Is the Decade of Action on Nutrition (2016-2025) leaving a footprint? Taking stock and looking ahead

[Extract]. Thanks to the strong leadership of Brazil, among others, the United Nations (UN) Decade of Action on Nutrition (“Nutrition Decade”) was proclaimed in 2016 by the UN General Assembly. The Nutrition Decade reaches its mid-term in 2020. The time has come to review the progress made so far in the six action areas of the Nutrition Decade’s Work Programme and identify areas in need of accelerated action and priority investment during the remaining period until 2025. Advocacy efforts during the first half of the Nutrition Decade on the importance of nutrition, healthy diets, and food systems for human and planetary health are showing results. The evidence of unhealthy diet and malnutrition being a key risk factor for disease and death globally is unequivocal. Global attention to the critical role of sustainable, resilient food systems for healthy diets and improved nutrition has never been as prominently present as we are observing today. Brazil is one of the first countries to recognize agroecology and biodiversity, and incorporate sustainability issues in their innovative, holistic national food-based dietary guidelines. A clear understanding of the effective interventions to be delivered by health systems has emerged. Voluntary or mandatory reformulation of processed food products is increasingly implemented by food industry stakeholders. More and more scientists break silos and work collectively across different sectors towards offering models to better predict impact of actions or inaction on nutrition, design more effective and innovative solutions to address malnutrition in all its forms and define appropriate metrics to monitor progress and ensure accountability.

Dietary assessment methods in surveillance systems targeted to adolescents: A review of the literature.

AIMS: The present paper aims to identify ongoing multinational surveillance systems (SURSYSs) assessing diet and nutrition targeted to adolescents, including European surveys involving multiple countries and similar initiatives conducted in non-European countries with developed economies, and to describe the dietary assessment methods used. DATA SYNTHESIS: A total of 13 SURSYSs conducted in Europe, USA, Canada, Australia and New Zealand were identified. Dietary assessment methods commonly used include 24-h recalls (24H-Rs) and questionnaires or interviews. Food frequency questionnaires (FFQs) are used in combination with 24H-Rs in six SURSYSs: only FFQs are used in four SURSYSs; 24H-Rs only in one system and a 24H-R in combination with a general questionnaire/interview in one SURSYS. Eleven systems collect information also on some dietary habits and ten systems on other nutritional indicators such as anthropometric and/or biochemical measures. The FFQs used are not homogeneous and often include limited food or beverage items such as fruits and vegetables or sugar-sweetened beverages. In seven systems, foods specifically consumed by adolescents, such as fast food or snacks, are not assessed; instead, a total of seven systems collect data on supplement intake and just in very few cases on fats, legumes and/or water. CONCLUSIONS: This study detected considerable variability across the systems identified, suggesting the need for a SURSYS targeted to adolescents that gathers as much as possible complete dietary information, with standardised methodology and regular periodicity. The detailed information provided by this review could be useful to national authorities for the choice of protocols to be applied in their own national surveys.

Potential health impact of strong tobacco control policies in 11 South Eastern WHO European Region countries.

Background: While some WHO European Region countries are global tobacco control leaders, the South Eastern region of Europe has the highest tobacco smoking prevalence globally and a relatively low level of overall implementation of the WHO Framework Convention on Tobacco Control (WHO FCTC). An abridged version of SimSmoke has been developed to project the health impact of implementing tobacco control policies in line with the WHO FCTC. Methods: Data on population size, smoking prevalence, policy-specific effect sizes and formulas were applied in 11 South Eastern WHO European Region countries [Albania, Bosnia and Herzegovina (the Federation of Bosnia and Herzegovina and the Republika Srpska), Bulgaria, Croatia, Israel, Montenegro, Republic of Moldova, Romania, Serbia, Slovenia and the former Yugoslav Republic of Macedonia] to project the relative reduction in smoking prevalence, number of smokers and number of smoking-attributable deaths resulting from implementing individual and/or combined six WHO FCTC measures. Results: For all countries, an increase in excise cigarette taxes to 75% of price yields the largest relative reduction in smoking prevalence (range 8-28%). The projections show that within 15 years smoking prevalence can be reduced by at least 30% in all countries when all six tobacco control measures are fully implemented in line with the WHO FCTC. Conclusion: The projections show that large health effects can be achieved and the results can be used as an advocacy tool towards acceleration of the enforcement of tobacco control laws in WHO European Region countries.

