European Nutrition and Health Report 2004

Transcription

1 European Nutrition and Health Report 2004

2 Forum of Nutrition Vol. 58 Series Editor Ibrahim Elmadfa Vienna The European Nutrition and Health Report project has been financially supported by the European Commission (EC), Health and Consumer Protection Directorate-General, Directorate C Public Health and Risk Assessment within the Health Monitoring Programme (Grant agreement No SPC ). However, neither the EC nor any person acting on its behalf is liable for any use made of the information available in this report.

3 European Nutrition and Health Report 2004 Volume Editors Ibrahim Elmadfa Vienna Elisabeth Weichselbaum Vienna 80 figures and 233 tables, 2005 Authors Elmadfa I, Weichselbaum E, König J Austria Remaut de Winter A-M Belgium Trolle E Denmark Haapala I, Uusitalo U Finland Mennen L, Hercberg S France Wolfram G Germany Trichopoulou A, Naska A, Benetou V, Kritsellis E Rodler I, Zajkás G Hungary Branca F, D Acapito P Italy Klepp K-I, Ali-Madar A Norway De Almeida MDV, Alves E, Rodrigues S Portugal Sarra-Majem L, Roman B Spain Sjöström M, Poortvliet E Sweden Margetts B UK Greece Basel Freiburg Paris London New York Bangalore Bangkok Singapore Tokyo Sydney

4 Ibrahim Elmadfa Institute of Nutritional Sciences University of Vienna Vienna, Austria Elisabeth Weichselbaum Institute of Nutritional Sciences University of Vienna Vienna, Austria Library of Congress Cataloging-in-Publication Data European nutrition and health report / Elmadfa, I.... [et al.]. p. ; cm. (Forum of nutrition ; v. 58) Includes bibliographical references and index. European Commission, Health and Consumer Protection Directorate-General No. SPC ISBN (hardcover : alk. paper) 1. Nutrition Europe. 2. Public health Europe. [DNLM: 1. Nutrition Surveys Europe. 2. Food Supply statistics & numerical data Europe. 3. Health Status Europe. ] I. Elmadfa, I. II. European Commission. Directorate-General for Health and Consumer Protection. III. Series. RA601.E dc Bibliographic Indices. This publication is listed in bibliographic services, including Current Contents and Index Medicus. Drug Dosage. The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means electronic or mechanical, including photocopying, recording, microscopying, or by any information storage and retrieval system, without permission in writing from the publisher. Copyright 2005 by European Commission, Health and Consumer Protection, Directorate-General Printed on acid-free paper ISSN ISBN

5 Contents VII VIII IX XI XVI List of Abbreviations List of Participants Introduction Executive Summary Outlook 1 Trends of Average Food Supply in the European Union 12 Food Availability at the Household Level in the European Union 19 Energy and Nutrient Intake in the European Union 19 Energy and Nutrient Intake in European Children 25 Energy and Nutrient Intake in European Adolescents 32 Energy and Nutrient Intake in European Adults 41 Energy and Nutrient Intake in European Elderly 47 Health Indicators and Status in the European Union 47 Prevalence of Overweight and Obesity 49 Blood Lipids 51 Mortality 54 Morbidity 56 Physical Activity 60 Smoking 62 General Discussion 66 Annexes 66 Illustrations of Food Supply Data, Based on FBS Data 76 Annex DAFNE Project 80 National Reports 80 Austria 96 Belgium 99 Denmark 111 Finland 119 France 124 Germany 133 Greece 150 Hungary 162 Italy V

6 167 Norway 173 Portugal 176 Spain 197 Sweden 204 United Kingdom 213 References 221 Subject Index VI Contents

7 List of Abbreviations A Austria B Belgium BMI Body mass index (body weight in kg/body height in m 2 ) CHO Carbohydrates D Germany DK Denmark DAFNE Data Food Networking project E Spain %E % of total energy F France FAO Food and Agriculture Organization FBS Food balance sheets FFQ Food frequency questionnaire FIN Finland GR Greece H Hungary HBS Household budget surveys I Italy MUFA Monounsaturated fatty acids N Norway NSPNon-starch polysaccharides PPortugal PUFA Polyunsaturated fatty acids S Sweden SCF Scientific Committee of Food SD Standard deviation SFA Saturated fatty acids UK United Kingdom WHO World Health Organization VII

