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.

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.

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.

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.

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.

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.