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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

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

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

to improve nutrition security and combat risk of malnutrition The NNEdPro Global Centre for Nutrition and Health in Cambridge led by Professor Sumantra Ray along with the NNEdPro India team have been investigating the diets of ‘Santhal’ tribe communities in rural India to identify key nutritional gaps. This consultancy work is providing a nutritional science basis to the Global Research Translation Award (GRTA) activities led by Professor Nitya Rao (UEA) in collaboration with Indian partner PRADAN. The project is seeking to encourage diet diversification in rural communities to improve nutrition and health. By suggesting subtle changes to traditional recipes which complement existing dietary and lifestyle patterns, the partners hope to achieve nutritional adequacy for these indigenous communities. The Nutritional Analysis Process With support from PRADAN, young Santhali people collected over 100 traditional recipes from their communities. The dietary assessment team at NNEdPro selected 32 individual recipes and 26 consumed menu templates for analysis. Some food ingredients specific to the Santhal tribe were not available through software such as Nutritics e.g. Red ants, Mahua flower, and certain green leafy vegetables (GLVs), therefore advice was provided from the NNEdPro India team based on Nutritive values of Indian foods (National Institute of Nutrition, India). Caption: Red Ants collected for a traditional recipe Each recipe was screened for deficiencies in total energy (kcal), macronutrients (protein, carbohydrates and fat) and micronutrients (sodium, potassium, calcium, iron, zinc, selenium, iodine, vitamin A, vitamin D, vitamin E, Thiamine, Riboflavin, Pantothenic acid, folates, vitamin B6, Vitamin B12, and vitamin C). Dietary values for which the National Institute of Nutrition in Hyderabad lacked reference to, like starch, fibre, sugars, saturated fat, mono-unsaturated fat, polyunsaturated fat, omega 3 and trans fatty acids, were obtained from the World Health Organisation (WHO) guidelines. Creation of New Menu Templates First, the NNEdPro UK team identified potential deficiencies through a nutritional analysis of the consumed menu templates. Next, the NNEdPro India team suggested new menu templates which could provide individuals in the Santhal tribe with all their nutritional needs, making a conscious effort to honour the Santhali indigenous recipes as much as possible. The result is 18 menu templates and 4 supplementary templates which fulfil the following criteria: ▪ Providing nutrients as per Dietary Reference Values (DRV), known as Recommended Dietary Allowances (RDA) in India ▪ Allowing sufficient micronutrients ▪ Making very small changes to consumption patterns ▪ Keeping all indigenous recipes in menu ▪ Not introducing new recipes ▪ Ensuring the method and time of cooking is reasonable ▪ Considering affordability, availability, acceptability ▪ Promoting egg consumption ▪ Adding snacks in between meals Each meal template represented 40% of daily individual needs, and individuals were assumed to consume 2 meal templates per day in addition to a snack which covered the remaining 20% of their intake. Nutritional Analysis Findings After analysing the traditional recipes and consumed menus, the NNEdPro team discovered that the main nutrients of concern were energy, fat (particularly saturated fat), fibre, potassium, calcium, zinc, iron, iodine, vitamin E and the B vitamins, including B1, B2, B6, B9 and B12. After the first round of improving the menu templates, the team saw significant improvements in the percentage of new menu templates meeting the DRVs: • Fat increased from 5.8% to 72% of DRV • Calcium increased by 30% • Iron increased by 38% • Zinc increased by 56% • Vitamin E increased by 57% • Vitamin B1, B9 and B12 increased by 34%, 47% and 55% respectively. For example, the Santhal tribe would typically consume Sakarkand/alu saag with rice. However, based on the nutritional analysis this meal was not meeting the requirements for energy (for males), fibre, potassium, calcium, iron, zinc, thiamine and folate. Adding 40g of Ghanghra Daal, a dish made up of blackeye beans, cumin, red and green chilli peppers and salt, showed an increase in energy, protein, fibre, potassium, calcium, iron, zinc, thiamine and folate (by 7%, 26%, 25%, 32%, 15%, 42%, 21%, 47% and 340%, respectively). This new menu template now meets all the nutritional requirements. Understanding the science in a cultural context PRADAN conducted Dietary Diversity Questionnaires (DDQ) to understand the dietary patterns and cultural behaviours of the Santhal communities. A total of 100 DDQs were conducted between November to December 2020, covering demographic information of household members and various food groups. Ages of household members ranged between 6 months to 80 years of age; and food preparation was mainly carried out by women, with the average age being 36 years old. The different food groups included cereals, white roots and tubers, green leafy vegetables, other vegetables, vitamin A rich vegetables, vitamin A rich fruit, other fruit, animal organs, meat, eggs, fish or other aquatic foods, pulses and seeds, milk and dairy, oils and fats, sweets and snacks. The questionnaires also collected information about food preferences, source of food (subsistence from own land, purchased from a market