8 List of Participants Coordinator of the European Nutrition and Health Report Ibrahim Elmadfa Coordinating Centre Ibrahim Elmadfa, Elisabeth Weichselbaum, Jürgen König Institute of Nutritional Sciences University of Vienna, Austria Partners Anne-Marie Remaut de Winter Nutrition Unit, Faculty of Agricultural and Applied Biological Sciences University of Gent, Belgium Ellen Trolle Danish Inst. for Food and Vet. Research Copenhagen, Denmark Irja Haapala, Ulla Uusitalo Department of Public Health and General Practice University of Kuopio, Finland Louise Mennen, Serge Hercberg Institut Scientifique et Technique de la Nutrition et l Alimentation Paris, France Günther Wolfram Department für Lebensmittel und Ernährung der TU München Weihenstephan, Germany Antonia Trichopoulou, Androniki Naska, Vassiliki Benetou, Elena Kritsellis Department of Hygiene and Epidemiology School of Medicine University of Athens, Greece Imre Rodler, Gábor Zajkás National Institute of Food Hygiene and Nutrition Budapest, Hungary Francesco Branca, Paola D Acapito National Institute of Research on Food and Nutrition Human Nutrition Unit Roma, Italy Knut-Inge Klepp, Ahmed Ali-Madar Department of Nutrition Faculty of Medicine University of Oslo, Norway Maria Daniel Vaz de Almeida, Elsa Alves, Sara Rodrigues Faculty of Nutrition and Food Sciences Porto University, Portugal Lluis Serra Majem, Blanca Roman Department of Clinical Sciences University of Las Palmas de Gran Canaria, Spain Nutrition Research Foundation (FIN) Barcelona, Spain Michael Sjöström, Eric Poortvliet PrevNut at Novum Karolinska Institutet Huddinge, Sweden Barrie Margetts Public Health Nutrition Institute of Human Nutrition University of Southampton, UK VIII

9 Introduction The European Nutrition and Health Report, funded by the European Commission, is the first report combining health and nutrition data from European countries. Thirteen countries of the European Union and Norway expressed their interest in participating in this project. These countries of the EU are Austria, Belgium, Denmark, Finland, France, Germany, Greece, Italy, Portugal, Spain, Sweden, the United Kingdom and Hungary which was included in the very last minute replacing Ireland. Thus it is the first and only new member state of the European Union (EU) included in a project which was designed to cover the European Union before May The Institute of Nutritional Sciences of the University of Vienna (Austria) acted as coordinating centre of this project under the supervision of Prof. Ibrahim Elmadfa. The main task of the participating countries was the collection of national data. These data were then forwarded to the coordinating centre. Where necessary, the data set was transferred into another format by the coordinating centre, which was responsible for the preparation of the final report. The main goals of this report were the compilation of available food and nutrient intake and health data, the identification of major nutrition and health problems in the participating countries and the EU regions, the identification of inadequacies of data collected in the participating countries, which would make a comparability of the collected data difficult. In the chapter, Trends of Average Food Supply in the European Union, data from food balance sheets (FBS) of the FAO (Food and Agriculture Organization) were used. In this chapter food supply trends in the participating countries during the past four decades are presented. These data were downloaded from the FAO database ( faostat/collections, FAO 2003) and transformed by the coordinating centre. The chapter, Food Availability at the Household Level in the European Union dealt with the food availability data at the household level, obtained through house-hold budget surveys (HBS) of the participating countries. It was prepared by the coordinating centre of the DAFNE (Data Food Networking) project under the supervision of Prof. Antonia Trichopoulou, University of Athens. In the chapter, Energy and Nutrient Intake in the European Union, national nutrient intake data from all participating countries are presented. Each participant had to collect these data which were brought into a consolidated form by the coordinating centre. Data were available for children, adolescents, adults and elderly. Only a few countries had intake data of other population groups (e.g. pregnant and lactating women, athletes) which are thus not included in this chapter, but presented in the national reports (see annex, National Reports). It has to be mentioned that the references used in this report are sometimes not up to date (e.g. the recommendations of the SCF), but were still taken as clues when no other more recent reference values, at a European level, were not available. The chapter, Health Indicators and Status in the European Union, consists of national data as well. The amount and kind of data concerning health issues was varying. Thus, for some parts (e.g. Mortality and Morbidity), data from other organisations or statistical centres (e.g. WHO, Globocan 2000) were taken. In the annex a national report of each participating country is included. These national reports provide more detailed nutrition and health data of the participating countries. IX

