Therapeutic properties have been attributed to the diet since ancient times. Epidemiological evidence starting in the early 1960s supports the relationship between different dietary components, dietary balance and the development of risk factors for prevalent chronic diseases in Western societies. There is also evidence supporting the protective effect of other components of the diet and lifestyle, like regular physical activity.

During the last two years, groups of Spanish experts in the field of food, nutrition and health sciences have been involved in the process of analysing each food group in Spanish food patterns under a standard format. For each food group, current level of consumption, trends and scientific evidence linking each particular group or its components with patterns of disease, risk factors or protective effects have been determined from a public health perspective.

Conclusions and recommendations for each food group, agreed under consensus by the Spanish Society of Community Nutrition (SENC) collaborative group of experts, are summarised and reflected in the Food Guide Pyramid presented in this paper.

The three levels of dietary data national, household and individual, are analysed and compared, and their use and misuse in FBDG development and monitoring are discussed. Food Balance Sheets (FBS) estimate the national availability of foods, and are an appropriate tool to evaluate food policies; they tend to overestimate food consumption, particularly for those foods with higher waste. Household Budget Surveys (HBS) estimate the household availability of foods, and are useful to evaluate dietary family interventions. Individual Dietary Surveys (IDS) evaluate individual food and nutrient intake and provide a unique estimation of nutritional status and are the best tool for planning FBDG; however, they are expensive and may be biased towards underreporting.

The understanding of the relationship between the different levels of food information is very important when formulating, evaluating and monitoring a nutrition policy in a country or region.

The objective of this paper is to present the development of the Nutritional objectives for the Spanish Population. Preparation of draft documents contributed by different working groups was followed by a consensus meeting held in Bilbao on 5–7 October 2000, hosted by the Spanish Society of Community Nutrition and sponsored by the World Health Organisation.

Establishing nutritional guidelines was conducted by: (1) analysing current food and nutritional data from nutritional surveys, for intermediate objectives; and (2) reviewing current scientific knowledge for final objectives. The objectives include intermediate and ultimate figures, and comprise percentage of energy from macronutrients and fatty acids, fruit and vegetable consumption, frequency of sweets, physical activity and body mass index, folate, calcium, sodium, fluoride and iodine intake, dietary fibre, cholesterol, alcohol and duration of breastfeeding.

The nutritional objectives for the Spanish population create a rational framework for the development of dietary guidelines and nutritional policies in Spain, within a Mediterranean context.

Sound food composition databases that are both comprehensive and representative of available foods are an essential basic tool to develop Food Based Dietary Guidelines (FBDG). The main drawbacks of current food composition databases available in the European Union are: partial coverage of foods and nutrients, variability of analytical data, lack of accuracy in the description of food items, need for harmonisation of the expression of nutrients. An inappropriate use of these databases could lead to gross errors in the assessment of the nutrient intake levels, in the identification of the major sources of a nutrient, in the comparison of data between countries and in the analysis of time trends. Inadequacy of food composition data is, in part, responsible for the failure to understand some relationships between nutrient intakes and health or disease and for difficulties in establishing quantitative dietary guidelines in terms of nutrients. Recommendations are made for the compilation of future food composition databases and tools are proposed to enhance the quality of existing data. A careful study of the food composition databases is always necessary before nutrition recommendations are given and before trends in nutrient intakes are interpreted.

Iodine deficiency disorders (IDDs) are an important problem in the world. Some 760 million people suffer from goitre and 1600 million are at risk. In Togo, a small West African country, the prevalence of visible goitre in 6–12-year-old children was 21.6% and 5.3% in two endemic regions in 1999. Goitre is considered endemic as it affects one adult in five. UNICEF–Togo (United Nations Children's Fund) in co-operation with the Togolese government has implemented different programmes with the aim of improving the survival and development of children and women and to defend and promote children's rights.

The aim of this paper is to describe the procedures followed and key results of a school-based nutrition education project implemented in Togo to prevent iodine deficiency disorders, by encouraging use of iodised salt.

