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The NNEdPro ANZ Regional Network works collaboratively to strengthen the nutrition education and competence of medical and healthcare professionals in Australia and New Zealand through innovation in research, resource development and delivery. On 28th June 2023, members of the ANZ Regional Network presented at the Australian & New Zealand Association for Health Professional Educators (ANZAHPE) Conference, on the Gold Coast, Australia. The theme of the 2023 Conference was ‘Turning Tides: Navigating the Opportunities’. Professor Eleanor Beck, Professor Lauren Ball, Dr Helen McCarthy, and Dr Breanna Lepre presented on all things interprofessional education, using nutrition as a case example for embedding knowledge from individual health disciplines into broader health professions education. Interprofessional education provides opportunities for understanding of the scope of practice, teamwork, and communication across a breadth of practice areas. Professor Beck, Head of Health Sciences at UNSW, highlighted interprofessional education as an opportunity to embed nutrition in health professions education, and the enablers and challenges. Dr Breanna Lepre, Assistant Director at the NNEdPro Global Institute, and Research Fellow at the University of Queensland, presented a Framework for Nutrition Education in Australian Medical Training and discussed strategies to support the implementation of nutrition concepts into health professions education. The key takeaway from this presentation is the opportunity to integrate nutrition into existing medical curricula, based on key cross-cutting themes, such as teamwork, communication, professionalism, and health promotion and disease prevention. Professor Lauren Ball, Professor of Community Health and Wellbeing at the University of Queensland, and Associate Director at the NNEdPro Global Institute, presented findings from a review of culinary education in medical training, as an innovative strategy to enhance the nutrition capacity of the health workforce. Finally, Dr Helen McCarthy, Deputy Associate Dean for Learning and Teaching and Research Fellow in the Institute of Health and Sport at Victoria University, concluded the presentation with the key takeaways. These recognised the agreement that IPE and IPP are important but hard to make a reality. Effective approaches depend on the environment; ‘start small’, ‘go big’, or use a combination of approaches, but most importantly being open to innovation in this space to make it happen. Attendees were left with the following questions to consider / discussion was guided by the following questions: - How can we advocate for embedding cross-disciplinary knowledge and skills -both top-down and bottom-up – embedded in curricula of other disciplines? - What are the scholarly strategies to justify that ‘your’ discipline knowledge is important? Discussion with attendees focused on the use of interprofessional university health clinics, where health students ‘share the care’ of patients, to gain an understanding of the scope of practice, and skills in teamwork and communication. In addition, the challenge of timetabling when implementing interprofessional education was acknowledged by attendees and underscored the need to use both top-down and bottom-up approaches to implementation. The symposium stimulated an interesting discussion highlighting the importance of this topic area, the challenges it presents, but also the innovation that is possible through collaboration. If you would like to know more about the ANZ NNEdPro Regional Network visit: https://www.nnedpro.org.uk/aus-nz

On the 23rd and 24th of March 2023, Professor Sumantra Ray and members of the NNEdPro team from the UK and the United States came together with two key organizations in New York City, SUNY Downstate Medical Center, as well as their community outreach partner at the Brooklyn Culinary Community Center. On the afternoon of 23rd March, a conceptual workshop comprised detailed presentations on the origins of the Mobile Teaching Kitchen (MTK), its international adaptation, and its potential in the US, particularly in New York City. The workshop was interspersed with presentations by SUNY Downstate Medical Center including their array of existing initiatives in food and nutrition-based community, public health improvement and also Chilis on Wheels, a prominent NGO working in New York around plant-based eating particularly in food insecure communities. Breakout groups from this workshop determined the next steps in terms of those who would be involved in both the preceptorship and training of champions, as well as potential target populations from which to recruit champions within the Brooklyn community. New York City – Culinary Workshop 24th March 2023 On the afternoon of the 24th of March, a culinary demonstration was conducted within the Brooklyn Culinary Community Center by Veronica Flores Bello who has been leading the Mobile Teaching Kitchen (MTK) initiative in Mexico. This demonstration used a menu with a variety of dishes, spanning an entire day, in a vegan template inspired by the Mexican MTK cookbook which is currently in genesis. These dishes comprised a low glycemic index but high nutrient value and protein rich meals, which are low cost and easy to prepare. Potential champions of the New York MTK undertook “See One, Do One, Teach One” sessions which were highly successful. We are also delighted to announce that we have recruited a coordinator from within the New York Healthcare Community. Along with culinary individuals, such professionals, and other preceptors, we are expecting to see further training of MTK Champions within New York over the coming months such that we expect two ticketed pop-up culinary events to be conducted by the champions potentially by July 2023, one of which would be targeting the Brooklyn community and would comprise health messaging back into the community, while the other would be targeting an externally facing audience, looking at the potential that the New York MTK might have to become a successful micro-enterprise and also propagating health education to members of the public across socio-economic groups. Participants: Collette Boston – In person Belinda Ruffin– In person Desiree Jones– In person Lwonia Rhodes – In person Verda S. Bataille – In person Anita Dedmon – In person Markees Pruitt – In person Jahanda King – In person Ruth Cervera – In person Ediberto Saldana – In person Ricardo Llerena – In person

On Tuesday, the 21st of March 2023, Professor Sumantra Ray and members of the NNEdPro team from both the UK as well as the United States joined Dr Terry Stone at MedStar Health and Georgetown University Medical Center in Washington, DC to give a guest talk on the initiation of the Mobile Teaching Kitchen (MTK) initiative in the United States within the Fresh and Savory culinary medicine program, which also saw its first session being delivered that morning to 3rd and 4th-year medical residents in Georgetown. Furthermore, also on the 21st of March the Lafayette Center, courtesy of Dr Teresa Stone hosted a hybrid session for stakeholders of the US Mobile Teaching Kitchen adaptation in Washington, DC. This session included around 20 attendees, including key leaders from nutrition, health care, and medicine, and those with an interest in lifestyle medicine, culinary medicine, and with links to universities within Washington, DC. The outcome of the multi-stakeholder workshop discussions on the 21st was a blueprint for the coming months in which an intercollegiate model has been proposed for the MTK adaptation in the Washington, DC area. In this model, five or more preceptors comprising mainly medical students in collaboration with culinary professionals would recruit at least 10 champions from across five college communities within Washington DC. These champions would be drawn from amongst college students who have insights or lived experiences regarding college hunger. The objective would be to train these college students with preceptorship from the medical student facilitators, such that they can become MTK champions and within coming months conduct two pop-up events around micro enterprise. This food based micro enterprise pop up events would target two audiences. One would be potentially medical residents, and another would be other college students at large. These ticketed events would provide culinary experiences for these audiences in which they would be served low cost, healthy, nutritious, and tasty meals which are nutritionally complete and served up along with health education. The entire process of training Champions using a “See One, Do One, Teach One” model as well as the impact of the pop-up events, centred on food based micro enterprise, would involve the measurement of knowledge, attitudes, and practices as well as other cognitive measures which would enable us to predict the future course of both the culinary health education as well as micro enterprise. Early insights would be shared at the learning lab within the Society for Nutrition Education and Behavior annual conference in Washington DC on the 20th of July 2023. Participants: Washington DC Area Stakeholders / Attendees Alka Gupta – Zoom Brad Moore – In Person Dorothy Nankanja – Zoom Dr David Bowman Martin Tull – Zoom Neha Kumar – Zoom Robert Hay – Zoom Scott Nichols – In Person Terri Stone – In Person Virginie Zoumenou – In Person Representative from the Georgetown University School of Medicine Food is Medicine Club – Zoom [Nicole Farmer – Remote Liaison] NNEdPro Global Institute / MTK International Organisers Kai Kargbo – Zoom Matheus Abrantes – In Person Sucheta Mitra – Zoom Sumantra (Shumone) Ray – In Person Tecla Coleman – In Person Veronica Flores – In Person Wanja Nyaga – Zoom