Secondhand smoke exposure at home among one billion children in 21 countries: findings from the Global Adult Tobacco Survey (GATS).

OBJECTIVE: Children are vulnerable to secondhand smoke (SHS) exposure because of limited control over their indoor environment. Homes remain the major place where children may be exposed to SHS. Our study examines the magnitude, patterns and determinants of SHS exposure in the home among children in 21 countries (19 low-income and middle-income countries and 2 high-income countries). METHODS: Global Adult Tobacco Survey (GATS) data, a household survey of people 15 years of age or older. Data collected during 2009-2013 were analysed to estimate the proportion of children exposed to SHS in the home. GATS estimates and 2012 United Nations population projections for 2015 were also used to estimate the number of children exposed to SHS in the home. RESULTS: The proportion of children younger than 15 years of age exposed to SHS in the home ranged from 4.5% (Panama) to 79.0% (Indonesia). Of the approximately one billion children younger than 15 years of age living in the 21 countries under study, an estimated 507.74 million were exposed to SHS in the home. China, India, Bangladesh, Indonesia and the Philippines accounted for almost 84.6% of the children exposed to SHS. The prevalence of SHS exposure was higher in countries with higher adult smoking rates and was also higher in rural areas than in urban areas, in most countries. CONCLUSIONS: A large number of children were exposed to SHS in the home. Encouraging of voluntary smoke-free rules in homes and cessation in adults has the potential to reduce SHS exposure among children and prevent SHS-related diseases and deaths.

Breastfeeding practices and policies in WHO European Region Member States.

OBJECTIVE: To provide an update on current practices and policy development status concerning breastfeeding in the WHO European Region. DESIGN: National surveys and studies conducted by national health institutions were prioritized. Sub-national data were included where no national data or studies existed. Information on national breastfeeding policies was collected mainly from the WHO Seventh Meeting of Baby-Friendly Hospital Initiative Coordinators and European Union projects. Owing to the different data sources and methods, any comparisons between countries must be made with caution. SETTING: WHO European Member States. RESULTS: Data from fifty-three WHO European Member States were investigated; however, a large proportion had not reported any data. Rates of early initiation of breastfeeding, exclusive breastfeeding and continued breastfeeding to 1 year all varied considerably within the WHO European Region. Exclusive breastfeeding rates declined considerably after 4 months, and were low in infants under 6 months and at 6 months of age. The majority of the countries with existing data reported having a national infant and young child feeding policy and the establishment of a national committee on breastfeeding or infant and young child feeding. The majority of the countries with existing data reported having baby-friendly hospitals, although the proportion of baby-friendly hospitals to the total number of national hospitals with maternity units was low in most countries. CONCLUSIONS: Breastfeeding practices within the WHO European Region, especially exclusive breastfeeding rates, are far from complying with the WHO recommendations. There are marked differences between countries in breastfeeding practices, infant and young child feeding policy adoption and proportion of baby-friendly hospitals.

WHO European Childhood Obesity Surveillance Initiative: health-risk behaviours on nutrition and physical activity in 6-9-year-old schoolchildren.

