drink and the percentage of children and adults that met the recommendations on energy and nutrients;
•    The total intake of nutrients from food, drink and dietary supplements and the percentage of children and adults that met the recommendations;
•    The place and moment of consumption of food and drink, and intake of energy and nutrients;
•    The diet by subgroups of the population, for example subgroups based on socio-demographic factors;
•    The changes in food consumption in the last decade.

In addition, the DNFCS 2019-2021 had to be available for food safety dietary exposure assessment, dietary environmental impact estimation, for public health programmes, and for scientific nutrition research.  

The target population comprised all men and women living in the Netherlands in the age of 1 to 79 years old regardless of nationality, with the exception of pregnant and lactating women, people who were institutionalised and those without adequate command of the Dutch language. The study population was designed to adequately represent the Dutch population as a whole. 

General information and food consumption data was collected from 3,570 people. The survey population was divided into age groups as follows: boys and girls aged 1-3 years, 4-11 years, 12-17 years, and men and women aged 18-50 years, 51-64 years, 65-79 years.  These age groups were in line with those used by the Health Council of the Netherlands for dietary recommendations.

Participants were drawn from a representative consumer panel of the market research agency Kantar (previously known as TNS NIPO). These persons participate in all types of studies and are not selected on the basis of dietary characteristics. 

The study population was monitored on the following characteristics: age and sex, region, degree of urbanisation and education (for children, by the educational level of their parents/carers).

Recruitment

The market research agency Kantar invited selected persons by post to participate in the study, by means of an invitation letter, an information leaflet  (in Dutch) and a reply card. There was a specific brochures for parents of invited children (1-15 years) and adolescents (12-20 years old). Participants could give their response either by post by sending back the reply card or by filling out an online answer through a link to the Kantar website.  

General questionnaire

Those who agreed to participate were sent a general questionnaire, whenever possible a digital version. Specific questionnaires  were sent to each of the age groups 1 to 3 year olds, 4 to 11 year olds, 12 to 18 year olds, 19-70 year olds and 71 to 79 year olds (in Dutch) . Contact with children ages 1 to 15 years old, was made initially through their parents or carers. The questions covered various background and life style factors such as patterns of physical activity, educational level, family situation, smoking habits, alcohol consumption and frequency of consumption of specific foods and dietary supplements.

Dietary recall

Two non-consecutive 24-hour dietary recalls, with an interval of about 4 weeks, were conducted per participant by a trained interviewer. Overall, all days of the week were equally represented in the recalls. The realization depended on the age of the respondent:  

 Children 1 to 8 years old were visited at home for the first interview. During this home visit, the the parent/carer of the child was interviewed on what the child had been eating and drinking, and height and weight of the child were measured by the interviewer. The second interview was conducted by telephone. For both interviews an appointment is made. The parent/carer of the child kept a food diary the day prior to both interviews.
Children 9 to 15 years old were visited at home for both interviews. For both home visits appointments were made. In presence of the parent/caretaker the child was interviewed on what he of she had been eating and drinking. During the first home visit also height and weight of the child were measured by the interviewer.
Adults 16 to 70 years old were interviewed about their food consumption by telephone, twice on a for the respondent unknown day. Height and weight measures were self-reported, during the first interview.
Adults 70 years and old were visited at home for the first interview. During this interview the interviewer asked what the participant had been eating and drinking; weight, arm and waist circumference were  measured by the interviewer. If possible, the second interview took place by telephone. For both interviews, an appointment was made and the participants keep a diary the day prior to both interviews.
 
Computer controlled
The interviewers used the computer directed interview programme for 24-hour recalls, GloboDiet (previously known as EPIC-Soft ©IARC). With GloboDiet the interviews were standardized and facilitated to enter the answers directly in the computer.

The Dutch eat more vegetable products such as fruit and vegetables, unsalted nuts and legumes and less red and processed meat. They also drink fewer sugary drinks.

