Most European countries are now affected by demographic transition and changing epidemiology of disease; the nutrition of children is increasingly recognised as crucial for present and future health. Adequate dietary intake and nutritional status among children are important for their own growth, development and function but there is now increasing evidence that childhood nutrition also influences adult health. Intrauterine nutrition influences adult morbidity and mortality, but the childhood diet and nutritional status modify the increased risk of being born small. Thus, childhood diet needs to be taken more seriously in order to improve a nation's health as well as producing bright, active children. A key factor is the recognition that nutritional interventions at different stages of the life cycle are necessary if childhood nutrition is to improve. The mosaic pattern of the geography and social structure of communities in Europe produces ‘poverty’ and ‘consumer’ related nutrition patterns - often side by side. At one extreme, there is an urgent need to prevent obesity; while at the other extreme serious attention is required towards the prevention of deficiency disorders, mostly related to poverty and social exclusion. Few European governments take childhood nutrition at all seriously. This paper reviews a number of micronutrient issues and makes the case for the development of evidence-based policies and programmes for improving the nutrition of children in Europe.

Estimation of the prevalence and secular trends in paediatric obesity in Europe is impeded by methodological problems in the definition of obesity and the paucity of data sets that mirror the demographic, cultural and socioeconomic composition of the European population. The available prevalence data show that paediatric obesity is increasing throughout Europe but the patterns vary with time, age, sex and geographical region. The highest rates of obesity are observed in eastern and southern European countries. Even within countries there may be marked variability in the rates of obesity. It is unclear whether these trends are a simple consequence of an overall increase in fatness in Europe or whether there may be sub-groups of children who, at certain ages, are either particularly susceptible to environmental challenges or are selectively exposed to such challenges. In addition to the general increase in adiposity in European youth, there is also evidence of an increasing degree of obesity, particularly in older children and adolescents. No definite conclusions can be made about the respective contribution of energy intake and physical activity to the increasing prevalence of obesity. Changing demographic and social circumstances are linked to childhood obesity but it is highly unlikely that these interact in similar ways in the genesis of obesity in different individuals and population groups. In conclusion, the limited understanding of the variability in susceptibility to obesity in European youth provides powerful justification for the development of preventive strategies which are population based rather than selectively targeted at high-risk children.

Adequate provision of nutrients composing the bone matrix and regulating bone metabolism should be provided from birth in order to achieve maximal bone mass, compatible with individual genetic background, and to prevent osteoporosis later in life. Low calcium intake (<250 mg day−1) in children is associated with both a reduced bone mineral content and hyperparathyroidism. Optimal calcium intake is, however, still a matter of controversy. The minimisation of fracture risk would be the ideal functional outcome on which to evaluate lifetime calcium intakes, but proxy indicators, such as bone mass measurements or maximal calcium retention, are used instead. Calcium recommendations in Europe and the United States are based on different concepts as to requirements, leading to somewhat different interpretations of dietary adequacy. Minerals and trace elements other than calcium are involved in skeletal growth, some of them as matrix constituents, such as magnesium and fluoride, others as components of enzymatic systems involved in matrix turnover, such as zinc, copper and manganese. Vitamins also play a role in calcium metabolism (e.g. vitamin D) or as co-factors of key enzymes for skeletal metabolism (e.g. vitamins C and K). Physical activity has different effects on bone depending on its intensity, frequency, duration and the age at which it is started. The anabolic effect on bone is greater in adolescence and as a result of weight-bearing exercise. Adequate intakes of calcium appear necessary for exercise to have its bone stimulating action.

Nutrition is a major environmental influence on physical and mental growth and development in early life. Food habits during infancy can influence preferences and practices in later life and some evidence suggests fair to moderate tracking of food habits from childhood to adolescence1–4. Studies support that good nutrition contributes to improving the wellbeing of children and their potential learning ability, thus contributing to better school performance5–7. Children and young people who learn healthy eating habits, are encouraged to be physically active, to avoid smoking and to learn to manage stress, have the potential for reduced impact of chronic diseases in adulthood4–8. Nutrition education is a key element to promoting lifelong healthy eating and exercise behaviours and should start from the early stages of life8–11; it should also address the specific nutritional needs associated with pregnancy, including reinforcing breastfeeding12.

Food habits are complex in nature and multiple conditioning factors interact in their development13. Young children do not choose what they eat, but their parents decide and prepare the food for them. During infancy and early childhood the family is a key environment for children to learn and develop food preferences and eating habits. As they grow and start school, teachers, peers and other people at school, together with the media and social leaders, become more important. Progressively children become more independent and start making their own food choices. The peer group is very important for adolescents and has a major influence in developing both food habits and lifestyles13.

Community trials suggest that nutrition education is an accessible effective tool in health promotion programmes with a focus on the development of healthy eating practices14, 15.

The lifestyles and diets of children in developed countries is changing rapidly in response to the social and cultural climate, as well as the availability of an increasing range of foods. The aim of this on-going study is to assess the trends in food-related behaviours of children and their attitudes towards food and nutrition. The study also monitors markers for physical activity, which have been presented elsewhere (Bellisle et al, 2000). Three successive surveys (1993, 1995, and 1997) were carried out on samples of 1000 French children aged 9–11 years and their mothers.