Food Based Dietary Guidelines (FBDG), in order to be attainable, should take into account the cultural context of the population for which they are developed. They need to focus on foods that actually determine the intake of nutrients for which desirable changes have been identified. Inter-individual variability of nutrient intakes – a measure of the heterogeneity of intakes – is determined by the variability in the consumption of its food sources among the population. The foods that determine a high proportion of inter-individual variability in nutrient intake can be identified on the basis of data banks that describe food and nutrient intakes in the population. The experience accumulated to design Food Frequency Questionnaire through selection of key foods suggests that high quantitative contributors to a specific nutrient may not be important determinants of its intake. On the other hand, the Pearson correlation between the intake of each food source and the total nutrient intake allows quantification of the percentage of variability explained by each item and takes into account the possibility of correlations between different food sources. Once a key food is identified, several strategies are available to modify its intake in the population: through changes in the percentage of consumers/in the mean portion size/in the frequency of intake. The anticipated level of change can be predicted according to the strategy adopted.

This paper focuses on the provision of adequate training in nutrition education to health and other community development workers for their improved performance and achievement. The difficulties encountered and special care needed when dealing with low-income, chronically deprived communities are raised. A brief analysis of past and present trends in nutrition education is presented to show the progress made from restricted, authoritative and not very successful proposals to more comprehensive and participatory approaches. The need to train and update regional and field-level personnel on the new approaches, theories and models offered by nutrition education is highlighted, but the scant availability of resources for training activities may be a great limitation for this undertaking. The contribution of educational, social, psychological and communication sciences, as well as marketing, in improving and broadening the performance of health and nutrition education is recognised. Some successful nutrition education projects, implemented in different regions, using various approaches, have managed to improve the nutrition situation of low-income groups and could be used as good examples to be followed. Recommendations for implementing nutrition education projects or activities need to consider some prerequisites, such as good knowledge and analysis of the nutrition situation, careful selection of the strategies and methods, careful planning and implementation, and clear definition of the procedures and instruments for follow-up and evaluation.

Food transitions in history have been fast, violent processes in some cases, while on other occasions they have taken place slowly, overlapping the traditional food culture as food items are replaced by new ones. Despite the contribution of potato and maize to avoiding famine in Europe, the exclusive crop system caused serious problems. Main food transitions are currently taking place in Asia. Emerging economies face the dilemma of improving the health and well-being of the population while avoiding excess and surplus. The challenge is twofold: on the one hand, to counteract the negative effects of food transitions and, on the other, to fight against hunger and malnutrition.

Evidence suggests that the effect of fasting on performance is not uniform, but it is dependent on the basal nutritional status of the subject. Breakfast consumption has a short-term effect in improving selected learning skills, especially work memory. School breakfast programmes have a positive effect on the nutritional status of children, on school attendance and probably on dropout rates. The effect of breakfast consumption on school performance depends on the interaction between the programme, student characteristics (malnutrition) and school organisation. Unless the school setting guarantees a minimum quality standard, the benefits of breakfast consumption will not be evident in performance in complex areas like language or maths.

The contribution of food, nutrition and physical activity to inequalities in health across Europe is largely unexplored. This paper summarizes cross sectional survey data on food patterns and nutrient intakes, and briefer data on physical activity, by various indicators of socio-economic status for countries across Europe. Factors are examined which underlie the outcome data seen. These include structural and material conditions and circumstances which contribute to excluding sociodemographic groups from participating in mainstream patterns of living. Trends in social and economic conditions, and their implications for nutritional and physical wellbeing are briefly outlined.

For policymakers considering strategy options for the prevention of cardiovascular disease (CVD) the distinction between effectiveness and cost effectiveness is critical. When cost limitations apply, an evaluation of cost effectiveness is essential if a rational decision is to be made. Policy changes and resource reallocation have opportunity costs, and therefore it is necessary to compare the cost of health gains achievable by means of different policies. Here the broad question is: How cost effective are diet change strategies compared to other measures aimed at reducing cardiovascular disease in EU member states?

An overview of published studies of cost effectiveness in the primary and secondary prevention of cardiovascular disease was conducted. Few comprehensive studies were available.

Estimated costs per life year gained were as follows: population-based healthy eating £14–560; smoking cessation £300–790; nurse screening and life style advice £900 (minimum); simvastatin (HMGCoA reductase inhibitor) £6200–11 300. Cost effectiveness is dependent on the underlying level of CVD risk in the target population, and the duration of the achieved alterations in behaviours and risk factors.