or other), frequency of consumption, and food availability throughout the year. For example; Rice was the preferred type of cereal, with 79% of individuals consuming rice in the last 24 hours. Additionally, 64% of respondents reported that cereals are sourced on their own land and 19% reporting that they are sourced from the market. We found that the majority of individuals (66%) consume cereals on a daily basis, and all respondents reported that cereals are available throughout the year. Producing a Recipe Book for the local communities The NNEdPro team are going to present the improved menu templates in the form of a recipe book, which has been informed by a good understanding of the local context. The DDQs have provided rich information about availability of local produce, accessibility to wider markets, traditional eating and lifestyle habits, type of labour, and cooking/preparation facilities. By connecting the nutritional science with the community context, the partners can be confident that the suggested improved recipes in the recipe book will meet the dietary needs and will be adopted by the local people because they are culturally relevant and appropriate. This blog was published on 09 December 2021 and was written by the team at NNEdPro Global Centre for Nutrition and Health (Sarah Armes, Project Officer/Research Assistant, Sally Ayyad, Project Officer/Research Assistant, Professor Sumantra (Shumone) Ray, NNEdPro Chair & Executive Director, Sanchita Banerjee, Deputy Network Lead (India) & Project Officer). Edited by Professor Nitya Rao and Hannah Gray, University of East Anglia. Acknowledgements to: Wanja Nyaga, Xunhan Li, Luke Buckner, Aseem Manna, Shuvojit Chakraborty, Nivedita Narain, Arundhita Bhanjdeo and Ayesha Pattnaik.

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]

From Agricultural Nutrition and Social Empowerment to Human Nutrition and Health in India – 24th July workshop. Organised by the NNEdPro Global Centre for Nutrition and Health, in partnership with the University of Cambridge TIGR2ESS GCRF Programme and the University of Surrey Maharashtra GCRF. Written by Wanja Nyaga and Jorgen Johnsen Edited by Sento Kai Kargbo, Sarah Anderson and Professor Sumantra Ray Life-course evolution of diabetes – learnings from the Pune Maternal Nutrition Study by Prof Chittaranjan Yajnik, Director, Diabetes Unit, King Edward Memorial Hospital and Research Centre, Pune, India. The Pune Maternal Nutrition Study started in 1993 in six villages near Pune, India, to determine the cause of low birthweight (LBW) in India and how we can study the life course evolution of diabetes and other health outcomes. Key indicators such as maternal size, nutrition, paternal size, metabolic variables and fetal growth were measured. The mothers (study participants) were followed over 24 years, with a follow-up rate of 96%. This has resulted in an impressive biobank of DNA, plasma, urine, buccal swabs, and microbiota samples. In his presentation, Prof Yajnik provided a brief overview of type 2 diabetes (T2DM), including the natural history of the disease and associated risk factors (e.g., genetics, age, obesity, diet, and physical inactivity). He further discussed the association between LBW, T2DM and other metabolic conditions. LBW was shown to be associated with T2DM and other metabolic conditions (Hales et al. 1991) owing to undernutrition in the early stages of the life-course, which can cause epigenetic changes and, in turn, increase susceptibility to metabolic disease (also known as the ‘thrifty gene hypothesis’). Anaemia in adolescent females and pregnant women: findings from the MAS Phase 1 and 2 studies by Dr Anand Ahankari, Surrey University, UK. Iron deficiency anaemia is highly prevalent in India, especially among pregnant women. Approximately 55% of girls and women of reproductive age have nutrition-related iron deficiency anaemia, and some Indian states have as high as >70% prevalence. In adolescent females, anaemia prevalence was extremely high (87%), and the likelihood of being anaemic increased significantly with age. Factors associated with lower anaemia risk were mid-upper arm circumference, MUAC (> 22 cm) and >3 days/week consumption of fruits and rice. In the case of pregnant women, about 77% were affected by anaemia, and this increased risk of anaemia was more notable in women with consanguineous marriages. Consanguineous marriages were also a major risk factor for low birth weight (LBW). Post-delivery data from full-term singleton live births showed a 7% prevalence of LBW. Lastly, haemoglobin levels in the population were associated with environmental exposures. Understanding this observation may help design better public health interventions to improve the health and wellbeing of adolescent females in rural India. Nutrition, wellbeing and empowerment: the thread that connects by Prof Ramanjit K. Johal, Punjab University, India. Prof Johal presented the work Punjab University has done relating to nutrition. Punjab University comprises a leading multidisciplinary team and is working to inspire change in health behaviours in marginalised communities. She described the TIGR2ESS flagship programmes across education, food, nutrition, empowerment, employment, and entrepreneurship and its expected outputs to improve the wellbeing and nutrition of farmers and rural communities in India. Prof Johal and colleagues conducted a 24-hour dietary recall study in two villages; however, the data is yet to be analysed. Meanwhile, their work is moving towards sustainable agricultural solutions