Although progress has been made towards international goals for the eradication of hunger and malnutrition, considerable work is still required to achieve them and to respond to emerging public health nutrition challenges. The present paper outlines sixteen major inter-linked nutrition challenges recently identified by the UN Standing Committee on Nutrition. While many of the challenges relate to the nutritional needs of children and mothers, an increased emphasis on nutrition-related chronic diseases that affect later life is also evident. Promoting healthy ageing and the maintenance of physical and mental function in older age are undoubtedly major challenges for the future, and the present paper also informs on the role of nutrition, specifically n-3 essential fatty acids, in the prevention of cognitive decline. The importance of determining the cost-effectiveness of nutrition interventions is advocated, in order that the nutrition community can respond appropriately to global nutrition challenges.

The prevalence and increasing trends of obesity in Spain are a matter of concern. In adults, the prevalence of obesity and overweight is 14·5 and 38·5 %, respectively, whereas in children and adolescents it is 13·9 and 26·3 %. This situation prompted the Spanish Ministry of Health and Consumer Affairs to draw up the Strategy for Nutrition, Physical Activity and the Prevention of Obesity (NAOS), which aims to improve the diet and encourage the regular practice of physical activity by all citizens, with special emphasis on children. Coordinated by the Spanish Food Safety Agency and the General Directorate of Public Health, a wide range of stakeholders participated in drafting the Strategy through a broad consultative process. Anchored on the core goal of adopting a lifelong perspective in the prevention and control of obesity, NAOS encompasses recommendations for action in four fields: family and community, schools, private sector, and the health system. Launched on 10 February 2005, the Strategy will undergo careful monitoring and evaluation. A newly created Obesity Observatory will carry out epidemiological surveillance, define indicators to measure impact of interventions, facilitate the exchange of experiences among different initiatives, identify research priorities, monitor adherence and application of the self-regulation agreements, and conduct rigorous evaluation of initiatives to identify those that are successful and should be prioritized. To our knowledge, NAOS is the first strategy of its kind in Europe and we recommend it as an example to be followed by countries that, like Spain, face the challenge of combating the pervasive epidemic of obesity.

Since the founding of the Food and Agriculture Organization of the United Nations in 1946, it has reported on the serious problem of hunger in the world and has undertaken various initiatives for eradicating this problem; however, they have ended in failure. The number of people suffering from hunger has increased from 500 to 800 million in a period of six decades, despite constant growth in world food production, which has been more than sufficient to cover the needs of all of humanity since the 1970s. This paper analyses FAO initiatives in the framework of the evolution of the nutritional situation in developing countries and identifies national and regional contexts in which technical solutions may be successful, as well as those requiring the implementation of economic, political and social measures.

High prevalence of malnutrition is often linked to conflict situations. Conflicts affect local livelihoods, impair productive activities and limit access to safe foods and basic services. Strategies to protect and promote nutrition of affected households and communities must be based on an understanding of this impact. While nutrition rehabilitation and food aid are clearly essential to preserve lives in the short run, they cannot provide lasting solutions. Impaired nutritional status ultimately reflects livelihood degradation but anthropometric indicators cannot be used to target timely interventions. They should be combined with simple indicators of food consumption which react more quickly to both crisis and relief/rehabilitation interventions. Local institutions should be encouraged to share information and build causality models of malnutrition for the main vulnerable livelihood groups as a basis for an integrated response. A communication component will systematically be needed to allow people to make informed decisions in a context with which they are often not familiar.