Written by Rory Langan What inspired you to take part in the Mobile Teaching Kitchens initiative? Mitra: “I Started in 2019, involved in fundraising initially and realized that this was something that mattered to me. Currently, we are adapting MTK in different regions. I knew how important nutrition is in India and enjoyed how it educated and empowered the community beyond simply delivering food and resources.” Ray: “The opportunity to do something tangible and visible accompanied by the rigor of research tools and also evidence-based education rolled into a single point of intervention”. Experience in research, education, and advocacy (public engagement), and MTK brings all these together to a single focal point and allows us to build an intervention in terms of widening and deepening its impact while also gaining insight into which things work and which don’t base on our ability to look at the evidence and really gather research data. How have you seen the Mobile Teaching Kitchens Initiative change the communities you have reached out to? What are the qualitative changes you have noticed in the communities you have worked with through this initiative? Mitra: Changes in the women who have gone through the training: “they have become more confident; they are learning a lot. The changes in several people in the community’s health are what the team has witnessed.” Ray: “I have seen those changes in qualitative terms in the competence and confidence in the champions trained as well as their families. There is an increased awareness in the entire communities that they hail from. This has been measurable in some of the changes we have seen in education, psychometry changes and focus group work which has demonstrated a lot more initiative in terms of individuals and groups gaining the locus of control for their own health and well-being. For MTK, their economic resilience.” What are the quantitative changes you have noticed in the communities you have worked with through this initiative? Mitra: “The number of people targeting when these women are being sold food and knowledge.” Ray: “Shifts in KAP scores as well as the number of associated measurements cross-sectionally as well as longitudinally.” Do you see the Mobile Teaching Kitchens initiative being replicated in other low to middle-income countries? Mitra: “Yes, definitely! There is already outreach happening! For example, Bangladesh, and Brazil. There are 12 countries total.” Ray: “Yes, with other elements we want to especially bring to other low/middle-income countries being micro-entrepreneurship, education as a byproduct of that, shifts of KAP as well as individual and group behaviours. All are replicated in other countries because the data show that those ought to be transferable. Do you see it being replicated in lower-income communities in higher-income countries? Mitra: “Definitely, yes. The US, the UK, and other countries in Europe are a few examples. Populations in migrant communities, refugees, or other financially not stable communities. Proposals are already being made.” Ray: “Yes, we are ready to go in the US and talking about doing this in the UK. This ought to be the same because there, we’re dealing with buckets of poverty and food/nutrition insecurity. An added benefit is that there is a multifaceted service by public health and healthcare professionals in these regions. The kitchens can be provided in communities with insecurity and limited literacy (one of health literacy).” What are the current limitations of the Mobile Teaching Kitchens Initiative? Mitra: “The primary limitations are in funding; our team is involved in fundraising. There is always a challenge in how much we can raise. There are limitations when we implement in different countries. The nature of the kitchen changes in different places. Building rapport takes time, but when the community sees the impact and when they see how we are with them in building this change, they see how it’s a positive change.” Ray: “The kitchens are quickly developed, but this is circumvented by learning what adaptations are needed for other countries. Limits are in expansion and solution is adaptation. There is no biological data, most of it is self-reported or reported by researchers observing phenomena, so this is subject to bias. Use of multiple data sources will circumvent this. The biggest limitation is sustainable funding. The pathway to microenterprise is self-sustaining. The plan to circumvent this issue is applying for enough funding through giving to bridge the developmental years.” How has this initiative changed over time since its inception? What have you learned about combatting global hunger through this initiative? Mitra: “A lot has changed, but we see a kind of change in sustainability in this initiative since its launch. We are making sure our champions feel confident, but more continuous training is required to keep everyone up to date on the most recent information. They get updates when other countries receive this training. Personally, this was just about providing enough food for people; now people see what is going into their meals, and that is something I have learned.” Ray: “There are three phases in the MTK initiative: assessment, intervention, and micro-entrepreneurship. Initially, we envisioned this project as only educational, but now it’s entrepreneurial, with an education achieved on the way. Combating global hunger is a way to take the programmatic approaches that are in UN member states based broadly on WHO guidance: Double duty actions (recommended by WHO) addressing over and under-nutrition deficiency as well as over-nutrition. This project combats hunger and hidden hunger through micronutrient intake. It is high visibility, high impact, and empowering communities with longer-term benefits (most important). Loci of control and sustainability get integrated through the community.” What are the next steps for the Mobile Teaching Kitchens initiative? Mitra: “We are expanding within the South Asia region; within India, we are expanding to other regions ‘Punjab’. Nepal, Mexico, we have the funding for the US. UK”, speaking to folks. Brazil. Italy and parts of Europe (in Switzerland), to say a few. Ray: “We intend to fully publish the existing data from microenterprise so we can look at how the training of the small number of champions quantitatively impacts the perceptions and awareness of many members of the public served. There will also be additional insights on return on investments and the business model of this MTK initiative. That will tell us if it is truly sustainable.”

Authors: Harmanpreet Kaur, Chhaya Bhanti, Anamika Ghosh, Aakriti Wanchoo Co-Authors: Shobhana Nagaraj, Anant Jani, Patrick Fahr Editors/Reviewers: Sumantra (Shumone) Ray, Sarah Armes, Wanja Nyaga, Ramya Rajaram, Sucheta Mitra Acknowledgement: Swapan Mehra and key project members from Vertiver, NNEdPro, and the University of Oxford Climate change is a major global issue affecting ecosystems and communities. Climate change refers to long-term shifts in temperatures and weather patterns. These shifts occurred naturally in the past but recently human activities have been driving them, primarily due to burning fossil fuels (like coal, oil, and gas), which produces heat-trapping gases. The change in temperature and weather has been seen and felt by everyone around the Globe, with serious implications for food production and human health. NNEdPro, in collaboration with Oxford University and Vertiver in India, has pledged to work in this area to raise awareness and encourage people to take action to save Mother Earth and limit the impact of climate change for future generations. The project focused on three components: (1) Climate Change and Health, (2) Climate Change and Livelihood, and (3) Climate Change and Food/Nutrition at Policy, Practice, and Population levels (both urban & rural). On 2nd September, a transect walk was organised in an urban slum in Kolkata, observing and interacting with slum dwellers in order to extract knowledge about the perceptions of climate change in the Community while analyzing the component at an Urban population level. The team was divided into three groups interacting with different individuals/groups at Batala slum with a total population of approximately 11000-12000 people residing in more than 1000 houses in Ultadanga. Simultaneously, the Vertiver team conducted an observational study of rural Rajasthan, analysing the impact of climate change on the rural population. One of the major observations made by all three teams in Kolkata was that people are unaware of the fact that their own practices are the leading cause of various undesirable changes in the environment. In terms of Climate change and Health, a portion of the population mentioned feeling uneasy and drastic energy loss due to the increased temperature, and the frequency of the common cold had increased in the past couple of years. When inquired about the effect of Climate change on livelihood, the reaction between all three groups was similar - Every individual was concerned that their low income would not be sufficient to sustain lives, but most of the population blamed COVID-19 and the government for the change. When asked about their food intake, it was mentioned that they usually reduce the amount of food group in their daily intake if the availability of the particular food is less in their location or the price is high. Only a few of the old aged people mentioned that the food they used to have, was tastier and more nutritious than the meals they are having now. They also mentioned that they have noticed the change in environment/climate/weather in the past few years. The Vertiver team in association with Basic Health Services (an organization working with rural people on health, nutrition and livelihood) conducted FGDs and key informant interviews in Handi village situated in Salumbar