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  Subjects -> NUTRITION AND DIETETICS (Total: 201 journals)
Showing 1 - 64 of 64 Journals sorted by number of followers
American Journal of Clinical Nutrition     Hybrid Journal   (Followers: 176)
British Journal Of Nutrition     Hybrid Journal   (Followers: 96)
Clinical Nutrition     Hybrid Journal   (Followers: 94)
International Journal of Obesity     Hybrid Journal   (Followers: 93)
International Journal of Sport Nutrition & Exercise Metabolism     Hybrid Journal   (Followers: 88)
European Journal of Clinical Nutrition     Hybrid Journal   (Followers: 75)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 62)
Journal of the Academy of Nutrition and Dietetics     Full-text available via subscription   (Followers: 61)
Food Science & Nutrition     Open Access   (Followers: 59)
Obesity     Hybrid Journal   (Followers: 58)
Advances in Nutrition     Hybrid Journal   (Followers: 55)
Annals of Nutrition and Metabolism     Full-text available via subscription   (Followers: 52)
Journal of Pediatric Gastroenterology and Nutrition (JPGN)     Hybrid Journal   (Followers: 52)
Journal of Human Nutrition and Dietetics     Hybrid Journal   (Followers: 52)
Diabetes, Metabolic Syndrome and Obesity     Open Access   (Followers: 48)
American Journal of Food and Nutrition     Open Access   (Followers: 48)
Nutrition in Clinical Practice     Hybrid Journal   (Followers: 45)
Journal of Nutrition     Hybrid Journal   (Followers: 42)
Annual Review of Nutrition     Full-text available via subscription   (Followers: 40)
Nutrition Reviews     Hybrid Journal   (Followers: 38)
European Journal of Nutrition     Hybrid Journal   (Followers: 36)
Food & Nutrition Research     Open Access   (Followers: 35)
Journal of Parenteral and Enteral Nutrition     Hybrid Journal   (Followers: 35)
International Journal of Behavioral Nutrition and Physical Activity     Open Access   (Followers: 31)
Nutrition & Dietetics     Hybrid Journal   (Followers: 31)
Public Health Nutrition     Hybrid Journal   (Followers: 30)
Journal of Nutrition, Health and Aging     Hybrid Journal   (Followers: 30)
Journal of Renal Nutrition     Hybrid Journal   (Followers: 28)
Current Opinion in Clinical Nutrition & Metabolic Care     Hybrid Journal   (Followers: 26)
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity     Hybrid Journal   (Followers: 25)
Appetite     Hybrid Journal   (Followers: 25)
Obesity Reviews     Hybrid Journal   (Followers: 25)
Current Nutrition & Food Science     Hybrid Journal   (Followers: 25)
Journal of Obesity     Open Access   (Followers: 24)
Childhood Obesity     Hybrid Journal   (Followers: 24)
International Journal of Nutrition and Metabolism     Open Access   (Followers: 23)
International Journal of Eating Disorders     Hybrid Journal   (Followers: 23)
Nutrition Research     Hybrid Journal   (Followers: 23)
Clinical Nutrition ESPEN     Hybrid Journal   (Followers: 23)
Advances in Eating Disorders : Theory, Research and Practice     Hybrid Journal   (Followers: 22)
Nutrition     Hybrid Journal   (Followers: 22)
Comparative Exercise Physiology     Hybrid Journal   (Followers: 21)
Nutrition & Diabetes     Open Access   (Followers: 20)
International Journal of Food Safety, Nutrition and Public Health     Hybrid Journal   (Followers: 20)
Journal of Nutrition Education and Behavior     Hybrid Journal   (Followers: 19)
Topics in Clinical Nutrition     Hybrid Journal   (Followers: 19)
Clinical Obesity     Hybrid Journal   (Followers: 18)
American Journal of Botany     Full-text available via subscription   (Followers: 18)
Canadian Journal of Dietetic Practice and Research     Full-text available via subscription   (Followers: 17)
Nutrition & Metabolism     Open Access   (Followers: 17)
African Journal of Food, Agriculture, Nutrition and Development     Open Access   (Followers: 17)
Journal of Nutrition and Metabolism     Open Access   (Followers: 16)
Journal of Advanced Nutrition and Human Metabolism     Open Access   (Followers: 16)
Nutrition and Dietary Supplements     Open Access   (Followers: 15)
Journal of Eating Disorders     Open Access   (Followers: 15)
Journal of Nutrition in Gerontology and Geriatrics     Hybrid Journal   (Followers: 15)
Maternal & Child Nutrition     Hybrid Journal   (Followers: 14)
Nutrition Today     Hybrid Journal   (Followers: 14)
Nutrition Research Reviews     Hybrid Journal   (Followers: 13)
Nutrition, Metabolism and Cardiovascular Diseases     Hybrid Journal   (Followers: 13)
Nutrition and Cancer     Hybrid Journal   (Followers: 13)
Food, Culture and Society: An International Journal of Multidisciplinary Research     Full-text available via subscription   (Followers: 13)
BMC Nutrition     Open Access   (Followers: 13)
Annual Review of Food Science and Technology     Full-text available via subscription   (Followers: 13)
Nutrients     Open Access   (Followers: 13)
Journal of Health, Population and Nutrition     Open Access   (Followers: 13)
Clinical Nutrition Insight     Full-text available via subscription   (Followers: 13)
Nutrition Journal     Open Access   (Followers: 12)
BMJ Nutrition, Prevention & Health     Open Access   (Followers: 12)
Asian Journal of Clinical Nutrition     Open Access   (Followers: 12)
Food and Foodways: Explorations in the History and Culture of     Hybrid Journal   (Followers: 12)
Advances in Digestive Medicine     Open Access   (Followers: 12)
International Journal of Food Sciences and Nutrition     Hybrid Journal   (Followers: 11)
Nutrition Bulletin     Hybrid Journal   (Followers: 11)
Frontiers in Nutrition     Open Access   (Followers: 11)
Ecology of Food and Nutrition     Hybrid Journal   (Followers: 10)
Asia Pacific Journal of Clinical Nutrition     Full-text available via subscription   (Followers: 10)
International Journal for Vitamin and Nutrition Research     Hybrid Journal   (Followers: 10)
Journal of Food and Nutrition Research     Open Access   (Followers: 10)
Journal of Dietary Supplements     Hybrid Journal   (Followers: 10)
American Journal of Food Technology     Open Access   (Followers: 9)
Pediatric Obesity     Hybrid Journal   (Followers: 9)
Nutritional Neuroscience : An International Journal on Nutrition, Diet and Nervous System     Hybrid Journal   (Followers: 9)
Obesity Facts     Open Access   (Followers: 9)
Nutrition & Food Science     Hybrid Journal   (Followers: 9)
Proceedings of the Nutrition Society     Hybrid Journal   (Followers: 8)
Current Nutrition Reports     Hybrid Journal   (Followers: 8)
Journal of Nutritional Biochemistry     Hybrid Journal   (Followers: 8)
Amino Acids     Hybrid Journal   (Followers: 8)
Nutrition and Health     Hybrid Journal   (Followers: 8)
Journal of Hunger & Environmental Nutrition     Hybrid Journal   (Followers: 7)
Journal of the American College of Nutrition     Hybrid Journal   (Followers: 7)
Current Developments in Nutrition     Open Access   (Followers: 6)