10 This report should not only compile data from the participating European countries, but should be an impulse for future projects in the area of nutrition and health. It should serve as a basis for improvements and for the planning of such future projects. Further, it shows what still has to be done in order to obtain comparable and representative data. Acknowledgement The excellent and patient editorial assistance of Dr. Lisa Kessler in the preparation of this manuscript is acknowledged. X Introduction

11 Executive Summary Trends of Food Supply in the European Union, on the Basis of the FAO Food Balance Sheets In the EU 1, an increase in per capita supply during the past four decades was observed for fruit, vegetables, sugar and sweeteners, oilcrops, vegetable oils, animal fats, red meat, poultry, fish and seafood, milk (excluding butter), eggs and beer. The average supply of potatoes, cereals and wine showed a decrease, that of pulses stayed at a relatively consistent level. Despite an increasing tendency in vegetable and fruit supply, the current supply situation cannot be regarded as sufficient. The average supply of meat is high in the participating countries. The proportion of fat in total energy supply increased during the past four decades. The average supply of total carbohydrates decreased, with a simultaneous increase of sugar and sweeteners. In the EU the average per capita supply of fruit and vegetables increased between 1961 and This increasing tendency was observed in the whole EU and also in each participating country. The highest supplies of vegetables were observed in countries of South Europe. The mean potatoes and cereal supply decreased during the observation period. An increase was observed in the supply of sugar and sweeteners in the EU. However, the UK and Finland showed considerable decreases in the supply of this food group. 1 The 15 member states of the EU before May The supply of pulses hardly changed in the EU average. The countries with the highest initial values showed in general a decrease in pulses supply. The highest per capita supplies of pulses were found in countries of South Europe. The mean supply of oilcrops in the EU showed an increasing tendency. The highest increase but also the highest supply the 4-fold of the EU average was found in Greece. The average per capita supply of vegetable oils increased in the EU during the past four decades. This trend was also observed in most participating countries. Here again, the highest per capita supplies were found in countries of South Europe (Spain, Greece and Italy). In these countries the high supply of vegetable oils is primarily determined by the generally high supply and consumption of olive oil in Mediterranean regions. In contrast to the increasing supply of vegetable fats, the average per capita supply of animal fats did not show any noticeable changes, only a slight increase was observed. In general, the total supply of meat increased in the EU average, but also in each participating country. Only the UK showed a decrease in the supply of nearly all meat varieties, except for poultry. Especially the supply of poultry showed a noticeable increase in the EU and all participating countries, but also the supply of red meat showed an increasing tendency. However, the mean supply of bovine meat in the EU in 2001 was about as high as it was in It showed an increasing tendency until the early 1990s and a decrease in the following years. The reason for this was probably the appearance of BSE (Bovine Spongiform Encephalopathy). Also the supply of mutton and goat did hardly change in the EU average. The average supply of fish and seafood in the EU increased during the observation period. The lowest supplies were found in countries of Central Europe. XI