The Food and Agriculture Organization of the United Nations promotes nutrition interventions considering food as the basis for action, given the strategic role of food and the agricultural sector to improve food security for the community; thus, a large number of people, especially the poor, who participate directly or indirectly in agricultural activities are able to obtain benefits from its multifunctional character. Food-based nutrition interventions have the purpose of improving food production and availability, processing and conservation, supply and commercialization, as well as access and food consumption. The basis of this focus is community and local government participation in the planning, execution, supervision and evaluation of specific interventions. Food-based nutrition interventions include the development of community gardens and farms in urban and rural areas; hydroponic gardens and other related initiatives in urban and periurban agriculture; as well as the promotion of traditional crops with nutritional value and the development of small agro-industries. Food-based nutrition interventions can be implemented to improve the food supply in street and itinerant markets, town squares and rural markets, and street food sales. In all food-based interventions, food safety and quality control must be taken into consideration throughout the food chain. The interventions on nutrition education increase the family's capacity to improve access to and consumption of food. Food-based dietary guidelines and nutrition education in schools are highlighted, as well as the utilization of school gardens.

On an international scale, the last seventy-five years have been a period of deep social, economic and political transformation for the developing countries. They have been especially influenced by the international phenomenon of globalization, the benefits of which have been unequally distributed among countries. In this context, the strategies used to improve the general nutritional health of the population of developing countries include broad approaches integrating nutritional interventions in a context of sustainable community development, while valuing the existing relations between fields as diverse as agriculture, education, sociology, economy, health, environment, hygiene and nutrition. The community nutrition programmes are emblematic of these initiatives. Nevertheless, in spite of the increasing evidence of the potential possibilities offered by these programmes to improve the nutritional status and contribute to the development and the self-sufficiency of the community, their success is relatively limited, due to the inappropriate planning, implementation and evaluation of the programmes. In the present article, I attempt to emphasie the importance of community participation of the population of developing countries in the community nutrition programmes within the context of globalization. This process is not only an ethical imperative, but a pragmatic one. It is a crucial step in the process of liberation, democratization and equality that will lead to true sustainable development.

A voluminous body of epidemiological research concerning the potential role of antioxidant nutrients in the prevention of cancers has accumulated over the past few decades. However, results of large recent intervention trials do not support a preventive effect against cancer for supplementation with antioxidant nutrients. Seemingly contradictory results between observational studies and randomised trials can be explained by the fact that doses used in clinical trials were much higher than the highest levels attained by the usual dietary intake which, in observational studies, were found to be associated with the lowest risk of cancer. Recently, the Supplementation en Vitamines et Mine´raux Antioxydants (SU.VI.MAX) study, a randomised, double-blind, placebo-controlled primary prevention trial, tested the efficacy of supplementation with a combination of antioxidant vitamins and minerals, at nutritional doses, in reducing the cancer incidence in a general population not selected for risk factors. After 7·5 years, low-dose antioxidant supplementation lowered the total cancer incidence in men only. This may be explained by a lower baseline status of certain antioxidants in men compared to women. Finally, the effect of antioxidant supplementation on the incidence of cancer could depend on baseline antioxidant status (which differs from gender and/or nutritional status) and the health status of subjects (healthy v. cancer high-risk subjects). Antioxidant supplementation may have a beneficial effect upon cancer incidence only in healthy subjects who are not exposed to cancer risk and who have a particularly low baseline status. High doses of antioxidant supplementation may be deleterious in subjects in whom the initial phase of cancer development has already started, and they could be ineffective in well-nourished subjects with adequate antioxidant status.

We have recently reported that xanthine oxidase is involved in the generation of free radicals in exhaustive exercise. Allopurinol, an inhibitor of xanthine oxidase, prevents it. The aim of the present work was to elucidate the role of exercise-derived reactive oxygen species in the cell signalling pathways involved in the adaptation to exercise in man. We have found that exercise causes an increase in the activity of plasma xanthine oxidase and an activation of NF-κB in peripheral blood lymphocytes after marathon running. This activation is dependent on free radical formation in exercise: treatment with allopurinol completely prevents it. In animal models, we previously showed that NF-κB activation induced by exhaustive physical exercise leads to an increase in the expression of superoxide dismutase, an enzyme involved in antioxidant defence. We report evidence in man that reactive oxygen species act as signals in exercise as decreasing their formation prevents activation of important signalling pathways which can cause useful adaptations in cells.