Journal of Food Chemistry and Nutrition     Open Access   (Followers: 6)
International Journal of Food Science and Nutrition Engineering     Open Access   (Followers: 6)
Molecular Nutrition & Food Research     Hybrid Journal   (Followers: 6)
International Journal of Child Health and Nutrition     Hybrid Journal   (Followers: 6)
Current Research in Nutrition and Food Science     Open Access   (Followers: 6)
Food and Nutrition Bulletin     Hybrid Journal   (Followers: 6)
Nutrition - Science en évolution     Full-text available via subscription   (Followers: 5)
Nutrition Bytes     Open Access   (Followers: 5)
Food Digestion     Hybrid Journal   (Followers: 5)
South African Journal of Clinical Nutrition     Open Access   (Followers: 5)
Bangladesh Journal of Nutrition     Open Access   (Followers: 5)
Plant Foods for Human Nutrition     Hybrid Journal   (Followers: 5)
Genes & Nutrition     Open Access   (Followers: 5)
Journal of Pharmacy and Nutrition Sciences     Open Access   (Followers: 5)
Universal Journal of Food and Nutrition Science     Open Access   (Followers: 4)
Nutrition and Metabolic Insights     Open Access   (Followers: 4)
Metabolism and Nutrition in Oncology     Open Access   (Followers: 4)
Journal of Medical Nutrition and Nutraceuticals     Open Access   (Followers: 4)
International Journal of Nutrition, Pharmacology, Neurological Diseases     Open Access   (Followers: 4)
World Food Policy     Hybrid Journal   (Followers: 3)
Journal of Agriculture, Food Systems, and Community Development     Open Access   (Followers: 3)
Frontiers in Sustainable Food Systems     Open Access   (Followers: 3)
Aktuelle Ernährungsmedizin     Hybrid Journal   (Followers: 3)
Nutrición Hospitalaria     Open Access   (Followers: 3)
PharmaNutrition     Hybrid Journal   (Followers: 3)
Revista Española de Nutrición Humana y Dietética     Open Access   (Followers: 3)
Ernährung & Medizin     Hybrid Journal   (Followers: 3)
Perspectivas en Nutrición Humana     Open Access   (Followers: 2)
Pakistan Journal of Nutrition     Open Access   (Followers: 2)
Oil Crop Science     Open Access   (Followers: 2)
Acta Portuguesa de Nutrição     Open Access   (Followers: 2)
Open Nutrition Journal     Open Access   (Followers: 2)
Journal of Spices and Aromatic Crops     Open Access   (Followers: 2)
Food Quality and Safety     Open Access   (Followers: 2)
Journal of Nutritional & Environmental Medicine     Full-text available via subscription   (Followers: 2)
Progress in Nutrition     Open Access   (Followers: 2)
Endocrinología, Diabetes y Nutrición (English Edition)     Hybrid Journal   (Followers: 2)
Revista Chilena de Nutricion     Open Access   (Followers: 2)
Journal of Renal Nutrition and Metabolism     Open Access   (Followers: 2)
International Journal of Gastroenterology, Hepatology, Transplant and Nutrition     Open Access   (Followers: 2)
Bioactive Carbohydrates and Dietary Fibre     Hybrid Journal   (Followers: 2)
Nigerian Food Journal     Full-text available via subscription   (Followers: 2)
Lifestyle Genomics     Open Access   (Followers: 2)
Journal of Nutritional Science     Open Access   (Followers: 2)
Food and Health     Open Access   (Followers: 1)
The Australian Coeliac     Full-text available via subscription   (Followers: 1)
Endocrinología, Diabetes y Nutrición     Full-text available via subscription   (Followers: 1)
Amerta Nutrition     Open Access   (Followers: 1)
Archive of Food and Nutritional Science     Open Access   (Followers: 1)
Open Obesity Journal     Open Access   (Followers: 1)
Food and Environmental Virology     Hybrid Journal   (Followers: 1)
Case Reports in Clinical Nutrition     Open Access   (Followers: 1)
European Journal of Nutrition & Food Safety     Open Access   (Followers: 1)
Journal of Food Science and Nutrition Therapy     Open Access   (Followers: 1)
Human Nutrition & Metabolism     Open Access   (Followers: 1)
Food Frontiers     Open Access   (Followers: 1)
Journal of Food & Nutritional Disorders     Hybrid Journal   (Followers: 1)
Plant Production Science     Open Access   (Followers: 1)
Egyptian Journal of Obesity, Diabetes and Endocrinology     Open Access   (Followers: 1)
Jurnal Penelitian Gizi dan Makanan     Open Access   (Followers: 1)
Journal of Ethnic Foods     Open Access   (Followers: 1)
Clinical Nutrition Experimental     Open Access   (Followers: 1)
RBONE - Revista Brasileira de Obesidade, Nutrição e Emagrecimento     Open Access   (Followers: 1)
Cahiers de Nutrition et de Diététique     Full-text available via subscription   (Followers: 1)
Indian Journal of Nutrition and Dietetics     Hybrid Journal   (Followers: 1)
Canadian Food Studies / La Revue canadienne des études sur l'alimentation     Open Access   (Followers: 1)
Revista Mexicana de Trastornos Alimentarios     Open Access   (Followers: 1)
RBNE - Revista Brasileira de Nutrição Esportiva     Open Access   (Followers: 1)
Jurnal Gizi dan Dietetik Indonesia : Indonesian Journal of Nutrition and Dietetics     Open Access   (Followers: 1)
Clinical Nutrition Open Science     Open Access  
Food Hydrocolloids for Health     Open Access  
npj Science of Food     Open Access  
Functional Foods in Health and Disease     Open Access  
Journal of Nutraceuticals and Herbal Medicine     Open Access  
Arab Journal of Nutrition and Exercise     Open Access  
Nutrire     Hybrid Journal  
UNICIÊNCIAS     Open Access  
Lifestyle Journal     Open Access  
Archivos Latinoamericanos de Nutrición     Open Access  
Revista Salud Pública y Nutrición     Open Access  
Open Food Science Journal     Open Access  
Segurança Alimentar e Nutricional     Open Access  
Indonesian Food and Nutrition Progress     Open Access  
Journal of Medicinal Herbs and Ethnomedicine     Open Access  
La Ciencia al Servicio de la Salud y Nutrición     Open Access  
Jurnal Riset Kesehatan     Open Access  
Jurnal Gizi Indonesia / The Indonesian Journal of Nutrition     Open Access  
Hacettepe University Faculty of Health Sciences Journal     Open Access  
Gazi Sağlık Bilimleri Dergisi     Open Access  
Media Gizi Indonesia     Open Access  
Jurnal Gizi Klinik Indonesia     Open Access  
NFS Journal     Open Access  
Journal of Nutrition & Intermediary Metabolism     Open Access  
Food and Waterborne Parasitology     Open Access  
Journal of Nutritional Ecology and Food Research     Full-text available via subscription  
Journal of Nutritional Disorders & Therapy     Open Access  
DEMETRA : Alimentação, Nutrição & Saúde     Open Access  
Nigerian Journal of Nutritional Sciences     Full-text available via subscription  
African Journal of Biomedical Research     Open Access  
Journal of the Australasian College of Nutritional and Environmental Medicine     Full-text available via subscription  
Médecine & Nutrition     Full-text available via subscription  
Journal of Sensory Studies     Hybrid Journal  
Journal of Muscle Foods     Hybrid Journal  