OBJECTIVE: To assess to what extent eight behavioural health risks related to breakfast and food consumption and five behavioural health risks related to physical activity, screen time and sleep duration are present among schoolchildren, and to examine whether health-risk behaviours are associated with obesity. DESIGN: Cross-sectional design as part of the WHO European Childhood Obesity Surveillance Initiative (school year 2007/2008). Children's behavioural data were reported by their parents and children's weight and height measured by trained fieldworkers. Descriptive statistics and logistic regression analyses were performed. SETTING: Primary schools in Bulgaria, Lithuania, Portugal and Sweden; paediatric clinics in the Czech Republic. SUBJECTS: Nationally representative samples of 6-9-year-olds (n 15 643). RESULTS: All thirteen risk behaviours differed statistically significantly across countries. Highest prevalence estimates of risk behaviours were observed in Bulgaria and lowest in Sweden. Not having breakfast daily and spending screen time ≥2 h/d were clearly positively associated with obesity. The same was true for eating 'foods like pizza, French fries, hamburgers, sausages or meat pies' >3 d/week and playing outside <1 h/d. Surprisingly, other individual unhealthy eating or less favourable physical activity behaviours showed either no or significant negative associations with obesity. A combination of multiple less favourable physical activity behaviours showed positive associations with obesity, whereas multiple unhealthy eating behaviours combined did not lead to higher odds of obesity. CONCLUSIONS: Despite a categorization based on international health recommendations, individual associations of the thirteen health-risk behaviours with obesity were not consistent, whereas presence of multiple physical activity-related risk behaviours was clearly associated with higher odds of obesity.

WHO European Childhood Obesity Surveillance Initiative: associations between sleep duration, screen time and food consumption frequencies.

BACKGROUND: Both sleep duration and screen time have been suggested to affect children's diet, although in different directions and presumably through different pathways. The present cross-sectional study aimed to simultaneously investigate the associations between sleep duration, screen time and food consumption frequencies in children. METHODS: The analysis was based on 10 453 children aged 6-9 years from five European countries that participated in the World Health Organization European Childhood Obesity Surveillance Initiative. Logistic multilevel models were used to assess associations of parent-reported screen time as well as sleep duration (exposure variables) with consumption frequencies of 16 food items (outcome variables). All models were adjusted for age, sex, outdoor play time, maximum educational level of parents and sleep duration or screen time, depending on the exposure under investigation. RESULTS: One additional hour of screen time was associated with increased consumption frequencies of 'soft drinks containing sugar' (1.28 [1.19;1.39]; odds ratio and 99% confidence interval), 'diet/light soft drinks' (1.21 [1.14;1.29]), 'flavoured milk' (1.18 [1.08;1.28]), 'candy bars or chocolate' (1.31 [1.22;1.40]), 'biscuits, cakes, doughnuts or pies' (1.22 [1.14;1.30]), 'potato chips (crisps), corn chips, popcorn or peanuts' (1.32 [1.20;1.45]), 'pizza, French fries (chips), hamburgers'(1.30 [1.18;1.43]) and with a reduced consumption frequency of 'vegetables (excluding potatoes)' (0.89 [0.83;0.95]) and 'fresh fruits' (0.91 [0.86;0.97]). Conversely, one additional hour of sleep duration was found to be associated with increased consumption frequencies of 'fresh fruits' (1.11 [1.04;1.18]) and 'vegetables (excluding potatoes)' (1.14 [1.07;1.23]). CONCLUSION: The results suggest a potential relation between high screen time exposure and increased consumption frequencies of foods high in fat, free sugar or salt whereas long sleep duration may favourably be related to children's food choices. Both screen time and sleep duration are modifiable behaviours that may be tackled in childhood obesity prevention efforts.

National physical activity recommendations: systematic overview and analysis of the situation in European countries.

