Patterns of food and nutrient intakes in Italy were estimated starting from a nationwide food survey carried out by the National Institute of Nutrition (NIN) in 1994–6, called INN-CA 1995. The present analysis looks at food and nutrient intakes of the subsample of the adults (18–60-year-old individuals). In particular, the two extreme quartiles of the distribution of total fat intake expressed as percentage of energy were considered in the analysis. The results showed that the subjects included in the fourth quartile (high-fat consumers) consumed fewer vegetables than the subjects in the first quartile (low-fat consumers). Furthermore, high-fat consumers had a tendency to have an unbalanced diet, whereas the low-fat consumers present a better pattern. In synthesis, 50% of the adults reach the goal of at least 400g of vegetables and fruit daily, and 25% consume less than 30 % of energy from total fats. Convincing that part of the population whose diet does not comply with dietary goals to come back to the Mediterranean tradition might be a priority for nutrition education in Italy.

Dietary intake characteristics were studied among 3833 adults of the second Dutch National Food Consumption Survey held in 1992. The subjects were classified into three groups based on their intake of total fat (% energy), saturated fatty acids (% energy), dietary fibre (g/MJ), and fruit and vegetables (g/d). All the classifications resulted in differences in energy intake. Except for dietary fibre, the mean energy intake was higher in the higher-intake tertiles. For the classification based on total fat, saturated fatty acids and dietary fibre the more prudent diets were accompanied with a lower energy-intake. As to the consumption of food groups, differences existed in both the proportion of consumers and in the mean consumption among users. It is concluded that the trends observed are probably more important than the actual figures.

The aim of the present study was to analyse the different food and nutrition profiles of the section of the Spanish population having either a low or a high intake of energy, fat, saturated fatty acids (SFA) and fibre in order to analyse the compliance with dietary guidelines. Analyses were made from the Catalan Nutrition Survey, comprising a random sample of 1600 people aged 18 to 60. Dietary information was obtained by means of two 24 h recall, and food and energy intake was categorized according to the quartiles of fat, SFA and fibre intake. The results show the food consumption patterns that distinguish low versus high fat, SFA and fibre eaters in the Spanish population, and facilitate the establishment of food-based dietary guidelines in Spain and other Mediterranean countries.

Presently, no national dietary guidelines — neither food- nor nutrient-based — exist for Austria. Usually, the recommendations of the German Society of Nutrition are used instead. The determination of national characteristics of nutritional behaviour and food consumption can reveal starting-points for the improvement of nutritional status in Austria. Seven-day weighed records (children and adolescents, n = 2.173) and 24-h-recalls (adults, n = 2.488) were used for the evaluation of nutrient intake and food consumption. For a sub-sample of children and adolescents, results from laboratory assessment of biomarkers were also available (n = 1.400). Based on fat intake, the age groups were divided into low fat intake (less than 25th percentile = 28–34 % fat energy) and high-fat eaters (greater than 75th percentile = 38–45 % fat energy). Approximately 75 % of the Austrian population have fat intakes above 30 % of energy intake, older age groups having a higher prevalence of high fat intakes. Intakes of saturated fatty acids reach 40–46 % of total fat. The usual intake of dietary fibre in the Austrian population is between 17–21 g/d; some individuals are able to achieve the recommended intakes for dietary fibre, but do not represent a significant majority of the population. The mean intakes of fruits are clearly higher in children and adolescents (10 % of total food intake) than in adults (2–6 %). Differences in the intake of selected nutrients in foods between low and high fat consumers, unexpectedly, did not result in different plasma concentrations of cholesterol, nor did it result in differences in fat soluble vitamins. Therefore, one of the primary dietary guidelines for Austria should be the reduction of fat consumption, which is also associated with increasing intakes of fruits and vegetables, increasing intakes of dietary fibre and decreasing intakes of cholesterol.

