The differentiation of key metabolic systems that occurs during intrauterine life is greatly influenced by environmental nutritional conditions, which in turn are related to maternal nutritional status. In postnatal life, childhood exposure to slow-acting environmental factors, primarily through the diet, will begin to condition adult susceptibility to diseases. Examples of these dietary factors are intake of saturated fat, sodium, calcium, etc. For example, bone calcium accumulation during childhood and adolescence will be a major determinant of risk of osteoporosis later in life. Similarly, a high intake of saturated fat during childhood may promote the process of atherosclerosis in persons with genetic susceptibility, thus accelerating the clinical manifestations of coronary heart disease in adult life.

These findings, although still not completely clarified, constitute a significant opportunity for preventive intervention. While preventive intervention in adult life may reduce risk, this is usually difficult and results are often limited. One example would be obesity. In contrast, interventions early in life, aimed at reducing these early risk factors, could potentially result in major reductions in the incidence of several diseases of adults.

The Bilbao School Health Service was created at the beginning of the century with the aim of preventing transmittable diseases among children as well as improving nutrition. At that time such services were established in many other countries. Since then, according to evolving societal changes and emerging needs, the Service has reoriented its scope and structure towards the Health Promotion scheme.

Current tasks include health screening examinations and hygiene surveillance as well as preventive and health education programmes.

The Education Council of the Catalonian government drew up a programme to improve the quality control of school canteens in Catalonia. The objectives of this programme were to contribute to developing healthier eating habits in school children through school canteens and to improve school canteen services considering other aspects such as service, operation, management, end-users, frontline staff and supervisors of menu planning.

This paper deals with two programme components aiming at introducing Nutrition in the school syllabus and school menu assessment. Various departments, organisations and associations were involved in programme development and implementation.

Initial analysis was based on information collected from formal administrative reports completed by a survey on 100 primary schools. From this preliminary analysis it was concluded that problem identification needs to be completed by an understanding of underlying reasons in order to design adequate solutions and guarantee implementation.

The nutrition of pregnant women is decisive in the course of gestation and the health of both mother and child. However, in the Spanish population, clinical monitoring of nutrition is rare, the control of bodyweight receiving most attention. Many studies show that pregnant women take too much fat and too little carbohydrate, and that intakes of fibre and several trace elements are lower than recommended.

Although many people think they know what a correct (varied and balanced) diet is, the concept is often misleading. Generally, they do not match the ideal theoretical framework for achieving an adequate energy profile of the diet. Neither do they facilitate intakes of vitamins and minerals close to recommended levels. Nutrition education programmes are therefore required to explain adequate dietary guidelines to pregnant women, and indeed to all women of childbearing age.

Considering the criteria suggested by a number of researchers concerning the number of food portions from each food group that pregnant women should include in their diets, the following guidelines for daily consumption are proposed: 3–4 portions of milk products, 2–3 portions of meat, fish or eggs, and 3 portions of fruit, 4–5 portions of vegetables or greens and 7–8 portions of cereals and legumes (a portion is defined as the amount of food that would be found on an average plateful or the normal units of consumption of a food).

Human milk is the best way to nurture the human infant. By breast-feeding their babies, mothers provide them with the best opportunities to wholly develop their potential, while protecting the infants and themselves from a whole range of diseases in the near future and in the years to come.

Even though these benefits are widely known and there is ample scientific evidence on the topic, it seems from published data that Spanish women are not breast-feeding their babies as much and for as long as they should. Less than 90% start breast-feeding, at 1 month there is already an attrition of 30%, at 3 months more than half of the infants are taking artificial milk and by 6 months only 10% continue to breast-feed their infants.

Low birth weight, Caesarean section and low study level are among the more significant factors that negatively affect breast-feeding.

There is still work to do to improve this situation. Promotion of breast-feeding among the general population, mothers and health professionals is needed.

The status reports and other information collected showed that interpretation of the data on breast-feeding prevalence and duration collected at national or regional level within European countries is difficult, since this information is not collected in every country or it is gathered under different criteria. However, there seem to be vast differences in prevalence of breast-fed children and breast-feeding duration between European countries and possibly within countries. There is a need to establish monitoring systems enabling comparability of data between countries. Assessing determinants for breast-feeding is required as well. There are a number of important consensus documents supporting breast-feeding action. These documents are related to either one or more of the following categories: health benefits of breastfeeding; recommendations regarding breast-feeding duration and exclusiveness; providing guidance on breast-feeding promotion. Current recommendation is exclusive breast-feeding for 6 months.

Sociodemographic and economic changes in Spain have played a role in the choice of infant feeding as more and more women enter the workforce. Nevertheless, the prevalence of breast-fed-only infants at 6 weeks remains fairly high, at 65.5% in 1999, although there is a sharp decline by 3 and 6 months postpartum. Achieving adequate nutritional status for lactation principally begins during pregnancy, as this constitutes the biological stage for accumulating nutrient stores. The benefits of breast-feeding for the mother and infant are presented, along with nutrition and dietary guidelines for the nursing woman. Apart from dietary considerations, special attention should be paid to encouraging a positive attitude and environment for breast-feeding success.

Current interest in preventive nutritional supplementation strategies during the reproductive cycle in developed countries focuses mainly on iron and folic acid. Iron deficiency is the most common cause of anaemia. Inadequate iron nutrition is mainly a problem in developing countries but it also seems to affect a large proportion of pregnant women in the industrialised world. There is no chance for diet modification alone to meet iron requirements during pregnancy. However, dietary advice must be provided to increase iron intake and iron bioavailability. The best choice is prescribed supplementation adapted to the individual's needs.

