European Journal of Clinical Nutrition (2003) 57, Suppl 1, S79–S81

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ORIGINAL COMMUNICATION
Community nutrition
J Aranceta1*

1
Community Nutrition Unit, Department of Public Health, Bilbao, Spain

Scientific evidence has placed community nutrition among the front line strategies in health promotion. Traditional food habits
have progressively changed in the last few decades. The combination of changes in food patterns and sedentary lifestyles have
contributed to a significant increase in the prevalence of overweight and obesity. Efforts in community nutrition should now
focus on three key aspects: nutrition education in schools and in the community, food safety and enhanced culinary skills in all
age groups. School meals and other catering services provided at work or community sites should be consistent with the
educational message. Catering services should ensure adequate nutritional supply, foster healthy eating practices and
encourage participation in gastronomic culture and social learning. Food safety includes the procurement of a safe adequate
food supply in sufficient amounts to cover the nutritional requirements of all individuals. It has become a priority for Public
Health. Social changes along new scientific developments will introduce new demands into community nutrition and request a
more important role for individually tailored advise. In order to face these challenges, community nutrition professionals need to
be highly qualified and skilled.
European Journal of Clinical Nutrition (2003) 57, Suppl 1, S79–S81. doi:10.1038/sj.ejcn.1601823

Keywords: community nutrition; nutrition education; food safety; culinary skills; Public Health; eating practices