The limited evidence from these studies tends to support the view that health protection strategies which promote healthy eating are likely to be more cost-effective than strategies involving modern cholesterol-lowering drugs, screening and advice in primary care, and are comparable to or less expensive per year of life saved than anti-smoking strategies. Given the considerable diversity in food habits, health care and public health systems among current and prospective EU member states, careful appraisal of the policy options within each member state is desirable to ensure that health gain is maximised. EU wide food based dietary guidelines are potentially the basis of large health gains in Europe, and cost-effectiveness studies tend to support their adoption.

Background and objectives: Breakfast consumption is important for nutritional balance in all population groups. The objective of this paper is to describe breakfast consumption patterns in Spanish children and young people.

Nutrition, physical activity and health related promotion programmes in schools have developed into a mature field of research over the past decades. A number of success factors have been identified and evidence-based interventions have been performed. However, the school setting as an arena for evidence-based health promotion programmes, is still not used to its full potential. Schools provide an excellent arena for reaching large segments of the population, such as young people, school staff, families and the surrounding community.

There is a need for an overview regarding the current status of nutrition, physical activity, related health as well as support structures in the EU member states. Based upon such an analysis, a consensus report should be written, pointing out the major problems at hand. Self-assessment tools for national as well as for school level should be produced, in order to guide changes, but also to include an element of continuous assessment of change, for evaluation purposes.

Physical activity appears to improve health-related quality of life by enhancing psychological well being and by improving physical functioning, particularly in persons compromised by poor health. Health enhancing physical activity (HEPA) can in addition to, and instead of, structured and planned exercise and sports comprise other forms of physical activity, such as occupational activities, lifestyle activities and recreational activities. However, wide-range and long-term population strategies are needed for the promotion of physical activity in each of the categories of HEPA. It is necessary to create realistic opportunities for different population groups and individuals. The theoretical knowledge of the determinants of the target behaviour has to be translated to a practical form. On the basis of available empirical studies, the Predisposing, Enabling and Reinforcing factors in the PRECEDE –PROCEED model for health promotion, are all relevant and important for the adoption and maintenance of physical activity. In the end, promotional activities are needed where people live and work, i.e. at local level.

In order to be successful, public health nutrition strategies require the active collaboration of all stakeholders in the promotion of healthy diet and lifestyle patterns. The food industry plays an important role both in providing products that meet consumers' needs in terms of taste, convenience, quality, nutrition and value as well as in communicating to consumers about the importance of good nutrition, including the contribution of specific foods to a balanced diet. The food industry contributes to educational efforts regarding healthy diets and lifestyles both directly – through product labelling, advertising, educational materials, on-line communications and information provided by Consumer Services departments – and indirectly, through active involvement and participation in educational programmes pursued in collaboration with nutrition and health education authorities. Through ongoing dialogue with its consumers and research conducted on consumer knowledge and attitudes towards diet, the food industry can ensure that communications developed are motivating and relevant to consumers' lives. In this paper, the specific contribution of the food industry will be illustrated through the promotion of healthy eating habits among children, focusing in particular on the importance of the breakfast meal.

This is a background paper for the EURODIET initiative. A number of international initiatives and documents were identified, such as the Baby-Friendly Hospital Initiative, the International Code of Marketing of Breast Milk Substitutes and a number of consensus reports from professional groups, that propose ways forward for breastfeeding promotion. These point at a range of initiatives on different levels. The determinants for successful breastfeeding have to be identified. They can be categorised into five groups; socio-demographic, psycho-social, health care related, community- and policy attributes. A framework for future breastfeeding promoting efforts on European level is suggested, within which these determinants are considered.

A common surveillance system needs to be built in Europe, where determinants of breastfeeding are included. There is also a need for a surveillance system which makes it possible to use the collected data on local level, not only on national and supranational level. Combined with a thorough review of the effectiveness of already existing breastfeeding promotion programmes, a co-ordinated EU – EFTA action plan on breastfeeding should be formulated and implemented within a few years. Urgent action could take place in parallel, especially targeting young, low-income, less educated mothers.