In March 1997, official dietary guidelines were for the first time published in Belgium by the National Council on Nutrition. These guidelines are entirely focussed on nutrient intake and do not translate this information into specific ‘food-based’ recommendations. In this paper, actual intake data for the adult Belgian population are compared to these guidelines. It is concluded that the overall macronutrient intake pattern in Belgium corresponds to the typical Western so-called affluent diet. As a next step, an attempt is made to outline a conceptual framework for developing food-based dietary guidelines on the basis of existing food consumption databases. For that purpose, nutrient and food intake profiles — percentage of consumers and mean intakes for the total population and for consumers only — are studied for subgroups of the population that do or do not comply to predefined dietary goals for total fat intake, fibre intake, and fruit and vegetable intake. Finally, it is shown with an example that these data can be used as a basis for formulating healthy food recommendations towards the general population in terms of specific foods or food groups to be avoided or to be chosen preferably. The food and nutrient intake data used in this paper are from the BIRNH study (Belgian Interuniversity Research on Nutrition and Health, 1980–1984), the only nationwide food consumption survey on an individual level ever carried out in Belgium.

Food-based dietary guidelines in Denmark have usually been expressed in simple terms only and need to be elaborated. Quantitative recommendations on fruit and vegetable intake were issued in 1998, recommending 600 g/d (potatoes not included). This paper is based on a national dietary survey in 1995 (n = 3098, age range 1–80 years) supplemented with data from a simple frequency survey in 1995 (n = 1007, age range 15–80 years) and from the first national survey in 1985 (n = 2242, age range 15–80 years). Only data on adults are included in this paper. Fat intake, saturated fat in particular, is too high (median intake 37 %energy and 16 %energy, respectively). Main fat sources are separated fats (butter, margarine, oil, etc.: 40 %), meat (18 %), and dairy products (21 %). Total fat intake decreased from 1985 to 1995 but fatty acid composition did not improve. Dietary fibre intake is from 18 to 22 g/d (women and men, respectively) with 62 % from cereals, 24 % from vegetables and 12 % from fruit. Mean intake of vegetables and potatoes was from 200 to 250 g/d (women and men, respectively). Mean intake of fruit and vegetables (potatoes not included) was 277 g/d, or less than half of the new recommendation (600 g/d). Only 15 % of participants in the frequency survey reported consuming both fruit and vegetables every day, and only 28 % reported to do so almost every day. In conclusion, dietary intake in Denmark is characterized by a high intake of saturated fat and total fat, and by a relatively low intake of fruit and vegetables.

The history of recommending certain food composition to the diet of the general public in Finland goes back to the 1950s. Since that time, the food circle with modifications has been the only official, and most widely used, tool for diet composition visualization for nutrition education. Official national dietary recommendations and guidelines have been launched in 1981, 1987 and the newest ones in 1998. Nordic Nutrition Recommendations have been used in Finland as a reference when national dietary guidelines have not been available or up to date. Specific quantitative food-based dietary guidelines have not been given, because dietary guidelines may be reached with a wide range of foods. Data from the 1992 Dietary Survey of Finnish Adults was used to identify differences in dietary intake and food consumption patterns between subgroups of the study population that represented the highest and lowest quartiles of fat, saturated fatty acid (SFA), fibre, and fruit and vegetable intake. The population groups having the lowest fat or SFA intakes or the highest fibre or fruit and vegetable intakes reached the nutrient recommendations of macronutrients and fibre reasonably well. Similarities in food consumption pattern associated with a nutrient profile close to the recommendations were high consumption of fruit, berries, vegetables, roots, legumes and rye. Differences, e.g. in fats used, were also found between diets that were close to the nutrient recommendations. More research is needed to determine the differences in food consumption patterns of different population groups before developing food-based dietary guidelines for these groups.

Dietary recommendations on nutrient intakes as published by the German Society of Nutrition are only met by a very small proportion of the adult population in East and in West Germany. Dietary data from the Nutrition Survey and Risk Factor Analysis Study in West Germany and from the National Health Survey in East Germany were used to identify differences in nutrient intakes and in food consumption patterns between subgroups of the study participants that were close to, or failed to meet the dietary guidelines. The subgroups were created by dividing subjects into quartiles on the basis of their daily intakes of total fat (%energy), saturated fatty acids (%energy), fibre (g/d) and the food group fruit and vegetables (g/d). Comparisons of the consumption patterns between subjects in the first and in the fourth quartile of intake of the nutrients under study were performed. Differences in food and nutrient intakes were seen among those more compliant and less compliant with the recommendations. The presented analysis provides first indications for future improvements of the existing food-based dietary guidelines in Germany.