BACKGROUND: Developing national physical activity (PA) recommendations is an essential element of an effective national approach to promote PA. METHODS: Systematic overview and analysis of national PA recommendations across the European Region of the World Health Organization (WHO). The WHO European national information focal points provided information which was complemented through online searches and input from other experts. RESULTS: Information received until summer 2012 from 37 countries was analyzed. Sixteen countries did not have national recommendations while 21 countries did. For 17 countries, the source document was accessible. Seventeen recommendations referred to adults, 14 to young people and 6 to older adults. Most national recommendations for children and young people are quite similar: 12 countries recommend at least 60 minutes of moderate- to vigorous-intensity PA each day, in line with the WHO global recommendation. Three countries recommend longer durations and one a lower one. In some countries, slight variations were found regarding the recommended intensity and minimum bouts. Only one country was fully in line with the WHO recommendations. Two countries have issued separate recommendations for pre-school children. For adults, most countries still follow the 1995 United States recommendations of "at least 30 minutes on 5 days a week". Three countries were fully in line with the WHO recommendations. Four countries give specific recommendations on reducing weight, avoiding weight gain or continuing weight maintenance. The six identified national PA recommendations for older adults are mainly similar to those for adults but underline that particularly for this age group also less activity has important health benefits; four countries also recommend balance training. CONCLUSIONS: About half of the countries for which information was available and likely less than 40% of all 53 countries in the WHO European Region have developed national PA recommendations. Further investment is needed to address this important step towards a comprehensive PA promotion approach. Much remains to be done for the 2010 WHO recommendations to be fully reflected in national documents across all parts of the Region and all age groups. In addition, avoiding extended periods of inactivity and overweight are only addressed by a minority of countries yet.

WHO European Childhood Obesity Surveillance Initiative: School nutrition environment and body mass index in primary schools.

BACKGROUND: Schools are important settings for the promotion of a healthy diet and sufficient physical activity and thus overweight prevention. OBJECTIVE: To assess differences in school nutrition environment and body mass index (BMI) in primary schools between and within 12 European countries. METHODS: Data from the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative (COSI) were used (1831 and 2045 schools in 2007/2008 and 2009/2010, respectively). School personnel provided information on 18 school environmental characteristics on nutrition and physical activity. A school nutrition environment score was calculated using five nutrition-related characteristics whereby higher scores correspond to higher support for a healthy school nutrition environment. Trained field workers measured children's weight and height; BMI-for-age (BMI/A) Z-scores were computed using the 2007 WHO growth reference and, for each school, the mean of the children's BMI/A Z-scores was calculated. RESULTS: Large between-country differences were found in the availability of food items on the premises (e.g., fresh fruit could be obtained in 12%-95% of schools) and school nutrition environment scores (range: 0.30-0.93). Low-score countries (Bulgaria, Czech Republic, Greece, Hungary, Latvia and Lithuania) graded less than three characteristics as supportive. High-score (≥0.70) countries were Ireland, Malta, Norway, Portugal, Slovenia and Sweden. The combined absence of cold drinks containing sugar, sweet snacks and salted snacks were more observed in high-score countries than in low-score countries. Largest within-country school nutrition environment scores were found in Bulgaria, Czech Republic, Greece, Hungary, Latvia and Lithuania. All country-level BMI/A Z-scores were positive (range: 0.20-1.02), indicating higher BMI values than the 2007 WHO growth reference. With the exception of Norway and Sweden, a country-specific association between the school nutrition environment score and the school BMI/A Z-score was not observed. CONCLUSIONS: Some European countries have implemented more school policies that are supportive to a healthy nutrition environment than others. However, most countries with low school nutrition environment scores also host schools with supportive school environment policies, suggesting that a uniform school policy to tackle the "unhealthy" school nutrition environment has not been implemented at the same level throughout a country and may underline the need for harmonized school policies.

WHO European Childhood Obesity Surveillance Initiative: body mass index and level of overweight among 6-9-year-old children from school year 2007/2008 to school year 2009/2010.