12 Also the mean supply of milk and milk products in the EU increased in the past four decades. The supply of beer increased on average during the observation period, whereas the average supply of wine showed a decreasing tendency. The total energy supply increased in the EU from 14.6 to 17.1 MJ/capita/day and was thus clearly sufficient. In the period of the proportion of animal products in total energy supply was 28% and that of plant products 72%. The energy supply of animal products increased in the period of by 8%, that of plant products increased by 14%. The average absolute energy, fat and protein per capita supply in the EU increased during the period of The relative share of protein and alcohol in total energy supply remained at a consistent level (14 and 2 %E, respectively). The proportion of fat increased from 34 to 41 %E, that of carbohydrates decreased from 50 to 43 %E. The data derived from FAO food balance sheets often differ from nationally published data. Food Availability in the European Union on the Basis of Household Budget Surveys, Data from DAFNE Project The average availability of fruit and vegetables was particularly low in the UK and in Scandinavian countries. The average availability of meat and meat products, as well as of sugared soft drinks was in general high in European households. In countries participating in the DAFNE project the average availability of potatoes, cereals and cereal products, meat and meat products, and of added lipids 2 decreased with increasing educational level of the household head. The average availability of fruit and juices of fruit and vegetables was higher in households of higher educated household head. The average vegetable availability in South Europe was higher in household with a household head of elementary education compared to households with a household head of higher education. In Central and North Europe the opposite trend was observed. In countries with a high consumption of cheese, the average milk and milk products availability increased with increasing educational level of the household head, in those with a generally low consumption it decreased. 2 In the DAFNE food classification scheme, added lipids include animal lipids, vegetable fats and vegetable oils. The highest potato availability in the participating countries which also were part of the DAFNE project was observed in Portugal, the lowest in Italy. In all countries the average availability decreased with increasing educational level of the household head. Pulses were preferably consumed in South Europe. In general, households with household heads of low educational level recorded higher values. The same trend was observed for the availability of cereals and cereal products. The highest availability of this food group was observed in Italy. Finland recorded the highest availability values for milk and milk products, Belgium the lowest. A higher milk and milk product availability in households of lower education was observed in Austria, Finland, Norway and Spain, a higher availability in households of higher education in Belgium, Germany, Greece, Portugal and Norway. Greece and Belgium were the high consumers of cheese, which was on average preferred in households with higher education. Meat and meat products are commonly consumed in European households. In the late 1990s, the daily availability values ranged between 129 g/person (Norway) and 182 g/person (Austria). Disparities are also observed in the type of meat preferred in the different European regions. Poultry was particularly consumed in Spain and Hungary, processed meat in Central Europe. In general a decrease in the daily availability of meat and meat products was observed with increasing educational level of the household head. The highest fish and seafood availability was found in Portugal, followed by Spain, Norway and Greece. The lowest availability was found in Austria in and in Hungary in Urban areas had in general higher fish consumption. Greece recorded the highest vegetable availability, Finland and Norway the lowest. In South Europe elementary education of the household head was found to be associated with higher vegetable availability, whereas the reverse trend was found in Central and Northern Europe. The average fruit availability was also relatively high in Mediterranean countries, but it was also considerable in Austria and Germany. Apart from Austria, Italy and Spain, the highest fruit consumers were households with a household head of college or university education. The range of availability of fruit and vegetable juices was substantially large. In general, countries with high fruit availability had a lower availability of juices. Juices were preferably consumed by people living in households with a highly educated household head. XII Executive Summary

13 South European countries recorded the highest fruit and vegetable availability. Some Central European countries, however, seemed to be forging ahead, particularly in relation to the availability of fruit and juices of fruit and vegetables. The deficit however remained in the UK and in Scandinavian countries. The highest availabilities of total added lipids were noted in Greece, Italy and Spain, with olive oil being the predominant added lipid. In all countries lipid availability was higher among households of elementary education. In Hungary, Norway and Austria the highest availabilities of sugar and sugar products were recorded. The daily availability of soft drinks ranged from 38 ml/ person/day in Portugal (1995) to 202 ml/person/day in the UK (1999). Values should however be interpreted with caution, since beverages consumed out of the household are not included. The effect of education on the availability of soft drinks does not follow a constant pattern. Energy and Nutrient Intake in the European Union In the participating countries, the average share of fat in total energy intake was in general above the recommended level of 30 %E [Eurodiet, 2000]. That of protein was either within or also above the recommended range of %E. As a consequence of this, the mean proportion of carbohydrates was generally below the recommendation of Eurodiet ( 55 %E). The intake of sucrose was relatively high ( 10 %E) in nearly all population groups and countries. In contrast the mean intake of dietary fibre was too low. The average intake of saturated fatty acids was in the participating countries too high, whereas the intake of polyunsaturated fatty acids was low in many of the participating countries. The proportion of alcohol in total energy intake was particularly in men of most countries considerable. Food folate and vitamin D were critical micronutrients in all participating countries. In some countries inadequate intakes of potassium, calcium and iodine were observed. The average intake of iron was too low in women at fertile age of all participating countries. The sodium intake was in general too high. The methods used for nutritional assessment in the participating countries were various, and also the age groups were not uniform. Thus, a direct comparison was not aspired to in this report. Children In European children, the average share of protein in total energy intake was between 12 and 17%. In Germany this proportion was particularly low, in Spain it was relatively high compared to the other countries. Spanish children further had a low average carbohydrate intake (43 45 %E). In all other countries it was at least 50 %E or only slightly below. In Austrian and Norwegian boys and girls, and in Finnish infants, the share of this nutrient in total energy intake was particularly high. The average proportion of sucrose in total energy intake was apart from Finnish children aged 3 years or less higher than 10%. The mean proportion of fat in total energy was in children of the participating countries higher than 30%, and it was notably high in Spanish and Belgian children. The average intake of saturated fatty acids (SFA) was between 14 and 18 %E. Only in Italian and Hungarian children it was lower. Apart from Hungarian and German children, the average intake of polyunsaturated fatty acids (PUFA) was in this population group below the recommended level of the WHO. The mean intake of vitamin D and folate was in general low in children of the participating countries and mostly not satisfying. Further, insufficient potassium intakes were observed in Austrian, German, Hungarian and Italian children, and in Danish girls. In contrast, the sodium intake in children of some countries (especially Hungary and Italy) was already considerable, and in some countries even above 5 g/day. In the participating countries younger children had on average a more sufficient calcium intake than children of higher age groups. A low intake was observed in Austrian, German, Hungarian, Italian and Norwegian children. As expected, the average intake of iron was too low in girls at fertile age. Adolescents Apart from Spain and Austria, the average share of protein in total energy intake of adolescents was within the recommended range of the WHO (2003). The highest proportion of carbohydrates was found in Norwegian adolescents and corresponded to the recommended intake of at least 55 %E [Eurodiet, 2000]. In all the other countries it was clearly below this level, the lowest proportion to be found in Spain with only 42 %E. The average proportion of sucrose in total energy intake was above the level proposed by the WHO (2003) in all countries with data from adolescents. Sugar-sweetened Executive Summary XIII