In France, the first national dietary survey, called ASPCC, was done in 1993–1994. According to this survey, the mean fat intake in France is rather high, both for men (37.7 %) and women (40 %). Saturated fat intake is above 15 % of energy. The intake of fruit and vegetables is particularly low for younger people and manual workers. Fruit intake is also lower for people from the north of the country. These data show the necessity of a targeted nutritional policy in France. Therefore, public health authorities are determining new dietary guidelines. The fact that people with unsatisfactory nutritional status are often not concerned with nutrition proves the importance of simple understandable food-based dietary guidelines.

The present study aimed to estimate current nutrient intake levels and food group consumption patterns in Greece using cut-off levels derived from the results of dietary recall interviews with 470 Cretan adults. It was found that the present-day Greek diet contains, in the main, adequate levels of fibre. In comparison with the traditional diet, however, the levels of saturated fat in the diet have greatly increased, particularly in younger adults. An association was found between low fruit and vegetable and low fibre intake and a fat intake that was mainly in the form of saturated fat, this being particularly evident in female subjects. Given the wide availability of olive oil, fish, fresh fruit and vegetables in Greece, the development of national dietary guidelines would be of great potential benefit, particularly to the younger generations.

The aim of the present study was to analyse the different food and nutrient intakes of the adult Irish population from the lowest and highest quartiles of intake for total fat (%energy) dietary fibre (g/MJ) and fruit and vegetables (g/day). Data on Irish adults (n = 715) from the Irish National Nutrition Survey conducted in 1989 were used for the analyses and showed that the average diet is low in dietary fibre, with fruit and vegetables being only half the recommended level of 400 g. Comparisons of people with low or high intakes (from lowest and highest quartiles) of total fat (%energy), dietary fibre (g/MJ) and fruit and vegetables (g/day) show patterns of food intake differing in both the percentage of consumers and in the mean intakes among consumers only. This analysis provides data which may be useful as a first step towards the development of food-based dietary guidelines for Ireland. In particular, the low intake of fruit and vegetables in the adult Irish population deserves special attention.

The average intakes of nutrients by a group of 489 adult Portuguese (≥ 40 years) living in a metropolitan area of Northern Portugal were studied using a food frequency questionnaire, and used to compare with the most recent recommendations for the same population by the National Council of Food and Nutrition. The data suggested a relative concordance between consumption levels and nutritional goals, however we found differences between subgroups of the population. Higher intakes of total fat and saturated fat, and lower intakes of fibre/energy and carbohydrates were shared by younger people (40–55 years), and higher intakes of total fat, saturated fat, fibre/energy, protein and carbohydrates and lower intakes of alcohol by women. Nutrients have been analysed in terms of the percentage contribution to total energy intake, but as alcohol is energy dense, its consumption can decrease the proportion of the energy intake from nutrients other than alcohol, and some caution must be taken in interpreting these results.

The Nordic and Swedish Nutrition Recommendations emphasize the balance between macronutrients in the diet. The amount of saturated and total fat should be limited to c. 10 %energy and 30 %energy, respectively, and the amount of total carbohydrates should be 55–60 %energy. Data from the first Swedish national dietary survey in 1989 show that the average diet is too high in fat, especially saturated fat (36–37 %energy and 16 %energy, respectively) while the content of total carbohydrates and dietary fibre is too low. However, parts of the population consume a diet that meets the recommendation for a particular macronutrient. A comparison of subjects with a low or high intake of total fat and saturated fat, dietary fibre or fruit and vegetables show some common trends with respect to the characteristics of a dietary pattern equal or close to the recommendations, e.g. more frequent consumption of fruit and vegetables and a lower consumption of some fat-rich foods, such as spreads, cheese and sausages.

Expert scientific advice to the UK Government has been translated into eight general dietary guidelines, which form the core of population-based dietary advice in the UK and are supplemented by a food selection guide showing the types and proportions of foods needed for a balanced and healthy diet. Data from the Dietary and Nutritional Survey of British Adults were used to identify statistically significant differences between subgroups of the study population that met, or failed to meet, population nutritional goals for intakes of total fat, saturated fat and dietary fibre. Several eating habits — including greater consumption of starchy foods (particularly wholemeal varieties), greater consumption of fruit and the substitution of reduced-fat milk for whole-fat milk — were shared by the subgroups that met each of the nutritional goals. This analysis provides clues for any future refinement of food-based dietary guidelines.