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Similar Journals
Journal Cover
BMJ Nutrition, Prevention & Health
Number of Followers: 12  

  This is an Open Access Journal Open Access journal
ISSN (Online) 2516-5542
Published by BMJ Publishing Group Homepage  [62 journals]
  • A 2020 Evaluation of Global Knowledge Networks in the UN Decade of Action
           on Nutrition (2016-2025): Proceedings of the 6th International Summit on
           Medical and Public Health Nutrition Education and Research

    • Authors: Lepre, B; Laur, C, Torgerstuen Johnsen, J, Bradfield, J, Lima Do Vale, M. R, Ball, L, Ray, S.
      Keywords: Open access
      PubDate: 2022-04-12T05:37:01-07:00
      DOI: 10.1136/bmjnph-2022-nnedprosummit.editorial
      Issue No: Vol. 5, No. Suppl_1 (2022)
  • 1 Putting research into practice: knowledge translation and implementation
           for action on nutrition

    • Authors: Bell, J; Fallows, E, Dael, P. V, McAuliffe, S, Kohlmeier, M, Hernandez, A. M, Adamski, M, Ray, S, Crocombe, D, Vale, M. L. d.
      Abstract: The transfer of research evidence into practice has been historically slow, and requires an integration of many elements, including quality evidence, supportive physical and intellectual environments, and facilitation, as discussed at the NNEdPro Sixth International Summit on Nutrition and Health. Examples of applying clinical research into practice focused on the use of group consultations (also known as group clinics or shared medical appointments) to support behaviour change, the role of dietary micronutrients during the COVID-19 pandemic and the potential of Precision Nutrition. An emerging area from early implementation evidence includes group consultations, also known as shared medical appointments, as discussed by Dr Fallows. Group consultations have been shown to improve clinical outcomes for some patient groups (e.g., HbA1c, lipids, BMI), as well as improve self-care and health education, and patient and clinician satisfaction. These groups have been piloted throughout the UK both face-to-face and virtually, with initial findings suggesting they are feasible and acceptable to patients and clinicians. Further work is needed to assess whether these could be cost-effective when scaled-up in National Health Service UK primary care. During the COVID-19 pandemic, there has been increasing emphasis on the central role of nutrition in health, including the role of dietary micronutrients, as discussed by Dr Van Dael and Shane McAuliffe. Nutrition plays an important role in immunity, yet the nutritional status of the most vulnerable population groups is likely to deteriorate further due to the health and socio-economic impacts of the novel coronavirus. Thus, implementation of this evidence into health care practice is key. Precision Nutrition, defined as an ‘approach that uses information on individual characteristics to develop targeted nutrition advice, products or services’, offers an exciting opportunity to further individualise dietary advice for behaviour change, as discussed by Dr Kohlmeier and Dr Hernandez. Precision nutrition is underpinned by the recognition that individuals differ in many important ways due to identifiable molecular traits and can be utilised to determine personalised weight loss interventions based on genetic variants. Use of implementation science is in line with one of the six cross-cutting pillars of the Nutrition Decade: Aligned health systems for universal coverage of nutrition actions. Dr Bell, an Advanced Accredited Practising Dietitian in Australia, provided an overview of key implementation science models and frameworks. Implementation frameworks such as the Action Research Framework, the Knowledge to Action Cycle, and the Spread and Sustain Framework, are underpinned by knowledge creation, effective education, and culture change. Dr Bell then highlighted how theoretical frameworks have provided guidance for the implementation of real world, complex nutrition interventions, including the Systematised Interdisciplinary Program for Implementation and Evaluation (SIMPLE) in Australia, and the More-2-Eat program in Canada.
      Keywords: Open access
      PubDate: 2022-04-12T05:37:01-07:00
      DOI: 10.1136/bmjnph-2022-nnedprosummit.1
      Issue No: Vol. 5, No. Suppl_1 (2022)
  • 2 Disseminating evidence during the COVID-19 pandemic

    • Authors: Kohlmeier, M; Vale, M. L. d.
      Abstract: Knowledge networks, such as the NNEdPro Nutrition and COVID-19 Taskforce, are central to the rapid creation and dissemination of evidence, as highlighted at the NNEdPro Sixth International Summit on Nutrition and Health. During the COVID-19 pandemic, the Taskforce rapidly collated evidence and widely shared clear and accessible resources globally, via NNEdPro Regional Networks. The impact of the Taskforce on disseminating evidence and encouraging collaboration was made evident, and thus demonstrates the importance of this approach for addressing regional and global nutrition challenges. Scientific journals, such as BMJ Nutrition, Prevention & Health, as discussed by Editor-in-Chief, Professor Kohlmeier, also play a significant role in the dissemination of evidence. Once published, research is open access, disseminated widely online, and is encouraged to be used to inform practice. During the COVID-19 pandemic, any article with research findings relevant to the Coronavirus outbreak, were also shared widely with policymakers to increase global uptake. Knowledge networks, and scientific journals such as BMJ Nutrition Prevention and Health, are critical to the generation and dissemination of evidence, which is key to its uptake and implementation in policy and practice.
      Keywords: Open access
      PubDate: 2022-04-12T05:37:01-07:00
      DOI: 10.1136/bmjnph-2022-nnedprosummit.2
      Issue No: Vol. 5, No. Suppl_1 (2022)
  • 3 Development of regional Networks by the NNEdPro global centre for
           nutrition & health

    • Authors: Tramojntt, C; Tejeda, M. Z, Guzanic, J, Martini, D, Korre, M, Sokolovic, M, Trigueiro, H.
      Abstract: The WHO describes knowledge networks as a mechanism to strengthen collaboration among countries and facilitate and enhance local nutrition action in the Nutrition Decade. In line with this recommendation, the NNEdPro Global Centre convened 12 Regional Networks across six continents to foster collaboration and implement nutrition actions for sustained impact. Each network has a lead who connects the broader NNEdPro group to the local network to share evidence and encourage collaboration within and between Networks. Each Network is encouraged to understand the needs of their region, locally tailor relevant interventions, and share learnings with other networks. The focus of these networks is on knowledge exchange, capacity building among members, and wider public health impact. An example of these networks in action is the use of the Mobile Teaching Kitchen (MTK) model, which empowers marginalised community members to become culinary health educators. The intervention was originally developed by the Regional Network in India, and adaptations of the MTK intervention are planned across the Swiss, Mexico, Italy & The Mediterranean, and the Brazil Regional Networks. Networks will learn from each other while making adaptation relevant to their local need, resources, and capacity. Knowledge networks underpinned by strong leadership and clear communication strategies are essential to take collaborative action on nutrition and end malnutrition in all its forms.
      Keywords: Open access
      PubDate: 2022-04-12T05:37:01-07:00
      DOI: 10.1136/bmjnph-2022-nnedprosummit.3
      Issue No: Vol. 5, No. Suppl_1 (2022)
  • 4 Effective communication and leadership in nutrition research & education