with their organic kitchen gardens and sewing training projects to improve awareness about food sources and develop culinary and entrepreneurship capacities with their stakeholders, despite challenges with COVID-19. Their work continues to show promise in improving knowledge about basic nutrition, food groups, increasing awareness of healthy eating, increasing confidence among stakeholders to discuss their health problems, as well as facilitating knowledge dissemination with peer groups and family members. Opportunities and challenges – Nutritional knowledge and rural livelihoods by Prof Shailaja Fennell, University of Cambridge, UK. Prof Fennell discussed lessons learned from the previous green revolution for sustainable agriculture, which focused on well-irrigated agricultural zones and semi-arid zones. However, marginal communities and the role of women as millet producers in the community were largely overlooked. Due to this neglect, there was a failure to recognise the importance of millet production in these marginalised communities. Prof Fennell also shared experiences with awareness building around millet production and consumption, in partnership with the International Crops Research Institute for the Semi-Arid Tropics (ICRISAT) and Odisha Millet Mission. There have been various attempts to bring millets to the front of food discussions in both urban and rural areas. The issue is not a lack of knowledge, but that the knowledge on millet and its value chain is not internationally recognised. Building on the year of millets (2023) in cooperation with the Millet Mission, more advocacy for millet production and consumption is underway through institutional architecture, drawing on experiences, local biodiversity and combining tradition and science. However, the value chain from production to plate needs to be improved to scale up millets. Current studies are tracing crop production from the rural household level to urban/rural household consumption. Phase one will focus on nutrition and livelihood activities at the household level to identify patterns. While phase two traces the journey of innovative products from the household farms to markets and then to the plate. NNEdPro/Bhavishya Shakti Mobile Teaching Kitchen (MTK) project by Professor Sumantra (Shumone) Ray, NNEdPro. Prof Ray presented on the NNEdPro/Bhavishya Shakti Mobile Teaching Kitchen (MTK) initiative in India. The MTK was first launched in 2017 in two slums in Kolkata, India, and since then has been adapted to other parts of India (Sanghol and Punjab). The MTK initiative aims to tackle food insecurity and malnutrition among underserved and vulnerable populations by engaging with local communities to deliver health and malnutrition screening sessions and effective nutrition education while distributing nutritionally balanced, locally sourced, and affordable meals. It also seeks to disrupt the vicious cycle of intergenerational poverty by introducing communities to sustainable development initiatives and a skill-building platform that links them with dignified livelihood alternatives. You can learn more about the NNEdPro/Bhavishya Shakti MTK initiative in Kolkata here. Impacts of COVID-19 on India’s food system and food environment by Jørgen T. Johnsen, Dr Marjorie Lima Do Vale, NNEdPro and Dr Rekha Bhangaonkar, Cambridge University, UK. Jørgen Johnsen presented the objective of the survey: to gather the TIGR2ESS flagship project teams’ perspectives on the impact of COVID-19 on different aspects of India’s food systems and environments. This included food supply, the food environment, consumer behaviour and diet quality. Currently, the findings from the qualitative interviews are being coded and summarised for a paper. Dr Lima Do Vale described the analytical framework (see image below) used to summarise the data based on the UN Nutrition framework of COVID-19’s impact on food systems. Lastly, Dr Bhangaonkar described the ‘Miro’ tool used and the process of implementing codes to summarise each identified theme. The codes were then adapted to NVivo for qualitative data analysis. Food, nutrition and education interface – A comprehensive nutrition curriculum by Dr Padmaja and team, ICRISAT, India. Dr Padmaja introduced the objective of the health and nutrition literacy programme developed by ICRISAT. Using comprehensive nutrition messaging, this programme aims to improve the wellbeing of poor rural tribal communities in Telangana, India. The study included adolescent girls, pregnant and lactating women (n=921), and the research questions were broadly categorised into assessing current nutrition knowledge, attitude and practice (KAP); how to improve these factors using nutrition messaging; and evaluating the efficacy of the intervention, in terms of improvements in KAP. The KAP focused on food safety, hygiene, nutrition and health. According to the results at baseline, the nutrition knowledge of pregnant and lactating mothers was inadequate, with an average score of less than 50% on the assessment. The pregnant women scored low on attitudes regarding healthy diets compared to lactating mothers and frontline workers, and although attitudes translate into practice, the baseline data revealed that all categories of respondents were not adopting appropriate dietary and nutrition practices. The awareness of iron, vitamin A and iodine was also generally low. Further research activities to be completed. This text was originally published at https://tigr2ess.globalfood.cam.ac.uk/news/uk-global-challenges-research-fund-cross-gcrf-uk-india-workshop-and-satellite-event-7th