block of Udaipur District (rural Rajasthan). The team interacted with smallholder farmers and migrant workers to assess the impact of climate change on agriculture and other aspects of their lives. Following are the key insights received from this interaction: Lack of opportunities in the village and reduced soil productivity and degraded natural ecosystems combined with insufficient and erratic rainfall have left people with no choice but to seek employment in urban areas. The majority of the men from families in this block migrate to nearby cities in Gujarat and Maharashtra for odd jobs/contractual jobs in search of income and secured livelihoods. The migrant workers on average spend 7 months a year away from their villages and return only occasionally throughout the year. Agriculture vulnerability is high in this area as the farmers here rely on water collected in nearby streams for both Rabi and Kharif crops. The staple crop grown is corn followed by wheat along with small vegetables like eggplant and ridged gourd. BHS has recently begun a project in which seeds of local millet varieties (Noni Makki, Kangani and Kodra) were provided to farmers as part of encouraging nutrition-sensitive agriculture practices and reviving millet cultivation. Farmers here have not been able to include millets as part of their staple diet, due to several barriers to growing millets, which include access to seeds, lack of awareness of their nutritional value, higher perceived input cost and labour. In addition, the reliance on PDS-based wheat for personal consumption has reduced the incentive to put extra effort to grow millets. Some aspects of nutrition and gender were also revealed during the FGD. Interviewed families stated that women are not allowed to consume any form of meat either chicken or egg, at home. The social norm dictates that people won’t drink water in those houses where meat is consumed by women. Out of 100 households, only 20% of people eat meat (mutton and fish) and that too only once in 2-3 months. The BHS centre in this area serves many people afflicted with chronic respiratory illnesses such as TB and Silicosis and rates of malnutrition and anemia are extremely high in this area, especially in women and children. The 6-month treatment prescribed by doctors is often times discontinued by the patients after 3 months with that money instead going to other uses including even damaging intoxicants such as tobacco or alcohol. Incidences of heat stroke and heat stress have become more common and climate change has been directly attributed to increased infant mortality rates. Vertiver and NNEdPro organised an exploratory hybrid workshop was conducted on the impact of Climate change on rural and urban food security (Exploratory Workshop on Climate Change and Heat Resilience in Food and Health Systems - India) on 3rd and 9th September 2022 to gather insights from various stakeholders. One of the key insights gathered was from Rajeev Khandelwal, from Aajeevika Mission (one of the key speakers at the workshop). It was stated that the migrated farmers often end up working in hazardous conditions wherein they become victims of life-threatening diseases, and they often bring back those diseases to their respective villages and native places. This additional adverse impact of climate on livelihood and the burden of disease among the low-income population is ever-increasing and targeting millions of people. Key policy people attended the workshop and represented organisations such as SM Sehgal Foundation, Centre for Research on Innovation and Science Policy (CRISP), Ajeevika Bureau, Indira Gandhi Institute of Development Research, and Banyan Roots. Stakeholders from Oxford University, Panjab University, Vertiver, Charities Aid Foundation (CAF), Oak Foundation, Calcutta Rescue, and Bhavishya Shakti Cooperative Society (NNEdPro) who are working on the issue of Climate change in India also participated in the workshop. In this day and age, consumers demand a certain uniformity in the way vegetables and fruits look and feel, but the change in weather events leads to changes in harvest, and Consumer’s demands are not met, and some food items were rejected as they did not meet the quality expectations of the consumers. This again causes the farmers to suffer due to less revenue and increasing losses after the harvesting season. Due to the scarcity of rainfalls during the cropping season, groundwater was depleted, leading to an uprising topic of concern for the public and Government in the North Indian States. A few approaches to address these issues are derived in discussions with various stakeholders, and policymakers on 2nd September 2022 in Kolkata and on 9th September 2022 in Delhi. Awareness Programs need to be conducted Implementation of Government policies at the grassroots level Inclusion of youths in policy-making and implementation Hence, planning is on the way as NNEdPro will be training MTK Champions to create awareness in their own community and then disseminating the knowledge within the communities.

TIGR2ESS-FP6: The Mobile Teaching Kitchen (MTK) in India Series March 2023 Authors: Harmanpreet Kaur, Wanja Nyaga, Sarah Armes Editors: Sumantra (Shumone) Ray, Sucheta Mitra, Ramya Rajaram Acknowledgements: We would like to acknowledge and thank key individuals particularly - Lord Diljit Rana, and Urmil Verma; organisations - Cordia Group of Institutes, Sanghol; Lord Rana Foundation Charitable Trust, and NNEdPro, for their time and resources towards this project. With the success of the Mobile Teaching Kitchen (MTK) project in Kolkata, the innovative initiative has since been adapted in different forms, throughout the country and all over the globe. One such adaptation was made in the land of five rivers – PUNJAB. MTK was inaugurated in Sanghol, Punjab at Cordia Group of Institutes and surrounding rural areas, in 2017. Sanghol is a place of great archaeological importance and also happens to be the birthplace of the NNEdPro Global Patron, Lord Diljit Rana (OBE). The project has been the rural replication of the MTK project in Kolkata, with further scope for cross-sectional study between two groups that include: 1. Mothers working in the educational institute of Cordia 2. Mothers residing in the villages around the Institute In 2019, 12 student volunteers, were trained in imparting Nutritional Education. Under their supervision, 10 mothers from the institute and 7 mothers from the nearby village ‘Pallo Majra’ were trained for dissemination of the skills and education in the surrounding areas to empower women and upgrade the health status of their children. But the first wave of COVID-19 led to a loss in connection with most of the student trainees due to various reasons such as academic progression. This also impacted the enthusiasm and interest of the community in the project, which translated to decreased involvement Post Covid. This brought the project to a plateau, that warranted completed rebuilding and retraining of the team for further phases. In the year 2021, new volunteers (students & teachers) were selected and the trained women from both the sub-sets were reapproached, leading us to relocate 5 of the in-house mothers. Village mothers could not be mobilised, as after the first wave, community women got involved in various programs initiated by both the State and Central government. Hence, the first, See One session for the newly inducted volunteers and Do One session for the old in-house mothers had been successfully conducted in November. A session with the team - pre and post-COVID-19. Due to a lack of involvement from the latter subset of women, a plan was devised to move into phase III of MTK directly from Phase-I, in March 2022 with consent from the college authorities and women keen to be attached to the project, mainly the smaller group of the former subset. The plan was to initiate a tiffin service or alternatively open a canteen serving healthy and nutritious snacks while disseminating knowledge to the consumers by in-house women with assistance from a few small entrepreneurs in the villages, who served homemade food to students/employees residing in their respective villages. This plan was made with the intention of fully realising the idea behind MTK and proving an opportunity for the women to follow through with their training and create a much larger impact through the dissemination of nutrition education to the wider communities attached to the villages. Due to several unavoidable factors, the plan couldn’t be executed and hence in September 2022, NNEdPro handed over participation certificates to people who were involved in the project since the beginning, along with a series of probable next steps, that they can follow to move forward with the MTK microenterprise in Punjab at Sanghol. Although our rural replication has come to an end this year, we hope to keep providing strategic support to women for being an entrepreneur or change agents for the community. Taruna Narang, the project facilitator from Cordia institute on behalf of all volunteer teachers mentioned that- “this project helped most of them to reconnect with the community influencer part of their self, which motivated them to be more connected with the students and learn new things about the community around them”. One of the hospitality departments when reflecting on the program said that - “they never realised while putting together ingredients for a dish that they form such an important part of a healthy life”. Certificate Distribution on 10th September 2022 It was a newer and enriching experience for both teams as we were able to understand the social and cultural setup in a rural area of Punjab and how it differs from urban areas in Kolkata. We look forward to incorporating the acquired experience into areas of new development for better outcomes in the future.