    • Authors: Yeo, G; Kirsty Pourshahidi, L, Laur, C, Ray, S, Douglas, P.
      Abstract: Effective communication and leadership are needed when developing knowledge networks for nutrition research and education. The need for clear and approachable communication was highlighted by Dr Giles Yeo, who advocated for consensus, which takes time. As a result, nutrition has become a competitive space, contributing to a pseudoscience vacuum for people who want readily available and easy-to-understand information. Evidence-informed knowledge networks, and the individual participants who make up such networks, are key in cutting through the pseudoscience. During the Nutrition Decade, knowledge networks need skilled leaders, as mentioned in Action Area 4, regarding effective leadership to address these challenges and inspire future generations. Dr Kirsty Pourshahidi discussed the many different definitions and styles of leadership, underpinned by concepts of motivation and positive influence. To train these leaders, the European Nutrition Leadership Platform (ENLP) was introduced as a dynamic network of around 850 global leaders in food and nutrition with a mission to train, inspire and connect leaders in this space. The ENLP is a prime example of how to train leaders to drive progress in voluntary networks during the Nutrition Decade.
      Keywords: Open access
      PubDate: 2022-04-12T05:37:01-07:00
      DOI: 10.1136/bmjnph-2022-nnedprosummit.4
      Issue No: Vol. 5, No. Suppl_1 (2022)
  • 5 Data-driven action for food systems transformation

    • Authors: Laperriere, A; Bohn, J, Vale, M. L. d.
      Abstract: Data that is accurate and accessible helps to drive innovation and progress, which was a key theme of discussion at the NNEdPro Sixth International Summit on Nutrition and Health. Data-driven policies and programmes have the potential to reorient food systems and end malnutrition by 2030, according to Andre Laperriere of Global Open Data for Agriculture and Nutrition (GODAN). The COVID-19 pandemic has exacerbated the existing food crisis, affecting production, processing, and distribution within the food system, and highlights the critical need for timely and reliable data to drive decision-making. The pandemic has affected food on the levels of production, transformation, and distribution, which presents an unprecedented opportunity for change. Using data, we can identify and learn from countries who have had the most success in reducing hunger (E.g., Armenia, Brazil, Ghana) and those which have achieved zero hunger while keeping adult overweight and obesity to a minimum (E.g., Republic of Korea, Japan). However, making practice and policy decisions involves a complicated process influenced by logic, current evidence, existing models and authorities, previous experiences, emotions, and cognitive biases, as discussed by Dr Jeffrey Bohn. Causal inference approaches could be one way to address some of these complications by merging nutrition data and scientific evidence to promote better decision-making in the context of nutrition-related communicable diseases targeted by the Nutrition Decade and the Sustainable Development Goals. Although challenges exist in all data science, there are particular challenges in applying mathematical precision in nutrition. Nutrition research considers dynamic processes that evolve and are often influenced by the process of studying them. Additionally, nutrition research occurs against the backdrop of traditional biomedical research where the randomised control trial (RCT) is considered the gold standard in proving causation. While pre-registration of data, protocol and analyses can address some of these primary challenges with research behaviour, to truly understand causation we must consider counterfactuals, which consider the context of the research (models, interventions, characteristics, and cognitive bias) for a more complete understanding. Causal inference tools can be applied to relevant, curated data to identify confounders and subsequent causal linkages. There is a necessity for the quality use of data to identify and strengthen high-impact policies and programmes for action on nutrition.
      Keywords: Open access
      PubDate: 2022-04-12T05:37:01-07:00
      DOI: 10.1136/bmjnph-2022-nnedprosummit.5
      Issue No: Vol. 5, No. Suppl_1 (2022)
  • 6 Development of the international knowledge application network hub in
           nutrition (iKANN)

    • Authors: Ball, L; Elahi, S, Lepre, B.
      Abstract: Research is a cumulative process, and the open flow of information is key to the uptake of evidence into policy and practice. There is growing interest in online knowledge hubs that provide open access to information for public good, and in particular, platforms that have the capability to foster collaboration between different stakeholders, such as content providers and users (e.g., health care professionals, researchers and policy makers). At the NNEdPro Sixth International Summit on Nutrition and Health, Professor Ball and Selvarani Elahi MBE presented on the development of the International Knowledge Application Network Hub in Nutrition 2025 (iKANN). iKANN is an open access, online portal that provides opportunities to interact with a collation of evidence accompanied by commentary and guidance for workforce capacity building. A key aim of the iKANN initiative is to synthesise and promote global evidence in food, nutrition, and health, and to drive the implementation of evidence into policy and practice. iKANN aims to enhance collaborative efforts with a range of stakeholders from different backgrounds, to support the monitoring of progress and drive improvements in the quality of research and co-ordination of efforts. iKANN was developed in line with the UN Decade of Action on Nutrition, and the encouragement from the World Health Organization to develop networks to support the nutrition and agriculture community to achieve food systems transformation and end malnutrition in all its forms. The initiative is led by the NNEdPro Global Centre, in conjunction with supporter, Swiss Re Institute, and implementation partners, which at the time of writing include GODAN, DSM, LGC, the BMJ, Nutrition in Medicine (NIM), Swiss Association for Co-operation on Food Education, and Konnexions.
      Keywords: Open access
      PubDate: 2022-04-12T05:37:01-07:00
      DOI: 10.1136/bmjnph-2022-nnedprosummit.6
      Issue No: Vol. 5, No. Suppl_1 (2022)
  • 7 Nutrition and global challenges: resilient food systems for healthy and
           sustainable diets