These improvements can be seen in both children and adults. It should be noted, however, that most Dutch people do not yet follow the Dutch dietary guidelines 2015. In these, the Health Council of the Netherlands lists which foods and patterns can ensure better health. These include the advice to eat enough fruit and vegetables and whole grain products such as bread.

DNFCS 2019 - 2021 shows that Dutch people (aged 7 to 69) eat more vegetables per day. Whereas the number of grams in DNFCS over 2007 - 2010 stood at 128 grams per day, and in 2012 - 2016 at 135 grams, the number of grams of vegetables is now163 grams. This doubles the percentage of adults meeting the vegetable guideline to 29%. In the previous DNFCS it was 12%. Fruit consumption per day also continues to rise: from 103 to 117 and now 129 grams per day.

At the same time, the Dutch ate considerably less red and processed meat: more than 20% less compared to the 2007-2010 survey. There was also a decrease in the amount of drinks with sugar consumed (such as soft drinks or fruit juices). For instance, the number of grams per day dropped from 382 in 2012 - 2016 to 240 grams now. The Dutch drank more tea and water.  

In addition,  the sugar and salt intakes of the Dutch population have gone down, while its fibre intake has gone up.  Although these are positive developments, people’s intakes of some other nutrients continue to be too high or too low.

These  figures correspond to the outcomes  on food products. In addition to changing eating and drinking patterns, changes in the composition of products may have affected the outcomes as well. For example, the National Approach to Product Improvement (Nationale Aanpak Productverbetering, NAPV) has led to less salt being added. The survey also showed a decrease in alcohol consumption, particularly among men. This corresponds to the decrease shown by the Health Survey.

For people in all age categories, the intake of vitamin D has increased compared to the previous survey (2012–2016). However, vitamin D intake is still too low for elderly people aged 70–79. Furthermore, some population groups have low intakes of particular types of vitamins and minerals, including the vitamins A, B2, B6, C and folate and the minerals calcium, iron and potassium. However, this is not necessarily a cause for immediate concern. Follow-up studies, such as nutritional status studies, are recommended to find out more about this. The same is true for the high intakes of some other vitamins and/or minerals.

Food consumption

• Dutch people consume an average of 3.1 kg of food and drinks per day. Two-thirds of these are drinks. The amount varies by age group: toddlers eat and drink about 1.6 kg per day and men aged 18-50 eat and drink the most on average at 3.7 kg per day.
• Non alcoholic beverages, Cereals and cereal products, Dairy products and substitutes, and Fats and oils are eaten or drunk almost daily.
• Diet composition differs between age groups. Children eat or drink relatively more dairy and dairy substitutes and drink less than adults.
• Almost 85% of all food and drink is consumed at home. Cakes and sweet biscuits, Fruit, nuts, seeds and olives, Stocks and Non alcoholic beverages are consumed relatively more outside the home. Fish and seafood and Alcoholic drinks are relatively more often consumed in restaurants.
• Children eat and drink at 7 times a day on average, adults at 10 times.

Dietary guidelines

• The extent to which guidelines are followed by Dutch adults varies from 10-50% between product groups.
• The best followed guidelines are those for wholemeal products and alcohol. About half of adults eat at least 90 grams of brown bread, wholemeal bread or other wholemeal products daily or drink no more than 1 glass of alcohol per day. About 30% of adults meet the guideline of eating at least 200 grams of vegetables daily and eating fish once a week.
• The guidelines least followed are those for unsalted nuts, fruit and tea. 10% of adults ate 15 grams of unsalted nuts and seeds per day. About 20% follow the guideline of drinking at least 3 cups of tea a day and about 20% eat at least 200 grams of fruit daily. The advice to take vitamin D supplements is followed by over a third of women over 50 and a quarter of men over 70.
• The proportion of vegetable protein of total protein is 43%. The long-term aim is for this to reach 60%.
• Children drink more glasses of drinks with sugar (about 2 glasses/day) than adults (almost 1 glass/day). It is recommended to drink as little drinks with sugar as possible.
• Consumption of vegetables, fruit and red and/or processed meat is healthier among the higher educated.