TIGR2ESS-FP6: The Mobile Teaching Kitchen (MTK) in India Series March 2023 Authors: Suveera Gill, Harmanpreet Kaur, Wanja Nyaga, Sarah Armes Editors: Sumantra (Shumone) Ray, Ramya Rajaram Acknowledgements: We would like to acknowledge and thank key individuals from Panjab University and NNEdPro, for their time and resources towards this project. ‘Economics’ is a factor that could affect the nutrition status and health of an individual. In developing countries like India, economic statuses such as purchasing power and affordability influence people's food choices, which in turn affects Nutritional Health. Health, Nutrition, and Spending Power form a TRIAD which is mainly neglected by both “Economists and Health Professionals.” The project, Transforming India's Green Revolution by Research and Empowerment for Sustainable food Supplies (TIGR2ESS) brought together a team that thinks out of the box and is dedicated to bringing about positive changes in and around them with innovative ideas of research and action plans. One such distinctive study design was put forward by Suveera Gill (Business Management Professor from Panjab University) and the team to connect the dots between the two most related and untouched topics of Nutrition and Costing. In this context, the cost of two North Indian vegetarian Thalis (platter), both for lunch and dinner for moderately active females and males, was planned and calculated, keeping in mind the sustainability of the ingredients (organic vis-a-vis conventional) used in the meal preparation. The quantities and nutritional value of dishes for preparing Thalis were based on the ICMR (Indian Council of Medical Research-National Institute of Nutrition, 2020) Dietary Guidelines. DietCal - an Indian professional dietary assessment and planning software based on the ICMR-NIN and Nutritics - software developed in London, was used for nutritional calculations. The study aimed to quantify what it costs a representative four-member household to prepare two full, balanced meals daily as agriculture can address nutritional and health problems by providing good quality harvests at affordable prices (Welch and Graham, 1999). Various studies (Magkos et al., 2003; Rosen, 2010 & Vigar et al., 2019) prove that organic food is tastier, more nutritious, and healthier as the bioavailability of nutrients is more than conventional food. But consumer awareness about this is scarce and is a definitive need of the hour. In India, organic farming is being practised by small and marginal farmers using biological fertilisers, derived from animal and plant wastes. However, organic food often has low yields with high production costs, making it more expensive for the general population. Thus, the trade-off between sustainability and affordability challenges the food system. Due to the lack of awareness in this field, both acceptance and practice are insufficient. With changes in the climate and its adverse effect on health, food choices, and livelihoods, we should consider changing our farming practices so that everyone can afford a healthy and nutritious diet. For sustainable development of the environment, health, and livelihood, providing support for organic farming by making favourable policies is an urgent requirement. We need to develop markets and facilitate linkages of production to consumption that benefits producers, consumers, and the environment. This value chain across the food system has been lacking in India, and added insight through further research can facilitate a planning strategy to move forward. This baseline study has contributed to unravelling the relationship between the healthfulness and cost of food nudging exploration in alternate contexts. To support the study further with evidence, NNEdPro has planned to include the concept of sustainability and costing in the new version of our Mobile Teaching Kitchens (MTK) cookbook 2.0, which will be launched by next year.

TIGR2ESS-FP6: The Mobile Teaching Kitchen (MTK) in India Series March 2023 ‘Poshan Rasoi’: A collaboration between Vertiver and NNEdPro to link nutrition with behaviour change in Delhi Authors: Harmanpreet, Chhaya Bhanti, Dolly Garia, Anamika Ghosh, Tanya Jaswal, Aakriti Wanchoo Editors/Reviewers: Sumantra (Shumone) Ray, Sarah Armes, Wanja Nyaga, Sucheta Mitra, Ramya Rajaram Acknowledgements: We would like to acknowledge and thank key individuals, particularly Indu Tripathi, Vasundhra Singh, Nikita Sharma, Deepshree Singh, Asim Manna, Debashis Chakraborty, Elizabeth Richards, Mousumi Naiya, Kanika Mondal; Organisations: Vertiver, NNEdPro, and Bhavishya Shakti and funding (from Vertiver) for their time and resources towards this project. About Poshan Rasoi Mobile Teaching Kitchen (MTK) Project has been a great achievement, with its final phase of micro-enterprise running successfully since 2019 in Kolkata. Inspired by the success, Vertiver Agency, a design and communications agency, and implementation partner for TIGR2ESS (Transforming India's Green Revolution by Research and Empowerment for Sustainable food Supplies) Project, which was wrapped up in March this year, put forward a plan for piloting of MTK in Delhi as they had strong community ties in East Delhi area. The programme was a week-long endeavour that culminated in a two-day workshop, titled ‘Poshan Rasoi’, held on the 28th and 29th of March, 2022 at Durga Mandir Community Hall, Shahdara, New Delhi. It sensitized community women in East Delhi to the benefits of consuming nutritious food. The programme engaged community women galvanized under Vertiver’s Su-Dhara programme, a community-centred multi-pronged behaviour change framework encompassing novel waste-to-wealth pilots and technological interventions that promote sustainable solid waste management practices. One such pilot tested under Su-Dhara involved introducing a Biogas plant that would be used to power a newly set up and locally-based community kitchen and simultaneously cater to the community’s organic waste. Both, the kitchen and the plant, would be operated by the community women who come from economically weaker sections and subsequently empower them to become microentrepreneurs. Putting two and two together, the scope of the project expanded, later on, to build on the waste-to-wealth pilot by including a component on the capacity development of these community women to produce and provide healthy and nutritious snacks in the community. Here NNEdPro’s role comes into existence. While the waste-to-wealth pilot suffered some technical difficulties and had to be discontinued, it was noted that the programme garnered significant interest from the community women, serving as an appetizer that could feed into a larger vision of empowering community women from marginalized societies to become either microentrepreneurs or trainers or both. Furthermore, it paved the way for the conceptualization of another pilot which involved training community women to become nutritional educators. The programme kick-started with a baseline assessment to understand the present nutrition and health status of the participating community women. Datasets collected included anthropometric data (wherein body, height and weight measurements were recorded), clinical assessments (wherein the presence of any diseases caused due to malnutrition such as goitre, oedema, and stomatitis was recorded), and demographic information. In addition, a Knowledge, Attitude, and Practices (KAP) survey and dietary recall of the participants were also conducted. Images showing Team Vertiver collecting primary data from the participating community women After the baseline study, the partners conducted the ‘Poshan Rasoi’ workshop, which was designed to raise nutritional awareness among community women who possessed a peripheral understanding of unhealthy street foods and expressed keenness on further developing their skills to promote nutritious food consumption. The workshop was based on the concept of “SODOTO” (“See One”, “Do One”, “Teach One”) formulated as part of the Mobile Teaching Kitchen (MTK) model by NNEdPro. The concept involves delivering comprehensive nutrition education and hygiene workshops via cooking demonstrations while leveraging a pre-set template menu comprising locally sourced ingredients. The following activities were undertaken during the 2-day workshop in the following chronological order: DAY1: “See One” On the first day of the workshop, an orientation session was held to bring the community women up to speed on the nutritional kitchen, the benefits