    • Authors: Hachem, F; Mahy, L, Ray, S, Kumar, V, Johnsen, J, Raman, K.
      Abstract: Can diets be healthy and sustainable' This was the question posed by Dr Hachem from the Food and Agriculture Organization (FAO) at the NNEdPro Sixth International Summit on Nutrition and Health. The market value of the global food system is an estimated $10 trillion, while the hidden costs of global food and land use systems sum up to an astounding $12 trillion, according to the Food and Land Use Coalition 2019 report and highlighted by Lina Mahy, from the World Health Organization (WHO). Of those hidden costs, more than half is attributed to unhealthy diets and harmful farming practices. Food systems must enhance food security and nutrition for all, be inclusive, and have a positive impact on the health of people and planet, as well as be economically viable, in line with Nutrition Decade Action Area 1, Sustainable, resilient food systems for healthy diets. There are 16 guiding principles to achieve healthy diets sustainably produced, with eight related to nutrition, including promotion of exclusive breastfeeding, variety and balance across food groups, consumption of whole grains, legumes, nuts and fruits and vegetables and moderate to small amounts of animal source foods. Governments can signal commitment to a more sustainable and healthy future through the development and dissemination of food-based dietary guidelines that embed health and sustainability objectives.Professor Ray of the NNEdPro Global Centre, spoke on the role of global knowledge networks in response to global nutrition challenges, using the example of the Mobile Teaching Kitchens (MTK) model. The MTK project uses a scalable, micro-level innovation model for health and social innovation in partnership with marginalised populations. The model aims to improve the nutrition knowledge and capacity of the population through demonstration by Teaching Kitchen champions, who are trained nutrition educators. Qualified dietitians and nutritionists share knowledge and skills with community-based volunteers, to support the development of Teaching Kitchen champions in a ‘See One, Do One, Teach One’ model. Promotion of nutritious, affordable, culturally appropriate, and environmentally sustainable food is central to the MTK model. Investing in some of the most marginalised in society can have an upward social and health impact including localised supply chains and microenterprise and aligns with the Sustainable Development Goals and the UN Decade of Action on Nutrition (2016-2025).Professor Kumar, of the Zero Budget Natural Farming Programme of Rythu Sadhikara Samstha, continued the discussion on diet sustainability, focusing on the role of climate resilient, community managed natural farming related to nutrition and food security. To set the scene, it was discussed that the food system is facing multiple crises which pose serious threats to food security, nutrition, and the livelihood of farmers. The environmental crisis places additional strain on the food system, including soil degradation and continuous loss of soil organic matter, water stress, global warming, water and air pollution, and decreased biodiversity, thus increasing the number of people at risk of food insecurity and poor nutrition, and worsening farmer distress. While some agricultural practices are historical, namely, deforestation, forest fires, ploughing and keeping lands fallow, recent use of chemical fertilizers and pesticides (biocides) have accelerated environmental decline. Regenerative agriculture, such as zero budget natural farming, was posed an alternative. It is defined as a holistic land management practice that leverages the power of photosynthesis in plants to close the carbon cycle, and build soil health, crop resilience and nutrient density. Professor Kumar reiterated the value of local knowledge networks, namely, organised women in natural farming and champion farmers, as a strength in scaling up nutrition interventions such as this. Collective action and peer learning can support behaviour change and address inequities. Collective efforts are key to sustained impact and in the words of Professor Kumar, ‘If you want to change a farmer, you have to change an entire village’.
      Keywords: Open access
      PubDate: 2022-04-12T05:37:01-07:00
      DOI: 10.1136/bmjnph-2022-nnedprosummit.7
      Issue No: Vol. 5, No. Suppl_1 (2022)
  • 1 IL-10 haplotypes and TNF-{alpha} levels are associated with low muscle
           mass in patients with chronic hepatitis C

    • Authors: Soares Vaz de Castro, P. A; Vries, T. P. d, Soares Chagas, A. L, Vieira, D. A, Bering, T, Rocha, G. A, Silva, L. D.
      Abstract: BackgroundDespite the negative impact of low muscle mass (MM) on the survival of cirrhotic patients, the mechanisms linked to MM loss are not completely understood in patients with chronic hepatitis C (CHC).ObjectivesTo evaluate whether the IL-10 haplotype (-1082G>A, -819C>T, and -592C>A) and serum levels of tumour necrosis factor-alpha (TNF-α) were associated with low MM in CHC patients.Methods94 consecutive CHC outpatients (mean age, 50.3±11.5 yrs.; 74.5% males; 68.1% without cirrhosis and 31.9% with compensated cirrhosis) and 164 healthy controls were prospectively enrolled. SNPs were genotyped by RT-PCR. Serum levels of TNF-α were measured by ELISA. CHC patients, prospectively, underwent scanning of the lean tissue, appendicular skeletal muscle mass (ASM), and fat mass by dual-energy X-ray absorptiometry. The data analysed included appendicular skeletal mass (ASM) standardized for height (ASMI=ASM/height2). The cut-off points for low ASMI were 5.45 kg/m2 and 7.26 kg/m2 for women and men, respectively, according to Baumgartner et al. (1998). The International Physical Activity Questionnaire was used to determine the physical activity level.Results IL-10 SNPs were in Hardy Weinberg equilibrium. Patients and healthy subjects showed the same distribution of genotypes. Low ASMI was found in 12/94 (12.8%) of the patients with CHC. The IL-10 haplotype ATA (low-producer genotype) was observed in 11/12 (91.7%) of the patients with low ASMI (P=0.03) and in only one of the patients without low ASMI 1/82 (1.2%) (Figure 1). In the multivariate analysis, low ASMI was significantly and independently associated with moderate-to-high physical activity (OR=0.31; 95%CI=0.09-0.98; P=0.05), TNF-α levels (OR=1.06; 95%CI=1.01-1.11; P=0.02) and ATA haplotype (OR=9.87; 95%CI=1.13-94.85; P=0.05).Abstract 1 Figure 1Association between the prevalence of the IL-10 haplotype ATA and the low appendicular skeletal mass standardized for height (ASMI) in patients with chronic hepatitis C (CHC)ConclusionThis is the first study to demonstrate that the IL10 haplotype is associated with low ASMI in CHC patients. We also demonstrated that TNF-α is associated with low ASMI in CHC patients.
      Keywords: Open access
      PubDate: 2022-04-12T05:37:01-07:00
      DOI: 10.1136/bmjnph-2022-nnedprosummit.8
      Issue No: Vol. 5, No. Suppl_1 (2022)
  • 2 Low phase angle is associated with cirrhosis and low muscle mass in
           chronic hepatitis C patients

    • Authors: Soares Vaz de Castro, P. A; Brito, M. D, Viana, N. L, Bering, T, Rocha, G. A, Silva, L. D.
      Abstract: BackgroundAlthough the use of electrical bioimpedance (BIA) is impaired when patients with hepatic cirrhosis have ascites, oedema and electrolyte disturbances, the measurement of phase angle (PhA) in this population has been shown to be superior to anthropometric and biochemical methods for early detection of malnutrition. The PhA reflects the cellular integrity and normal values (according to sex and age) indicate preserved cellular activity. In patients with chronic hepatitis C (CHC), the role played by PhA has not been completely clarified.ObjectivesTo evaluate the prevalence of low PhA and its association with demographic, clinical and nutritional variables in CHC.MethodsWe prospectively included 222 patients [mean age, 53.7 ± 11.7 years; males, 116 (52.3%); diabetes mellitus, 40 (18.0%); hypertension, 91 (41.0%); cirrhosis, 87 (39.2%); underweight (BMI,
      Keywords: Open access
      PubDate: 2022-04-12T05:37:01-07:00
      DOI: 10.1136/bmjnph-2022-nnedprosummit.9
      Issue No: Vol. 5, No. Suppl_1 (2022)
  • 3 A pilot study of nutrition management in the department of pediatric
           oncology in a local district hospital in Kazakhstan

    • Authors: Kaliyeva, A; Chan, M. Y, Turgambayeva, A.
      Abstract: IntroductionMaintaining optimal nutritional status is important for children with cancer because it can affect clinical outcomes. This study aimed to prospectively study clinical practices in children’s cancer departments to improve the nutritional health of children and adolescents receiving cancer treatment. Currently, there are no unified and harmonized protocols for assessing the nutritional status and nutritional support of children in pediatric wards in Kazakhstan.Method200 children with cancer aged 6 months to 17 years (n=200) were recruited. Dietary data and other relevant anthropometric and biochemical data were collected using a data collection form validated and developed by the researchers. Data processing is still in progress. They were randomly allocated either to a treatment group or a control group (age-matched and gender matched). The treatment group received nutritional advice and support and the control group received the standard treatment.ResultsA significant decrease in the intake of protein and energy with the consumed diets, which are prescribed by doctors in daily practice, was revealed, which is a risk factor for the development of severe nutritional disorders (p>0.5).Patients who were assigned nutritional support in addition to the General diets during the study had higher nutrient intake. Comparing week zero with subsequent weeks of nutritional support, children in the main group showed significant improvements in the thickness of the triceps skin fold (P
      Keywords: Open access
      PubDate: 2022-04-12T05:37:01-07:00
      DOI: 10.1136/bmjnph-2022-nnedprosummit.10
      Issue No: Vol. 5, No. Suppl_1 (2022)
  • 4 The state of nutrition education in UK medical schools