An analysis of dietary survey data from Sweden and Ireland revealed that with a declining ratio of energy intake to estimated basal metabolic rate (EI : BMR), %energy from fat, saturated fat and carbohydrate fell while that of protein increased. However, where the definition of under-reporting is less strict, as in the Irish database (EI : BMR) < (1·27), the quantitative effect on macronutrient balance, while statistically significant, is not of such magnitude as to be of nutritional significance. However, with respect to foods, under-reporting was found to be of considerable significance in using such data to formulate food-based dietary guidelines. The Swedish data show that under-reporting of foods is associated with a decreasing percentage of consumers, decreasing intake per eating occasion and decreasing frequency of eating. The development of food-based dietary guidelines will involve comparisons of patterns of food intake among people with contrasting high or low intakes of target nutrients. The Swedish data compared food intakes for those with low or high intakes of saturated fatty acids (SFA) among under-reporters and acceptable reporters of energy intake. Whereas absolute values were always lower with the lower EI : BMR group (< 1·1) compared to the higher EI : BMR group (> 1·35) the ratio of intakes for the low vs. high SFA groups were broadly significant at either EI : BMR ratio. This paper highlights the difficulties that under-reporting will pose for food-based dietary guidelines.

Information on the perceived difficulties in trying to eat a healthier diet is important in assisting those in nutrition education devise more effective programmes. The objective of this study was to determine the main perceived barriers that people have in trying to eat a healthy diet in the 15 member states of the European Union (EU). A cross-sectional study in which quota-controlled nationally representative samples of approximately 1000 adults (15 years upwards) from each member state completed a face-to-face interview-assisted questionnaire. The most frequently mentioned perceived barriers to healthy eating concerned time and taste factors. Time-related factors were more important for younger respondents and those with a higher level of education, who appear to regard taste as being compromised by healthy eating. Variation exists both between member states and between demographic groups in the frequency of barriers mentioned. A lack of knowledge about healthy eating was not selected by many as an important barrier. A major obstacle to nutrition education is the fact that 70 % of EU subjects believe their diets are already healthy. It may be that nutrition educators should concentrate on showing consumers how to evaluate their own diet appropriately in terms of fat, fibre, and fruit and vegetables. Food-based guidelines may be useful in this endeavour.

Development of food-based dietary guidelines relies on correct identification and interpretation of current dietary intake patterns. The process involves assessing which foods discriminate between those with desirable and undesirable intakes of particular nutrients. It is therefore important that those involved in this task are aware of any source of variability in the underlying food consumption data that cannot be attributed to true differences between individuals. A short survey duration can introduce a high degree of within-person variation and not reflect usual or more long-term food or nutrient intakes. As survey duration increases, the % consumers identified by a survey increases and the intakes among consumers only decrease while the total population intakes do not change. A short survey duration may also lead to misclassification of individuals into high and low consumers. Survey duration is therefore an issue that should be considered in the interpretation of dietary data when developing food-based dietary guidelines.

Recently, the concept of food-based dietary guidelines has been introduced by WHO and FAO. For this concept, several assumptions were necessary. The validity and potential consequences of some of these assumptions are discussed in this paper on the basis of the Dutch National Food Consumption Surveys. The topics were interrelationships among dietary characteristics, nutrient density, diets in accordance with the guidelines, and food variety.

To obtain insight into overall diet quality, a dietary quality index based on nutrients and a food-based quality index based on food groups were created and tested. As expected the results showed that a higher dietary quality index was associated with an improved intake of the nutrients included in the index, in particular a lower intake of total fat and cholesterol. This was related to a lower consumption of cheese, fats and oils, meat and meat products, and a higher consumption of fruit and vegetables. The information obtained with a dietary quality index can be used to assess the feasibility of a particular goal in combination with other relevant goals and to obtain clues or confirmation for recommendations regarding food consumption.

The food-based quality index created showed that a combination of several food-based goals (formulated in quantitative terms) was associated with an increase in food consumption, without a clear relevance for the dietary quality. Therefore, the formulation of food-based guidelines should be based on explicitly stated dietary goals. The findings regarding nutrient density were in the direction of what was assumed, namely a positive association between density and absolute intake, although the expected effects were not completely found. The results regarding the association between variety and dietary intake were characterized mainly by differences in quantity rather than dietary quality.

The data indicate that energy intake may be an important pitfall in implementing food-based dietary guidelines, that ‘eat a variety of food’ can be an empty slogan and that nutrient density is positively related to the absolute intake of specific micronutrients. Further, the ‘absence’ of interrelationships among risk nutrients indicates that a selection process has to be applied.