of consuming nutritional food, and how a regularized nutritional diet can prevent a plethora of diseases. In the ‘See One’ session, the community women observed the preparation of nutritionally balanced and affordable meals, as demonstrated by the trainers from NNEdPro. Images showing community women interacting with the nutritional educators and NNEdPro experts at the “See One” session DAY 2: ‘Do One, Teach One” In the next session, ‘Do One’, the community women prepared and cooked nutritious dishes themselves. These included Chikki (peanut-based sweet), Spinach cutlet, Mixed vegetable sabji, and Vegetable Pancakes. In the final session, ‘Teach One’, the trained community women prepared 10 individual dishes which were enjoyed by all. Images showing delicious and nutritious recipes cooked by the participating community women during the “Do One” session Through the programme, a group of 10 women was mobilized and educated on basic nutrition concepts. They were further taught how to prepare low-cost healthy snacks and food including Champion Thali, a specially curated platter comprising 5-6 nutritional food items. After the workshop, the participating community women received a detailed cookbook with a selection of nutritious recipes that they could easily follow. During September, participation certificates were handed to the participants in Delhi and strategic and digital material support for the school programme was provided by the NNEdPro India team. Post-programme developments Building on the success of this programme, a range of nutrition-related activities has been carried out either solely by the community women or in collaboration with Team Vertiver and NNEdPro. For instance, some Community women held an in-person rally at a local park to extend their learnings on nutrition and build “nutrition dialogues'' within their community. During the event, the community women communicated nutritional facts on millets, oils and salts, etc., and prepared and shared nutritional dishes as tasters. Seeing the interest among the community women in learning more about healthy cooking habits and nutritious facts, nutrition-related infographics were designed and disseminated with the women through Su-Dhara’s active digital channels including Whatsapp and Facebook. Image of trained community women facilitating a nutrition-based training workshop with their local community members For instance, during Navratri, while being cognizant of food items generally avoided, recipes of three nutritious thalis and their associated nutritional values were circulated among the community women. Sample images of digital content such as nutritional values of the Navratri Thali and salt-related facts, respectively, floated across digital channels connected with the community women To sum it up, through the Poshan Rasoi programme and subsequent interactions with the community women, the appetite of community women for carrying forward nutrition-related work was gauged. This has been pivotal in drawing up a larger vision that entails empowering community women from marginalized societies to become either nutritional microentrepreneurs or trainers or both. To realize this vision, a micro pilot, titled ‘Bal Poshan Jagrukta’, was conceptualized and thereafter, successfully implemented at a primary government school in Delhi on December 15th, 2022. The Su-Dhara Swachhata Doots, in collaboration with Team Vertiver and Team NNEdPro, steered an interactive workshop for primary government school students and teachers on the importance of consuming nutritious food. The primary goal of the workshop was to bring science-based nutrition education to young children from financially weaker sections, through a creative mix of engaging and informative activities. The process leading to the workshop including its implementation was deeply collaborative, involving multiple stakeholders including the government, schoolteachers, nutritional experts, behaviour change agents, and on-ground implementers. To onboard a school for the implementation of the workshop, Team Vertiver procured permission from the Director and Additional Director of Education, at the Municipal Corporation of Delhi. During the workshop, a range of activities was undertaken including nutrition-themed poem recitals, storytelling, quizzes, photo sessions with the Poshan Mascot, and more. We were graced by over 90 pairs of eager eyes who chipped in, boisterously, to express what they knew about nutrition while expressing the same eagerness to learn more. Given that the subject of discussion was definitely a drool-worthy one, the Su-Dhara Doots also prepared home-cooked chikkis, which were shared along with other goodies such as locally-available chestnuts, millets, and more, with the students and teachers. Additionally, the students were also prompted to catalyze a transition to affordable and nutritious food within their households. For this purpose, each student was handed a leaflet of a millet-based Upma recipe to try out with their families at their homes. It was truly encouraging to witness the dedication and commitment put forward by the school teachers in bringing nutrition education to the children. The pilot was instrumental in gauging the pre-existing level of knowledge that the students possessed and concomitantly, raising their awareness of the key concepts related to nutrition. All in all, the pilot demonstrated the potential for scaling up and offered essential insights that would be vital for the development of a more comprehensive, large-scale, and long-term educational programme on nutrition for schools. The support team behind ‘Bal Poshan Jagrukta’ including East Delhi community leaders of Su-Dhara Dr Prabha Aggarwal and Smt. Neelam Tyagi

Author(s): Mayara de Paula and Sarah Armes Reviewer(s): Shane McAuliffe and Professor Sumantra (Shumone) Ray Diet has long been recognised as an important factor influencing our health. Today, fruits and vegetables, protein and healthy fats are at the top of everyone’s mind. One food group often overlooked are spices, those wonderfully colourful powders, seeds, bulbs, and roots that are used to add flavour and colour to the foods we cook and consume all around the world. Spices come from different parts of plants and shouldn’t be confused with herbs which only come from the leaves of the plant (Institute 2022). Despite spices being used in relatively small quantities in food, spices contain some of the highest concentrations of antioxidants, bioactive compounds, and polyphenols. These compounds have been shown to be protective against inflammation, oxidative stress, cancer, high blood pressure, diabetes, and cardiovascular disease (affecting the heart or blood vessels) to name a few. We’ve reviewed the research and highlighted the health benefits of some of the most consumed spices: Black Pepper Black pepper (Piper nigrum L.) is one of the most widely consumed spices worldwide, known for its pungent flavour when added to dishes, but also its ability to enhance the taste of other ingredients (Srinivasan 2007). The main active component of pepper is piperine which has been shown to reduce the time it takes to digest food, act as an antioxidant, enhance the bioavailability of drugs in the body, and possess anti-mutagenic and anti-tumour effects (Takooree et al. 2019). Garlic Belonging to the plant family of lilies, garlic is a type of bulbous plant that originated in central Asia. There are more than 450 varieties, first cultivated over 4000 years ago it is believed to be one of the oldest food flavourings discovered. Today, garlic is as popular as it was millions of years ago. Garlic has a long history of medicinal use with broad health benefits largely due to the presence of sulphur and various compounds including allicin, alliin, and methyl allyl trisulfide (MATS). These compounds have been shown to have anti-inflammatory effects even down to modulating inflammatory genes. As well as the active compounds, garlic is also high in B vitamins and vitamin C, making it an ideal nutrient-rich food to add to meals (Mirzavandi et al. 2020). Ginger Ginger is well-known throughout the world and is used extensively in Asian cuisines. Coming from the Zingiber officinale plant, ginger has been used as a traditional remedy for nausea, vomiting and pain. Like most spices, ginger has several compounds with the major ones being gingerol, shogaols, zingiberene, and zingerone (Zhang et al. 2021). In a large comprehensive review of 109 randomised controlled studies, ginger was found