During endurance exercise, oxygen consumption by the skeletal muscle can increase 100–200 times. We previously found that during an ultramarathon race (50 km, forest trail through hilly terrain) compared with a day of rest, vitamin E disappeared faster (as measured using 2H-labelled α-tocopherol) and lipid peroxidation increased. Therefore, we hypothesized that prior supplementation with antioxidants (vitamins E and C) would decrease oxidative stress during distance running and, therefore, decrease lipid peroxidation and inflammation, decreaseDNA damage, decrease muscle damage and/or improve recovery. To test these hypotheses, we carried out a randomized, double-blind study in runners (n 11 females, 11 males) who were participants in an annual ultramarathon race. We found that supplementation with both vitamins E and C only prevented increases in lipid peroxidation, but had no apparent effect on DNA damage, inflammation or muscle damage. These results suggest that the mechanism of oxidative damage is operating independently of the inflammatory and muscle damage responses.

Antioxidants have shown beneficial effects in several biological systems, in which they were able to prevent oxidative stress-associated damage. Vitamins C and E are key antioxidants in man. Dietary intake cannot accurately reflect plasma vitamin levels. However, the plasma levels of antioxidant vitamins could also reflect the acute assimilation of these vitamins. It has been pointed out that antioxidant vitamin blood contents reach a saturation level by intake of dietary supplements. Antioxidant vitamin plasma levels are the parameter most used to determine antioxidant status. However, the vitamin plasma levels may not reflect the nutritional status of vitamins. It has been pointed out that the vitamin E in adipose tissue can be used as a measure of vitamin E status. To determinate antioxidant vitamin contents in lymphocytes and neutrophils after exercise is a useful tool to assess the functional status of antioxidant vitamins.

We have examined the current scientific evidence on the relationship between nutrition and the most frequent tumours in the Spanish population: lung, colorectal, prostate, breast and stomach. Consumption of fruit is negatively associated with cancer of the lung and stomach, possibly with colorectal cancer, but probably not with prostate cancer and breast cancer. Consumption of vegetables probably reduces the risk of colorectal and stomach cancer, but probably is not associated with cancer of the lung, prostate and breast. Consumption of red and processed meat is positively associated with colorectal cancer and probably with stomach cancer. Animal fat is possibly associated with colorectal cancer and probably with prostate and breast cancer. High alcohol intake increases the risk of colorectal and breast cancer, while dairy products and calcium seem to decrease the risk of colorectal cancer. Obesity is a recognised risk factor of colorectal cancer and breast cancer in postmenopausal women, while foods with a high glycaemic index and glycaemic load possibly increase the risk of colorectal and prostate cancer. The relevance of nutrition on the cancer process is evident. Nevertheless important issues remain to be solved and further studies are needed. This accumulative knowledge should be used by public health authorities to develop recommendations and activities to reduce overweight and obesity and to promote healthy dietary habits.

Since the 1970s it has been postulated that dietary fibre is a protective factor against colorectal cancer. Several epidemiological studies have been performed following different designs (correlation studies, case–control, cohort) and overall they have supported the hypothesis of a benefit of dietary fibre. However, a few intervention trials have not demonstrated the preventive role of dietary fibre on the occurrence of adenomatous colorectal polyps. Nevertheless, there are multiple animal experimental studies that support the role of fibre in the prevention of colorectal cancer. In the present review, the most important contributions to this controversial question are revised. Finally, it is recommended to continue encouraging an increase in the daily consumption of fibre, since it probably plays an important role in the prevention of colorectal cancer, together with other beneficial effects.

