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Authors: Nikitah Ray (NNEdPro Junior Ambassador Co-Lead & Founder of the ‘Nikitah’s Little Library’ project) & Sucheta Mitra (NNEdPro India & MTK Co-Lead) Reviewer/Editor: Prof Sumantra (Shumone) Ray Special Acknowledgements: NNEdPro India/MTK Team (Debashis Chakraborty, Harmanpreet Kaur, Asim Manna, Sabyasachi Ray); NNEdPro India/MTK Educational Supervisors (Mitali Gupta, Chitra Ray, Elizabeth Richards); NNEdPro/MTK Kolkata Champions; Minha Rajput-Ray, Luke Buckner & MTK Researchers (NNEdPro Virtual Core) Note: These images have been shared with the consent of the families and communities involved In 2016 NNEdPro decided to start working on improving the nutritional status in urban slums of India; we had detected some barriers so during the summer of 2017 we held a workshop in Cambridge to give ideas for the first and foremost design of the kitchen as a previous physical facility had been demolished as it was built in an unregistered slum territory so the council did not like this slum having ‘privileges’ of their own; I (Nikitah) had been in that meeting and had decided to sketch one of my own, and being 8 years old at the time I had decided to base it off a mobile ice-cream van! Ironically, this caught the attention of many NNEdPro core members who chose to look at the opportunities it would bring and weighing out the pros and cons it was considered something with serious potential. From there professional blueprints were being made, collaborators were getting on board and soon 5 members of NNEdPro, Luke, Lanthi, Riya, Minha and Sumantra were bringing in ~£40K in funding which would help for a physical van to be designed especially for a teaching kitchen. The concept became an enterprise officially named the NNEdPro Mobile Teaching Kitchen (MTK) where the central motto is ‘see one, do one, teach one‘ which encourages MTK champions to teach others, meaning that the knowledge is wider spread than just the MTK. From starting out by giving food for free to seeing customers' experience to being able to charge for the nutritionally enhanced vegetarian menus in several parts of Kolkata and India, here are the mothers are learning to cook the kitchen food in preparation for the MTK. And here the champions are in the kitchen itself serving food to the public. Following the success of the MTK, the mobile library is a separate entity we created attached to the slums where the main MTK champions live and these are attached to the schools in these slums. Nikitah’s Little Library The word ‘library’ is derived from the Latin liber, “book”.The first systematically organised library in the ancient Middle East was established in the 7th century BCE by Assyrian ruler Ashurbanipal in Nineveh, in contemporary Iraq. It contained approximately 30,000 cuneiform tablets assembled by topics. Shiyali Ramamrita Ranganathan, (born August 9, 1892, Shiyali, Madras, India—died September 27, 1972, Bangalore, Mysore), an Indian librarian and educator, was known as the father of library science in India and her contributions worldwide influence. The idea of a Mobile Library for the children of the marginalised communities in Kolkata, India was outlined (by Nikitah) as early as 2018 when the MTK entered operations. However, this came to fruition when in Autumn 2021 funds were raised (by Nikitah from her school) via a children’s workshop on ‘Diwali and spreading kindness’ organised by the parents’ association and primary section at St Leonard’s School in St Andrews Scotland. At the end of March 2022 and early April 2022, the mobile library idea was executed in two slums at Kolkatanamely Chetla Lock Gate and RG Kar, where NNEdPro is working to create Nutritional Knowledge awareness amongst women and families since 2017. On 30th March 2022, Nikitah’s little library was inaugurated and set up at the Integrated Child Development Services (ICDS) school in the Chetla slum community, where 3 college students from the slums were assigned the duty of Librarians to distributing books among interested children from the slum and nearby areas to read and learn, keeping track of borrowing, monitor attendance of children in Library, and gathering more books for the library. This library was inaugurated by members of the NNEdPro Global delegation present at the time. Similarly, on 14th April 2022, Nikitah’s little library was set up in the RG Kar slum at a registered club named “Milan Saathi”. A named ICDS teacher has been given the responsibility of taking care of books and making sure that education reaches every child residing in that/nearby area. This library was inaugurated by local Councilor Dr Meenakshi Ganguly, a renowned Gynecologist in Kolkata. Both Libraries have started taking up considerable pace in line with the mission of EDUCATION FOR ALL and provide hubs for bilingual literacy and educational materials in English, Bengali and translations between the two languages particularly for ages 5-15. We hope to see these libraries flourish and develop further in long run to help ignite the untapped potential of the next generation as we bring together linguistic aspects of literacy together with learning in food, nutrition, health, and life skills. Please donate NOW by clicking THIS LINK.

Chefs as Agents of Change to Accelerate Transformation of Food Systems through solutions-driven advocacy for culinary and food professionals Author: Jaroslav Guzanic (Executive Chef; Culinary Instructor/Educator; Project Director and Founder of the Swiss Association for Cooperation on Food Education; Chefs' Manifesto Switzerland; Co-Lead of the NNEdPro Swiss and Non-Mediterranean Europe Regional Network) Acknowledgements for consultation: Keren Allen (Project and Partnership Lead – SDG2 Advocacy Hub Secretariat | www.sdg2advocacyhub.org); Wanja Nyaga, Sucheta Mitra and Matheus Abrantes (NNEdPro) Reviewer/Editor: Professor Sumantra (Shumone) Ray The Chefs’ Manifesto, together with the support of multiple partner networks (also with the support of the Swiss Association for Cooperation on Food Education as a research promoter) compiled a survey between February-May 2021 to learn what chefs perceive to be the top practical actions they can take to help accelerate food systems transformation in the Decade of Action. The UN Food Systems Summit (UNFSS) was convened by UN Secretary-General António Guterres and held in September 2021. The purpose was to shape global commitments and to raise global awareness of food systems, and how they might be transformed to reduce diet-related diseases, resolve hunger, and restore planetary health. The Secretary-General was calling all citizens to collective action, to “radically change the way we produce, process, transport, market and consume food”1. Building on global platforms and events, the UNFSS aimed to generate agreements and highlight collaborative actions. Initiatives locally, regionally, nationally, and globally that support food systems transformation had been explored prior to the Summit occurring. Knowledge sourced from these initiatives informed future recommendations from the Summit. The UNFSS followed 5 Action Tracks 1. Ensuring access to safe and nutritious food 2. Shifting to sustainable consumption patterns 3. Boosting nature-positive production 4. Advancing equitable livelihoods 5. Building resilience to vulnerabilities, shocks and stress2 2021 was a critical year with events such as the UNFSS, Nutrition for Growth (N4G) and COP 26 all being convened throughout 2021, truly was a superb year of opportunities for collective action whereby chefs created a global manifesto identifying a framework of actionable steps. It was critical that advocacy actions were at the forefront of these events, driving forward change by bringing in as many diverse voices as possible, to ensure that 2021 actively heralds in the remainder of the Decade of Action to achieve the SDGs. As Agents of Change, and to drive action, chefs need to come together in one collective, connected voice. Chefs’ Pledge The Chefs’ Manifesto network took a leading role to further focus and narrow the SDG roadmap for chefs, as well as bridging and connecting across chef networks worldwide. This was motivated by the UN Food Systems Summit, and the urgent need to generate actions to be able to achieve the SDGs by 2030. Through conducting a survey, the aim was to learn from participants, what the top priorities were for 2021, the results of which informed the creation of a ‘Chefs’ Pledge’. This Pledge was a commitment to key practical priorities that can have the greatest impact to enact change in and across food systems. It aimed to create collective momentum to rally greater attention and engagement of chef food systems champions, mobilising them even further as agents of change, at key global events, especially the past UN Food Systems Summit. Participants and Stakeholders 1. Chefs and cooks and other partner networks who had wished to join 2. External certified, as well as non-certified chefs 3. Scientific group of the UNFSS 4. Chairs and Vice Chairs of the Action Tracks 5. Other scientists and food professionals 6. Food science and culinary students Objectives This international survey aimed to narrow the already existing Chefs’ Manifesto Action Plan[1], formed from the UN SDGs to a much more succinct, 8-point practical action pledge, which could begin to be immediately implemented by existing and future chefs, cooks, and food professionals. Through statistically prioritising which actions would be deemed to have the most impact from the wider Action Plan, the objective was to uncover the 8 key actionable solutions chefs globally would like to prioritise to tackle food systems challenges and accelerate transformation. The research was conducted from late February through to May 2021. Study Design The aim was to conduct analytical surveys, questionnaires and multiple global, inclusive dialogues across the culinary sector (the reports of which were submitted to the UN Food Systems Summit 2021) interviews to learn from participants what the top priorities for chefs in 2021 and beyond were and what actions and impactful ideas they have enforced, the results of which informed the creation of a Chefs’ Pledge - a potential SDGs roadmap for other chefs and culinary students to improve food systems in their specific region or community. The survey was translated into several languages, including Mandarin/Chinese, Arabic and Spanish. This allowed for a greater diversity of voices and participation. The preliminary results were published in June 2021 as part of the preparations for the 2021 UN Food Systems Pre-Summit Event, which was held in Rome, Italy. Other key information and data were also collected during the Swiss Independent Dialogue on May 14 2021 organised by the Swiss Association for Cooperation on Food Education. Timeline Methods Chefs’ Manifesto and partnering organisations invited participants via social media, direct email, through partner networks and various campaigns. Effective until the 1st of June 2021, several hundred respondents have participated from more than 50 countries, with a wide variety of skills and expertise, yet all with a common goal: to make the positive transformation to our food systems, share existing examples of practice and accelerate good food for all. Survey participants identified as being engaged as one of the following: trained chefs and scientists (represented by 62%), cooks (7%), culinary students (3%) and other food-related non-culinary professionals (24%). Over 50 countries were represented including, but not limited to India, the Philippines, Ghana, Slovakia, South Africa, Colombia, China, Brazil, Mexico, Ireland Australia, Austria, New Zealand, Kenya and Switzerland. The survey questions were categorized into 8 Thematic Areas as introduced above. At the end of the survey, participants were asked to share practical and innovative actions (based on the thematic areas) they have been implementing or measures and efforts they had implemented in support of the transformation of food systems. A summary of the responses is as follows and has been prioritized based on the statistical prevalence of all, so far received replies to the survey questions (to each thematic area) and subsequent dialogues. Each question was headlined with one of the 8 Thematic Areas. Participants were asked to rank using a number system, with 1 = most important = the action they believe would have the greatest impact when implemented. The Chefs’ Manifesto created the survey, engaged, co-ordinated and briefed partner networks to support partner networks to promote and conduct the survey. Secondly, they collected and analysed the data, and hosted several dialogues to discuss findings and the Chefs’ Pledge commitment and curated Chefs’ Pledge commitment. Moreover, they shared an official logo and asked all participants to place the designed materials on all Chefs’ Pledge graphics and curated social media tiles for wider dissemination. Furthermore, the Chefs’ Pledge was disseminated throughout the Chefs’ Manifesto and partner networks to promote, share, and seek commitments globally and also shared the Chefs’ Pledge commitment with the UNFSS. Finally, they committed themselves to organising several chefs to participate and be the public face of the actions at different global key events hosted by the UN and its partnering networks. Partner networks and individual participants promoted the survey within their networks, and shared links via email and social media. They participated in dialogues hosted by the Chefs’ Manifesto. Additionally, they put forward specific chefs and/or delegates to endorse the Chefs’ Pledge and suggested chefs and/or delegates participate in FSS dialogues focused on this throughout 2021 and suggest chefs endorse the Chefs’ Pledge alongside global events such as the FSS, COP 26 and N4G. The Chefs’ Manifesto will act as the convenor of the Chefs’ Pledge and the pledge was being taken from the Action Plan in the Chefs’ Manifesto aligned to the SDGs. Any network that signed onto the pledge had its logo represented on the document as a partner network. In exchange, they promoted the survey to their members and hosted a discussion or dialogue to help shape the final pledge. Results Thematic Area 1: Ingredients are grown with respect for the earth & its oceans Action 1: Choosing ingredients with the lowest impact on the environment (38%). Action 2: Use purchasing power by choosing producers or suppliers who work sustainably and only buy from the sources who share your values (28%). Action 3: Sustainable ingredients and producers through your menus in restaurants, public catering venues and community kitchens (34%). Thematic Area 2: Protection of biodiversity and improved animal welfare Action 1: Use different varieties of plants, grains, and proteins and champion “wild” variants and avoid monoculture (31.8%). Action 2: Raising awareness about the importance of free-range eggs, sustainably sourced fish and animal welfare on daily menus in households and restaurants (21.8%). Action 3: Choosing producers who commit to higher animal welfare standards (19.4%). Action 4: Using purchasing power to choose only fish and seafood that is abundant and sourced sustainably (27%). Thematic Area 3: Investment in Livelihoods Action 1: Knowing your ingredients and investigating the journey from farm to fork and reducing the number of intermediaries between you and the farmer (23.4%). Action 2: Use your purchasing power to choose products that are priced fairly, to enable a viable livelihood for farmers and suppliers (13.5%). Action 3: Supporting more farmers to access marketplaces by choosing to buy from small-scale producers (13%). Action 4: Promoting equal opportunities and providing training within your restaurants (15.8%). Action 5: Providing training and mentoring to chefs (15.8%). Action 6: Further support for female farmers, female producers and female chefs (18.5%). Thematic Area 4: Natural resources and reduction of food waste Action 1: Monitoring and setting targets to reduce and prevent food waste. It is also about managing food safety processes and use by dates to avoid wastage (15%). Action 2: Planning food orders and menus to minimise food