to improve chemotherapy-induced nausea and vomiting (CINV), nausea and vomiting in pregnancy, digestive function, osteoarthritis, pain, cancer risk factor, and metabolic markers including lipid levels, blood pressure and cholesterol levels (Anh et al. 2020). Cinnamon Cinnamon (Cinnamomum Zeylancium) has been used as a spice and as traditional herbal medicine for centuries, commonly added to beverages, desserts, liqueurs, teas, chicken and lamb dishes, bread, and pastries. Cinnamon exhibits varying levels of cinnamaldehyde, cinnamic acid, coumarin, linalool, eugenol, caryophyllene, and polyphenol polymers. Suggested beneficial health effects include anti-microbial activity, lowering of blood glucose, blood pressure and serum cholesterol, antioxidant properties, anti-inflammatory, wound healing properties and hepato-protective effects (Ranasinghe et al. 2013). Most of the human research on cinnamon has been undertaken to determine its effectiveness for the treatment of type 1 and/or type 2 diabetes mellitus. These findings are contradictory, yet there is some evidence to support this theory. Multiple clinical trials revealed that cinnamon improved glycaemic indicators (Khan, et al. 2003; Zare, et al. 2019; Lira Neto et al. 2022). Despite this, some studies have demonstrated no effect on glycaemic control and no preventive effect on metabolic diseases (Altschuler, et al. 2007; Talaei, et al. 2017). Turmeric Turmeric is a spice that is widely used throughout the Middle East and Asia not only to add flavour and colour to dishes, but also to provide health benefits as a component of traditional medicines. Turmeric is likely the most studied of the spices commonly combined with other spices in Asian cuisines and contains key bioactive curcuminoids, including curcumin. Curcumin, responsible for the vibrant yellow pigmentation, makes up approximately 3.14% of turmeric’s weight and is its main active phytochemical. Curcumin has interested researchers for its medicinal values and variety of biological functions, such as antibacterial, anti-inflammatory, antimicrobial, and anti-cancer effects (Kunnumakkara et al. 2017). Preliminary evidence from human trials, curcuminoid extracts and other novel formulations may have the potential to help manage symptoms of type 2 diabetes, metabolic syndrome, and arthritis. Despite its proposed beneficial properties, several studies have shown that curcumin is poorly absorbed, rapidly metabolized, and rapidly excreted; therefore, it has limited bioavailability (Singletary 2020). Food for thought Despite the growing interest in spices and health, most of the evidence available to date stems from animal studies. Another factor to consider is dosage. It is also worth noting that many spices, including those highlighted above, are poorly absorbed. As such, the dosage provided by research studies is usually much higher than the usual quantities of spices used in everyday cooking. Therefore, care should be taken when extrapolating the benefits to humans. By similar logic, while the proposed benefits of spices include the potential to positively impact on aspects of conditions such as cancer, cardiovascular disease, and diabetes, it is important to state that these compounds should not be considered as a replacement for evidence-based medical therapies. There is also a consideration of drug nutrient interactions with certain spice compounds and their influence on the bioavailability of different drug classes (for example curcumin and the chemotherapy drug acalabrutinib). While many interactions are likely to be dependent on dosage and probably be less likely to provide clinically relevant when consumed as part of a habitual diet, caution is advised if considering supplementation with higher doses (Pilla Reddy, Jo, and Neuhoff 2021). Despite some of the caveats within the research space, there is no doubt that spices have promising benefits which can be highly relevant in the nutrition space. Aside from the potential health benefits, adding spices to your daily cooking is a sure way to add more colour and flavour! Our pioneering Mobile Teaching Kitchen programme aiming to empower and educate marginalised communities through nutrition education has released its very own cookbook full of healthy recipes incorporating many wonderful spices. You can grab yours here! References: Altschuler, J.A., Casella, S.J., MacKenzie, T.A. and Curtis, K.M., 2007. The effect of cinnamon on A1C among adolescents with type 1 diabetes. Diabetes care, 30(4), pp.813-816. Anh, Nguyen Hoang, Sun Jo Kim, Nguyen Phuoc Long, Jung Eun Min, Young Cheol Yoon, Eun Goo Lee, Mina Kim, Tae Joon Kim, Yoon Young Yang, Eui Young Son, Sang Jun Yoon, Nguyen Co Diem, Hyung Min Kim, and Sung Won Kwon. 2020. 'Ginger on Human Health: A Comprehensive Systematic Review of 109 Randomized Controlled Trials', Nutrients, 12: 157. Institute, McCormick Science. 2022. 'CULINARY SPICES'. https://www.mccormickscienceinstitute.com/resources/culinary-spices. Khan, A., Safdar, M., Ali Khan, M.M., Khattak, K.N. and Anderson, R.A., 2003. Cinnamon improves the glucose and lipids of people with type 2 diabetes. Diabetes care, 26(12), pp.3215-3218. Kunnumakkara, A. B., D. Bordoloi, G. Padmavathi, J. Monisha, N. K. Roy, S. Prasad, and B. B. Aggarwal. 2017. 'Curcumin, the golden nutraceutical: multitargeting for multiple chronic diseases, Br J Pharmacol, 174: 1325-48. Lira Neto, J.C.G., Damasceno, M.M.C., Ciol, M.A., de Freitas, R.W.J.F., de Araújo, M.F.M., Teixeira, C.R.D.S., Carvalho, G.C.N., Lisboa, K.W.S.C., Marques, R.L.L., Alencar, A.M.P.G. and Zanetti, M.L., 2022. Efficacy of Cinnamon as an Adjuvant in Reducing the Glycemic Biomarkers of Type 2 Diabetes Mellitus: A Three-Month, Randomized, Triple-Blind, Placebo-Controlled Clinical Trial. Journal of the American Nutrition Association, 41(3), pp.266-274. Mirzavandi, Farhang, Mehdi Mollahosseini, Amin Salehi-Abargouei, Elham makiabadi, and Hassan Mozaffari-Khosravi. 2020. 'Effects of garlic supplementation on serum inflammatory markers: A systematic review and meta-analysis of randomized controlled trials', Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 14: 1153-61. Pilla Reddy, Venkatesh, Heeseung Jo, and Sibylle Neuhoff. 2021. 'Food constituent– and herb-drug interactions in oncology: Influence of quantitative modelling on Drug labelling', British Journal of Clinical Pharmacology, 87: 3988-4000. Ranasinghe, Priyanga, Shehani Pigera, G. A. Sirimal Premakumara, Priyadarshani Galappaththy, Godwin R. Constantine, and Prasad Katulanda. 2013. 'Medicinal properties of ‘true’ cinnamon (Cinnamomum zeylanicum): a systematic review', BMC Complementary and Alternative Medicine, 13: 275. Singletary, Keith. 2020. 'Turmeric: Potential Health Benefits', Nutrition Today, 55. Srinivasan, K. 2007. 'Black Pepper and its Pungent Principle-Piperine: A Review of Diverse Physiological Effects', Critical Reviews in Food Science and Nutrition, 47: 735-48. Talaei, B., Amouzegar, A., Sahranavard, S., Hedayati, M., Mirmiran, P. and Azizi, F., 2017. Effects of cinnamon consumption on glycemic indicators, advanced glycation end products, and antioxidant status in type 2 diabetic patients. Nutrients, 9(9), p.991. Takooree, Heerasing, Muhammad Z. Aumeeruddy, Kannan R. R. Rengasamy, Katharigatta N. Venugopala, Rajesh Jeewon, Gokhan Zengin, and Mohamad F. Mahomoodally. 2019. 'A systematic review on black pepper (Piper nigrum L.): from folk uses to pharmacological applications', Critical Reviews in Food Science and Nutrition, 59: S210-S43. Zare, R., Nadjarzadeh, A., Zarshenas, M.M., Shams, M. and Heydari, M., 2019. Efficacy of cinnamon in patients with type II diabetes mellitus: A randomized controlled clinical trial. Clinical nutrition, 38(2), pp.549-556. Zhang, Mengmeng, Rong Zhao, Dan Wang, Li Wang, Qing Zhang, Shujun Wei, Feng Lu, Wei Peng, and Chunjie Wu. 2021. 'Ginger (Zingiber officinale Rosc.) and its bioactive components are potential resources for health beneficial agents', Phytotherapy Research, 35: 711-42. Photo: Christina Rumpf