The nutritional intakes of the Spanish child and adolescent population are presented, as well as the population at risk of inadequate nutrient status. A random sample of 3534 people aged 2–24 years were interviewed between 1998 and 2000. Interviews included two 24 h recalls and a general questionnaire and anthropometric evaluations for the entire sample. After excluding under-reporters (18·7 %), the final sample was 2855 individuals (1348 males and 1507 females). The average intake of energy was 9543 kJ in males and 7804 kJ in females, with important variations seen by age group. Energy intake increased with age in both sexes until 14–17 years, which also applied to almost all of the nutrients studied, with the exception of vitamin C. A decreasing trend in the percentage of energy from carbohydrates was seen in both sexes. At the low socioeconomic level, it was observed that all nutrient intakes were less favourable when compared with higher socioeconomic levels. Nutrients with associated intakes below one-third of the Spanish recommended nutrient intake (RNI) included vitamin D (42 % of the sample) and folate (10 % of females), and the percentages falling below two-thirds of the RNI corresponded to: vitamin D (97 %), vitamin A (60 %), vitamin E (54 %), folate (58 % of females), Fe (23 % of females), vitamin C (8 %), Mg (4·5 %), Ca (5 % of females) and vitamin B6 (5 % of females). Adolescents aged between 14 and 17 years was the group with the highest nutritional risk, especially among girls. Nutritional adequacy in Spanish children was, in general, adequate, although it is necessary to analyse the implications of high inadequate intakes of vitamins D, E and A, which means that the current recommended intakes should be reconsidered. It should be noted that folate levels should be doubled in the near future.

Cross-sectional population studies provide valuable information for nutrition surveillance and planning intervention strategies. The enKid Study is the largest nutrition survey on the child and adolescent Spanish population to date. In the present paper, nutrition risks in children and young people of the Basque country based on the enKid Study subsample for the Basque region are presented. Dietary assessment was completed by means of a 24 h recall and a food frequency questionnaire completed in an interview with the mother or caregiver for children under 13 years. A second 24 h recall was completed on 25 % of the sample. Body weight, height and circumference were measured on each individual. Overweight and obesity were defined using Cole et al. cut-offs. Fat intake supplied 40 % of energy intake and saturated fats 13·8 %. Overall, 80 % of the sample had intakes of fat above 35 %. Main food sources of fats were added fats (32 %), meat (20 %) and milk products (20 %). Buns, cakes and pastry supplied 11 % of total fat intake. The nutrients showing the highest proportion of people who did not reach one third (33 %) of the Spanish dietary reference intake levels were vitamin D, vitamin E, vitamin A and folate. Prevailing food pattern showed a high consumption of meat and meat products, milk, dairy products and cereals. Conversely, consumption of fruit, vegetables and fish was low; in fact, 89 % of the sample had a normal consumption of fruit and vegetables below five portions a day. Prevalence of obesity was estimated at 3·94 %, and 17·85 % of the sample was classified as overweight.

Prevalence estimates of obesity in a national random sample of Spanish children and young people are presented in this paper, defined by age- and sex-specific BMI national reference standards for the 85th percentile (overweight) and 97th percentile (obesity), as well as by Cole et al. criteria. A random sample of 3534 people, aged 2–24 years, was interviewed between 1998 and 2000. The study protocol included personal data, data on education and socioeconomic status (SES) for the family, dietary assessment, anthropometric measurements and physical activity. The prevalence of obesity was 13·9 % (95 % CI 12·7, 15·1) considering Spanish reference standards as cut-offs. Obesity was significantly higher in boys (15·6 %) than in girls (12 %). The highest values were observed between 6 and 13 years of age. Using Cole's cut-offs, the estimated prevalence of obesity was 6·3 % (95 % CI 5·4, 7·5) with a similar pattern to that previously described by sex. Regarding sociodemographic factors, sex, age group, region, size of locality of residence, mother's level of education and family SES level were significant predictors for obesity in children and adolescents under 14 years. Among young people, the main sociodemographic predictors for obesity were geographical region and family SES level. Odds ratio for obesity was 1·27 for those with a more frequent consumption of buns, cakes and snacks, and 1·71 for those with more frequent consumption of sugared drinks. Adequate consumption of fruit and vegetables, usually having breakfast and regular sports practice had a protective effect. The available data show that obesity in Spain is a public health issue given its magnitude and increasing trends. Among Spanish children and young people, those at prepubertal age, particularly boys, can be identified as a group at higher risk for overweight and obesity, particularly children from lower SES families.