waste by offering smaller portion sizes (11.9%). Action 3: Being creative through pickling, preserving, dehydrating and freezing (11%). Action 4: Using purchasing power to engage with suppliers and producers to help incorporate surplus produce into menus (10.6%). Action 5: Become a community food champion and re-distribute surplus food through community sharing and food bank programmes or apps (11%). Action 6: Being resource efficient and managing water usage to cut costs and protect the environment (13%). Action 7: Diverting waste from landfill and investigating turning food waste into compost or bio-gas. It is about considering offsetting the carbon used in your restaurant or switching to renewable energy sources (14%). Action 8: Using purchasing power through working with producers and suppliers to avoid excess packaging and to use recycled, recyclable and biodegradable packaging (13.5%). Thematic Area 5: Celebration and local foods Action 1: Use your purchasing power by buying locally produced foods in season and avoiding air-freighted foods (27%). Action 2: Showcasing local producers and traditional techniques on restaurant menus (17%). Action 3: Become a community food champion through engaging with your local community and working with schools and teaching kids about nutritious food and how to cook it (17%). Action 4: Becoming the connection between producers and consumers. Helping to show people where their food comes from. Inviting farmers and connecting them to diners. Organise events to bring people - young and old - together around good food. (16%) Action 5: Promoting kitchen gardens and urban farming. Encouraging people to start growing their own food. (24%). Thematic Area 6: A focus on plant-based ingredients Action 1: Make vegetables, beans and pulses the centre of your dishes (32.5%). Action 2: Using less, and better, meat (20.6%). Action 3: Incorporating plant-based proteins on menus and in restaurants and other public catering venues (20.6%). Action 4: Avoid using words like “vegan” and “vegetarian” which may be off-putting (26.3%). Thematic Area 7: Education on food safety and healthy diets Action 1: Showcasing best practise on food safety, allergens and nutrition in your kitchens and through your menus. (24%) Action 2: Be a community food champion and support good nutrition education for all young and old. Volunteer to teach a nutritious cooking class in a school, community centre or care home. (18%) Action 3: Educating diners about the importance of eating a colourful plate. (20%) Action 4: Use annual events like International Chefs Day (20 October), World Food Day (16 October) and local holidays to get creative and engage people in nutritious cooking. (18%) Action 5: Using technology as a tool for teaching others. Make videos, and run webcasts and online sessions. Thematic Area 8: Nutritious food that is accessible and affordable for all Action 1: Support initiatives that provide access to nutritious meals in communities (43%) Action 2: Helping raise awareness about what a nutritious meal looks like and how to cook well on a budget. (30%) Action 3: Creating more Chef's communities across the world to share stories, best practices and learnings on how to help ensure good food is accessible and affordable for all. (18%) Action 4: Spreading the word and using social media to raise awareness about food issues and how to be part of the solution (9%).4 Conclusion The conclusion resulted in 8 practical actions that were deemed the most likely to accelerate food systems transformation. These were as follows: 1. I will get to know my ingredients: How are they grown, reared or sourced? I will choose ingredients with the lowest impact on the environment. 2. I will lead by example: To maintain the rich diversity of the world’s natural larder by using different varieties of plants, grains and proteins. I will champion ‘wild’ variants and avoid monoculture. 3. I will get to know my ingredients: Who grows, harvests, sources and packages them? How do they get to you? I will investigate the journey from farm to fork. I will choose ingredients with as few intermediaries as possible between myself and the farmer. 4. I will lead by example: by separating, monitoring and setting targets to reduce food waste. 5. I will use my purchasing power: Buying locally produced foods in season and avoiding air-freighted foods. 6. I will lead by example: Making vegetables, beans and pulses the centre of my dishes. 7. I will be a community food champion: Showcasing best practices on food safety, allergens and nutrition in my kitchen and through my menus. 8. I will be a community food champion: Supporting initiatives that provide access to nutritious meals. Chefs were then asked to sign a pledge, committing to one or more of these actions, to help ensure good food for all. Continuity of the research, as well as satellite activities and events, followed until December 2021. In 2022 following the NNEdPro International Summit on Nutrition and Health, there is momentum and opportunity to develop as well as implement several of these practical actions, especially in the wake of the globalisation of the Mobile Teaching Kitchen initiative: www.nnedpro.org.uk/mtk References 1https://www.unccd.int/actions/food-systems-summit-2021 2https://www.unccd.int/actions/food-systems-summit-2021 3 https://sdg2advocacyhub.org/chefs-manifesto/chefsagents 4https://sdg2advocacyhub.org/chefs-manifesto/actions/chefs-pledge-results-are Attachment 1: Global Dialogues Summary https://www.un.org/sites/un2.un.org/files/global-dialogues-compiled-summary_final.pdf Websites www.foodplatform2030.org www.nnedpro.co.uk/switzerland Research Design and Implementation The Chefs’ Manifesto Other Researchers The Chefs’ Manifesto, World Association of Chef's Societies, Social Gastronomy Movement, Chef Ann Foundation, Le Cordon Bleu London, Good Food Fund China, James Beard Foundation, Chefs 4 the Planet and other external networks – the full list of researchers and other details regarding the survey can be requested by sending an inquiry to info@foodplatform2030.org

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 once again been a strong focus on the long-term effects of COVID-19, including recovery from and long-term management of the disease. In the UK, the NHS have created a new hub ‘Your COVID recovery’ to host useful and accessible resources for patients and recovering from the disease and their families (3). Examples of the resources include information on the disease itself, patient's wellbeing and their road to recovery. The Suth African and Indian governments have both released further guidance on the long-term management of patients recovering from COVID-19 (4,5). The European Respiratory Society has published a statement on the follow up of patients suffering from long covid (6). The ERS taskforce agreed on eight clinical questions which would be used to search the existing literature and identify the optimal strategies for follow-up care that may positively impact the patient's quality-of-life. Overall, they found that the evidence available for follow-up care for patients with long COVID-19 was limited. There have been two more additions to the BMJ COVID-19 journal exploring long-covid. Researchers from King’s College London analysed self-reported data from the UK ZOE covid app and found that the risk of developing long covid was lower among people with the omicron variant of SARS-CoV-2 compared to those with the delta variant (7). Another test negative case control study estimated the change in odds of covid-19 over time following primary series completion of the inactivated whole virus vaccine CoronaVac in São Paulo State, Brazil (8). The authors found a significant increases in the risk of moderate and severe covid-19 outcomes three months after primary vaccination in adults >65 years. Despite the recent attention, there is still a lot unknown about the recovery from COVID-19 and long-covid should be made a priority research area across the globe. A final addition this month is an interesting perspective on the difficulties of science communications during the pandemic, emphasising the importance of educating both the public and policymakers about the scientific process and its constant evolution (9). Nutrition Updates A number of further papers have been added to the nutrition resources site during the month of June. In the clinical nutrition space, we have a literature review on the challenges of providing enteral nutrition in the prone position, a commonly used technique in critically ill patients during the pandemic, with a case study from practice also included (10). Further to this, a large US review examines the impact of malnutrition on clinical outcomes from COVID-19, emphasising the importance of a focus on nutrition in primary prevention (11). We have added an RCT from Pakistan, examining the effectiveness of micronutrient supplementation (Curcumin, Quercetin, and Vitamin D3) as an adjuvant therapy for mild to moderate symptoms of COVID-19 (12). The authors highlight some promising findings and highlight the need for an expansion of this research, particularly in developing countries, in the search for safe, cheap, accessible, and effective treatments for early-stage COVID-19 infection. A further paper from India examines the impact of COVID-19 infection on treatment adherence and outcomes in patients with diabetes mellitus (13). Lastly, on the subject of Long COVID and COVID recovery, a new paper documents the effectiveness of intensive, multidisciplinary rehabilitation on nutritional and functional outcomes in patients recovering from COVID-19 (14), strengthening the evidence of the importance of multi-modal care in this patient group. In addition, a study from the Netherlands discusses some of the challenges faced by COVID patients receiving dietetic treatment in primary care (15). References ​ COVID-19: Useful Resources: https://www.nnedpro.org.uk/coronavirus COVID-19: Nutrition Resources: https://www.nnedpro.org.uk/covid-19nutrition-resources NHS: Your COVID recovery: https://www.yourcovidrecovery.nhs.uk SA National Institute for Communicable Diseases- Lond covid: https://www.nicd.ac.za/diseases-a-z-index/disease-index-covid-19/long-covid/ Ministry of Health and Family Welfare Government of India - NATIONAL COMPREHENSIVE GUIDELINES FOR MANAGEMENT OF POST- COVID SEQUELAE - https://www.mohfw.gov.in/pdf/NationalComprehensiveGuidelinesforManagementofPostCovidSequelae.pdf European Respiratory Society Statement on Long COVID-19 Follow-Up: https://erj.ersjournals.com/content/early/2022/02/03/13993003.02174-2021 Covid-19: Long covid risk is lower with omicron than delta, researchers find: https://www.bmj.com/content/377/bmj.o1500 Change in covid-19 risk over time following vaccination with CoronaVac: test negative case-control study: https://www.bmj.com/content/377/bmj-2022-070102 In Layman's Terms: The Power and Problem of Science Communication https://pubmed.ncbi.nlm.nih.gov/35757894/ Challenges to Provision of Adequate Medical Nutrition Therapy in a Critically Ill COVID-19 Patient Fed in the Prone Position https://pubmed.ncbi.nlm.nih.gov/35761886/ Impact of malnutrition on clinical outcomes in patients diagnosed with COVID-19 https://aspenjournals.onlinelibrary.wiley.com/doi/10.1002/jpen.2418 Oral Co-Supplementation of Curcumin, Quercetin, and Vitamin D3 as an Adjuvant Therapy for Mild to Moderate Symptoms of COVID-19 —Results From a Pilot Open-Label, Randomized Controlled Trial https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9211374/pdf/fphar-13-898062.pdf Impact of SARS-CoV-2 Pandemic on Glycaemic Control, Metabolic Status, Treatment Adherence, Quality of Life in Diabetes Mellitus Patients in Tertiary Care Hospital of Eastern India https://pubmed.ncbi.nlm.nih.gov/35733731/ The Effects of an Intensive Rehabilitation Program on the Nutritional and Functional Status of Post-COVID-19 Pneumonia Patients https://pubmed.ncbi.nlm.nih.gov/35745230/ Nutritional problems of patients with COVID-19 receiving dietetic treatment in primary care https://pubmed.ncbi.nlm.nih.gov/35732588/ ​ ​ Previous monthly statements ​ April 2022 May 2022 June 2022

Author: Timothy McAuliffe Editor/Reviewer: Professor Sumantra (Shumone) Ray Acknowledgements: Thank you to the NNEdPro 2022 Summer School Team (Breanna Lepre, Sarah Armes, Pauline Douglas, Eleanor Beck and Matheus Abrantes) for the opportunity to share this reflection based on the winning essay for 2022. I am grateful to Rima Al-Nimr, Dr Auden McClure, Dr Larry Myers, and Dr Steve Bensen at the Geisel School of Medicine at Dartmouth College (New Hampshire, USA) for introducing me to teaching kitchens during my medical education. Further acknowledgement to Tecla Coleman (NNEdPro US Regional Network Co-Lead) for facilitating the Dartmouth-NNEdPro Summer School scholarship scheme 2022. Barriers to Nutritious Eating A healthy eating pattern is a central part of nutrition and overall well-being. However, many individuals encounter challenges maintaining a nutritious diet. Fifty-eight percent of US adults indicated that they should probably be eating healthier.(1) Providing foundational information about healthy foods is a core component, and lack of information is a frequently cited challenge for patients (2) (3) (4). A more nuanced mix of personal circumstances and structural barriers highlights a consistent set of challenges encountered across many populations. A lack of time or motivation to cook healthy foods poses a frequently cited barrier (4) (5) (6) (7). Furthermore, higher relative costs of nutritious foods and equipment necessary for food preparation generate challenges in preparing healthy meals (3) (4) (7). Many note that special dietary needs, preferences, and cultural eating traditions may generate barriers in making dietary changes (3) (4) (7). Finally, factors related to social or community eating habits contribute as well (2) (4) (6). Teaching Kitchen Model In the face of barriers to healthy eating and personal meal preparation among community members, teaching kitchens have emerged to address these challenges. Teaching kitchens leverage nutrition and culinary education to improve patient culinary skills to strengthen healthy eating patterns. These sessions, which can occur in a community or health centre kitchen, generally include interactive cooking instruction to teach culinary skills, improve confidence in cooking, and build knowledge on healthy meal preparation and eating (8) (9) (10). The central aim of the teaching kitchen model is to educate and engage a diverse audience (including patients with obesity or managing chronic disease) in eating and cooking in thoughtful ways to improve their health and cooking capabilities. Specific objectives include [1] improving familiarity with different eating patterns (e.g., plant-based diet, Mediterranean diet), [2] promoting cooking skill capabilities and confidence, [3] providing recipes that can be applied to at-home cooking, [4] encouraging mindful eating habits, and finally [5] promoting an environment where individuals can engage in their food preparation. Teaching Kitchen Impacts on Health In addition to improving general eating habits and cooking skills, teaching kitchens have tangible benefits for patient health. First, they can act as primary prevention strategies for diseases. Surveys from a teaching kitchen programme showed participants increased the frequency of eating fruits and vegetables and reduced the likelihood of eating fast food (10). Families participating in a kitchen-based nutrition programme were about three times as likely to follow a Mediterranean dietary pattern and saved approximately $20 per week on food costs due to home-prepared meals (11). Another teaching kitchen programme, combined with lifestyle and exercise guidance, was associated with reduced participant weight, BMI, waist circumference, blood pressure, and total cholesterol (8). A diet rich in fruits and vegetables and the Mediterranean diet have shown reductions in risks of cardiovascular disease, gestational diabetes, and breast cancer (12) (13) (14). Once patients are managing a chronic condition, nutrition-focused teaching kitchens can further improve outcomes. A Mediterranean