Author: Joshua Clamp / Editor: Shane McAuliffe A recent article published in BMJ Nutrition, Prevention & Health tested the efficacy of a remotely delivered weight management service in a primary care setting. Reference: Walker L, Smith N, Delon C. Weight loss, hypertension and mental well-being improvements during COVID-19 with a multicomponent health promotion programme on Zoom: a service evaluation in primary care. BMJ Nutrition, Prevention & Health 2021;bmjnph-2020-000219. Doi: 10.1136/bmjnph-2020-000219 Background Obesity and related metabolic diseases, including Type 2 Diabetes and cardiovascular disease, remain a major public health challenge in the UK. Some 63% of adults in England are overweight or obese, which has been associated with increased risk of Covid-19 complications (PHE, 2020). Not only this, but national lockdowns as a result of Covid-19 have themselves contributed to weight gain (ZOE Covid Study, 2020). In the UK, weight management services have traditionally involved community-based, group lifestyle programmes delivered in a face-to-face format. However, the arrival of national lockdowns in England meant that service providers had no choice but to rapidly shift to virtual delivery and say goodbye to the traditional setting. With lockdowns now lifted in the UK, some weight management services are once again being delivered face-to-face. However, many services in primary care settings remain remote due to the increased vulnerability of primary care patients. Limited research exists on the efficacy of remotely delivered weight management services in such contexts. Developing an understanding of how these services can be optimised for maximum efficacy in these patients is therefore important. The intervention This study explored the efficacy of a remotely-delivered, community-based group weight loss intervention in a primary care setting. The intervention involved a weight loss and health promotion programme delivered as part of an initiative from the registered UK charity Public Health Collaboration. This programme, officially titled the ‘Low Carb Real Food Lifestyle Programme’, involved six 90-minute sessions conducted across ten weeks and was delivered via Zoom. Participants also had access to optional extra support through private social media groups. The patients were recruited from a four-practice, 32000-patient primary care network in Hampshire, UK. Participants were adults with T2D, pre-diabetes or who had been advised to lose weight, plus those living with or caring for someone in one of these categories. Evidence points towards the use of multiple healthy lifestyle behaviours in reducing risk of mortality (Loef & Walach, 2012). As such, this programme included education on several important lifestyle factors, including diet, physical activity, sleep, stress management, gut health and behaviour change. The programme was designed to provide a foundational understanding nutrition, physiology, and behaviour change to help participants understand, engage in and feel some control over their health. Traditional weight loss programmes often involve a focus on caloric restriction and/or may utilise structured meal plans. This intervention, however, did not adopt a calorie-focused approach. Instead, it included an element of carbohydrate restriction, which has reported benefits of reduced blood pressure and weight loss in primary care patients and anecdotal improvements in wellbeing (Unwin et al., 2020). Participants of this programme were encouraged to restrict sugar, processed foods and starchy carbohydrates such as bread, pasta, rice and potatoes and to focus on eating minimally processed foods to satiety. An individualised approach was encouraged to ensure that preferences and demands associated with each participant’s lifestyle were met, and to make changes at their own pace. This advice was provided alongside resources including a one-page guide to low-carbohydrate eating and lists of foods to enjoy and avoid, as well as recipe suggestions. Measurements A range of measures were used to assess the efficacy of this intervention. The primary outcome measures were weight loss, changes in body mass index, waist circumference, and mental wellbeing, measured using the Warwick Edinburgh Mental Wellbeing Scale. Secondary outcomes were changes in blood pressure and blood glucose control. Subjective outcomes regarding participant experience were also recorded, collected via a questionnaire. Most data were collected prior to the first session and after the last session, however participants were encouraged to monitor and record their weight and waist circumference at regular intervals. The design of this study meant there was no control group, and instead authors chose to use a pre-post comparison. Results 30 people attended the information session, however only 20 completed the programme and had data valid for analysis. Of these 20, 17 (85%) were female and the majority (60%) were classified as having obesity. All participants were over 40 years old. All primary outcome measures improved significantly, with participants achieving a mean weight loss of 5.8kg, representing a mean weight loss of 6.5%. Mean BMI reduced by 2 kg/m2, and mean waist circumference reduced by 5.2 cm, whilst mental wellbeing scores also increased. Blood pressure and blood glucose levels also improved, and participants on insulin reduced their dosage. Feedback from participants also reflected the positive objective outcomes, and described improved confidence, increased positive