Folic Acid supplementation during the periconceptional period reduces the occurrence and recurrence of neural tube defects (NTDs). According to the updated edition of American Dietary Reference Intakes, recommended dietary allowance for folate for women of childbearing age varies throughout the reproductive cycle from 400 μg day−1 of dietary folate equivalents (DFEs) for non-pregnant women, to 600 μg day−1 DFEs for pregnant women and 500 μg day−1 DFEs in lactating women. Increasing dietary folate, fortifying staple foods with folic acid or use of folic acid supplements can increase folate intake.

Homelessness includes a wide range of people, from those living onthe street (strictly homeless) to people living temporarily withrelatives or friends because they have lost their home. Programesfor the homeless should design strategies aimed at encouraginginsertion processes, thus considering the different dimensionsinvolved. Within this framework Caritas delivers an array ofassistance services for the homeless facing the stages of insertion.In Spain there are 315 centres offering meals for 20 000 people,most of them along with other services such as reception,residential premises or day-care centres. Caritas is responsible for42% of them. Overall, it is easier to get a lunch than any othermeal during the day, followed by dinner, while it is difficult toget a breakfast.

Social dining rooms are valuable places for a first contact (firststage of the insertion process) and even to start the second stage(personal recovery).

Increased health inequalities are a result of poverty and socialinequalities. Examples of how food intake is affected by povertyexist throughout the European Region. The diets of low-income groupsare likely to be inadequate. Low-income groups and specific groupssuch as children, adolescents, pregnant and lactating women, andolder people often face problems gaining access to a healthy varietyof safe foods. Safe healthy food may not be accessible to those mostin need. Yet access to a safe and varied healthy diet is afundamental human right and policies are needed to address this.

The health of elderly people is often affected by inadequatenutritional intake. Psychosocial determinants and the higherprevalence of acute and chronic illnesses are risk factors fornutritional deficiencies in the elderly. Nutritional assessment (NA)or nutritional risk screening must be an important elements in careprogrammes for elderly people in the community and should be part ofall geriatric assessment programmes.

Nutritional support in the elderly not only co-operatesinpharmacological treatment but also very often is a primary therapyfor their health. The type of artificial nutrition (AN) to use willdepend on the present illness and the previous health record. Due tothe fact that enteral feeding (EF) is less expensive and aggressivewe should use EF whenever possible, leaving parenteral nutrition(PN) for specific situations where EF should not be used. AN, ifproperly prescribed, formulated, administered and monitored, is safeas long as qualified personnel are trained in its use. Combined AN(oral, enteral and parenteral) allows a step-by-step improvementthat could lead to final oral feeding. Finally, while it is truethat age should not be considered in isolation as a contraindicationfor AN, we should be aware that, in final life stages, oral feedingcan be the only satisfaction left for the elderly.

The reviewed literature indicates that, even in industrialisedcountries, the nutrition of mature and aged subjects is ofteninadequate (because of deficiency or excess), which may lead topremature or pathological senescence.

Recent nutritional research on ageing laboratory animals shows thatdietary restriction may be the most effective procedure to achievealong and disease-free life span, probably owing to a betterprotection against mitochondria-linked oxygen stress. Likewise, theexperimental and clinical work from many laboratories, including ourown, indicates that age-dependent changes in the cardiovascular andimmune systems are linked to oxygen stress and that an adequateintake of dietary antioxidants may protect those systems againstchronic degenerative syndromes in the physiopathology of whichreactive oxygen species (ROS) play a key role.

The extant data indicate that the antioxidant vitamins C and E arecentrally involved in defending the above two systems against ROSattack. Moreover, recent research suggests that theglutathione-related thiolic antioxidants, thiazolidine carboxylicacid (thioproline) and N-acetylcysteine, as well asthe phenolic liposoluble ‘co-antioxidants’ of Curcuma longa, mayhave a significant protective effect against age-relatedatherogenesis and immune dysfunction.

Key messages from this paper are the following. (1) It is generallyaccepted that oxygen free radicals released in metabolic reactionsplay a key role in the physiopathology of ‘normal ageing’ and ofmany age-related degenerative diseases. (2) Consumption of adequatelevels of antioxidants in the diet is essential in order to preservehealth in old age. (3) A certain degree of protection againstatherogenesis and immune dysfunction may be achieved by preventingvitamin E deficiency and an excessive oxidation of theglutathione-supported thiol pool.

Effective population-based strategies require people trained andcompetent in the discipline of Public Health Nutrition. Since 1997,a European Master's Programme in Public Health Nutrition has beenundergoing planning and implementation, by establishing initialquality assurance systems with the aid of funding from the EuropeanCommission (DG SANCO/F3). Partners from 17 European countries havebeen involved in the process. A European Network of Public HealthNutrition has been developed and accredited by the EuropeanCommission.

The aim of this paper is to highlight the importance of anevidence-based approach to the development, implementation andevaluation of policies aimed at improving nutrition-related healthin the population. Public Health Nutrition was established torealise a population-level approach to the prevention of the majornutrition-related health problems world-wide. The scope is broad andintegrates activity from local, national, regional and internationallevels. The aim is to inform and develop coherent and effectivepolicies that address the key rate-limiting steps critical toimproving nutrition-related public health. This paper sets out therationale for an evidence-based approach to Public Health Nutritiondeveloped under the umbrella of the European Network for PublicHealth Nutrition.