Seven decades of Queen Elizabeth II as the beloved monarch of hearts and minds We at NNEdPro were deeply saddened by the passing of Her Majesty The Queen on 8th September 2022. Our thoughts and condolences go out to The Royal family and all her loved ones. Ahead of the state funeral on 19th September 2022 we are sharing this humble tribute. Our Honorary Joint Presidents, The Lord Rana OBE and The Lord Balfe, both members of the House of Lords, and NNEdPro Associate Director Dr Rajna Golubic (University of Oxford), have had the pleasure of meeting Queen Elizabeth II on various occasions and reminisce on their encounters with affection. Lord Diljeet Singh Rana OBE, in his role as a member of the House of Lords and leading on many aspects of UK-India business relations, has had the privilege of seeing Her Majesty in person at innumerable gatherings, as well as meeting personally. On one particular occasion, Lord Rana was invited to join a small group to dine with The Queen and fondly remembers how amazed he was by how the she put all her guests at ease and the remarkable attention to detail she had when making everyone feel so comfortable and valued. Lord Rana speaks of her incredible knowledge, quality of conversation, as well as her interest and dedication to service as being exemplary and unique. He feels truly honoured to have had the acquaintance of Her Late Majesty Queen Elizabeth II and conveys that her kindness will forever be remembered by one and all. Lord Balfe also had the pleasure of meeting Her Majesty on various occasions in his role as a member of the House of Lords. According to him, Her Majesty realised the importance of international solidarity. Her devotion was not just to the Commonwealth but to its peoples of many different races, religions and levels of affluence. Like NNEdPro, she supported the developing world and its people. We can take strength from her example in developing our International cooperation and desire to build a more just and equitable world. NNEdPro Associate Director, Dr Rajna Golubic, had the pleasure of meeting Her Majesty during the quincentenary celebration of St John's College in April 2011. Dr Golubic, being a representative of the graduate student committee, was one of the few invited to attend the celebratory lunch with Her Majesty The Queen and speaks fondly of this once-in-a-lifetime opportunity. She will cherish the memory of The Queen's genuine interest in the research taking place, her warm and kind manner, and her dedication and service to the nation which was evident not only in her life's work but also when meeting in person. Dr Golubic is deeply saddened by Her Majesty's passing and will remember her for her elegance, clarity of communication and the role model she became for many female leaders. As a global organisation headquartered in the UK but working across continents, many of us have taken inspiration from the life and work of Queen Elizabeth II, who was loved and respected by millions all over the globe. Through seven decades of selfless service, she gave the UK a unique place in the modern world. May Her Majesty rest in peace, and may her unparalleled legacy live forever more! Compiled by Professor Sumantra Ray, Sarah Anderson and Matheus Abrantes on behalf of the NNEdPro Global Institute for Food, Nutrition and Health (Cambridge, UK) Images from https://www.royal.uk

Written by: Wanja Nyaga Reviewed by: Dr Luke Buckner, Sally Ayyad, Ebiambu Agwara, and Prof Sumantra Ray Nutrition Implementation Coalition The Nutrition Implementation Coalition was formed in 2019 as a collaborative group convened by NNEdPro and including Nutritank, ERimNN and Culinary Medicine UK. Together, these organisations bring a variety of educational, professional and research experiences, sharing the same vision to advocate for a greater focus on nutrition education for healthcare professionals. This coalition fully supports the implementation of the newly launched national nutrition curriculum in the UK but recognises that the most challenging step is still to come in implementing this into medical school training. AfN Curriculum October 2021 marked the launch of the new Association for Nutrition (AfN) convened Curriculum in Nutrition for medical graduates (co-created with a nationally representative Inter-Professional Group in the UK). NNEdPro colleagues took part in the process of formulating and launching the curriculum. This nutrition curriculum provides undergraduate students with the knowledge, understanding and skills required to support them in being safe practitioners before they move on to the next stage of their medical training. The Undergraduate Curriculum in Nutrition for Medical Doctors supports the development of 13 core nutritional competencies for all undergraduate medical students at the point of graduation, assessed through the achievement of 11 graduation fundamentals. The curriculum supports the understanding and skill development of the core competencies and has 8 key curriculum statements. The curriculum statements are supported by teaching points which can be integrated across foundation courses (or introductory learning) where the principles of basic nutrition underpinning good health across the life course can be incorporated alongside basic biochemical and physiological principles, within public health teaching, and within clinical teaching by speciality. Thus, ensuring students understand the importance of nutrition in the prevention and both the progression and management of disease and conversely how disease can exert an effect on the nutritional state. Roundtable In February 2022, the Nutrition Implementation Coalition coordinated and chaired a roundtable with approximately 29 representatives from 14 medical schools. The aim of the Roundtable was to bring together medical schools and interested nutrition educators in the UK, providing a ground for discussion on how different curriculum developers can envision accommodating greater focus on nutrition for medical students. What did we learn from the roundtable? Below is our capture of key points shared by various members during the roundtable highlighting where they felt it is important medical students are competent and confident on graduation. Medical Attitudes in Nutrition Care Acting as role models to doctors and other health professionals Recognising how all members of the Multidisciplinary team (MDT) have a role in developing and supporting good nutritional care Nutrition knowledge Understanding the role of food and nutrition in the management of NCD, and other disease states/health issues Nutrition Practice Understanding nutrition science and recognise how they contribute to: - Identifying those at risk of malnutrition/or are malnourished through history taking, screening, routine blood tests Thinking about drug-nutrient interactions when prescribing/reviewing It was agreed that doctors are an important part of the MDT and should act as role models in ensuring the identification, first-line treatment and monitoring of nutrition status. It is also important they are confident to use all the resources available to them, including clinical and social prescribing and referring to registered dietitians and nutritionists where appropriate. Further feedback highlighted how this may be incorporated into medical curricula: Integrating nutrition where relevant rather than a standalone subject may help to demonstrate relevance to students and can be added in short regular additions to current teaching. Medical students would value more practical consultation skills and a chance to practice in simulated patient consultations. Clear signposting where nutrition teaching is placed ensures teaching is explicit via learning outcomes and linked to examination. Linking knowledge directly to patient care- A case-based approach seems to be easier for students to identify with. Doctors are not nutritionists but can benefit from learning more detail on nutrition interventions where relevant. Collaborating with nutrition faculty and dietetic colleagues helps to provide teaching expertise and can assist medical schools in lecture delivery and course development. In summary, there is recognition that nutrition training for doctors needs improvement, but is unlikely to get large amounts of extra time. Hence, there was a focus on greater emphasis on existing content, signposting to further reading, and practical training with clear translation to clinical care. It is also highlighted that doctors should not be expected to be nutritionists and so will need to recognise the capabilities of their training and use experts such as dietitians and trained nutritionists. Link to the AfN curriculum. Survey Responses In a few words, share ideas on how to improve the implementation of nutrition education. Do you perceive barriers to implementing more nutrition at your medical school, and if possible, please share in the text below. Yes. No. Why? Give two examples of where you have already changed (or plan to change) your medical school nutrition training.