diet-focused cooking and nutrition programme for patients with type 2 diabetes was associated with reductions in diastolic blood pressure and total cholesterol (15). A culinary education programme for individuals with cancer resulted in increased knowledge and confidence in preparation skills for plant-based diets and reduction in processed meat intake (16). Overall, evidence highlights that teaching kitchens can generate meaningful improvements for patients in primary and tertiary disease prevention. Implementation and Evaluation of Teaching Kitchens Implementation of teaching kitchens has already started gaining meaningful traction. The Teaching Kitchen Collaborative, founded in 2016, has a network of 45 teaching kitchens worldwide (17). Furthermore, culinary teaching has been incorporated into medical education, such as implementation in curricula at medical schools at Geisel (Dartmouth), Stanford, and Tulane (18). This mirrors culinary medicine programmes available through broader academic medical centers across the United States (9) (19). Nutrition professionals, instructors, and medical students have highlighted the meaningful impact of teaching kitchens on patient health and training: "With poor nutrition consistently cited as a major cause of morbidity and mortality, hands-on culinary medicine training in a teaching kitchen as a formal part of medical education has been shown to improve future physician confidence in comprehensive patient lifestyle counseling, as well as their own self-care. Evidence-based, technique-driven culinary training is an innovative and effective way to both teach and cement nutrition in medical education." – Rima Itani Al-Nimr, MS, RDN, LD, Lecturer in Medical Education & Medicine, Nutrition in Medicine Curriculum Director; The Geisel School of Medicine at Dartmouth “Our session in the teaching kitchen was a truly valuable opportunity for students to gain first-hand knowledge surrounding nutritious choices, food accessibility, and technical culinary skills. This experience will allow us to better provide informed care and resources to our patients.” – Adriana Radosavljevic, Medical Student at The Geisel School of Medicine at Dartmouth The core resources required to establish new teaching kitchens include a kitchen location, cooking equipment and food, and a course instructor and/or clinician to lead the programme. Furthermore, connections with community organisations or healthcare settings will enable more community members to be engaged with teaching kitchen programmes. The primary measurement is how many individuals are able to access teaching kitchen culinary education programmes. Beyond this, secondary evaluations should focus on impact and outcomes. These include patient-reported confidence in cooking skills, comfort and readiness in preparing meals, and interest in eating healthy foods and avoiding processed food. Outcome evaluation of major health measurements – such as weight, HbA1c, blood pressure, and cholesterol – can connect teaching kitchen instruction with concrete health outcomes. Conclusion and Call to Action Teaching kitchens provide an engaging and supportive environment for patients to learn fundamental culinary skills, new recipes, and healthy habits and offer an innovative new pedagogy for impactful nutrition education. In addition to improving general eating habits, studies have found culinary education significantly improves patient health outcomes. Academic and community organisations have shown how successful models can be developed and integrated into the community. With appropriate funding, stakeholder engagement, community involvement, and focused measurement, teaching kitchens can personalize healthy eating and equip patients with the skills and tools necessary to improve their well-being. Medical providers and researchers in patient care and nutrition should advocate local medical organisations to establish and sponsor the development of community-based teaching kitchens. Providing tailored and hands-on nutrition-based culinary training for all patients can improve population health, reduce medical care costs, and build robust community connections. By investing in teaching kitchens, professionals focused on improving nutrition can provide more comprehensive health support for patients. NOTE: Please refer to the award-winning NNEdPro Mobile Teaching Kitchens initiative as well as its successful adaptation in Mexico. In July 2022, the MTK initiative has won the Society for Nutrition Education and Behavior Program Impact Award and is poised and really for adaptation to the US context in collaboration with prime movers in the field across US partner organisations. References 1. Public views about Americans' eating habits [Internet]. Pew Research Center Science & Society. Pew Research Center; 2020 [cited 2022May31]. Available from: https://www.pewresearch.org/science/2016/12/01/public-views-about-americans-eating-habits/ 2. Beck AL, Iturralde E, Haya-Fisher J, Kim S, Keeton V, Fernandez A. Barriers and facilitators to healthy eating among low-income Latino adolescents. Appetite. 2019Apr4;138:215–22. 3. Oliver TL, McKeever A, Shenkman R, Diewald L. Barriers to healthy eating in a community that relies on an emergency food pantry. Journal of Nutrition Education and Behavior. 2020Nov8;52(3):299–306. 4. Munt AE, Partridge SR, Allman-Farinelli M. The barriers and enablers of healthy eating among young adults: A missing piece of the Obesity Puzzle: A Scoping Review. Obesity Reviews. 2016Oct20;18(1):1–17. 5. Ashton LM, Hutchesson MJ, Rollo ME, Morgan PJ, Collins CE. Motivators and barriers to engaging in healthy eating and physical activity. American Journal of Men's Health. 2016Dec5;11(2):330–43. 6. Nicholls R, Perry L, Duffield C, Gallagher R, Pierce H. Barriers and facilitators to healthy eating for nurses in the workplace: An integrative review. Journal of Advanced Nursing. 2016Nov9;73(5):1051–65. 7. de Mestral C, Stringhini S, Marques-Vidal P. Barriers to healthy eating in Switzerland: A nationwide study. Clinical Nutrition. 2016Apr7;35(6):1490–8. 8. Eisenberg DM, Righter AC, Matthews B, Zhang W, Willett WC, Massa J. Feasibility pilot study of a teaching kitchen and self-care curriculum in a workplace setting. American Journal of Lifestyle Medicine. 2017May23;13(3):319–30. 9. Polak R, Phillips EM, Nordgren J, La Puma J, La Barba J, Cucuzzella M, et al. Health-related culinary education: A summary of representative emerging programmes for health professionals and patients. Global Advances in Health and Medicine. 2016Jan1;5(1):61–8. 10. Black M, LaCroix R, Hoerster K, Chen S, Ritchey K, Souza M, et al. Healthy Teaching Kitchen Programmes: Experiential Nutrition Education Across Veterans Health Administration, 2018. American Journal of Public Health. 2019Oct17;109(12):1718–21. 11. Razavi AC, Sapin A, Monlezun DJ, McCormack IG, Latoff A, Pedroza K, et al. Effect of culinary education curriculum on Mediterranean diet adherence and food cost savings in families: A randomised controlled trial. Public Health Nutrition. 2020Aug3;:1–7. 12. Estruch R, Ros E, Salas-Salvadó J, Covas M-I, Corella D, Arós F, et al. Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts. New England Journal of Medicine. 2018Jun21;378(25). 13. Assaf-Balut C, García de la Torre N, Durán A, Fuentes M, Bordiú E, del Valle L, et al. A Mediterranean diet with additional extra virgin olive oil and pistachios reduces the incidence of gestational diabetes mellitus (GDM): A randomized controlled trial: The St. Carlos GDM Prevention Study. PLOS ONE. 2017Oct19;12(10). 14. Toledo E, Salas-Salvadó J, Donat-Vargas C, Buil-Cosiales P, Estruch R, Ros E, et al. Mediterranean diet and invasive breast cancer risk among women at high cardiovascular risk in the predimed trial. JAMA Internal Medicine. 2015Nov1;175(11):1752. 15. Monlezun DJ, Kasprowicz E, Tosh KW, Nix J, Urday P, Tice D, et al. Medical School-based teaching kitchen improves hba1c, blood pressure, and cholesterol for patients with type 2 diabetes: Results from a novel randomized controlled trial. Diabetes Research and Clinical Practice. 2015Aug;109(2):420–6. 16. Miller MF, Li Z, Habedank M. A randomized controlled trial testing the effectiveness of coping with cancer in the kitchen, a nutrition education programme for cancer survivors. Nutrients. 2020Oct15;12(10):3144. 17. History & leadership [Internet]. Teaching Kitchen Collaborative. Teaching Kitchen Collaborative, Inc.; 2022 [cited 2022Jun1]. Available from: https://teachingkitchens.org/history-leadership/ 18. Green S. Food as medicine: Integrating Nutrition Education into the Medical Education Curriculum [Internet]. Geisel News. Trustees of Dartmouth College; 2018 [cited 2022Jun1]. Available from: https://geiselmed.dartmouth.edu/news/2018/food-as-medicine-integrating-nutrition-education-into-the-medical-education-curriculum/ 19. Culinary Medicine Programme [Internet]. DHMC and Clinics. Dartmouth Hitchcock Medical Center and Clinics; [cited 2022Jun1]. Available from: https://www.dartmouth-hitchcock.org/weight-welln

Author: Joshua Clamp / Editors: Shane McAuliffe and Sumantra Ray A recent announcement from the US Congress has set in motion a move towards improved nutrition education for health care professionals. Representatives James McGovern and Michael Burgess have secured a bipartisan resolution calling for this long-awaited and well-needed transformation. With momentum building, the potential for nutrition-trained healthcare professionals to mitigate the health and economic implications of unhealthy diets is growing, mirrored by an increased prominence of nutrition among the public and professionals. NNEdPro firmly aligns with this mission and supports these bold policy changes and calls to action. Nutrition plays a central role in maintaining good health. Unhealthy diets can increase the risk of obesity, type II diabetes, cardiovascular disease and cancer, bearing physical, emotional and financial costs for individuals and those around them. Furthermore, with public health spending related to diabetes exceeding $200 billion each year, and $90 billion in reduced productivity, there are significant economic and societal costs [1]. All the while, inequities in the food and healthcare systems result in more extreme food insecurity and health complications for individuals from minority ethnic and low-income backgrounds. Overcoming the health and economic challenges of unhealthy diets demands changes to the policy landscape, a reimagining of the food environment, and an array of strategies to support individual behaviour change. Whilst this process of change requires a complex, systems-level, and multidimensional approach, key strategies with the potential to have potent, positive impacts have been identified. Health care professionals are perfectly positioned to provide education and counselling on nutrition to patients, facilitate behavioural change in nutrition and lifestyle, and in turn drive positive health outcomes. Providing such staff with the knowledge, skills, tools, and capacity to include nutrition in their practice is therefore essential. Despite this, a well-recognised evidence-practice gap exists between the knowledge required for effective nutrition care and the nutrition education provided to medical students and other health professionals during training [2]. Medical staff receive little to no education on the relationships between diet, food and health, and are not provided with the skills necessary to counsel patients. One systematic review found that nutrition was insufficiently incorporated into medical education, regardless of country, setting, or year of medical education. Some reports have identified that medical students receive less than two hours of nutrition training throughout their time studying [3]. Consequently, much medical staff lack the capacity, and in many cases confidence, to deliver quality nutritional advice. The historical lack of nutrition education in medical training is a double-edged sword. Not only does a lack of training limit one’s ability to learn, understand, and share nutrition advice, but its very absence is suggestive of insignificance in health and health outcomes. Health professionals may therefore be left not only without the tools to deliver effective nutrition counselling but without the motivation to do so. Growing awareness of this evidence-practice gap has spurred research into how nutrition training may be effectively implemented into medical curricula. This issue has been a focus of NNEdPro, and its international network of nutrition professionals has contributed to numerous publications in this space across a 13-year journey advocating for the important role of nutrition education across the globe [4]. In the USA in particular, over the years NNEdPro has highlighted the need to advance nutrition education in the training of health care professionals [5,6,7]. Further NNEdPro publications: Global architecture for the nutrition training of health professionals: a scoping review and blueprint for next steps Reports, interviews, and surveys were analysed and used to generate recommendations for building global nutrition capacity. Read the full publication here. Read our blog on this review here. Reference to nutrition in medical accreditation and curriculum guidance: a comparative analysis A review of directories found that nutrition content or instruction on nutrition education is missing from important accreditation and formal curriculum guidance for medical education internationally, with only 45% including nutrition. Read the full publication here. Hidden curriculum within nutrition education in medical schools Interviews with medical students highlight the important context in effective nutrition education and the limitations of merely mapping nutrition content. Read the full publication here. Time for nutrition in medical education Analyses of surveys of medical students and doctors confirm the desire and necessity for more nutrition within medical education in the UK, as well as a need for greater clarity of a doctor’s role in nutrition care. Read the full publication here. A 13-year journey towards implementing improved medical nutrition education in the UK and beyond Read the full publication here. The combined efforts of organisations and institutions have built momentum, bridging the historical evidence-practice gap. The growing body of peer-reviewed research now provides a strong enough foundation on which policy changes can be brought about. The US Congress's announcement to support nutrition education within medical schools, residency, and fellowship programmes represents a huge step forward in this movement. The resolution encourages action in several key areas: Physician and health professional training programmes to provide meaningful nutrition education. It urges federal agencies to provide oversight, to ensure federal funding goes to the programmes that prioritise nutrition education. Asks agencies to find research and support the development and dissemination of curricular resources. Calls upon government and private institutions to raise awareness of the critical role of diet and nutrition in health, and the responsibility of health care practitioners to promote healthy diets. Importantly, this announcement raises the importance of nutrition education in medical training to a level of national concern, and will likely be a key topic at the long-awaited relaunch of the White House Conference on Nutrition, Hunger, and Health happening in late 2022. Thanks to the hard work and collaboration of individuals, organisations and institutions, nutrition education is being implemented in medical curricula. As a result, the health workforce is becoming better equipped with the knowledge and skills to help patients with diet and behaviour change, leading to improved health outcomes and a reduced economic burden of diet-related diseases. NNEdPro will continue to support this transformation and is excited to learn about future developments in this exciting space. NOTE: NNEdPro will contribute to a conference on malnutrition in September 2022, organised by the National Institutes of Health (NIH) in the USA. On this occasion, we will draw from this body of knowledge. Key references 1. American Diabetes Association (2018) Economic Costs of Diabetes in the U.S. in 2017. Diabetes Care, 41 (5): 917–928, doi.org/10.2337/dci18-0007 2. Bassin S, Al-Nimr R, Allen K, Ogrinc G (2020) The state of nutrition in medical education in the United States, Nutrition Reviews, 78(9): 764–780, doi.org/10.1093/nutrit/nuz100 3. Crowley J, Ball L, Hiddink GJ (2019) Nutrition in medical education: a systematic review, The Lancet Planetary Health, 3(9): E379-E389, doi.org/10.1016/S2542-5196(19)30171-8 4. Elaine MacAninach and Prof Sumantra Ray. A 13-year journey towards implementing improved medical nutrition education in the UK and beyond. https://www.nnedpro.org.uk/post/a-13-year-journey-towards-implementing-improved-medical-nutrition-education-in-the-uk-and-beyond 5. Kris-Etherton PM, Akabas SR, Bales CW, et al. (2014) The need to advance nutrition education in the training of health care professionals and recommended research to evaluate implementation and effectiveness. Am J Clin Nutr, 99(5 Suppl):1153S-66S, doi:10.3945/ajcn.113.073502 6. Kris-Etherton PM, Akabas SR, Douglas P, et al. (2015) Nutrition competencies in health professionals' education and training: a new paradigm. Adv Nutr, 6(1):83-87, doi:10.3945/an.114.006734 7. Van Horn L, Lenders CM, Pratt CA, et al. (2019) Advancing Nutrition Education, Training, and Research for Medical Students, Residents, Fellows, Attending Physicians, and Other Clinicians: Building Competencies and Interdisciplinary Coordination. Adv Nutr, 10(6):1181-1200, doi:10.1093/advances/nmz083 NNEdPro publications Lepre B, Trigueiro H, Johnsen JT, et al. (2022) Global architecture for the nutrition training of health professionals: a scoping review and blueprint for next steps. BMJ Nutrition, Prevention & Health, e000354, doi: 10.1136/bmjnph-2021-000354 Lepre B, Mansfield KJ, Ray S, et al. (2021) Reference to nutrition in medical accreditation and curriculum guidance: a comparative analysis. BMJ Nutrition, Prevention & Health, 4, doi: 10.1136/bmjnph-2021-000234 Martin S, Sturgiss E, Douglas K, et al. (2020) Hidden curriculum within nutrition education in medical schools. BMJ Nutrition, Prevention & Health, 3, doi: 10.1136/bmjnph-2019-000059 Macaninch E, Buckner L, Amin P, et al. (2020) Time for nutrition in medical education. BMJ Nutrition, Prevention & Health, 3, doi: 10.1136/bmjnph