feelings about health, and better energy overall. Furthermore, majority (78%) of participants were confident in their ability to maintain their changes, and over 80% said that that the experience via Zoom worked well. Finally two-thirds of feedback survey respondents reported losing weight without hunger and with reduced food cravings. Strengths, limitations and points for consideration The study had a small sample size, and no control group was used. Additionally, the sample was not randomised, increasing risk of selection bias. Furthermore, much of the data were self-reported, which introduces reporting bias. Long-term follow up was not possible, thus it cannot be said whether such an intervention had a lasting impact on the measured outcomes. The ability of this paper to provide evidence or the efficacy of carbohydrate restriction as an independent driver of weight loss and health improvement is limited. The study did not have the capacity to reliably measure carbohydrate intake of participants, and so exact compliance was unknown. Furthermore, as the intervention used multiple approaches, the positive results cannot be pinned directly to the carbohydrate restriction. Authors also highlighted possible confounding factors that could have affected outcomes, such as the COVID-19 pandemic itself and the drastic changes it imposed on our daily lives. This may have had a positive confounding effect due to there being more time to cook, make meals from scratch, and exercise, as well as fewer social opportunities that may challenge compliance. On the other hand, increased stress, as well as reduced access to food retailers and exercise venues may have had a negative influence. Despite these limitations, the results observed were very positive, and in line with those from similar interventions. This intervention clearly demonstrated the potential for remotely delivered weight management services in primary care patients. One final factor for consideration is the different demands of remote vs face-to-face delivery, and how these demands translate to differing accessibility for different individuals. For example, whilst it is clear that remote delivery can offer logistic, financial and time benefits, it also requires access to and understanding of certain technologies. Patients from different socioeconomic backgrounds may therefore have greater access to and preference of different delivery formats. This is an issue that should be considered when developing and delivering future remote weight management services. Key takeaways This study represents one of the first evaluations of a remotely delivered group-based weight loss or health promotion programme in primary care patients. Results support the notion that an effective health promotion programme can be delivered to a range of participants without the need for premises or meeting in person. This provides promise for addressing obesity and related metabolic conditions in novel ways. It also supports evidence that the provision of information and guidance on a range of dietary factors, including a focus on carbohydrate restriction, can lead to significant changes in weight and other chronic disease risk factors. However, as discussed due to the nature of the study and measuring capacity of the researchers, exact carbohydrate intake could not be measured. So whilst carbohydrates were estimated to have decreased, authors suggest that the advice to eliminate sugar and restrict starches and ultra-processed foods was effective in contributing to the observed benefits. Thus, this guidance could provide a realistic, acceptable alternative to strict carbohydrate restriction or carbohydrate counting. It is worth noting that this advice is also common across a number of dietary approaches for weight loss and overall health improvement. Moreover, this supports the evidence that the use of a holistic approach, targeting both the education and application of multiple features of healthy lifestyles, including nutrition, physical activity, stress management, sleep, and behaviour change, can be efficacious in achieving weight loss. References & further reading Covid Symptom Study. Has lockdown influenced our eating habits? the silent pandemic: how lockdown is affecting our future health. 2020. Available: https://covid.joinzoe.com/post/lockdown-weight-gain#:~:text=The%20factors%20that%20may%20have,less%20healthy%20diet%20(19%25) Loef M, Walach H. The combined effects of healthy lifestyle behaviors on all cause mortality: a systematic review and meta-analysis. Prev Med. 2012;55(3):163-70. Doi: 10.1016/j.ypmed.2012.06.017. Epub 2012 Jun 24. PMID: 22735042. Public Health England. Excess weight and COVID-19. insights from new evidence 2020. Available: https://www.gov.uk/government/publications/excess-weight-and-covid-19-insights-from-new-evidence Unwin D, Khalid AA, Unwin J, Crocombe D, Delon C, Martyn K, Golubic R, Ray S. Insights from a general practice service evaluation supporting a lower carbohydrate diet in patients with type 2 diabetes mellitus and prediabetes: a secondary analysis of routine clinic data including HbA1c, weight and prescribing over 6 years. BMJ Nutrition, Prevention & Health 2020;3(2):285-294. Doi: 10.1136/bmjnph-2020-000072. PMID: 33521540; PMCID: PMC7841829. Walker L, Smith N, Delon C. Weight loss, hypertension and mental well-being improvements during COVID-19 with a multicomponent health promotion programme on Zoom: a service evaluation in primary care. BMJ Nutrition, Prevention & Health 2021;bmjnph-2020-000219. Doi: 10.1136/bmjnph-2020-000219.