    • Authors: Yoon, W. Y; Ragavan, S, Stokes, A, Tay, T, Christian, N, Gilani, S, Macaninch, E.
      Abstract: BackgroundNutrition plays a significant role in decreasing the burden of disease in the population. Quality nutritional teaching is essential to allow clinicians to effectively counsel patients on their diet and nutrition. However, nutrition education at UK medical schools is not rigorously standardised.ObjectivesThis study aims to quantify the nutritional teaching at UK medical schools and measure variation in teaching methods and duration.MethodsA Freedom of Information request was emailed to all public medical schools in the UK with programmes resulting in a primary medical qualification. Data were requested on how much time was allocated to lectures, practical skills, e-learning and independent study on nutrition. The lognormal and normal distributions were tested with Anderson-Darling, D’Agostino-Pearson and Shapiro-Wilk tests.ResultsOf thirty-seven universities contacted, twenty-six universities responded (70.2%), four declined to respond, and seven did not provide data (figure 1a). The mean number of teaching hours is 26.9 hours (CI 95%, 14.8–38.8). Universities spend an average of 2.7 hours on group learning (CI 95%, 0.6–4.8) and 12 hours on lectures (CI 95%, 8.5–15.4) (figure 1c). The mean teaching hours were greatest in Year 1 of medical schools at 8.7 hours (CI 95%, 5.9–11.5) (figure 1d). Teaching hours follow a lognormal distribution (LR
      Keywords: Open access
      PubDate: 2022-04-12T05:37:01-07:00
      DOI: 10.1136/bmjnph-2022-nnedprosummit.11
      Issue No: Vol. 5, No. Suppl_1 (2022)
  • 5 Postoperative ileus and perioperative nutrition optimisation in an
           enhanced recovery after surgery programme

    • Authors: Reyhani, H; Macaninch, E, Martyn, K, Copeland, E.
      Abstract: IntroductionMalnutrition prior to Elective Lower Gastrointestinal Surgery (ELGIS) impacts on post-operative recovery. Prolonged post-operative ileus (PPOI) is a prevalent complication post-surgery that may require Total Parenteral Nutrition (TPN) with severe intestinal arrest.The Malnutrition Universal Screening Tool (MUST) is validated for malnutrition screening. There has historically been poor uptake of nutrition screening and assessment in surgical patients.ObjectivesTo gauge severity of PPOI via proportion of patients requiring TPN, and association of PPOI with MUST scores.MethodsA retrospective audit of patients undergoing ELGIS at a 58-bedded tertiary Digestive Diseases Unit on the South Coast of England over 3 months was performed.Primary outcomes: Incidence of PPOI; Proportion of patients requiring TPN for PPOI.Secondary outcomes: Incidence of Preoperative MUST scoring; Post-operative time to MUST scoring and MUST scores documented.Results39 eligible patients were included. 11/39 (28%) developed PPOI; 0 (0%) progressed to TPN.MUST scoring preoperatively was documented for 11 (28%) patients. 2/11 (18%) scored ≥1 [i.e. were at some risk of malnutrition]. Scores documented for these patients were: 1 and 2. Of these, 2/2 (100%) developed PPOI in their postoperative course.MUST scoring postoperatively was documented for 36/39 (92%). 12/36 (33%) scored ≥1. Of these, 6/12 (50%) developed PPOI. Average days to postop MUST scoring: 3.7 ± 2. Of those with PPOI, 6/11 (55%) scored ≥1 on MUST postoperative.ConclusionsPPOI is prevalent among ELGIS patients, but not associated with high TPN use in this sample. Nutrition screening (MUST) is not routinely done preoperatively, reflecting a missed opportunity in nutrition optimisation for surgery. Larger studies are required to assess outcomes of improved nutrition screening. High rate but low accuracy and timeliness of MUST scoring postoperatively was suggested by this study. Barriers to MUST utilisation and accurate scoring by surgical teams should be explored in future studies.
      Keywords: Open access
      PubDate: 2022-04-12T05:37:01-07:00
      DOI: 10.1136/bmjnph-2022-nnedprosummit.12
      Issue No: Vol. 5, No. Suppl_1 (2022)
  • 6 Eating in or out of home in the Portuguese population: are there
           differences in dietary intake'

    • Authors: Silva, M; Rodrigues, S, Correia, D, Torres, D, Lopes, C, Severo, M.
      Abstract: BackgroundEating out of home (OH) has been increasing due to social and contextual changes. This phenomenon varies according to age, region and eating location and can contribute to a poor diet quality. Overall, there is insufficient information on the nutrient intake and types of food groups consumed OH by the Portuguese population.ObjectivesDescribe and compare energy and nutrient intake and food groups (FG) consumption according to eating out patterns (EOP), by age groups.MethodsThis analysis used data from the National Food, Nutrition and Physical Activity Survey (IAN-AF;2015–2016) and includes 5005 individuals (3-84 years). Dietary intake was estimated by two non-consecutive days of food dairies in children (
      Keywords: Open access
      PubDate: 2022-04-12T05:37:01-07:00
      DOI: 10.1136/bmjnph-2022-nnedprosummit.13
      Issue No: Vol. 5, No. Suppl_1 (2022)
  • 7 Assessment of nutrition related knowledge, attitudes and practices of
           pregnant and lactating mothers in the tribal areas of Telangana, India

    • Authors: Ravula, P; Kasala, K.
      Abstract: BackgroundTribal population – especially pregnant and lactating women are susceptible to undernutrition because of low socio-economic, cultural norms and practices regarding dietary habits and practices, market access and availability. Nutrition knowledge, attitudes and practices (KAP) studies offer an opportunity to better understand the socio-cultural-psychological-behavioural determinants of nutrition, providing an evidence for planning knowledge interventions.ObjectivesThis paper aims to assess nutrition KAP during pregnancy and lactation in selected locations of Adilabad and Komaram Bheem-Asifabad districts of Telangana, India.MethodsA cross sectional KAP baseline survey was conducted on 358 individuals in the selected locations during February-March 2020. Tablet based data collection was implemented for pregnant and lactating mothers, and frontline workers (Anganwadi workers, School teachers and Accredited Social Health Activist - ASHA workers). Data was validated, coded and analyzed using STATA. Alongside descriptive statistics, differential weightage method was adopted to generate the knowledge, attitudes and practices scores for the respondents.ResultsThe nutrition knowledge of pregnant and lactating mothers was inadequate less than 50 percent across all the respondents (table 1). Pregnant women scored low on attitudes regarding healthy diets compared to lactating mothers and frontline workers. Attitudes translate into practices, however the baseline data revealed that all categories of respondents were not adopting appropriate dietary and nutrition practices.Abstract 7 Table 1Scoring percentages on KAP during pregnancy and lactation periods Pregnant Women Lactating Mothers Anganwadi Workers School Teachers ASHA workers Knowledge 27.74 32.90 41.63 47.81 40.99 Attitudes 44.52 92.03 92.36 92.71 94.71 Practices 48.57 42.27 46.42 47.57 45.53 ConclusionThe inadequate knowledge by all categories of respondents indicates a gap in nutrition literacy and education. It is planned to co-design, co-create innovative approaches to improve nutrition knowledge through nutrition messaging for a transformative behavior change about nutrition, healthy diets, dietary behaviors and practices.
      Keywords: Open access
      PubDate: 2022-04-12T05:37:01-07:00
      DOI: 10.1136/bmjnph-2022-nnedprosummit.14
      Issue No: Vol. 5, No. Suppl_1 (2022)
  • 8 Do nutrition education programmes improve health outcomes in patients
           with chronic diseases' A systematic review