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 During May, there has been a prominent global focus on COVID-19 vaccination. The WHO have updated their COVID-19 vaccine tracker and landscape to allow close monitoring of countries’ vaccine progression (3). An observational study has described the public health impacts of COVID-19 vaccine programmes in the US, providing insights into the effects experienced in a high-income country with a private healthcare system (4). There are vast inequalities in vaccine uptake, in particular between high- and lower-income countries. A recent ‘Call to Action’ has increased awareness in these disparities and has sparked interesting discussion (5). The authors describe the low COVID-19 vaccine coverage in Africa due to vaccine nationalism and vaccine diplomacy and call for committed leadership for universal immunisation. Additionally, a research study has found that a fourth dose of the BNT162b2 vaccine provided additional protection against both SARS-CoV-2 infection and severe covid-19 disease for people aged 60 years and over, compared to three doses (6). These findings support the use of multiple vaccines for COVID-19 prevention. Long-covid continues to be a large area of focus, with the NHS updating their information on the long-term effects of COVID-19 (7). An observational cohort study found that the likelihood of long covid symptoms was observed to decrease after covid-19 vaccination and evidence suggested sustained improvement after a second dose (8). These conclusions reinforce the importance of vaccination in COVID-19 recovery. Two interesting studies have been published this month looking into the effects of food consumption and physical activity and COVID-19 during home isolation. A cross-sectional study conducted during the first months of lockdowns in Peru found that during confinement, weight gain was mostly associated with food consumption and personal food system factors, whilst weight loss was associated with external food system factors (9). The pandemic – infection and lockdown restrictions - has resulted in a significant decrease in physical activity. One study observed that activity reduced for both infected personas and close contacts over the course of quarantine (10). Additionally, those who were physically active felt less exhausted during their quarantine periods and were less likely to report prolonged physical and psychological symptoms than those who were inactive. These findings stress the significance of exercise in COVID-19 recovery and rehabilitation. ​ Nutrition Updates During May we have identified further useful additions to the literature related to COVID-19 and nutritional status. An interesting study from the UK - The Phyto-V Study – describes a randomised controlled trial (RCT) comparing placebo vs. a phytochemical-rich and pre/probiotic lactobacillus food supplement in patients with symptomatic COVID-19 infection (11). The study found notable outcomes on GI symptoms as well as subjective scores relating to fatigue and overall wellbeing. Related to this, we have seen a narrative review published from experts in the field of micronutrients and omega-3 fatty acids, providing a call to action in considering these nutrients to play an important role in immune function of older adults, with particular reference to the COVID-19 pandemic (12). In the clinical nutrition space a paper from the ASPEN journal of parenteral and enteral nutrition compares the effectiveness of predictive energy equations vs. indirect calorimetry when estimating energy requirements for mechanically ventilated patients with COVID-19 (13). This has been notoriously difficult to accurately measure given a high degree of fluctuation in energy expenditure during the course of critical illness with COVID, as the taskforce have published on in the past (14). Another recently published study from JPEN compares the calculated risk and exposure to infection of patients with short bowel syndrome with the general population in Germany during the pandemic – a group who have been considered at high risk throughout (15). Considering food security, a recent paper from the US examines the influence of food insecurity on changes in eating habits during the pandemic (16). This work identifies notable disparities in eating behaviour across the spectrum of food security in this population, with potentially negative nutrition related consequences at both ends of the scale. On a similar note, a new addition to the BMJ-Nutrition Prevention and Health Special Collection on Nutrition Interactions with COVID-19 looks at food system factors influencing changes in body weight in Peruvian adults during first wave lockdowns (17). Lastly, in the nutrition and long-COVID space, a new Cambridge University Press article explores food consumption and behavioural changes associated with taste and smell changes in those recovering from COVID-19 infection (18). We have also added two BDA resources in this area, the first on Long COVID and Diet (19) and a further resource on the evidence for Low histamine diets and Long-COVID (20). ​ References ​ COVID-19: Useful Resources: https://www.nnedpro.org.uk/coronavirus COVID-19: Nutrition Resources: https://www.nnedpro.org.uk/covid-19nutrition-resources The COVID-19 vaccine tracker and landscape compiles detailed information of each COVID-19 vaccine candidate in development by closely monitoring their progress through the pipeline: https://www.who.int/publications/m/item/draft-landscape-of-covid-19-candidate-vaccines Public health impact of covid-19 vaccines in the US: observational study: https://www.bmj.com/content/377/bmj-2021-069317 COVID-19 vaccine hesitancy in Africa: a call to action : https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00563-5/fulltext Short term, relative effectiveness of four doses versus three doses of BNT162b2 vaccine in people aged 60 years and older in Israel: retrospective, test negative, case-control study: https://www.bmj.com/content/377/bmj-2022-071113 Long-term effects of coronavirus (long COVID): https://www.nhs.uk/conditions/coronavirus-covid-19/long-term-effects-of-coronavirus-long-covid/ Trajectory of long covid symptoms after covid-19 vaccination: community based cohort study: https://www.bmj.com/content/377/bmj-2021-069676 COVID-19, body weight and the neighbourhood: food system dimensions and consumption associated with changes in body weight of Peruvian adults during first wave lockdowns: https://nutrition.bmj.com/content/early/2022/05/04/bmjnph-2021-000416 Impact of physical activity on COVID-19-related symptoms and perception of physical performance, fatigue and exhaustion during stay-at-home orders: https://bmjopensem.bmj.com/content/8/2/e001319 A Randomised, Double-Blind, Placebo-Controlled Trial Evaluating Concentrated Phytochemical-Rich Nutritional Capsule in Addition to a Probiotic Capsule on Clinical Outcomes among Individuals with COVID-19—The UK Phyto-V Study https://www.mdpi.com/2673-8112/2/4/31 Perspective: Role of Micronutrients and Omega-3 Long-chain polyunsaturated Fatty Acids for Immune Outcomes of Relevance to Infections in Older Adults - a Narrative Review and Call for Action https://pubmed.ncbi.nlm.nih.gov/35587877/ Energy expenditure in Covid 19 mechanical ventilated patients: A comparison of three methods of energy estimation https://aspenjournals.onlinelibrary.wiley.com/doi/10.1002/jpen.2393 Critical care nutrition and COVID-19: a cause of malnutrition not to be underestimated. BMJ Nutrition, Prevention & Health 2021;4:doi: 10.1136/bmjnph-2021-000271 SARS-CoV-2 Antibody Prevalence in Adult Patients with Short Bowel Syndrome – A German Multicenter Cross-Sectional Study https://aspenjournals.onlinelibrary.wiley.com/doi/10.1002/jpen.2410 Disparities in dietary practices during the COVID-19 pandemic by food security status https://pubmed.ncbi.nlm.nih.gov/35601457/ COVID-19, body weight and the neighbourhood: food system dimensions and consumption associated with changes in body weight of Peruvian adults during first wave lockdowns https://nutrition.bmj.com/content/early/2022/05/04/bmjnph-2021-000416 Alterations in taste and smell associated with SARS-CoV-2: an exploratory study investigating food consumption and subsequent behavioural changes for those suffering from post-acute sequelae of COVID-19 https://www.cambridge.org/core/journals/journal-of-nutritional-science/article/alterations-in-taste-and-smell-associated-with-sarscov2-an-exploratory-study-investigating-food-consumption-and-subsequent-behavioural-changes-for-those-suffering-from-postacute-sequelae-of-covid19/998A4E0AC9FC010B4B7494E053FB61BE# BDA: Long Covid and Diet: Food Fact Sheet https://www.bda.uk.com/resource/long-covid-and-diet.html BDA: Low histamine diets and Long Covid https://www.bda.uk.com/resource/low-histamine-diets-and-long-covid.html ​ ​ Previous monthly statements ​ April 2022 May 2022

The NNEdPro Professional Training Course for The Power Of Nutrition Team Written by Wanja Nyaga, ANutr Reviewed by: James Bradfield, RNutr and Prof Sumantra Ray, RNutr Background The Power of Nutrition is an innovative financing and partnership platform. Their vision is a world where every child has the right nutrition to achieve their full potential. This is achieved by raising money and creating partnerships to advance the fight against malnutrition in Africa and Asia. In October 2021, the NNEdPro Global Centre was delighted to embark on a new training scheme with the innovative organisation, Power of Nutrition (PoN). NNEdPro has a proven track record in training students and professionals alike, but this was a new venture for all involved which involved the specific tailoring of many new materials. The Power of Nutrition is an innovative financing and partnership platform. Their vision is a world where every child has the right nutrition to achieve their full potential. This is achieved by raising money and creating partnerships to advance the fight against malnutrition in Africa and Asia. Source: https://www.powerofnutrition.org/ The aims and goals of PoN match well with NNEdPro’s mission; to tackle the global crisis of malnutrition (in all its forms) by conducting research and delivering education in gap areas, empowering professionals, policymakers and the public; facilitating sustainable improvements in nutrition and health behaviours, accelerating progress towards the United Nations 2030 goals. Of course, the work of NNEdPro can only be conducted with willing partners and so this was a training scheme that was designed to promote inter-disciplinary and cross-sector collaboration. This was achieved by a series of lectures and workshops over a four-month period. As a multi-disciplinary think-tank, NNEdPro is focused on equipping professionals with the tools they need to make a difference in nutrition outcomes, regardless of the sector within which they work. Having the opportunity to challenge ourselves in designing a bespoke programme for learners with a wide array of backgrounds and experiences was one that we thoroughly enjoyed, as detailed below. Scope of the Professional Training The programme consisted of five-highly informative modules, that were delivered by well-seasoned presenters with extensive experience in clinical and public health, health systems, research and nutrition science over a period of 4 months. The module titles were: Foundational Concepts in Global Nutrition, Health and Disease Identification and Management of Nutrition and Health Risks Nutrition Interventions in Food and Health Systems Nutrition Implementation for Population Health across the Lifecycle Multisectoral and Systems Approaches and Nutrition-sensitive Policy Each module aimed to equip the professionals with a clear understanding of various topics as outlined below: Foundational Concepts in Global Nutrition, Health and Disease This module focused on definitions of malnutrition and how undernutrition and obesity can co-exist. It also covered the descriptions of stunting and wasting (two of the more extreme forms of undernourishment) and the how-to tell the difference between them. There was an additional lecture and discussion on understanding the problems associated with anaemia, in the context of long-term health. Participants also received the latest update on the United Nations’ Sustainable Development Goals, how planetary issues and sustainable nutrition models play into achieving these goals and why nutrition underpins so many of the goals. As part of keeping up with current global challenges, the presenters shared how and why COVID-19 is disrupting progress in reaching nutrition goals. Examples given included food poverty and insecurity as well as barriers and opportunities to achieve global nutrition targets. Identification and Management of Nutrition and Health Risks It was important for the participants to gain an in-depth understanding of the lifecycle approach and the windows of optimal nutrition intervention. This goes hand in hand with the background of why the first 1,000 days are a ‘golden window’ of opportunity and why maternal health is such a strong predictor of population health. In addition, there were key presentations on the tools and epidemiological data used to identify nutrition and health risks and how interventions impact outcomes. There was an emphasis on other topics that play an important role in nutrition statistics of individuals and populations such as: An overview of the difference between population dietary advice and individual risk management Key nutrition interventions from public health disease prevention to supplementation programmes Why supplements and fortification can be difficult to implement in the food system and why they are important The importance of an integrated approach for the sustainability of interventions Why context is important –hygiene, cooking practices, storage abilities all contribute to nutrition success Population health models – understanding the impact of the socio-political-economic context Implementing Maternal Infant and Young Child Nutrition (MIYCN) practices: the breadth of interventions from breastfeeding and weaning practices to adolescent nutrition to global differences Understanding the touchpoints in the lifecycle where nutrition intervention can make the biggest impact Understanding why female empowerment, education, mental health, agriculture, food labelling and taxation have an impact on nutrition status Understanding how the capacity-load model/DoHAD explains long-term health consequences of malnutrition in pregnancy globally Towards the end of the program, the participants took part in moderated discussion groups where they were tasked with mapping out program impact pathways, carrying out stakeholder analysis for a multisectoral approach and using gap analysis for predicting future research needs and health trends. The training partnership was a huge success and we hope that it forms the basis for more partnerships in the future. A huge thank you to all involved in the preparation, delivery of this training programme, namely, Prof Sumantra (Shumone) Ray, Dr Federica Amati, Dr Anand Ahankari, Dr Marjorie Lima Do Vale, James Bradfield, James Bryant, Dr Luke Buckner, Helena Trigueiro, Mei Yen Chan, Jørgen Torgerstuen Johnsen, Elaine Macaninch, Mayara de Paula, Dr Celia Laur, Prof Caryl Nowson, Breanna Lepre, Wanja Nyaga, Sucheta Mitra, Matheus Abrantes, Xunhan Li, Sarah Armes and Sally Ayyad. Many thanks to the Power of Nutrition Coordinating team and colleagues for participating in the workshop and for a wonderful collaborating experience. Resources: Power of Nutrition Handbook and VLE Global Health Report WHO Nutrition Resources Tracking progress on food and agriculture-related SDG indicators 2021 WHO Malnutrition Resources State of Food Security and Nutrition Report (SOFI 2021)