BACKGROUND: The World Health Organization (WHO) Regional Office for Europe has established the Childhood Obesity Surveillance Initiative (COSI) to monitor changes in overweight in primary-school children. The aims of this paper are to present the anthropometric results of COSI Round 2 (2009/2010) and to explore changes in body mass index (BMI) and overweight among children within and across nine countries from school years 2007/2008 to 2009/2010. METHODS: Using cross-sectional nationally representative samples of 6-9-year-olds, BMI, anthropometric Z-scores and overweight prevalence were derived from measured weight and height. Significant changes between rounds were assessed using variance and t-tests analyses. RESULTS: At Round 2, the prevalence of overweight (including obesity; WHO definitions) ranged from 18% to 57% among boys and from 18% to 50% among girls; 6 - 31% of boys and 5 - 21% of girls were obese. Southern European countries had the highest overweight prevalence. Between rounds, the absolute change in mean BMI (range: from -0.4 to +0.3) and BMI-for-age Z-scores (range: from -0.21 to +0.14) varied statistically significantly across countries. The highest significant decrease in BMI-for-age Z-scores was found in countries with higher absolute BMI values and the highest significant increase in countries with lower BMI values. The highest significant decrease in overweight prevalence was observed in Italy, Portugal and Slovenia and the highest significant increase in Latvia and Norway. CONCLUSIONS: Changes in BMI and prevalence of overweight over a two-year period varied significantly among European countries. It may be that countries with higher prevalence of overweight in COSI Round 1 have implemented interventions to try to remedy this situation.

Overview of 71 European community-based initiatives against childhood obesity starting between 2005 and 2011: general characteristics and reported effects.

BACKGROUND: Community-based initiatives (CBIs) on childhood obesity are considered a good practice approach against childhood obesity. The European Commission called for an overview of CBIs implemented from 2005-2011. A survey was executed by the National Institute for Public Health and the Environment of the Netherlands, in collaboration with the World Health Organization Regional Office for Europe. The objective of this paper is to provide an overview of the European CBIs, as identified in the survey, presenting their general characteristics, applied strategies (separately for actions targeting the environment and/or directly the children's behaviour) and the reported effects on weight indicators. METHODS: Potentially eligible CBIs were identified by informants in 27 European Union countries, Iceland, Liechtenstein, Norway, and Switzerland, and through desk research. School based approaches could be included if they complied with criteria related to being 'community-based'. In total, 278 potential eligible CBIs were identified and of these, 260 projects were approached. For 88 an electronic questionnaire was completed; of these 71 met all criteria. The included projects were reported by 15 countries. RESULTS: 66% of the 71 CBIs implemented actions in more than one setting or throughout the neighbourhood. Most frequently reported environmental actions were professional training (78%), actions for parents (70%), and changing the social (62%) and physical (52%) environment. Most frequently reported educational activities were group education (92%), general educational information (90%), and counselling sessions (58%). The vast majority (96%) implemented both environmental and individual strategies and about half of the CBIs reported a public-private partnership. Eight CBIs provided evidence supporting positive effects on weight indicators and/or overweight prevalence in a general population of children (aged 6 to 12 yrs), and one CBI did not support this. Two of those CBIs were also conducted among adolescents (aged 12 to 16,5 yrs), but showed no effect in this age-group. CONCLUSIONS: Despite diversity of included CBIs, common characteristics were the application of integrated actions at a local level, aimed at changing the environment and the children's behaviour directly. Evidence supporting effectiveness on weight indicators is available, although the design and conduct of most of these studies were suboptimal (i.e. no control group, a small sample size, not random).

WHO European Childhood Obesity Surveillance Initiative: implementation of round 1 (2007/2008) and round 2 (2009/2010)

Nutritional surveillance in school-aged children, using measured weight and height, is not common in the WHO European Region. At the first consultation with Member States in the process leading to the WHO European Ministerial Conference on Counteracting Obesity in 2006, Member States recognized the need for harmonized surveillance systems among primary-school children on which policy development within the Region could be based. Establishment of the WHO European Childhood Obesity Surveillance Initiative (COSI) by the WHO Regional Office for Europe was a response to this need. COSI aims to measure trends in overweight and obesity in children aged 6.0–9.9 years in order to monitor the progress of the epidemic and to reverse it, and to make intercountry comparisons within the Region. This is the first official WHO report on the implementation of COSI during two data collection rounds (school years 2007/2008 and 2009/2010) in 16 participating countries. This document uses the strengths, weaknesses, opportunities and threats technique to evaluate the implementation and reports the experiences gained, the challenges encountered and the obstacles overcome by countries participating in COSI.