A 10-point summary on diet, nutrition and the role of micronutrients E Fallon, S McAuliffe & S Ray on behalf of the NNEdPro Global Centre for Nutrition and Health (Design by M Abrantes; Reviewed by E Beck, L Buckner, J Bradfield, D Crocombe, M McGirr & K Martin) 26th March 2020. Correspondence to: info@nnedpro.org.uk In the wake of the current and unprecedented COVID-19 pandemic, on 20th March 2020, the Director-General of the World Health Organization (WHO) emphasised the importance of appropriate diet and lifestyle measures including adequate nutrition to protect the immune system. This is of course not a substitute for adherence, first and foremost, to key public health and medical advice on prevention. However, as vast sections of society spend more time at home, it provides an opportunity to focus on strengthening the four lifestyle pillars of sleep, mind, exercise and diet. To elaborate on diet and nutrition, particularly given the variable quality of online information, we have put together a 10-point summary as general guidance: 1 The Coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2) is highly transmissible and can be potentially lethal. Hence any strategies that can prevent or mitigate respiratory infection risk and strengthen overall immunity are critical at this time. 2 Poor nutrition, due to either insufficient dietary intake of key nutrients or a poor overall diet quality, can compromise immune function and increase overall infection risk. 3 Micronutrients, commonly known as vitamins and minerals, are required in small quantities but are critical for health and pivotal in strengthening the immune system. 4 Multiple micronutrients are essential for good immune function, particularly vitamins A, C, D, E, B2 (riboflavin), B6 (pyridoxine), B12 (cobalamin) and B9 (folic acid) and minerals iron, selenium, zinc, magnesium and copper (Calder, Carr, Gombart & Eggersdorfer, 2020) and these are found in a variety of foods that form part of a balanced diet in line with national guidelines. 5 There are a variety of foods rich in vitamins and minerals (see below), in particular fruit and vegetables, which can be fresh, tinned or frozen: 6 In the United Kingdom, as an example, several micronutrient deficiencies are prevalent as the Government’s National Diet and Nutrition Survey (2019) demonstrates widespread inadequacy in the intakes and/or status of vitamin D, vitamin A (retinol), folate and selenium across the UK population and in specific age groups. This is likely to be mirrored more widely across multiple countries. 7 Certain individuals are at greater risk of micronutrient deficiency; this includes women of childbearing age, particularly pregnant and lactating women, infants and toddlers, children, adolescents (particularly females), older adults (Maggini, Pierre & Calder, 2018), obese individuals, and the critically ill, plus individuals with inflammatory bowel disease (Kilby, Mathias, Boisvenue, Heisler & Jones, 2019) and other chronic inflammatory and malabsorptive conditions. 8 In many high risk groups, a balanced diet alone may not be sufficient to meet these requirements and deficiencies can contribute to impaired immune function. This can be due to a variety of factors affecting intakes, absorption and also due to increased utilisation of micronutrients during times of infection. In such cases, the immune system can be supported by micronutrient supplementation particularly to help correct deficiencies. 9 As a key example from the UK, Vitamin D supplementation is recommended at 10 micrograms a day, as per guidelines. The average diet provides less than half of this amount. In fact, Public Health England (PHE) is now recommending that people consider taking a Vitamin D supplement of 10ug throughout the spring and summer as lockdown continues and access to sunlight may be limited. This is of particular concern in individuals in the high-risk category, which includes people who are housebound, living in a care home and those with darker skin. 10 Overall, whilst COVID-19 is causing inevitable distress to one and all, aside from the impact of the viral illness itself, prevention through social distancing and staying at home can affect both mood and feelings. This may cause depression, anxiety, loneliness and irritability. During these testing times, it is important to remember that eating well, staying hydrated, thinking positively, sleeping adequately and staying active will contribute to both physical and mental wellbeing. Some examples of useful UK resources include: (i) NHS ‘stay at home’ exercises – https://www.nhs.uk/live-well/exercise/gym-free-exercises/ (ii) Doing things for others – www.actionforhappiness.org (iii) A mental health community pack – https://www.maldon.gov.uk/healthandwellbeing Stay well, stay safe and follow WHO and regional Government advice such as remaining at home and social distancing alongside meticulous hand-hygiene – diet and lifestyle measures are not a substitute for current public health advice on mitigation and suppression of the epidemic through our individual and collective actions – however, we hope that this rough guide will help health professionals, health caterers, policymakers and members of the public to gear up for the weeks ahead as we ride out the worst of the COVID-19. NB Notes: This is a rapid synthesis of best available evidence for a general/mixed audience – a series of peer reviewed publications aimed at professionals and policymakers will follow in our COVID-19 related special collection in BMJ Nutrition, Prevention and Health. This article is intended to be general guidance only and is not geared to address