Author: Joshua Clamp / Editors: Shane McAuliffe and Breanna Lepre Key reference: Lepre B, Trigueiro H, Johnsen JT, et al. Global architecture for the nutrition training of health professionals: a scoping review and blueprint for next steps. BMJ Nutrition, Prevention & Health 2022;0:e000354. doi:10.1136/ bmjnph-2021-000354 Nutrition underpins personal, public, and planetary health and represents a key theme in the sustainable development goals of the United Nations (UN). Globally, 690 million people do not have enough to eat, while 1.9 billion adults are overweight and of these 650 million are obese. This coexistence of undernutrition, overweight, and obesity, known as the double burden of malnutrition, is a primary focus of the UN Decade of Action on Nutrition (2016–2025). If member states are able to implement policies and interventions to address the double burden of malnutrition, this decade will see profound improvements in public health outcomes internationally. Effective, evidence-based nutrition care plays a vital role in improving individual and population health and is recognised as an essential component of routine health care delivery. Healthcare professionals with the requisite nutrition knowledge, capacity and confidence are perfectly poised to initiate and support nutrition care, facilitating the necessary behavioural and lifestyle changes that can lead to improved health outcomes. Building the capacity of health professionals to provide nutrition care in health care settings is therefore of considerable importance. However, a number of challenges still stand in the way of reaching this potential. For example, whilst it is evident that sufficient training to provide healthcare professionals with this knowledge, capacity and confidence is crucial, medical doctors receive alarmingly insufficient exposure to nutrition training, irrespective of geographical region, setting, or year of training (Macaninch et al., 2020). Understanding these challenges and developing strategies to overcome them is therefore important in strengthening the capacity of the health workforce, and in turn, benefiting population health and reducing the double burden of nutrition. This scoping review by Lepre et al. (2022) provides an overview of the capacity building efforts in the context of nutrition education for healthcare professionals. It uses a combination of methods, including a review of published literature and interviews with experts, to gather findings and develop a blueprint for the next steps. Methods A total of 18 policy documents related to nutrition education and capacity were included and screened for the literature review. Relevant capacity-building efforts in the context of nutrition education for the health workforce were identified and considered for guidance. To complement these findings, semi-structured face-to-face interviews with key personnel from the WHO Nutrition and Food Safety (NFS) were conducted. Members of the NNEdPro Virtual Core, an international, multidisciplinary network of 42 professionals were also engaged, allowing for the consideration of regional implications in countries other than the UK. Three key questions were asked in interviews and surveys, as detailed below. Finally, workshops and presentations with experts, including WHO Chief Scientists, were also conducted to gain further insight into global nutrition capacity. Key questions: 1. Where do you see a role for medical/healthcare nutrition education within the Nutrition Decade efforts and the work of NFS/WHO? 2. What do you perceive as the main barriers to policy formulation and implementation around medical/healthcare capacity building in this area? 3. Can you identify any current or emerging opportunities to embed medical/healthcare nutrition education into primary and/or secondary prevention initiatives? Key themes from the literature review, interviews, and workshops The importance of medical and healthcare professional nutrition education and capacity One clear message from the reviewed literature was the importance of healthcare professionals and the healthcare system in the promotion of nutrition in the general population, and subsequently improved public health. Furthermore, whilst few countries have the recommended density of nutrition professionals, 96% of countries reported nutrition-focused professionals as regulated health professionals. The healthcare system is the primary delivery channel for nutrition interventions and policy changes, with the education sector coming in second. Barriers to the application of nutrition in practice Despite this acknowledgement of the importance of nutrition in healthcare, a number of barriers continue to limit the application of nutrition in practice. Most notably, a lack of healthcare professionals with adequate nutrition skills and knowledge. A lack of specific skills including motivational interviewing techniques and understanding of practical nutrition recommendations in areas such as infant feeding were identified as barriers. Finally, the confines of the current model of care result in limited time with patients, and difficulties in eliciting positive behavioural change. Barriers to policy formulation and implementation related to medical and healthcare nutrition capacity building One of the barriers to policy formulation and implementation related to medical and healthcare nutrition capacity building identified by participants was time, namely that long-term efforts are required to develop and implement these policies, which may influence action. Additionally, difficulty in collaboration & coordination between key organisations was identified as a barrier. Finally, issues were also identified relating to the definition of nutrition professionals, and the consistency of this definition across borders. Five key themes were identified from presentations and other intermediate outputs, which were also used to inform recommendations. These themes confirm the need for a competent and motivated health workforce coupled with scalable nutrition education interventions for sustainable change and indicators to monitor progress in nutrition. The themes are as follows: Recommendations to improve medical and healthcare professional nutrition education and capacity The analysis of policies included in the literature review, as well as suggestions and comments made during the interview and presentation stages, identified a number of proposed strategies to improve nutrition capacity. A summary of recommendations identified from the literature review and interviews is provided below: Nutrition education and resources – Enhancing nutrition education for healthcare professionals will improve understanding of diet and the progression and onset of non-communicable disease, leading to improvements in detection, treatment and prevention. Core competencies should extend beyond the basic principles of healthy diets, and include motivational interviewing techniques, onward referral pathways, and leadership skills. Nutrition education for teachers and the incorporation of nutrition education into school curricula, as well the upscaling of community-based programmes can further enhance nutrition capacity. The expansion and dissemination of open access nutrition resources can further facilitate improvements in nutrition capacity. Increased availability of online resources, as well as the leveraging of smart technologies to assist in learning can accelerate improvements faster. “Accessible, evidence-based public nutrition education is key to empowering individuals and communities to make healthy dietary choices” Nutrition Research – Innovative nutrition research provides a fundamental evidence base for nutrition education, guidelines and policy development. Increased nutrition research capacity can better support the identification and clarification of problems in nutrition care, delivery and education. Transdisciplinary evidence-based research should also underpin the evaluation of nutrition interventions, and can help understand limitations, feasibility and benefits, as well as measure the impact of programmes in multiple regional and national contexts. Nutrition champions – Advocates for nutrition education and health improvement can empower others to make healthy choices. Nutrition champions may also play a role in advocating for increased investment in nutrition. Women may have a role as nutrition champions by passing on nutrition knowledge and skills to their community. Identifying and enabling nutitrion champions therefore has the potential to not only improve the nutrition capacity of a community, but to advance equity, equality, and non-discrimination in food systems. Government and policy – Political entities must commit to a supportive environment for the delivery and implementation of nutrition policy and programmes. For example, pledges from local governments to prioritise nutrition education can support drafting, piloting, and delivery of nutrition education in healthcare professionals. Changes to the policy environment can also improve allocation of financial resources for physical infrastructure and facilities. Governance in nutrition – It is important that systems are in place to review and measure on-going progress related to established nutrition education and capacity goals. The Nutrition Professionals Density measure is a validated indicator for measuring nutrition capacity. Further clarification on the definition of ‘nutrition professional’, along with the implementation of registration and accreditation systems can ensure quality training and professional competence. Similarly, indicators monitoring the effect of nutrition education on population health status, dietary choices and the food industry should also be developed and strengthened. 3 key recommendations Establishment of a national curriculum for nutrition education across all healthcare sectors, including the development and expansion of online resources. Individual and government pledge for adopting nutrition education in community and healthcare as a priority, including establishment of frameworks for best practice. Improved global data collections mechanisms and validated indicators to assess and measure capacity and progress, such as the nutrition professionals density Indicator. Conclusion The importance of building medical and healthcare professional nutrition capacity is clear. Enhanced nutrition capacity at the individual, organisational and systemic levels will facilitate improvements in health outcomes and help to address the double burden of malnutrition. Using a complement of methods, including a review of published literature and interviews with experts, this review synthesises key recommendations to improve nutrition education and capacity. Nutrition data collection, policy, education and implementation of change, along with global nutrition surveillance and monitoring systems, will provide the necessary capacity to eliminate malnutrition in all its forms and allow progression towards the Sustainable Development Goals. References and further reading Lepre B, Trigueiro H, Johnsen JT, et al. Global architecture for the nutrition training of health professionals: a scoping review and blueprint for next steps. BMJ Nutrition, Prevention & Health 2022;0:e000354. doi:10.1136/ bmjnph-2021-000354 Macaninch E, Buckner L, Amin P, et al.Time for nutrition in medical education. BMJ Nutrition, Prevention & Health 2020;3:e000049. doi:10.1136/ bmjnph-2019-000049 A 13-year journey towards implementing improved medical nutrition education in the UK and beyond

By Sento Kai Kargbo Reviewed by Maria Veronica Flores Bello, Sucheta Mitra, Wanja Nyaga and Luke Buckner Acknowledgements Sincere thank you to NNEdPro Global Centre Faculty led by Prof Sumantra Ray, including Dr Luke Buckner, Helena Trigueiro, and Daniela Martini, and to Tecnologico De Monterrey Faculty led by María Verónica Flores Bell with coordination input from the NNEdPro Mexico Regional Network led by Mercedes Zorrilla Tejeda. Background NNEdPro Global Centre, alongside local charities, launched the Mobile Teaching Kitchen (MTK) initiative in 2017 aiming to create a sustainable approach to tackling cycles of food insecurity, intergenerational poverty, and malnutrition among underserved and vulnerable populations. The MTK looked to ameliorate malnutrition by improving diet diversity and awareness through cooking demonstrations of sustainable, nutritious, and affordable meals using locally sourced ingredients. Since 2017, the MTK has been successfully implemented in 2 marginalised communities in Kolkata (RG Kar and Chetla) as well as a rural setting in Sanghol (Punjab), India (see Buckner et al, 2021. Bhavishya Shakti: Empowering the Future. Establishing and evaluating a pilot community mobile teaching kitchen as an innovative model, training marginalised women to become culinary health educators in Kolkata, India). The MTK - Mexico Adaptation Following the success in India, the team was excited to transfer this knowledge to other regions. Through NNEdPro’s regional networks we collaborated with the University of Tecnologico de Monterrey in Mexico. In the latter part of 2021, third-year students from the BSc, alongside nutritionists and other health professionals launched an adaptation of the MTK model. This initiative aimed to tackle the same issues as the original project in India, albeit with different nutritional interventions adapted to the local diet. The populations focused on were in underserved communities of Mexico City, Guadalajara, and Monterrey. Primary aim: To improve health outcomes in underserved communities through effective food and nutrition education, thereby increasing community resilience to food insecurity and malnutrition. Secondary aim: To foster innovation capacity in students so that they can become agents of change within their communities. Phase I of the Initiative – Planning and Designing a Model for Mexico During the initial phase of the MTK-Mexico adaptation, Prof Sumantra Ray, NNEdPro Executive Director, and Dr Luke Buckner, Assistant Director and MTK Project Lead at NNEdPro, shared insights and lessons learned from the MTK experience in India with the students in Mexico City, Monterrey, and Guadalajara. Prof Ray, Dr Buckner, and other MTK project team members also provided live feedback to students who presented their ideas for implementing the MTK in Mexico leading to a highly engaging and creative discussion on designing and implementing a successful community-based health intervention. Following the workshops, the students curated a set of recipes as part of a template menu using affordable, locally sourced ingredients. The NNEdPro team was impressed by the effort, novelty, and applicability of their menus which truly embraced the MTK concepts. This stage was followed by baseline data collection to understand the needs of the communities. With the help of their educators, the students administered surveys collecting demographics and socioeconomic status data, as well as ascertaining nutrition knowledge, attitudes, and practices (KAP). Phase II of the Initiative – Implementation and Evaluation In Phase II, the students adopted the “See One, Do One, Teach One” (SODOTO) method to deliver nutrition education in a more traditional, storytelling manner via cooking demonstrations following the pre-set template menu. The template menu comprises nutritionally balanced meals prepared using locally sourced ingredients. The SODOTO workshops are comprehensive nutrition education, cooking, and hygiene workshops designed to stimulate health behaviour change among participants. At the end of the workshops, KAP surveys were administered to assess improvement, if any, in nutrition knowledge and attitudes. The project evaluations are underway, with more updates to come. For more details on the MTK project in Mexico, including key updates and upcoming papers, watch this space. SODOTO Workshops - MTK-Mexico Adaption, Mexico City and Tonalá, Jalisco. References Mexico Regional Network webpage https://www.nnedpro.org.uk/mexico The Mobile Teaching Kitchen (MTK) webpage https://www.nnedpro.org.uk/mtk Buckner et al., 2021. Bhavishya Shakti: Empowering the Future. Establishing and evaluating a pilot community mobile teaching kitchen as an innovative model, training marginalised women to become culinary health educators in Kolkata, India. https://nutrition.bmj.com/content/early/2021/07/28/bmjnph-2020-000181