Nutritional and pubertal status influences accuracy of self-reported weight and height in adolescents: the HELENA Study.

BACKGROUND AND AIMS: The aim of this study was to assess factors that have an effect on the accuracy of self-reported weight and height in adolescents. METHODS: Weight and height of 3,865 European adolescents aged 12.5 to 17.5 years were self-reported via specific questionnaire. Then real weight and height were measured using accurate equipment and standardized protocols. Differences (D) between self-reported and measured weight and height were calculated, and factors that could have influenced the accuracy of self-reported weight and height were assessed. Data were analyzed using ANOVA, Student's t test and multivariate regression. RESULTS: Adolescents underestimated their weight (D = -0.81 kg; n = 2,968) and overestimated their height (D = +0.74 cm; n = 3,308). Obese girls underestimated their weight (D = -4.70 kg) and overestimated their height (D = +0.22 cm) to a greater extent (p < 0.05) than obese boys (D = -3.13 kg and +0.14 cm for weight and height, respectively). Underestimation of weight (D = -1.25 kg) and overestimation of height (D = +0.15 cm) were only significant for girls who had finished puberty (Tanner stage 5). Socioeconomic status, nutritional knowledge, physical fitness, physical activity level, food choice and preference, and healthy eating behaviour had no significant influence on the accuracy of self-reported weight and height. CONCLUSION: Our data confirms that self-reports of weight and height made by adolescents are inaccurate and demonstrate that inaccuracy is strongly influenced by nutritional status, pubertal status and gender.

EURRECA/WHO workshop report: 'Deriving Micronutrient Recommendations: Updating Best Practices'.

This paper describes the outcome of the workshop 'Deriving Micronutrient Recommendations: Updating Best Practices' which took place in Brussels in April 2012. The workshop was organised jointly by the European Micronutrient Recommendations Aligned (EURRECA) Network of Excellence and the World Health Organization (WHO) Regional Office for Europe. The delegates included, among others, representatives from nutrient recommendation setting bodies (NRSBs) across Europe. The current paper focuses on the gaps and needs of NRSBs as identified by the workshop participants: (i) practical tools and best practices to adapt dietary reference values, (ii) comparable nationally representative food consumption data (including updated and complete food composition databases), (iii) adequate financial resources and technical capacity, (iv) independence and transparency in expert selection, research conduct and communication of research results and (v) clear correspondence of terminology used at national levels.

Validity of dietary patterns to assess nutrient intake adequacy.

The purpose of the present study was to conduct a systematic review of the literature on the value of the methods used to assess dietary patterns for measuring nutrient intake adequacy in the population. Systematic review on Pubmed database up to April 2008. The search included specific key words and MeSH terms. No language limit was set. Only studies that compared food patterns with nutrient intake adequacy or nutrient biomarkers were included in the analysis. The search resulted in 1504 articles. The inclusion and exclusion criteria limited the selection to thirty articles. Nineteen studies evaluated the usefulness of the dietary patterns, either a priori defined (thirteen studies), or defined by factor analysis (four studies) or by cluster analysis (two studies), but only nine of them tested their validity (four a priori defined and four a posteriori defined). Diet indices showed moderate to good validity results for measuring the adequacy of intakes for alpha-carotene, beta-carotene, vitamin C, vitamin B6, Ca, folic acid, Fe and Mg. The factor analysis approach showed moderate to good validity correlations with the adequacy of intake of alpha-carotene, beta-carotene, lutein, lycopene, vitamin C, vitamin B6 and folic acid. Vitamin B12 and vitamin E are the micronutrients with less probability of being adequately assessed with dietary patterns a priori or a posteriori defined. Diet indices are tools with fair to moderate validity to assess micronutrient intake adequacy.

How is the adequacy of micronutrient intake assessed across Europe? A systematic literature review.