14 beverages make a considerable contribution to total sucrose intake, not only in adolescents. Apart from Norwegian girls, the upper level of fat intake of Eurodiet (30 %E) was exceeded by all countries. The highest intake was observed in Spain. However, in Spain beside Norway the lowest proportion of SFA in total energy intake (%E) was recorded. On average the mean intake of PUFA (%E) was too low in European adolescents. The average cholesterol intake was in general higher in boys than in girls. The vitamin D intake was in general low, especially in Austrian male and female adolescents, and in Spanish female adolescents. In Norwegian male adolescents it was particularly high with an average of 5.4 µg/day. The mean folate intake was low and clearly below the recommended level of 400 µg/day [Eurodiet, 2000]. Female adolescents of all participating countries with data of adolescents had an insufficient potassium intake. In Austria and Germany it was also too low in boys. The supply of calcium was on average good. Only in Austrian adolescents the mean intake was too low. In some of the participating countries low magnesium intakes were observed as well. The iron intake was too low in female adolescents. Adults The average share of protein in total energy intake in adults was above the recommended upper level (15 %E, by Eurodiet, 2000) in some countries, whereas the mean carbohydrate intake in European adults was low. In Belgium and France it was even lower than 40 %E (compared to the recommended 55 %E, by Eurodiet, 2000). Apart from Hungary and the UK, the mean proportion of sucrose in total energy intake was relatively low in European men. As a consequence of the low proportion of carbohydrates (%E) the average intake of dietary fibre (g/day) was low in European adults, especially in women. The highest intakes were recorded in Germany, Portugal, Finland and Norway. On average, the fat intake in the participating countries was high (%E). The highest proportion of fat in total energy intake was found in Belgian men and women. In contrast, Portugal and Norwegian women had the lowest fat intakes (%E). The intake of SFA (%E) was very high in Austrian and Belgian adults, whereas in Italian and Portuguese adults it was relatively low. In many of the participating countries the average PUFA intake (%E) was below the recommended lower level of the WHO (2003). As a consequence of the high fat intake, the average intake of cholesterol (mg/day) was relatively high in the participating countries as well. In Hungary and in France the highest average cholesterol intakes were recorded, in both men and women. The intake of vitamins in European adults was in general relatively good. However, the vitamin D intake was low in UK and Swedish women (below 2 µg/day), but particularly high in Swedish men (6.3 µg/day) and Finnish men (6.3 µg/ day). The average folate intake was below the recommended level of 400 µg/day [Eurodiet, 2000] in men and women of all participating countries. Typical for the usual diet of industrial countries, the average estimated sodium intake (g/day) was relatively high in European adults, especially in Hungary and Italy. An insufficient intake of potassium (g/day) was more prevalent in women than in men. The mean supply of calcium was relatively good in European adults. Only in Austria, Hungary and the UK low calcium intakes were observed. Apart from Portugal, the average iron intake in women was clearly below the guideline of 15 mg/day [Eurodiet, 2000]. The average iodine intake was particularly high in adults of Finland and the UK. Elderly The share of protein in total energy intake was in European elderly in general within the recommended range of the WHO (2003). Like in adults, the average intake of carbohydrates (%E) was too low and that of fat too high. The carbohydrate intake was particularly low in Belgian and Danish elderly men. The average sucrose intake was above the recommended upper level of 10%E [WHO, 2003] in Germany, Greece and the UK. Especially in the countries with a high total fat intake, the average intake of SFA (%E) was very high. The PUFA (%E) intake was in general too low in European elderly. The vitamin A intake in elderly of the participating countries was on average sufficient. Only in Hungarian elderly it was clearly below the recommendations. The mean vitamin D intake was below the recommended intake of 10 µg/day [Eurodiet, 2000] in elderly men and women of all participating countries. The highest mean intakes were found in Norwegian and Austrian elderly men. Low intakes of riboflavin were more prevalent in male than in female elderly. The mean folate intake was among women and men of all countries below the recommended level of 400 µg/day. Like in adults, the mean estimated sodium intake was relatively high in European elderly, especially in Hungarian men and Italian elderly of both sexes. The mean supply of potassium was not sufficient in elderly of most participating countries. In Austrian, Hungarian and Spanish elderly the average calcium intake was below the recommended level of 800 mg/day [Eurodiet, 2000]. XIV Executive Summary