A Message of Gratitude to Sanchita from the NNEdPro Chair 2022 started off for us on a very sad note as our principal project officer for India and dear colleague, Sanchita Banerjee, passed away on 3rd January at the age of just 62 whilst battling COVID19 complications in hospital - our thoughts, prayers and heartfelt condolences go to her family members – many of us were lucky enough to attend a meeting convened by Sanchita just before Christmas where she beautifully summarised all the work undertaken in India over last year and thanked each one of us personally for our contributions and we were able to thank her as well expressing our heartfelt appreciation. Little did we know at that time that this would be an untimely and unexpected farewell, but we are so grateful that we could express our gratitude and appreciation to Sanchita directly in this meeting. Sanchita first came to us through our Kolkata workshop in Autumn of 2017 where the Mobile Teaching Kitchen (MTK) intervention was designed. After several collaborative exchanges and dialogue with Dr Minha, our medical director, 18 months later she joined NNEdPro formally and served for almost 3 amazing years as our lynchpin for the MTK in India as well as the deputy lead of our India Regional Network. Sanchita worked tirelessly with unparalleled dedication as well as earning the respect and friendship of one and all for the innumerable contributions she made as well as the inspiration she provided to us all. She was a great believer in the mission and vision of NNEdPro at large and was one of the most regular attendees at all our webinars, always contributing to the discussion. There are so many more ways in which Sanchita managed to touch the lives of all those who knew her and indirectly impacted everyone associated with NNEdPro by taking the original MTK model to new heights. We pray that the lovely soul that we have known as Sanchita finds peace and that her memory can live on through the legacy of her work. We have decided to dedicate our MTK fundraiser and awareness event, The Confluence (February 2022) to pay a small tribute to the life and work of Sanchita and we will initiate a memorial award scheme in her honour this year. A natural collaborative networker, Sanchita took great pleasure in driving high-quality work with careful attention to achieving a positive impact on beneficiaries, along every step of the way. In this piece my colleagues have compiled a snapshot of her contributions over the past year alone, followed by heartfelt messages of support from across the NNEdPro community. - Prof Shumone Ray A lookback on NNEdPro work led in India by Sanchita over 2021 In the first quarter, Sanchita worked to initiate the ‘Bhavishya Shakti’ Base Kitchen at Lake Town. This project involved partnership between NNEdPro and local charities. The project team included health professionals and local community volunteers trained in basic nutritional concepts. She was involved in the customisation of Mobile Teaching Kitchen (MTK) menu templates and conducted door-to-door surveys to increase the reach of the base kitchen, as well as running a Nutritional Awareness campaign for the employees of local offices and conducted Bank visits for marketing of food delivery services from the Bhavishya Shakti Base kitchen. Over the second quarter of the year as fieldwork was still quiescent due to pandemic measures, Sanchita conducted a nutrition practices survey among doctors and dietitians for the health and life insurance sector giving us new insights into nutrition education needs in India based health systems. Subsequently, as fieldwork reopened, she and the NNEdPro India team rapidly re-launched the MTK van in Lake Town whilst also arranging and honour the MTK champions in their roles as working mothers. Also, as part of combatting the COVID-19 situation in Kolkata at the time, Sanchita had key involvement with an impactful NNEdPro led and crowdsourced free meal distribution scheme for COVID-19 patients facing food and nutrition insecurity during isolation in the community which served well over a thousand families. July marked the commencement of our role in a Global Research Translation Award (GRTA), led by the University of East Anglia, tackling health, nutrition, education, and environment issues in India. As part of the GRTA, Sanchita worked alongside the NGO ‘PRADAN’ team to create a list of menus ready for nutritional analysis providing rapid and novel dietary insights into a marginalised tribal population. Alongside this project, Sanchita contributed towards and co-ordinated the development of the Creative Communication, Extension & Resource Management for Sustainable Development course at Indira Gandhi National Open University (IGNOU) for learners across India. This course aimed to teach others about creative extension approaches and communication strategies to address the wellbeing and empowerment of rural and urban communities, especially women and children, by producing and exchanging relevant contextual knowledge and practices. By September, the meals served from the Bhavishya Shakti Base Kitchen hit the highest level of sales recorded throughout the year bringing precious microenterprise income to the MTK champions. During the months of October to December, the MTK van once began operating at one of the Bagbazar slums being served by Calcutta Rescue (CR) and the RG Kar slum, the origins of the entire MTK initiative. Sanchita was involved with a plethora of CR field visits and staff training sessions. On November 14th Sanchita organised Children’s Day celebrations to increase awareness about the rights, education, and welfare of children, especially in the urban slums. In December, Sanchita finalised the development of daily menu templates for the ongoing GRTA project in readiness for a new recipe book based on previously little-known tribal diets of northern and eastern India. At the end of December 2021 Sanchita orchestrated a collective celebration of the year’s achievements by NNEdPro members and collaborators, made possible by her unparalleled dedication to service above self. With Special Thanks to Sanchita for the Brightest Feathers in the MTK Cap Sanchita had been the bedrock behind many achievements across borders. In the UK these included the launch of the MTK Cookbook at the 2021 University of Cambridge Festival with online cooking demonstrations as well as the promulgation of recipes from the MTK to culinary students at Westminster Kingsway College in London and the Cambridge Vice Chancellor’s Award for Research Impact and Collaboration alongside collaborators of the UK-India ‘TIGR2ESS’ programme. Over the latter part of 2021 the MTK also underwent successful adaptation and first phase implementation in Mexico City led by Tec de Monterrey and taking inspiration from the wonderful work of Sanchita and the NNEdPro India team. - Compiled from Sanchita Banerjee’s Presentation to the NNEdPro Global Centre (December 2021) by Sarah Armes and Matheus Abrantes (Edited by Prof Shumone Ray) Key Messages from the NNEdPro Virtual Core My thoughts and deepest condolences are with all the family and friends of Sanchita. She was such an inspiration to all Remembered with fondness and humility – Pauline Douglas May the universe grant eternal peace for Mrs Sanchita Banerjee. May we all remember her contributions to the MTK Initiative, Bhavishya Shakti and her spirit of sincerity in all she did over her lifetime in social work and development. May her family, friends and colleagues receive comfort and strength to be there for each other at this time of challenge – Dr Minha Rajput Ray So sad to hear this news, thinking of her family, friends, and colleagues we will all sorely miss her enthusiasm and kindness! – Dr Luke Buckner It is extremely sad and very hard to believe this. All my prayers and strength to her family, friends, and all of us who worked closely with her. May her soul Rest in Peace. Will miss you always!! – Sucheta Mitra Messages from NNEdPro Global Connections I am so sorry that is devastating, she was such an incredibly beautiful human being, may she RIP and live on through MTK – Ananya (Ria) Roy I am so incredibly sad to hear this news. What an inspirational person. I’m so sorry for her family and close friends. I hope her memory can provide so comfort. Rest in peace. – Dr Harrison Carter I am so sorry to hear this heart-breaking news :( I will miss her a lot and her kind and passionate spirit. Thinking of her family, friends, and colleagues – Jorgen Johnsen Heart-breaking news. My sincere condolences to Sanchita’ s family & friends. May her soul rest in peace, she will be greatly missed – Wanja Nyaga Her kindness, enthusiasm and good heart will be deeply missed. May her soul Rest in Peace – Matheus Abrantes Our community has lost a truly special and wonderful human being. Although I did not have the good fortune to meet Ms Banerjee in person, we worked together across continents during the early years of the Mobile Teaching Kitchen project. It was an absolute pleasure working with her and learning from her. The ease, patience, dedication with which she managed correspondence across time zones while coordinating the front on the ground is a quality that I hope to instil in myself. I am thankful that I got to know you albeit briefly and I will always remember you with fondness. My good wishes, strength, and condolences to the Banerjee family. Our NNEdPro family has truly lost a very special person. I will miss you – Dr Shivani Bhat NNEdPro (India and South-Asia Regional Network) National and International Collaborators Very saddened to hear the terribly shocking news of Sanchita’ s passing away. She was a very kind, helpful and hard-working lady. I think she visited SANGHOL twice and trained many, with NNEdPro cooking programmes. My heartfelt condolences to all affected by this tragedy May her soul rest in peace in the heavenly abode – Lord Diljit Rana The news of unfortunate and untimely demise Ms. Sanchita has shocked us all. It is an irreparable personal as well as a societal loss extremely difficult to overcome. We convey our heartfelt condolences to the NNEdPro family, and all concerned and pray the Almighty to grant peace to the departed soul. May her dedication to the nutrition programs continue to inspire us all – Management and Staff, Cordia Group of Institutes, Sanghol, India Alas!!! So painful to learn about Sanchita left us. Hard to believe. Sanchita has been such a wonderful, sweet friend, key member of NNEdPro MTK project. Such a loving, caring, responsible human being. Difficult to forget the time spent with Sanchita in Sanghol, during my visit to Kolkata, her telecons following up the tasks so meticulously. Shall be missing you personally Sanchita. Praying Great Almighty to give courage and strength to her family to face this irreparable loss and the soul of divine sister to rest in Peace – Urmil Verma, CGI, Sanghol Really shocked to read about sudden demise of Sanchita ji. She was a woman of dedication. Really her services will be missed by Cordia MTK team – Dr Harjinder Singh, CGI, Sanghol This is a shocking news. May the soul rest in peace and I am really really going to miss her – Taruna Narang, CGI, Sanghol I am so sad to hear this and it has come as a massive shock to all of us in CR who were working with her. In the brief time we knew her, we found her to be very warm, caring, and conscientious – Jaydeep Chakraborty and the Calcutta Rescue team This is heart breaking for me. First week of December Sanchita and I had a good and deep discussion on how to extend NNEdPro work in western India. She was in Pune to visit her son. I will always remember her with respect and love. Life is really short. Looks like God needed her more than us – Sukanya Patwardhan Very sad and shocked to hear of Sanchita’ s untimely passing! She was so active, enthusiastic, and dedicated a person who had so much to contribute. Our prayers and thoughts are with her family and dear colleagues. May God give them the strength to bear this tragic loss. RIP dear Sanchita – PRADAN Team (GRTA/TIGR2ESS) Only few interactions I had with you, but you always accommodated me with warmth and politeness. May your soul Rest in peace – Suvajit Chakraborty, PRADAN (GRTA/TIGR2ESS) So sorry to hear the passing of Sanchita. Her contributions to TIGR2ESS events were so helpful and she gave so much to those around her – Shailaja Fennel, University of Cambridge (TIGR2ESS) I am so sorry to hear this. May her memory be a blessing to us all – Marla Fuchs (TIGR2ESS) This is shocking. She was so helpful for the MTK visit by the OMM members to Kolkata and MTK/NNEdPro visit to Bhubaneshwar, our scholars participating in Summer School and the Odia translation of Odia translation of NNEdPro 10 pointer on Micronutrients. My sincere condolences and prayers – Srijit Mishra (TIGR2ESS) This is so sad and tragic news. Our deepest sympathies and complete solidarity – Suraj Kumar (TIGR2ESS) This news has indeed left one shaken. Such a wonderful colleague she was and so engaged. In fact, we were in touch after our FP6 meeting to share the rubric of the soft skills development programme we had designed as she wanted to use it for her team. RIP Sanchita! You will be missed greatly. Pray for her family to have the strength to bear the loss. Also wish them an early and full recovery from COVID. - Ramanjit Johal, Panjab University (TIGR2ESS) Really devastated by this news. Sanchita was so regular in joining our weekly meetings, always smiling, helpful, taking on additional work. Never imagined this could happen and we will lose her so suddenly. Spoke to her on the 22nd and we were laughing and chatting as always. I also had the good fortune to meet her. She will be missed so much. May her soul rest in peace. All my prayers for her, wherever she is. And much courage and strength to her family to bear this terrible loss – Nitya Rao, University of East Anglia (TIGR2ESS) Never imagined this. May she find eternal peace. May her family find strength to battle their own illness as well as bear this loss – Padmaja, ICRISAT Hyderabad (TIGR2ESS) Devastating