the needs of specific population groups or individuals with disease conditions including those which can impact immunity and susceptibility to infection – for those with underlying conditions we ask that appropriately qualified medical and/or other health professionals are consulted at all times – the NNEdPro Global Centre cannot be held liable for any unintended consequences that arise due to the actions of individuals in response to this general article. During this time there are a number of pieces of information online and in circulation which are of variable quality and integrity – please beware of ‘quackery’ and ‘profiteering’ behaviours and ensure that only trusted sources of information are followed. Additional Recommended Reading Check out our dedicated COVID-19 Microsite for further information and resources Check out our dedicated COVID19 and Nutrition Resources Microsite for further reading Read and share this blog post in other languages বাংলা (Bengali) Deuschland (German) हिंदी (Hindi) Oriya (Odia) Português Brasileiro (Brazilian Portuguese) ਪੰਜਾਬੀ (Punjabi) Slovenský (Slovak) తెలుగు (Telugu) Le Français (French) Melayu (Malay) 繁體中文 (Traditional Chinese) Español (Spanish) More languages coming soon References Alpert, P. (2017). The Role of Vitamins and Minerals on the Immune System. Home Health Care Management & Practice, 29(3), 199-202. doi: 10.1177/1084822317713300 BMJ 2017;356:i6583 http://dx.doi.org/10.1136/bmj.i6583 Calder, P.C.; Carr, A.C.; Gombart, A.F.; Eggersdorfer, M. Optimal Nutritional Status for a Well-Functioning Immune System is an Important Factor to Protect Against Viral Infections. Preprints 2020, 2020030199 Carr, A., & Maggini, S. (2017). Vitamin C and Immune Function. Nutrients, 9(11), 1211. doi: 10.3390/nu9111211 Gammoh, N., & Rink, L. (2017). Zinc in Infection and Inflammation. Nutrients, 9(6), 624. doi: 10.3390/nu9060624 Kilby, K., Mathias, H., Boisvenue, L., Heisler, C., & Jones, J. (2019). Micronutrient Absorption and Related Outcomes in People with Inflammatory Bowel Disease: A Review. Nutrients, 11(6), 1388. doi: 10.3390/nu11061388 Kubenam, K. (1994) The Role of Magnesium in Immunity, Journal of Nutritional Immunology, 2:3, 107-126, DOI: 10.1300/J053v02n03_07 Maggini, S., Pierre, A., & Calder, P. (2018). Immune Function and Micronutrient Requirements Change over the Life Course. Nutrients, 10(10), 1531. doi: 10.3390/nu10101531 Moriguchi, S., & Muraga, M. (2000). Vitamin E and immunity. Vitamins & Hormones, 305-336. doi: 10.1016/s0083-6729(00)59011-6 National Diet and Nutrition Survey. (2019). Retrieved 25 March 2020, from https://www.gov.uk/government/collections/national-diet-and-nutrition-survey Public Health England (2016). Government Dietary Recommendations (2016202). Retrieved from https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/618167/government_dietary_recommendations.pdf Rayman, M. (2012). Selenium and human health. The Lancet, 379(9822), 1256-1268. doi: 10.1016/s0140-6736(11)61452-9 Verdrengh, M., Tarkowski, A. Riboflavin in innate and acquired immune responses. Inflamm. res. 54, 390–393 (2005). https://doi.org/10.1007/s00011-005-1372-7 Appendix

An innovative model training marginalised women to become culinary health educators Written by Sento Kai Kargbo, MTK Project Officer at NNEdPro Edited by Luke Buckner, MTK Project Lead at NNEdPro Reference: Buckner, L., Carter, H., Crocombe, D., Kargbo, S.K., Korre, M., Bhar, S.B., Chakraborty, D., Douglas, P., Gupta, M., Maitra-Nag, S., Muhkerjee, S., Saha, A., Rajput-Ray, M., Tsimpli, I., and Ray, S. (2021). ‘Bhavishya Shakti’: Empowering the Future’: establishing and evaluating a pilot community mobile teaching kitchen as an innovative model, training marginalised women to become nutrition champions and culinary health educators in Kolkata, India. BMJ Nutrition Prevention & Health; 0. Doi: i:10.1136/bmjnph-2020-00018 A recent article published in BMJ Nutrition (BMJ NPH) demonstrates the feasibility of a novel Mobile Teaching Kitchen (MTK) as a nutrition education and upskilling platform for marginalised women in Kolkata, India, and the potential for upscaling to similar people worldwide. The MTK as a public health intervention showed promising results in educating and empowering a group of lay disadvantaged women into culinary health educators, otherwise referred to as ‘MTK Champions’. This blog aims to summarise key findings, limitations, and opportunities for future research. Background. Malnutrition – undernutrition, micronutrient deficiencies, and overweight/obesity, and other diet-related non-communicable diseases – affects nearly 2 billion people worldwide and is a leading cause of death and disability worldwide (WHO 2019). The simultaneous existence of underweight and overweight/obesity (“double burden of malnutrition”) persists as a public health emergency in India across the socioeconomic gradient (NFHS-4 2017). According to the Global Nutrition Report (2016), although there has been overall progress in rates of exclusive breastfeeding and prevalence of overweight among children under 5 years old in the region, there is still much work to be done as the overall state of malnutrition remains a cause for concern. The NNEdPro Global Centre, in partnership with local charities, launched the “Bhavishya Shakti” MTK intervention in two slums (Chetla, RG Kar) in Kolkata, India, where the project team including health professionals trained local community volunteers in basic nutritional concepts who then transferred this knowledge to a group of women via a teaching kitchen. The MTK intervention was delivered over the course of 6 months, from baseline assessment to