Since the last century, fortified and enriched foods are products whose original composition has been modified–through addition of essential nutrients–to satisfy specific population needs. For the fortification of foods to have a positive impact on nutritional status, the micronutrients added must be well absorbed and utilized by the organism (bioavailability). Diverse factors affect bioavailability, such as the nutritional status of individuals, the presence in the diet of substances which facilitate or inhibit its absorption, interactions among micronutrients, illnesses, and chemical characteristics of the compound used for fortification. In countries such as Chile, Venezuela and Mexico, important effects have been demonstrated in reducing iron deficiency anaemia in children under 5 years of age. In less than a decade, the salt iodization programme has also proven its effectiveness. Other programmes have fortified foods with Zn, vitamin A and folic acid, which are deficient in infants and children of many populations. In summary, food fortification is a low-cost, relatively simple strategy that may reach a wide range of people, and contribute to reducing the high prevalence of micronutrient deficiencies affecting children, especially in poor countries. The costs due to losses of human capital and their repercussions on health and future development are very high. Building links among academic researchers, politicians, food manufacturers and consumers is essential in order for food fortification to be efficacious and effective, and therefore should be considered as part of an integral strategy to combat micronutrient deficiencies.

School meals have changed during the last decades. The traditional service style with on-site food preparation has shifted towards catering delivery services. Vending machines, school cafeterias and other ways of food distribution are widely used in many schools, particularly in secondary schools. From a health promotion approach, the quality and quantity of food and beverages consumed while in school have an enormous potential impact on the health and well-being of young people. Most children spend a significant part of their lives in school. Additionally, school meals supply 30–35 % of daily energy intake and provide an important contribution to nutrient intake. School life is a critical period in the acquisition and practice of healthy behaviours. Environmental interventions in schools, to increase availability and access to healthy foods such as fruit and vegetables, have proved to be effective. School meals should make high-quality foods available which allow nutrient requirements to be met, consistent with dietary guidelines and offering a positive nutritional experience. School meals should be part of the educational process in the life of the school.

Patients with eating disorders (ED) show alterations in both their behaviour and their intake of food, frequently presenting nutritional and somatic affectations. Besides the classical forms such as anorexia or bulimia nervosa, there has recently been an increase in atypical or incomplete forms of ED, such as binge eating. Primary care (PC) services form the central and closest nucleus of health care for the individual and the family, where ED occur and leave their mark. This allows PC to provide an integral response at all levels of care for ED. Primary prevention at school, in the family and community is fundamental to avoiding its inception. Secondary prevention is based on early diagnosis and treatment of ED and favours a better prognosis of the illness. Tertiary prevention tries to reduce the serious consequences with rehabilitation measures to alleviate complications and avoid risk to life. Due to its complexity, these patients are afforded the attention of multidisciplinary teams of specialists with experience in treating this condition. In consultation with the team, the general practitioner should adopt a leading role at all levels of attention, as he/she is the link between the team, the family and the patient. This requires both regulated, specific training in the disease and the allocation of resources to carry it through. Putting into practice all these plans would allow us to give a positive answer to the question posed in the title of the present article.

The increasing availability of nutrition and health information has not always increased the knowledge of the general population, but presents them with the need to know and understand in order for choices to be made. While communicating science to the lay public, several challenges are encountered, ranging from the heterogeneity of the audience, the consumers, who demand certainty and a straightforward message, through the different aims and agendas of all the communicators, to the inherent complexity of the scientific message. Nowadays, the media is one major source of scientific information to the general public. The present article examines what the role of the media and scientists should be in bringing scientific communication to the public and how this communication could be improved.