15 Health Indicators and Status in the European Union The prevalence of overweight and obesity in the participating countries was very high. It was already considerable in childhood. The average blood cholesterol levels were in general elevated. In some countries the amount of exercise and the proportion of people doing exercise were assessed and were in most of them low. The proportion of smokers in the participating countries was high and increased in most countries between 1995 and The prevalence of overweight and obesity is already considerable in children. In Spanish boys the prevalence of obesity was particularly high with more than 20%. In European girls overweight and obesity were less prevalent than in European boys of the corresponding age group. In adult men of the participating countries which had data about overweight and obesity, the prevalence of overweight was between 35 and 53%, in women between 20 and 35%. The prevalence of obesity was on average between 6 and 26% and 6 and 31%, respectively. The highest percentage of overweight and obese men and women was recorded in Greece. In European adults the total blood cholesterol level was on average too high, whereas the status of HDL-cholesterol was relatively good. The quotient of total cholesterol to HDL-cholesterol was within the recommended range (3 5) in all countries. The serum LDL-cholesterol concentration was on average too high in European adults. Cardiovascular diseases (CVD) are the leading cause of death in European countries. Most death cases due to CVD can be attributed to cardiac heart disease, followed by cerebrovascular disease. Malignant neoplasms are the second most prevalent reason for death in the participating countries. The incidence of cancer was in 2001 on average higher in men than in women. In men, the most prevalent types of cancer were lung and prostate cancer, in women it was breast cancer. The prevalence of malignant neoplasms of the lung was in men clearly more prevalent than in women. However, it has to be considered that the amount of smokers in women has noticeably increased during the past years and that in the future the prevalence of lung cancer in women might not differ very much from that in men. The proportion of smokers in men as well as in women is relatively high in the participating countries. On average it was higher in men than in women. Apart from Denmark and Belgium, the prevalence of smokers increased in the participating countries during the period of Executive Summary XV

16 Outlook The description of dietary habits, nutrient and food intake, and health status of people of the participating countries was not the only aim of the European Nutrition and Health Report. It should also be a basis for other projects or assessments, which will be accomplished in the future. Concerning the outcomes of the presented data, the most prevalent inadequacies in health and dietary lifestyle are: A too low availability (and in some countries intake as well) of fruits and vegetables, despite an increasing supply of these food groups. A too high supply and availability of meat and meat products. A generally too high intake of fat, especially of saturated fatty acids. A generally low intake of complex carbohydrates and, consequently, a low intake of dietary fibre. A relatively high proportion of sucrose in carbohydrate intake in most population groups and countries. A generally inadequate intake of some vitamins (especially vitamin D and folate). A generally inadequate intake of some minerals (e.g. calcium, iodine, and iron in women). A generally too high intake of sodium (particularly in the form of table salt). A generally high intake of alcohol, particularly in men. An alarming high prevalence of overweight and obesity. A low amount of exercise and low proportion of people doing regular exercise in some countries. A high proportion of smokers, which even shows an increasing tendency in most participating countries. In order to obtain comparable data for future European nutrition and health reports, the following goals should be considered for further assessments: Standardised methods for the assessment of nutritional status, including food and nutrient intake, should be used (e.g. according to the suggestions of the EFCOSUM group). For the assessment of overweight and obesity a consistent method should be considered (preferably measured data should be used). For children uniform cut-off points for the definition of overweight and obesity should be chosen. A standardised method for the assessment of physical activity should be used (e.g. International Physical Activity Questionnaire 3 ). Uniform age groups should be used. Uniform educational levels should be used. Reference values for nutrient intake valid for whole Europe should be updated including also aspects of health promotion and disease prevention. 3 More details to the International Physical Activity Questionnaire can be found at (accessed September 7, 2004). XVI