post-intervention data collection. This paper aimed to assess the feasibility of a mobile teaching kitchen as an upskilling platform and nutrition education tool to train marginalised women to become culinary health educators. Figure 1. Timeline of data collection and nutrition education delivery. Baseline assessment. With the help of volunteers, licensed dietitians and physicians collected demographic data (age, gender, education level, occupation, no. of siblings) and performed physical exams (anthropometry and clinical assessments) to evaluate the nutrition status of MTK Champions. KAP (knowledge, attitudes, and practices) surveys were also administered to assess awareness of dietary practices. SODOTO Workshops. The ‘See One, Do One, Teach One’ ("SODOTO") workshops were comprehensive nutrition education and hygiene workshops delivered via cooking demonstrations following a pre-set template menu comprising locally sourced ingredients. In the See One session, MTK champions observed the preparation of nutritionally balanced, affordable meals. In the next session, ‘Do One’, the Champions performed the meal preparations themselves, and in the final session, Teach One, they taught a group of community members who opportunistically assembled. Additionally, following each consecutive session of the SODOTO workshops, the cognitive flexibility and mentalising skills of the MTK Champions were assessed using standard theory of mind (ToM) tasks, the Wisconsin Card Sorting Task, and the Unexpected Transfer task – a novel aspect of the proposed intervention. Mentalising refers to the mothers’ ability to predict, understand, and cater to their children’s psychological needs. Insights into mentalising skills may highlight which candidates are flexible to adapt behaviour to the understanding of others. Figure 2. Overview of the process of knowledge transmission from trained professionals through to the community. In the post-intervention data collection step, clinical assessments and anthropometric measurements were repeated to allow for longitudinal analysis of nutrition and health status. KAP surveys were also re-administered. At the end of the workshops, MTK Champions formed a microenterprise where they prepare and sell meals whilst transferring knowledge onto members of their community. Summary of key findings All Champions were domestic helpers (n=8) or housewives (n=6). Although, the majority of the champions were educated to primary level (up to class IV) (n=6). The maximum level was up to UK college standard (XII standard) or above (n=1), and the lowest level was no formal education (n=4). As anticipated in this timeframe, there was no statistically significant difference in weight, height, or MUAC at baseline or post-intervention in both mothers and children across the 2 slums. Of the 11 signs of micronutrient deficiencies observed at baseline, only 3 were seen post-intervention. The most common clinical sign observed was pallor. At baseline, the combined KAP subsections were as follows (mean (SD)): knowledge 11.7 (1.05), attitude 40.6 (0.74) and practice 23.4 (1.24). Following the intervention, the scores were found to have changed by +4.8 (knowledge), −3.8 (attitude), and +0.8 (practice). Figure 3. Breakdown of KAP scores of Chetla and RG Kar slums Findings from the MTK pilot intervention in Kolkata should be interpreted with caution given the small sample size (n=12) which limits internal and external validity. Furthermore, many of the clinical assessments, especially the examination of the physical signs are subjective, therefore prone to the effects of chance, bias, and confounding. Anthropometric measurements are also prone to subjective inconsistencies or errors. Conclusion. Malnutrition poses serious health and economic consequences for individuals and communities. Nutrition and health interventions, like the MTK, provide an opportunity for cost-effective, innovative, and adaptable action toward addressing nutrition and health inequities among underserved populations, which has been further exacerbated by the ongoing COVID-19 pandemic. The main outcomes of the success of the MTK were improvements in nutrition knowledge and practice among the Champions post-intervention. Further, the MTK also serves as a microenterprise opportunity to generate novel sources of household income and new leadership and educator roles within the community. There is also the potential to adapt and upscale this kind of intervention to other settings globally, across the socioeconomic gradient. References World Health Organization. Malnutrition is a world health crisis, 2019. Available: https://www.who.int/nutrition/topics/world-food-day-2019-malnutrition-world-health-crisis/en/2 Ministry of health and family welfare. National family health survey (NFHS-4) 2015-16 India, 2017. Available: http://www.rchiips.org/nfhs5 Global Nutrition Report. Country Nutrition Profiles – India. Available: https://globalnutritionreport.org/resources/nutrition-profiles/asia/southern-asia/india/ Buckner, L., Carter, H., Crocombe, D., Kargbo, S.K., Korre, M., Bhar, S.B., Chakraborty, D., Douglas, P., Gupta, M., Maitra-Nag, S., Muhkerjee, S., Saha, A., Rajput-Ray, M., Tsimpli, I., and Ray, S. (2021). ‘Bhavishya Shakti’: Empowering the Future’: establishing and evaluating a pilot community mobile teaching kitchen as an innovative model, training marginalised women to become nutrition champions and culinary health educators in Kolkata, India. BMJ Nutrition Prevention & Health; 0. Doi: i:10.1136/bmjnph-2020-00018 NNEdPro. Mobile Teaching Kitchen (MTK) [Internet]. 2021 [cited Aug 12]. Available: https://www.nnedpro.org.uk/mtk