Since its inception, NNEdPro’s COVID-19 Taskforce has worked to improve health during the COVID-19 pandemic, by focusing on nutrition research, clinical practice and public health. As a global organisation, our dedicated microsites contain a repository of generic and region specific public health resources to highlight up-to-date policy and practice across our regional networks(1). Additionally, the taskforce has identified areas for research and evidence synthesis relating to the nutritional aspects of COVID-19 prevention and treatment, including issues of food and nutrition security (2). Our aim has been to coordinate and share resources with NNEdPro’s global and regional networks, and the public, to highlight key challenges, policy updates and best guidance on good nutrition and health practices in the context of COVID-19. Each month the NNEdPro COVID-19 microsites are updated with new resources related to both public health and nutrition in the context of the COVID-19 pandemic. These evidence collections are linked closely with our research focussed ‘Evidence Tracker’ as well as the International Knowledge Application Network Hub in Nutrition (iKANN). Alongside this, we will endeavour to produce a monthly statement reflecting on these updates to the evidence base as well as inviting thoughts from taskforce members involved in these areas of work. Public Health Updates There has been a focus on COVID-19 vaccines during July and August, with a particular focus on three population groups. Two studies have investigated COVID-19 vaccination in pregnancy (3,4). Pregnancy is an independent risk factor for severe COVID- 19, and vaccination is the best way to reduce the risk of infection. However, there have been some opposing opinions from professionals and the public regarding the safety of using vaccines before, during and post pregnancy. The World Health Organisation (WHO) and Centers for Disease Control (CDC) considered the potential effects of vaccination on foetal development, placental transfer of antibodies and maternal safety and have decided to recommend pregnant, postpartum and lactating women to receive the COVID-19 vaccine. In this review, the authors examined the evidence supporting the effectiveness, immunogenicity, placental transfer, side effects, and perinatal outcomes of maternal covid-19 vaccination, as well as describing the vaccine hesitancy in pregnancy (3). A Canadian population based retrospective cohort study assessed the risk of preterm birth, small for gestational age at birth, and stillbirth after covid-19 vaccination during pregnancy (4). The authors concluded that COVID-19 vaccination during pregnancy was not associated with a higher risk of preterm birth, small for gestational age at birth, or stillbirth. There is still little evidence into the pregnancy specific effects of COVID-19 vaccines. Therefore, vaccination during pregnancy must be prioritized in vaccine research. A BMJ feature looked into what is known about COVID-19 vaccines in children under 5 years (5). The US authorised the vaccination of under 5s in June 2022, joining Argentina, Bahrain, Chile, China, Cuba, Hong Kong, the United Arab Emirates, and Venezuela in offering covid-19 vaccines to the youngest age category. The UK is currently only offering vaccines to those over the age of 5. This feature reported on the evidence of the vaccines’ effectiveness in this age group. A multicentre prospective cohort study described the incidence of, risk factors for, and impact of vaccines on primary SARS-CoV-2 infection during the second wave of the covid-19 pandemic in susceptible hospital healthcare workers in England (6). The study investigated NHS clinical, support and administrative staff between September 2020 – April 2021 and recorded their COVID-19 infection and vaccination status. Being under 25 years, living in large household, having frequent exposure to COVID-19 patients, working in an emergency department and being a healthcare assistant were the factors increasing the likelihood of infection in the second wave. Time to first vaccination was strongly associated with infection (P<0.001), with each additional day multiplying a participant’s adjusted odds ratio by 1.02. The authors concluded that without the rapid COVID-19 vaccine rollout to healthcare workers in England from December 2020, the second wave infections could have been 69% higher. Equitable delivery of booster vaccines to healthcare workers is therefore essential. ​ Nutrition Updates A number of further papers have been added to the nutrition resources site across the months of July and August. The BMJ-NPH Nutrition Interactions with COVID-19 special collection has seen 3 new publications in the last number of weeks (7). Two publications from July examine the impact of dietary interventions (periodic fasting and ketogenic diet therapy) on metabolic health (8,9), a widely considered risk factor for COVID-19 susceptibility and severity. The most recent August submission comes from a collaboration between members of the NNEdPro Nutrition and Covid-19 Taskforce and Diabetes Digital Media (DDM), providing interesting insights into changes in diet, physical activity and sleeping behaviours in adults with type 1 and type 2 diabetes during the COVID-19 pandemic in the UK (10). Additional factors considered in new papers added include the impact of ultra-processed food intake on the risk of COVID-19, with data taken from the UK Biobank suggesting a higher risk associated with higher UPF consumption (11). Further to this, a Finnish epidemiological study examines the effects of the pandemic on incident cases of chronic disease, suggesting reduced access to healthcare services as an important factor in their findings (12). On the subject of food security, two studies examine the implications for food access during pandemic times. One study from the Academy of Nutrition and Dietetics in the USA describes changes in practice, challenges and areas of need for registered dietitians working in the area (13). A further systematic review examines global trends in food security and dietary habits of University students (14), noting some concerning trends posing a high risk of weight gain and food insecurity. The final additions to the microsite collections consider the role of micronutrients in cardiovascular disease and potential implications for COVID-19 infection (15), a clinical case report on the complexities of long-term care With Gastro-Jejunal (GJ) feeding tubes and enteral migration (16) and lastly, qualitative exploration of the clinical presentation, trajectory, management and recovery of COVID-19 in older people (17). References ​ COVID-19: Useful Resources: https://www.nnedpro.org.uk/coronavirus COVID-19: Nutrition Resources: https://www.nnedpro.org.uk/covid-19nutrition-resources Covid-19 vaccination in pregnancy: https://www.bmj.com/content/378/bmj-2021-069741 Risk of preterm birth, small for gestational age at birth, and stillbirth after covid-19 vaccination during pregnancy: population based retrospective cohort study: https://www.bmj.com/content/378/bmj-2022-071416 What do we know about covid-19 vaccines in under 5s? https://www.bmj.com/content/378/bmj.o1892 Burden of SARS-CoV-2 infection in healthcare workers during second wave in England and impact of vaccines: prospective multicentre cohort study (SIREN) and mathematical model: https://www.bmj.com/content/378/bmj-2022-070379 BMJ NPH Nutrition Interactions with COVID-19: https://nutrition.bmj.com/pages/collections/nph_nutrition_interactions_with_covid-19/ Association of periodic fasting with lower severity of COVID-19 outcomes in the SARS-CoV-2 prevaccine era: an observational cohort from the INSPIRE registry https://nutrition.bmj.com/content/early/2022/06/30/bmjnph-2022-000462 Reduced COVID-19 severity elicited by weight loss from a medically supervised ketogenic diet in a geographically diverse ambulatory population with type 2 diabetes and obesity https://nutrition.bmj.com/content/early/2022/07/01/bmjnph-2022-000444 A web-based survey assessing perceived changes in diet, physical activity and sleeping behaviours in adults with type 1 and type 2 diabetes during the COVID-19 pandemic in the UK https://nutrition.bmj.com/content/early/2022/07/19/bmjnph-2021-000391 Impact of ultra-processed food intake on the risk of COVID-19: a prospective cohort study - https://pubmed.ncbi.nlm.nih.gov/35972529/ The impact of the COVID-19 pandemic on incident cases of chronic diseases in Finland https://pubmed.ncbi.nlm.nih.gov/35972418/ Repeated Cross-Sectional Surveys of Registered Dietitian Nutritionists Demonstrate Rapid Practice Changes to Address Food Insecurity During the COVID-19 Pandemic https://pubmed.ncbi.nlm.nih.gov/35963532/ Effect of COVID-19 Outbreak on the Diet, Body Weight, and Food Security Status of Students of Higher Education; A Systematic Review https://pubmed.ncbi.nlm.nih.gov/35946073/  https://pubmed.ncbi.nlm.nih.gov/35946073/ The Mutual Relationship among Cardiovascular Diseases and COVID-19: Focus on Micronutrients Imbalance https://www.mdpi.com/2072-6643/14/16/3439 Complexities of Long-Term Care With Gastro-Jejunal (GJ) Feeding Tubes and Enteral Migration During COVID-19 Pandemic Times: A Case Report https://pubmed.ncbi.nlm.nih.gov/35968246/ A qualitative exploration of the clinical presentation, trajectory, management and recovery of COVID-19 in older people: Learning from frontline staff experiences https://pubmed.ncbi.nlm.nih.gov/35962626/ ​ Previous monthly statements ​ April 2022 May 2022 June 2022 July 2022 ​