Introduction Figure 1 describes key elements of interest related to

It has long been recognised since Ancient times that food
habits influence physical strength and the development of
certain disease conditions. In the scientific era, a great body
of evidence supports the role of diet in the onset of many
chronic diseases (OMS, 1990; WRCF, 1997; Kafatos &
Codrington, 2001).
The 21st century is open to nutrigenomics and the
possibility to design optimal feeding strategies and nutrition
fitting individual needs on the basis of genetic determinants.
Scientific evidence has placed community nutrition among
the front line strategies in health promotion and as an
obligatory area to be included in every health plan.
Concept and framework
Community nutrition has been defined as the group of
activities linked to Applied Nutrition within the context of
Public Health, whose main goal is to tailor individual and
population food patterns according to updated scientific
knowledge, in a certain region with a final aim of health
promotion (Aranceta, 2001).
*Correspondence: J Aranceta, Community Nutrition Unit, Department of
Public Health, Luis Briñas, 18, 4th floor, 48013 Bilbao, Spain.
E-mail: jaranceta@unav.es
Guarantor: J Aranceta.
community nutrition action. These elements should be
addressed by specific objectives in health plans and policies
at the regional and national level.
A number of the areas covered by community nutrition are
close to health care actions. Transition of individual patients
through hospital and health care services is usually a short
break in their living experience as an individual member
within the community. Therefore, both areas of action must
be coordinated in order to achieve the best nutrition
condition prior to accessing the hospital or care services
and the best possible condition when living in hospital and
care premises and during convalescence stages.
At the population level, traditional food habits have
progressively changed. In Spain, the traditional pattern was
close to the so-called ‘Mediterranean Diet’ or other derived
patterns with higher consumption of fish, dairy products,
vegetables and wine, those called as Atlantic Diet in the last
few years (Serra-Majem et al, 2002).
Changes have been more dramatic among children and
young people, although it can be recognised in population
subgroups or even among elderly people. Children and
young people have higher consumption of refined cereal
products, dairies, meat, butchery products and sausages;
bakery products such as buns, cakes and biscuits, sugary and
salted snacks, sweets and soft drinks (Serra-Majem et al,
2002).
 Community nutrition
J Aranceta
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Community Nutrition
Surveillance of Food Chain
Nutritional
Mass catering epidemiology
Clinical Nutrition and Dietetics Nutrition Education
Mass Media
Food Industry
Food and Nutrition Policy
Figure 1 Action areas under the scope of community nutrition.
The combination of the consumption pattern described
above along increasing sedentary lifestyles have contributed
to an important increase in the prevalence of overweight and
obesity in children and adolescents. The prevalence of
obesity in Spanish children has increased from 6.4% in
1984 to 13.9% in 2000 (Serra-Majem & Aranceta, 2001).
Key aspects
Efforts should now focus on three key aspects: nutrition
education in schools and in the community; food safety and
enhanced culinary skills in all age groups.
Nutrition education
It is required to structure health and nutrition education
programmes to be implemented or included in the school
curriculum. In many cases it would be required to organise
additional workshop activities in order to master cooking
and other preparation skills according to the developmental
stage of children. Self-efficacy and responsibility for their
own food habits should be fostered among children (Boyle &
Morris, 1999).
Immigrants and some ethnic minorities are at risk of
difficult adaptation to prevailing food patterns. In both
cases, comfortable integration should be encouraged while
being respectful to their own habits, culture and traditions.
Objectives should be planned in the mid and long term as
well, not only limited to the short term; thus ‘politically
correct’ decisions may not always be acceptable.
School meals and other catering services provided at work
or community sites should be consistent with the educa-
tional message. They are the closest chance to practice
‘healthy eating’. Catering services should support educa-
tional activities as part of the same project. They should be
acknowledged as profit companies, but not withstanding
European Journal of Clinical Nutrition
their three basic objectives: ensure adequate nutritional
supply; foster healthy eating practices and encourage
participation in gastronomic culture and social learning
(Aranceta, 2001).
Food safety and food security
Food safety has become a major priority for public health
across the world. The concept includes the procurement of a
safe adequate food supply in sufficient amounts to cover the
nutritional requirements of all individuals (Aranceta, 2001).
On the basis of the responsibility of food producers and
manufacturers, the food production chain and novel foods
should be rapidly under programmes monitoring food safety
and zero risk. Food trace-ability, monitoring and research
related to their potential impact on health together with
ongoing improvement of food labelling may contribute to
reduce a new source of risks for consumers.
Culinary skills
Healthy family meals need the consensus among all family
members regarding daily foods available at home. It is
required that all members in the family progressively are
involved in the different tasks concerned, that is, buying
food, preparing meals and planning the family menu.
Two additional variables should be considered for a
healthy diet: time available to prepare and eat food and
cooking skills. Many people do not have the skills or have
lost any interest in food preparation, traditional cooking
styles, low-fat cooking or how to prepare fruits and
vegetablesFwhich can be time consuming- in more attrac-
tive ways. Modern societies have lost cooking experts and
have gained ‘food warming’ and fast food experts, who often
base their diets on processed, frozen, canned or ready-to-eat
foods.
This situation contributes to higher intakes of salt,
hydrogenated fats, sugar, food additives, refined cereal foods
linked to appealing foods due to their taste, flavour, texture,
packaging, etc, which continuously invites consumption.
Such a cooking style favours inadequate diets, with a poor
content in regulatory elements and fibre while being highly
energy dense.
Future trends
In the near future, we will experience significant social
changes related to longer life expectancy, considerable
increase in the number of persons older than 65 y or even
older than 100 y; higher education levels in all age groups
including elderly people and cultural diversity not always
adapted to prevailing local uses.
Work, leisure time and family structure will change in the
near future as well. These changes with the new advances
and developments in the scientific knowledge domain will
introduce new demands into community nutrition and