news. My thoughts are with her family and friends and everyone at NNEdpro who worked with her. She was such a kind soul and it was clear how much she was adored by everyone who got to know her and will be dearly missed and remembered by many – Jodie Weber and Ianthi Tsimpli, University of Cambridge (ESRC Project) NNEdPro (India and South-Asia Regional Network) Kolkata Team Remedy Clinic Study Group Since taking over as a Project officer over two and half years ago, Sanchita became acquainted with her responsibilities and commitments within a short period. Thereafter, she performed exceedingly well. Soon, she became well-known with everyone associated with NNEdPro global, Remedy clinic and Bhavishya Shakti. It's hard to believe, she will not be interacting with us anymore. It would be very difficult to fill in the void created by her sad and unexpected demise. My heartfelt condolences to your family. I sincerely pray for her soul to rest in peace – Dr (Prof) Sabyasachi Ray Very sad news. May her soul rest in peace - Sudeshna Mitra It is heart-breaking news for me. Sanchita ma’ m not colleague she was friend for me. Every matter we have discussed. I lost my one friend and good people. Rest in peace Sanchita ma’am – Debashis Chakraborty It is unfortunate for me that Sanchita ma'am had passed away. She used to treat me like her own son. For past 2 years, she groomed me to be a better person both personally and professionally. I pray to God that Sanchita ma'am's soul rest in peace. Ma'am bless me from heaven so that I can follow all your words all my life – Asim Kumar Manna It started with “tum toh mera beta k age ki ho” and ended with “mai aaj hospital jaa rhi hun admit hone”. With the change in calendar date a major change came this year. We lost you. I will always miss you as a supportive senior, guiding guardian and loving leader to the team. I promise to make you proud of me one day – Harmanpreet Kaur Volunteers Sanchita, wherever you are, we will always remember you as a dear friend, a dedicated project officer, a good organizer, a kind soul and above all a very understanding and accommodating co-worker. You will always remain with us – Chitra Ray It is extremely sad & hard to believe this. May Her soul rest in peace – Mitali Gupta Sanchita, it is indeed very heart wrenching to let you go but know your smiling face and your dedication will prevail with us. Our deepest sympathy and condolences to your family members. Rest in peace till we meet again in that world – Suchitra Richard It's a very very sad news. May her soul rest in peace – Mrs Mala Mukherjee [BENGALI LANGUAGE – English Script] Kichutei mon ke manate parchina je Sanchita nei. khoob kosto hoche – Kashmira Ghosh MTK Champions [BENGALI LANGUAGE – English Script] Manoniya ma'am, Apni hothat kore amader majhkhan thek chole jaben amra keu vabte pari ni. Amar et jonno khub dukhkhito. Apni amader cholar pothe perona chhilen. Amra apnar kachh thek anek kichu shikhechchi. Tai amra apna I antorik o priti sroddhar madhyame pronam janai Apni jekhane thakun valo thakun santi thakun. R sara jibon amader pashe thakun. [BENGALI LANGUAGE – Bengali Script] আমাদের মধ্যে যে ম্যাম নেই তা আমরা ভাবতেই পারছি না,আমরা খুবই দুঃখিত।।আমরা সকলেই ম্যামের আত্মার শান্তি কামনা করি।।উনি যেখানেই থাক ভালো থাক।।।উনি চিরকাল আমাদের মধ্যে অমর হয়ে থাকবেন।। - Shyamoli

Author: Joshua Clamp / Editor: Shane McAuliffe Key reference: Lee MF, Eather R, Best T. Plant-based dietary quality and depressive symptoms in Australian vegans and vegetarians: a cross-sectional study. BMJ Nutrition, Prevention & Health. 2021;e000332. Doi: 10.1136/bmjnph-2021-000332 Depression and other mood disorders are significant predictors of suicide and are responsible for over 800,000 global suicide-related deaths per year (WHO, 2017). Pharmacology and psychotherapy represent the primary treatments for depression, however, approximately one-third of patients do not respond to these interventions (Al-Harbi, 2012). Lifestyle factors such as a healthy diet and exercise are increasingly recognised for their favourable impact on symptoms of depression and may represent a cost-effective supplement to existing treatment options. A large number of studies have explored the relationships between different dietary patterns and mental health disorders such as depression. However, few studies have yet considered how diet quality within these specific dietary patterns influences their relationship with mental health disorders. A recent cross-sectional study published in BMJ Nutrition, Prevention and Health explored this question in the context of plant-based diets (PBDs). What is diet quality? The term ‘diet quality can be challenging to define, and there is disagreement on exactly how to measure it. Broadly, it refers to the nutritional adequacy of an individual’s dietary pattern. Dietary patterns scoring high on diet quality are generally considered to involve a healthy intake of fresh fruit, vegetables, nuts, seeds, legumes, whole grains, water, lean meats, and dairy, along with a low intake of red and processed meats and foods high in lower-quality ingredients such as refined vegetable oils, salt, refined grains, alcohol, sugary snacks, and drinks. PBDs represent one category of dietary patterns and can be divided into two primary categories: vegetarian and vegan diets. Australia has seen a surge in the number of people adopting plant-based lifestyles, with over 2 and a half million Australians choosing to go meat-free. This equates to 12% of the total population, with the largest proportion of plant-based dieters being young adults between 18 and 45. Adopting a vegetarian or vegan diet offers environmental benefits, including reduced greenhouse gas emissions and land and water use (Scarborough et al. 2014). There are also clear animal welfare benefits, and many reported health benefits. However, whilst there is growing evidence on the association between PBDs and lowered disease risk, these diets are not innately synonymous with a “healthy” diet. A healthy PBD is characterised by high consumption of fresh fruit, vegetables, nuts, seeds, legumes, whole grains and water, and the omission of meat and/or dairy. In parallel, unhealthy PBDs are characterised by the omission of meat and/or dairy, but also by consumption of foods high in lower quality ingredients such as refined sugars and fats. Diet and depression There is strong evidence from dietary intervention studies that healthy diets rich in fresh fruits, vegetables, nuts, seeds, whole grains, and legumes are associated with reduced symptoms of depression (Firth et al. 2019). However, evidence regarding the association specifically between PBDs and depression is inconsistent and conflicting. According to a number of literature reviews, some studies observe that vegans and vegetarians are at increased risk of depression whilst others indicated those who adhered to PBDs had decreased depressive symptoms (Iguacel et al. 2021, Jain et al. 2020). The reasons for these conflicting results remain unclear. From a mechanistic standpoint, adoption of a PBD may improve mood and reduce risk of depression due to the rich abundance of health-promoting nutrients in plant foods, such as complex carbohydrates, fibre, polyphenols, and antioxidants. Plant foods containing these nutrients have been found to decrease chronic inflammation and oxidative stress, and improve the gut microbiome-brain axis. In addition, PBDs may increase risk of deficiency of certain micronutrients, including B vitamins, zinc, and iodine, as well as certain amino acids and polyunsaturated fatty acids. These deficiencies could negatively impact mental health and brain function, for example by disrupting regulation of serotonin and dopamine. The studies responsible for these conflicting results give little attention to diet quality and its influence on depression, and instead group different people’s vegetarian or vegan diets together. However, as discussed, the potential benefits and risks of following a PBD may be dependent on the foods and nutrients eaten within the confines of a PBD, rather than the PBD itself. This need for greater consideration into diet quality rather than whole dietary patterns underlies the purpose of this study by Lee et al. (2021). Study design and results The study explores the association between diet quality of vegans and vegetarians and depressive symptoms in 219 Australian adults aged 18-44. It used a cross-sectional design and took the form of an online, anonymous, quantitative survey. The Centre for Epidemiological Studies Depression (CESD) survey was used to measure symptoms associated with depression, whilst dietary quality was measured using an adapted Dietary Screening Tool. Results from this dietary survey of vegans and vegetarians revealed a great deal of variation in diet quality between participants. This supports the idea that following a PBD does not necessarily mean that person is following a ‘healthy’ diet. Results also showed a significant relationship between diet quality, BMI, and depressive symptoms when analysed as categorical valuables. Comparing BMI, CESD score and diet quality scores as continuous variables revealed that variation in diet quality was significantly associated with the variation in CESD score in individuals below the clinical cut-off for depression. However, for individuals with scores over the clinical cut-off for depression, diet quality score did not significantly influence CESD score, although BMI did. This suggests that plant-based followers above the clinical cut-off score for depressive symptoms tended to have higher BMI’s and this covariant could be associated with diet quality and/or prevalence of depressive symptoms, with the exact dynamics of this relationship warranting further investigation. "These findings suggest that a high-quality plant-based diet may be protective against depressive symptoms in vegans and vegetarians." Thus the findings show an association between diet quality and non-clinical depressive symptoms. Concerningly, the expanding value of packaged vegan food in Australia is projected to reach approximately $A215 million (Hinton T, 2021) and consumption of vegan food high in lower-quality ingredients such as refined vegetable oils, fried food, salt, refined grains, alcohol, sugary snacks, and drinks is increasing. Individuals may therefore inadvertently be consuming a diet high in plant-based foods consistent with lower diet quality, which is broadly a known risk factor for increased depression. Consumer understanding of and access to high-quality plant-based foods may therefore be important if dietary interventions are to support traditional therapies for depression and other mental health disorders. It is important to consider the limitations of this study. The cross sectional-nature of the design means causality cannot be inferred. Specifically, little attention has been given to the motivations for following a PBD. Individuals may decide to adopt a PBD after the onset of a mental disorder symptoms, and thus results may be a product of reverse causality. Similarly, vegans and vegetarians are likely to have concerns regarding animal welfare and environmental sustainability, and may therefore carry a burden of awareness that could contribute to depressive symptoms. Furthermore, as data were self-reported, recall bias may exist that relates to the adherence to the diet. Finally, with over 90% of participants identifying as female, and a large majority being partnered, having a university degree, and feeling they were healthier than their peers, there was a lack of heterogeneity in the sample, which limits the generalisability of the study’s interpretation. Summary Whilst depression and other mood disorders remain to be significant health challenges, emerging research is revealing how diet and other healthy lifestyle factors may positively influence such conditions. Much of the research investigating the relationship between PBDs and mental health disorders has considered whole dietary patterns, and little attention has been paid to factors such as diet quality. Using tools to measure depression and diet quality, this study observed a relationship between high-quality vegetarian and vegan diets and decreased depressive symptoms. This study is the first to highlight such an association in this population of Australian adult vegans and vegetarians. As such, the findings are in line with broad data regarding the protective role of diet in mental health and brain function. Key findings Following a PBD does not necessarily mean following a “healthy” diet. Future studies looking at the relationship between dietary patterns and mental health disorders should consider diet quality. In line with existing research on diet quality and mental health disorders, there appears to be a relationship between high-quality PBDs and reduced depressive symptoms. References and further reading Al-Harbi KS. Treatment-resistant depression: therapeutic trends, challenges, and future directions. Patient Prefer Adherence. 2012;6:369–88. Doi: 10.2147/PPA.S29716 Firth J, Marx W, Dash S, Carney R, Teasdale SB, Solmi M, Stubbs B, Schuch FB, Carvalho AF, Jacka F, Sarris J. The Effects of Dietary Improvement on Symptoms of Depression and Anxiety: A Meta-Analysis of Randomized Controlled Trials. Psychosom Med. 2019;81(3):265-280. Doi: 10.1097/PSY.0000000000000673. Hinton T. Value of packaged vegan food Australia 2016-2020, 2021. Iguacel I, Huybrechts I, Moreno LA, Michels N. Vegetarianism and veganism compared with mental health and cognitive outcomes: a systematic review and meta-analysis. Nutr Rev. 2021;79:361–81. Doi:10.1093/nutrit/nuaa030 Jain R, Degremont A, Philippou E, Latunde-Dada GO. Association between vegetarian and vegan diets and depression: a systematic review. Proc Nutr Soc. 2020;79. Doi:10.1017/S0029665119001496 World Health Organization. Depression and other common mental disorders: global health estimates, 2017. Available from: https://apps.who.int/iris/bitstream/handle/10665/254610/W?sequence=1 Food, Mood and Mental Health