    • Authors: Alexander, A; Sureshkumar, A, Jones, M, Marais, D.
      Abstract: Background/ObjectiveNutrition education plays a key role in the management of chronic diseases. This review aimed to assess whether nutritional educational programmes (NEPs) utilising whole-diet approaches improved health outcomes in patients with chronic diseases.MethodsSearches were conducted on 5 databases (Medline, Pubmed, EMBASE, CINAHL and Web of Science) independently by three reviewers. Search terms and MESH headings included: Nutrition OR diet OR eating habits AND education OR teaching OR training OR counselling AND health OR morbidity OR mortality OR well-being OR quality of life. Studies of NEPs involving educational interventions on whole diet modification (i.e. improving total nutritional intake) vs. usual diet or no intervention were included. Studies lacking a comparison group, case-control studies and those involving single dietary or nutrient modifications were excluded. Papers were independently assessed for eligibility; quality (Agency for Healthcare Research and Quality assessment tool); risk of bias (Cochrane Risk of bias 2 tool) and data extracted. Outcomes of interest were nutritional status, biochemical markers and quality of life. Data heterogeneity meant meta-analyses could not be performed so a descriptive approach was used.ResultsFrom a total of 8453 papers, 18 studies were identified as relevant and grouped by disease: cancer (n=8); Type 2 diabetes (n=6) and CKD (n=4). NEPs in 12 studies were dietician-led, with the remainder delivered via telehealth (n=2), group therapy (n=2), nutritionist (n=1) or nurse specialist (n=1). Results showed that NEPs had statistically significant improvements in quality of life and prevention of malnutrition in cancer patients, but did not prevent deterioration in weight. Diabetic patients showed improvements in weight loss, reduced waist circumference and HbA1c; however changes in BMI, blood pressure and cholesterol were not significant. NEPs did not improve clinical markers in CKD (e.g. cholesterol, phosphate and eGFR), but following the intervention patients reported better knowledge of their illness. ConclusionsThis review suggests that nutrition education programmes are an important tool in improving health outcomes of patients with cancer, Type 2 diabetes and CKD.
      Keywords: Open access
      PubDate: 2022-04-12T05:37:01-07:00
      DOI: 10.1136/bmjnph-2022-nnedprosummit.15
      Issue No: Vol. 5, No. Suppl_1 (2022)
  • 9 Should we be providing food directly to patients in primary care' A
           systematic review of the literature

    • Authors: Ball, L; Somerville, M, Crowley, J, Calleja, Z, Barnes, K.
      Abstract: BackgroundThe World Health Organization recommends all countries to facilitate healthy eating through primary care settings; recognised as one of the ‘best buys’ for improving the health of societies. However, health professionals face barriers to discussing nutrition and weight management in consultations, warranting alternative models of support to be explored. Providing food directly to patients in primary care is an underexplored yet promising approach to healthy eating and weight management.ObjectivesThis systematic review aimed to determine whether providing food to patients in primary care facilitates weight loss and improves other health outcomes.MethodA systematic literature review was conducted using four electronic databases. Interventions that directly and exclusively provided foodstuffs and/or supplements to patients in primary care settings were included. Interventions that involved other components such as exercise classes or education sessions were excluded.ResultsFour studies fulfilled the inclusion criteria; two from the United Kingdom, one from the USA and one from Israel. Two studies utilised meal replacement products but differed in length and intensity of the intervention, another study provided green tea and vitamin E supplementation to patients and the final study incorporated a voucher for use at a farmers’ market hosted at a primary care clinic. Three of the four studies observed some weight loss among participants and all studies observed at least one other improvement such as reduced waist circumference, blood pressure or glycosylated haemoglobin (HbA1c). However, the methodological quality of the studies ranged from weak to moderate, reducing confidence in results.Discussion/ConclusionA small but promising body of literature exists on providing food directly to patients in primary care. There is clear opportunity for further research on the efficacy and cost-effectiveness of directly providing food to patients to support weight loss, improve health outcomes and ultimately inform policy initiatives for primary care.
      Keywords: Open access
      PubDate: 2022-04-12T05:37:01-07:00
      DOI: 10.1136/bmjnph-2022-nnedprosummit.16
      Issue No: Vol. 5, No. Suppl_1 (2022)
  • 10 How does self-perceived nutrition competence change over time during
           medical training' A prospective longitudinal observational study of
           New Zealand medical students

    • Authors: Crowley, J; Ball, L, Wall, C.
      Abstract: BackgroundMedical nutrition education aims to equip doctors with adequate nutrition knowledge, skills, attitudes and confidence to counsel patients about how to improve their diet and health. Incorporating sufficient nutrition education into medical curricula remains an ongoing challenge for medical schools.ObjectiveThis study aimed to describe changes in medical students’ self-perceived nutrition competence at three time points during medical training.MethodA prospective longitudinal observational study was conducted among one year-group of students at the University of Auckland, School of Medicine. In May 2016, Year 2 medical students (phase 1, preclinical) were surveyed for self-perceived nutrition competence using the validated NUTCOMP tool. The survey was repeated with the same students in February 2018 as Year 4 students and July 2019 (phase 2, clinical) as Year 5 students.ResultsIn 2016, 102 of 279 eligible Year 2 medical students completed the survey [response rate (RR 36.7%)]. In 2018, 89 Year 4 students repeated the survey (RR 87.3%) and 26 students as Year 5 students in 2019 (RR 25.5%). There was a significant increase in total NUTCOMP scores (knowledge, skills, confidence to counsel and attitude towards nutrition) between Year 2 and Year 4 (p=0.012). There was a significant increase in the confidence to counsel construct (mean difference 7.615, 95% CI 2.291-12.939, p=0.003) between Year 2 and Year 4. Constructs with lowest scores at all time points were nutrition knowledge and nutrition skills. There was clear desire for more nutrition education from all students: Year 2 [mean=3.8 out of 5, (1.1)], Year 4 [mean=3.9 out of 5 (0.9)], Year 5 [mean=3.8 out of 5 (0.8)].ConclusionMedical students’ self-perceived nutrition competence in providing nutrition care increased modestly at three points throughout medical training. Opportunity exists for further supporting medical students to increase their competence nutrition care, which could be achieved through mandatory and greater medical nutrition education.
      Keywords: Open access
      PubDate: 2022-04-12T05:37:01-07:00
      DOI: 10.1136/bmjnph-2022-nnedprosummit.17
      Issue No: Vol. 5, No. Suppl_1 (2022)
  • 11 An evaluation of the current state of hypertension diagnosis and
           management in a rural primary care practice