Changes 

• Intake became healthier for many components of the dietary guidelines from 2007-2010 to 2019-2021. 
• Consumption of unsalted nuts, fruits, vegetables, and tea increased more than 20%. An increase is recommended for these food groups.
• For red and processed meat and sugary drinks, consumption decreased by more than 20%. This is also in line with the recommendation of the Dutch dietary guidelines.
• Consumption of dairy products decreased with 10% since 2007-2010, while in 2015 the Health Council recommended to keep the intake at the same level. In recent years (since 2012-2016), however, intake has remained the same.
• There are some potentially unfavourable changes. Fewer people eat fish once a week and the use of dietary supplements has increased.

Macronutriënts

• The intake of carbohydrates, proteins, unsaturated fatty acids, trans fatty acids and linoleic acid in the Netherlands meets the recommendations.
• The amount of saturated fats, the total amount of fat (both as a share of energy intake) and alcohol is high for part of the population.
• Dietary fiber intake is low.
• We also see more people with a high fat intake (as a share of energy intake).
• There are a number of beneficial changes: The intake of sugars (mono- and disaccharides) has decreased. We also see that alcohol intake has decreased (particularly among men) and that dietary fiber intake has increased in recent years.
• Higher fiber consumption, fewer sugars and a favorable fatty acid pattern can be important to prevent obesity and chronic diseases.

Vitamines

• The intake of vitamins B1, B3, B12 and K1 is sufficient in adults.
• For children, this applies to vitamin B3, B12 and K1. Folate intake is also sufficient for men. •
• Vitamin D intake is low in seniors aged 70-79 years. Also, not all of them follow the supplementation advice for vitamin D. Following this advice more closely, together with sufficient calcium, can reduce the risk of bone fractures. Vitamin D intake has increased in recent years.
• Low intakes are observed in part of the population for a number of vitamins (vitamins A, B2, B6, C and folate). There are no concrete indications that these low intakes are a concern from a public health perspective. For a number of these nutrients (vitamins B2, B6 and C) we see more people with a low intake than before. Follow-up research into nutritional status (for example certain blood values) or the prevalence of clinical symptoms is desirable.
• For many vitamins, no statement can be made about compliance with the standard for different age/gender groups, because there is insufficient knowledge about the needs of these nutrients. This is more often the case with teenagers.
• A high intake of retinol is seen in part of the population. With a high intake, a health risk cannot be ruled out. However, there are no concrete indications that the situation is worrying for public health. Follow-up research into the possible high intakes is desirable.

Minerals

• The intake of iodine, copper, magnesium and zinc appears to be sufficient in adults. For children, the intake of copper and iodine seems sufficient.
• Low intakes are seen in part of the population for a number of minerals (calcium, iron and potassium). There are no concrete indications that these low intakes are a concern from a public health perspective. Follow-up research into nutritional status (for example certain blood values) or the prevalence of clinical symptoms is desirable.
• For a number of minerals (calcium, iron, magnesium, potassium and zinc), no statement can be made about compliance with the standard for different age/gender groups, because there is insufficient knowledge about the needs of these nutrients. This is more often the case with teenagers. • Sodium intake is high throughout the population. High sodium intake is associated with high blood pressure. However, there may be a favorable change: the intake of sodium from foods and salt added at the table and/or during preparation appears to have decreased.
• High intakes are observed in part of the population for a number of minerals (zinc, iodine, copper, magnesium). With a high intake, a health risk cannot be ruled out. However, there are no concrete indications of a worrying situation for public health. Follow-up research into the possible high intakes is desirable.

Client: Ministry of Health, Welfare and Sport

Coordination:  RIVM Centre for Nutrition, Prevention and Care

Data collection: Kantar 

Period: 2019-2021