Author: Joshua Clamp / Editor: Shane McAuliffe Introduction This article explores the history, development, and future of nutrition education in UK primary schools. It details the importance of effective food and nutrition education in early years, and considers the major hurdles it faces, as well as the solutions being implemented to maximise it’s potential. It will also explore the pathways forward for teachers, schools, and institutions, and how curriculum changes can be supported to effectively bring about positive behavioural and cultural change. The importance of nutrition education Good nutrition is essential for the mental and physical development of children. However, childhood undernutrition and overnutrition remain major challenges in the UK (NNEdPro, 2021). Nutrition education underpins improving nutritional status, and provides people with the knowledge, skills and motivation to make wise dietary and lifestyle choices. Understanding and improving the landscape of nutrition education delivery and support for children is therefore of high importance. Centres of education offer a perfect platform to address issues related to food, diet, nutrition and health, as well as environmental issues. These institutions, which include pre-school facilities, schools, universities and technical training centres, among others, represent a key pathway to increasing nutrition education. NNEdPro is striving to improve nutrition education, and has fought alongside many other industry players for the implementation of nutrition education into the UK medical curriculum. Whilst efforts continue, the launch of the AfN’s UK medical nutrition curriculum in October 2021 represents a major stride forward to achieving this shared mission (AfN, 2021). The benefits of nutrition education extend beyond the direct gain of knowledge related to food and nutrition. Being taught about nutrition relays a signal that it is important enough for it to be taught. This is vital in shifting culture to a place where food and nutrition are valued and prioritised. This idea is not just true for nutrition education in the medical curriculum. The same is true for nutrition education in school settings, such as primary schools. Benefits of nutrition education in primary schools Behaviours, beliefs and attitudes start to develop at a young age, meaning intervention during these years offers a valuable opportunity to positively shape the lives of children, and in doing so shape the cultures and beliefs of future societies. For nutrition to be a positive, prioritised part of this society and culture, it should be ingrained in such a way that it can be shared and explored. Schools are a setting for the delivery of structured learning, and simultaneously offer an arena for the exploration of food and nutrition, in which pupils can develop behaviours, beliefs and attitudes. They are one of the main social contexts in which lifestyle habits are developed, meaning food should therefore be part of this picture. Simultaneously, a key responsibility of primary schools is to equip children with the life skills and capacity to support their wellbeing. Given the vital role of nutrition in a healthy, fulfilled life, nutrition education must not be overlooked. More widely, schools provide a perfect platform for action, through a ready-made learning environment, facilities for physical activity and food service as well as the opportunity for engagement with peers, parents and teachers. Furthermore, schools are a well-equipped vehicle for nutrition education as they provide opportunities to practise healthy eating and food safety through school feeding programmes, and through the sale of food on premises. They can be a channel for community participation, for example via school garden projects or school canteens, or through local intersectoral committees. Moreover, nutrition lessons can be made simple, interesting, colourful and easily learned by demonstration, illustration and practical action – approaches which are valuable in primary school settings. Moreover, primary school nutrition education can go beyond improving the knowledge, and even health of students. It has the potential to empower students to become active participants and future leaders in shaping the food environment and food systems that are better able to deliver healthy and sustainable diets. Background on nutrition education in UK primary schools Over the years, nutrition education has been, and in many settings remains to be a low priority. There has traditionally been a lack of understanding and clarity on the content relating to food & nutrition as a subject, with multiple revisions of the curriculum leaving teachers confused and unable to navigate it (JOFF, 2017). These issues were exacerbated by a lack of understanding of the standards for food & nutrition teaching, in addition to a lack of evaluation of this teaching. Other programmes have been developed to support primary school nutrition education over the last few decades. These include the Children’s Food Trust’s ‘Let’s Get Cooking’, and the Soil Association’s Food for Life programme. There also exists a variety of corporate resources and school offers, including voucher schemes for cooking equipment, store or farm visits and competitions. 1991 British Nutrition Foundation (BNF) launches Food – a Fact of Life, which provides free teaching resources for young people aged 3-16 which cover food, where it comes from, cooking, and healthy eating. It is not an intervention programme but rather a bank of resources and materials to support the delivery of nutrition education in schools. It aims to provide a comprehensive, progressive programme that communicates up to date, evidence based, consistent and accurate messages about food and nutrition. The evolution of this programme’s curriculum, technology and pedagogy have brought it from the medium of physical resources and VHS tapes, to fully-online support with dynamic resources and interactive features (Ballam, 2021). 2014 Cooking and food education became compulsory in the national curriculum for pupils up to the end of key stage three as part of the School Food Plan (Dimbleby & Vincent, 2013). In the UK, each of the four nations has its own distinct curriculum, however key learnings are consistent between them. The curricula for England for key stage one and two required pupils to understand and apply the basic principles of a healthy and varied diet and develop and understanding of where food and ingredients come from. The curriculum for key stage three extends to the practical preparation and cooking of predominantly savoury dishes using a range of cooking techniques. 2015 To further support food and nutrition education, Public Health England, BNF, Food Teachers Centre, and other key players produced a new framework for food teaching standards in UK schools. This framework is a guide to the knowledge and skills expected of primary school teachers who teach children about food. Its goal was to raise the quality of food and nutrition teaching in schools by helping primary schools implement the requirements for food within the new national curriculum. In combination with other action points from the School Food Plan, these curriculum measures seek to promote a 'pro-food' ethos in schools and heighten awareness of the integral part that food and a whole school approach plays in children's health, wellbeing and attainment. 2020 As part of Food – a fact of life, the BNF published the characteristics of good practice in teaching food and nutrition education in primary schools (BNF, 2020). The publication sets out a series of characteristics of good practice with regard to teaching food in UK primary schools through a whole school perspective. They have been designed so that they can be adopted as part of a good practice approach by all those that teach food in primary schools. These characteristics include taking a whole school approach, running practical food lessons, establishing good food hygiene and safety practices, and exploring where food comes from. The guide demonstrates how different people within the primary school set-up can work together to ensure each characteristic is adopted. Have these measures been successful? A survey conducted by the British Nutrition Foundation in 2017 revealed that 13% of 8–11 year-olds think pasta came from an animal, whilst 23% of pupils aged 5–7 indicated that bananas, roast chicken, broccoli and whole-grain bread were in the dairy and alternatives food group (Ballam, 2017). Surveys such as this one reveal that a deficit in the basic understanding of food and nutrition in young people still exists. A review of the implementation and effectiveness of the national cooking and nutrition curriculum was conducted by the Jamie Oliver Food Foundation (JOFF) in 2017. This report on the Food Education Learning Landscape (FELL), reported that the launch of the curriculum led to an increase in pupils participating in learning which enabled them to develop knowledge and skills related to food origins, food preparation, and healthy heating. However, this was not true for all schools, and variability in these increases in nutrition was observed between schools. For example, in more than half of primary schools, pupils receive less than 10 hours of food and nutrition teaching a year, but one in ten schools get more than 30 hours (JOFF, 2017). More importantly, these marginal increases in knowledge and skills were insufficient to result in significant cultural and behavioural changes. Reasons for this included a number of key elements missing, related to physical and socio-cultural opportunities to engage, as well as pupil motivation. Pupils in many primary schools reported a lack of positive messaging about healthy eating and food choices across their wider school environments. The common practice of offering foods high in fat and sugar as part of rewards, celebrations and fundraising in primary schools contradicts pupils’ food education. Thus, the wider school environment lacks consistency with the pupils teaching. Additionally, many teachers are unable to fully deliver on the curriculum’s requirements due to being under supported and under-resourced, reporting that they do not have the time, budget and facilities to do so. Additional research amongst primary school teachers reveals a lack of professional training in food and nutrition, with food safety comprising the bulk of this training. During the initial teacher training year, a trainee may only receive around three hours of D&T study, with ‘food’ being just one part of this (Ballam, 2017). Additionally, the number of food teachers is declining. In 2016 the number of food teachers across key stages one, two and three had dropped from 5,300 to 4,500 during the previous five years. This is compared to 34,100 English teachers in 2016 (DfE, 2016). Another barrier to effective nutrition education is a lack of rigorous evaluation, unlike the more “core” components of the curriculum like English and maths. This undermines the effectiveness and importance of nutrition education, and perpetuates its low status as a subject. “Although significant progress has been made, there is still a long way to go and in many schools nationwide, the picture of food education gives cause for concern.” - JOFF Pathways forward for nutrition education To bring about the necessary cultural and behavioural changes in primary schools, improvements in nutrition education cannot simply involve changes to the curriculum or the provision of additional resources. Changes must be made to the level of priority it is given within the curriculum, the standards teachers and schools must deliver to, and the evaluation of this teaching. Simultaneously, nutrition education must extend beyond the confines of its lessons. Nutrition can and should be integrated into, as well as act as a medium for the education of other subjects, such as art, math, science and geography. Beyond lessons, nutrition education can be integrated into other areas of the school experience, such as during school meals and snacks, which may involve cooking demonstrations, food tastings, activities and challenges. Additionally, the initiatives improving the provision of healthy school meals in the UK offer a perfect platform to further implement nutrition education. For example, free breakfast clubs offer a platform for further discussion and engagement with food and nutrition education. Other opportunities existing beyond the classroom include the use of school gardens, which can offer engaging, valuable, practical experience. School libraries may dedicate sections or weeks to promote stories and books on food, nutrition and health. School assemblies are an opportunity to invite guests in, show films/documentaries, and set school challenges. Finally, field trips to farms and museums can create enriching experiences for pupils. It is also important to consider how the improvement of programmes such as free school meals may help tackle the socioeconomic barriers facing children experiencing higher levels of food insecurity and schools located in areas of high deprivation. Programmes such as these not only increase access to healthy food, but when used as an opportunity to support learning related to food and health, can contribute to improving nutrition education. As discussed, such changes will only be effective when used in combination with school-wide engagement, and consistency in messaging and opportunities. Primary school nutrition education must extend to parents, support workers, teachers, and the wider school environment. There must be a wider system of positive influence that fosters adoption of healthy behaviours and the propagation of a healthy food culture. A systematic review of teacher-delivered nutrition education programmes in the USA found that effectiveness of primary school-based nutritional education programs depends upon these wider factors including support from school leadership and policy makers, changes in the food school environment, and strategies embedded to engage parents and families (Cotton et al., 2020). Similar issues are highlighted in the recommendations from that emerged from the JOFF research into primary school nutrition education. Firstly, the knowledge and skill development of the whole school workforce must be supported in order to deliver high-quality food education and maintain positive consistent messages for pupils. Additionally, it is important that schools become ‘healthy zones’ where pupil health and wellbeing is consistently and actively promoted through the policies and actions of the whole school community. Finally, the reporting and evaluation of food education, school food culture and school food provision should be mandatory. Action steps to facilitate these changes were also included in this report. The Government should make School Food Standards mandatory in all schools and cover all food consumed when at school, whilst the Department for Education and the National Governors Association should jointly re-issue guidance for governors on their responsibilities for school food, and consider placing a ‘health and wellbeing’ statutory duty of care onto governors. The most recent significant publication to discuss issues relating to primary school nutrition education was the National Food Strategy (NFS). It once again highlighted the persisting lack of prioritisation of nutrition education in primary schools (NFS, 2021). Solutions and action steps reflected those of JOFF, and gave strong mention to the importance of deeper inspection and review of cookery and nutrition lessons. The government has committed to publishing its response to the NFS within six months. Summary Nutrition education represents a key step in improving the diets and health of primary school pupils. Improvement efforts have ramped up over the last decade, and marginal gains in pupils knowledge of nutrition and health have been observed. However, these efforts have been unable to elicit change on the scale needed, and further policy and legislative developments are required. Only with long-term investment into nutrition education within and outside the classroom, may we see the necessary changes in food culture and behaviour in primary school pupils. Key references & further reading AfN (Association for Nutrition). 2021. UK Undergraduate Curriculum In Nutrition for Medical Doctors. Available from: https://www.associationfornutrition.org/careers-nutrition/wider-workforce/nutrition-training-for-medical-doctors [Accessed 26th November 2021] Ballam R. 2017a. Food for thought: why our teachers need to be taught about nutrition. Huffington Post. Available at: http://www.huffingtonpost.co.uk/roy-ballam/food-for-thought-why-our-_b_17549188.html. [Acceessed 25th November 2021] Ballam R. Food education – let’s go back to the future. Nutrition Bulletin. 2021;46(4):412-414. doi: 10.1111/nbu.12524 BNF (British Nutrition Foundation). 2020. Food – a Fact of Life: Characteristics of good practice in teaching food and nutrition education in primary schools. Available from: https://www.foodafactoflife.org.uk/professional-development/ppd-toolkit/primary/characteristics-of-good-practice-in-teaching-food-and-nutrition-education-in-primary-schools/ [Accessed 26th November 2021] Cotton W, Dudley D, Peralta L, Werkhoven T. The effect of teacher-delivered nutrition education programs on elementary-aged students: An updated systematic review and meta-analysis. Prev Med Rep. 2020;20:101178. doi: 10.1016/j.pmedr.2020.101178 DfE (Department for Education). 2016. Statistics: school workforce. Available at: https://www.gov.uk/government/collections/statistics-school-workforce. [Accessed 29th November 2021] Dimbleby H, Vincent J. 2013. The School Food Plan. Available from: http://www.schoolfoodplan.com/wp-content/uploads/2013/07/School_Food_Plan_2013.pdf [Accessed 28th November 2021] JOFF (Jamie Oliver Food Foundation). 2017. A Report on the Food Education Learning Landscape. Available from: https://www.akofoundation.org/wp-content/uploads/2017/11/2_0_fell-report-final.pdf [Accessed 24th November 2021] NFS (National Food Strategy). 2021. The Plan. Available from: https://www.nationalfoodstrategy.org/ [Accessed 29th November 2021]. NNEdPro. Child Malnutrition & COVID-19 in the UK. Available from: https://www.nnedpro.org.uk/post/child-malnutrition-covid-19-in-the-uk [Accessed 11th December 2021]