request a more important role for individually tailored advise
(ADA, 2002).
In order to face these challenges, community nutrition
professionals need to be qualified and skilled in commu-
nication techniques and human relationships (Olmstead-
Schafer et al, 1996).
Cost–benefit analysis related to improved preventive
nutrition and care will facilitate consensus within the
profession. Scientific evidence will delineate care protocols
and preventive actions related to food patterns.
New recommendations
Functional foods, novel foods and substances related to the
new concept of ‘optimal nutrition’ will become common in
the next few years. Such products will be valuable as
supplementary tools on the basis of a traditional, pleasant
and overall healthy diet (Figure 2).
Willett (Willett & Stampfer, 2003) has recently suggested
some relevant changes in the pyramid model for a healthy
diet known since the 1980s, later revised in the 1990s. These
recent changes place a special focus on the glycaemic index
of several foods, particularly refined cereals, which have now
moved from the base of the pyramid where they used to be
on the very top, with a suggestion of moderate use. Other
new features are related to the different kinds of added fats
and oils. Oleic acid-rich fats are now placed at the bottom of
the pyramid. Changes include moderation for dairy products
and alert about sugary soft drinks, salted and sugary snacks,
meat with high-fat content and sweets.
Even when we accept the overall idea of this new proposal,
the Spanish Society of Community Nutrition agreed to a new
pyramid for the Spanish population in its 2001 consensus
(Aranceta et al, 2001). In this document, from a common
functional approach, whole-grain cereals were added to the
bottom of the model and emphasised the presence of fruits
and vegetables in the adjacent level, underlying among
other considerations their fibre content, which can con-
tribute to moderation of the glycaemic index of some foods.
Extra virgin olive oil was highly recommended to be used
both with raw and prepared foods, and the moderate
consumption of fermented milks, fish, lean meat, legumes
and nuts was also highly recommended. Spanish Mediterra-
nean dietary pattern includes an option for a limited
consumption of red wine or other low alcoholic beverages
during meals. Moderation of alcohol means one to two
glasses of wine for men and one glass for women, except for
nonalcohol drinkers or medical contraindication.
Supporting evidence may lead to recommendation of a
moderation in the consumption of meat with a high-fat
content, processed bakery products, butchery products and
sausages, sweets, sugary soft drinks and fat spreads.
Based on the concepts and strategies outlined above, we
should aim towards a global action for regional and local
Community nutrition
J Aranceta
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Nutrition education
Food preparation skills
Nutrigenomics
Novel Foods
Functional foods
Food safey New Recommendations
Figure 2 Key themes for community nutrition in the 21st century.
authorities in a cohesive way, in order to maintain and even
improve, whenever possible, the favourable health indica-
tors in all Mediterranean countries, particularly France and
Spain.
References
ADA (2002): Key trends affecting the dietetics profession and the
American Dietetic Association. J. Am. Diet. Assoc. 102, S1821–
S1839.
Aranceta J (2001): Nutrición Comunitaria, 2nd edición. Barcelona:
Masson.
Aranceta J, Serra-Majem Ll & SENC Working Party for the Develop-
ment of Food-based Dietary Guidelines for the Spanish Population
(2001): Dietary Guidelines for the Spanish population. Pub. Health
Nutr. 4, 1403–1408.
Boyle MA & Morris DH (1999): Community Nutrition in Action. An
Entrepreneurial approach Second Edition. Belmont, CA, USA: West/
Wadsworth ITP Inc.
World Cancer Research Fund/American Institute for Cancer Re-
search. Food expert panel (WRCF) (1997): Nutrition and the
Prevention of Cancer: A Global Perspective. Washington, DC:
WCRF/AICR.
Kafatos A & Codrington C (eds) (2001): Nutrition and Diet for
Healthy Lifestyles in Europe: The EURODIET Profect. Pub. Health.
Nutr. 4, 265–381.
Olmstead-Schafer M, Story M & Haughton B (1996): Future training
needs in public health nutrition: results of a national delphi
survey. J. Am. Diet. Assoc. 96, 282–283.
Organización Mundial de la Salud. Comité de expertos (1990): Dieta,
nutrición y prevención de enfermedades crónicas. Serie informes técnicos
no. 797. Geneva: OMS.
Serra-Majem Ll & Aranceta J (eds) (2001): Obesidad Infantil y Juvenil.
Estudio enKid, Vol 2, pp 1–195. Barcelona: Masson SA.
Serra-Majem Ll, Ribas Barba L, Garcı́a Closas R, Pérez Rodrigo C, Peña
Quintana L, & Aranceta J (2002): Hábitos alimentarios y consumo
de alimentos en la población infantil y juvenil española (1998–
2000): variables socioeconómicas y geográficas. In eds Ll Serra-
Majem & J Aranceta. Alimentación infantil y juvenil. Estudio enKid.
pp 13–28. Barcelona: Masson.
Willett WC & Stampfer MJ (2003): Nueva pirámide de la alimenta-
ción. Sci. Am. (edición española). 318, 54–61.
European Journal of Clinical Nutrition