EURopean micronutrient RECommendations Aligned is a network of excellence funded by the European commission, and established to address the problem of differences between countries in micronutrient recommendations as well as to understand how nutritional information including requirements and adequacy of intake is processed among different population groups. The aims of the present paper were to review the methods used for the adequacy assessment of the intake of six micronutrients of public health concern (vitamin A, folate, vitamin B12, Fe, Zn and iodine) in non-European and European nutrition surveys carried out on the apparently healthy population and to compare in particular the adequacy across surveys for folate intake. A systematic literature review was conducted to identify nutrition surveys that assessed micronutrient intake adequacy. The search yielded 9049 records, out of which 337 were eligible for the selected micronutrients. The majority (83.9 %) of the European surveys compared the adequacy of the nutrient intake against the Recommended Dietary Allowances (RDA); only a few surveys (8.0 %) used the estimated average requirement cut-point method, while none of them used the probability approach. The comparison of folate inadequacy across eight countries revealed that about 25 % of the adult female population had inadequate intakes when judged against the different recommendations used by the respective investigators, but nearly 75 % had inadequate intakes when compared against the estimated average requirement cut-point value of 320 microg/d. The present review showed that different methods were applied across Europe to estimate the adequacy of micronutrient intake, which led to different prevalence estimates of micronutrient inadequacy.

How to find information on national food and nutrient consumption surveys across Europe: systematic literature review and questionnaires to selected country experts are both good strategies.

The present research was conducted within the framework of the EURopean micronutrient RECommendations Aligned project. In order to identify the best practice in assessing nutrient intakes, a search strategy for collecting data from national food consumption surveys/studies in Europe was developed. Systematic literature searches were carried out on twenty-eight European and the four European Free Trade Association countries. A questionnaire was also sent to two to five experts in each country. Systematic reviews using PubMed yielded 12 703 abstracts that were reduced to 200 studies using inclusion and exclusion criteria. Similarly, a search of ministry web sites yielded 3033 hits, and subsequently reduced to nine surveys. Belgium, France, Germany, Ireland, Sweden, Spain and the United Kingdom were the countries with most data and Slovenia and Liechtenstein were those with the least. Seventy-eight expert questionnaires were obtained from all countries except for Liechtenstein, Luxembourg and Slovakia. Detailed results and references are given. A systematic search and questionnaires are equally good at identifying national surveys across countries. Literature searching provides globally accessible and objective information albeit limited, whereas the questionnaire provides information that, depending upon responders, can be more complete. A combination of both strategies is recommended.

How does the quality of surveys for nutrient intake adequacy assessment compare across Europe? A scoring system to rate the quality of data in such surveys.

Research was conducted within the EURopean micronutrient RECommendations Aligned (EURRECA) Network of Excellence, to find the best practice in assessing nutrient intakes. Objectives include: to search for and use data on individual nutrient intake adequacy (NIA) assessment collected in twenty-eight European countries and the four European Free Trade Association countries; to design and test innovative tools for data quality analysis. The information was obtained using the method described by Blanquer et al. in the present issue. The best-practice criteria were devised to select the most appropriate survey in each country. Then a survey quality scoring system was developed in consultation with experts and tested on these surveys. Weights were allocated according to a variable priority order agreed by consultation. The thirty-two countries yielded twenty-four national surveys (eight countries excluded). Data collection techniques: eleven countries/surveys used personal interviews only; six used combinations of techniques. Dietary assessment methods: two used repeated 24 h recalls only; eleven used combinations. NIA assessment methods: two used probabilistic approach and sd/Z-scores only; eleven used comparison with estimated average requirements/RDA only. Countries were ranked according to the survey quality scoring, but careful interpretation is needed because of incomplete data from some surveys; bearing this in mind, the information quality is high in 37.5 % countries, medium in 50.0 % and low in 12.5 %. Although there is room for improvement and caution should be taken when drawing conclusions and recommendations from these results, the lessons learned and tools developed at this first attempt form the basis for future work within the EURRECA framework for aligning European micronutrient recommendations.