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

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

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

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

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

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

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

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

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

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

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