    • Authors: Bhat, S; Molony, D.
      Abstract: BackgroundHypertension is the leading cause of cardiovascular-related mortality in Ireland. Due to the lack of diagnosis, awareness and early treatment, the prevalence of hypertension in the community is increasing at an alarming rate. Latest guidelines suggest the use of ambulatory blood pressure measurement (ABPM) as the gold standard to diagnose hypertension.ObjectivesTo investigate the current prevalence of hypertension in a rural primary care practice by assessment of current anthropometric measures and the uptake of 24hr ABPM. This study also explores the development of a practice-based algorithm to better identify and manage patients with hypertension.MethodsThis study included (1) a retrospective cross-sectional chart audit assessing the anthropometric measurements and uptake of 24hr ABPM in patients aged ≥25 years with the last clinic BP systolic ≥150mmHg or had a coded diagnosis of hypertension and (2) the development of a hypertension management protocol based on clinical guidelines.ResultsA total of 890 patients were included. Out of those with a coded diagnosis of hypertension (78%, n=691), the mean BMI was 29.9 with a mean weight of 84.4kg, 13% were current smokers and 64% had an ABPM. With 22% (n=199) of the patients without a coded diagnosis of hypertension, the mean BMI was 28.8 with a mean weight of 85.2kg and 26% had an ABPM. Overall, 18% of the patients had diabetes and 62% of the patients had a lipid disorder.Abstract 11 Figure 1Prototype of the hypertension protocol developed to streamline diagnosis and management of hypertension in the practiceDiscussionWith most of the patients currently being overweight and have a history of lipid disorder along with almost half of the patients without an ABPM, this audit exposes a significant gap in diagnosis and management of hypertension. To meet guideline targets, an evidence-based hypertension protocol (figure 1) was designed and implemented where the practice nurses were empowered to measure, identify and refer patients with elevated blood pressure for ABPM and nutritional counselling.
      Keywords: Open access
      PubDate: 2022-04-12T05:37:01-07:00
      DOI: 10.1136/bmjnph-2022-nnedprosummit.18
      Issue No: Vol. 5, No. Suppl_1 (2022)
  • 12 Evaluating the impact of a sustainable kitchen supplying affordable
           surplus-food based meals to local communities in Winchester

    • Authors: Buckner, L; Gnanananthan, P, Howie, C, Lobo-Horth, G, Vora, C, Perrin, R.
      Abstract: BackgroundCommunity kitchens comprise of small groups of people who meet regularly to prepare meals, and are a means to develop kitchen skills, improve nutrition and diet diversity, and to reduce social isolation. FirstBite Café is a community kitchen based in Winchester, Hampshire founded in 2016 that has aimed to re-use food that would otherwise be destroyed, to produce high quality and affordable meals for its local communityObjectivesWe sought to evaluate the impact FirstBite has had on its customers, volunteers, and wider community. Concurrently we hoped to produce local data on the role of community kitchens and possible recommendations on the continued development of the Café.MethodsA questionnaire was developed to capture demographics, attitudes, and perceptions of customers towards the café, and the impact the café has had on them. Two volunteer focus groups were run, asking what values attracted them to the café, what prompted re-attendance, who benefits from the café, and where they see the café going forward.ResultsOf the 67 respondents, the largest proportion of customers were aged between 55 and 75, and 41.7% lived alone; with the majority attending for over 12 months. The factors most appreciated were the food (87%), company (78%), affordability (75%) and core values of the kitchen (48%). The focus groups corroborated the greatest benefit came from developing social skills and confidence, giving a sense of purpose and community, and reduced social isolation in the elderly, those with mental health issues, and background of substance misuse.ConclusionsThe results of this evaluation were overwhelmingly positive, with the impact of the café on reducing social isolation and providing nutritious and affordable food echoed throughout. The barriers that FirstBite is now facing revolve around infrastructure and accessibility, and a permanent location with greater space would continue to extend its effectiveness.
      Keywords: Open access
      PubDate: 2022-04-12T05:37:01-07:00
      DOI: 10.1136/bmjnph-2022-nnedprosummit.19
      Issue No: Vol. 5, No. Suppl_1 (2022)
  • 13 An innovative approach to the double-burden of malnutrition in Kolkata,
           India: medical college workshops and the piloting of a 'mobile teaching

    • Authors: Buckner, L; Korre, M, Rajput-Ray, M, Kargbo, S, Banerjee, S, Chakraborty, D, Ray, S.
      Abstract: BackgroundIndia suffers from significant undernourishment, alongside obesity at concerning levels. Both poor diet and health education contribute to this, we developed a pilot local capacity building research project to apply a novel intervention in line with the United Nations ‘Sustainable Development Goals’.MethodsFollowing NNEdPro’s key contributions to the ‘14th World Congress of Public Health’ in Kolkata (2015), a capacity building exercise was launched for healthcare professionals and students. 10 selected attendees became ‘NELICO (Nutrition Education and Leadership for Improved Clinical/Public Health Outcomes) Champions’ leading action research projects. Project 1: Utilising ‘See one, Do one, Teach one’ education models, dietitians and volunteers transformed 12 slum-dwelling women into educators, teaching to prepare and cook nutritionally balanced, affordable and tasty template menus using local ingredients. The research team measured baseline and post-intervention nutritional status and knowledge, attitude and practice (KAP) of participants. Project 2: Performed an interactive nutrition workshop at 2 Kolkata medical colleges, measuring KAP of students before and after.Results Project 1: Increased nutritional KAP’s (p
      Keywords: Open access
      PubDate: 2022-04-12T05:37:01-07:00
      DOI: 10.1136/bmjnph-2022-nnedprosummit.20
      Issue No: Vol. 5, No. Suppl_1 (2022)
  • 14 NNEdPro global centre response to the UK government obesity strategy

    • Authors: McAuliffe, S; Vale, M. L. d, Macaninch, E, Bradfield, J, Crocombe, D, Kargbo, S, Rio, D. D, Fallon, E, Martyn, K, Kohlmeier, M, Beck, E, Almoosawi, S, Ray, S.
      Abstract: BackgroundFollowing considerable interest in the relationship between obesity and COVID-19, the UK Government have released a policy paper: ‘Tackling obesity: empowering adults and children to live healthier lives’.1 This response may be focused on a limited and potentially historical view of overweight and obesity. We consider the complexity of the condition, its determinants, and co-existing conditions.2 ObjectivesWe sought to gain consensus iteratively, using implementation framework thinking, to advocate for the appreciation of a wider, more complete understanding of the existing science behind obesity and the appropriate strategies needed to address it.ResultsWe identified four strategic points and provided recommendations for more comprehensive coverage and greater impact: 1. Improving focus and messaging 2. Understanding drivers of food choice and nutritional status 3. Promoting healthy eating from early years 4. Addressing the complexity of obesityDiscussion 1. Effective messaging should be inclusive, collaborative and non-judgemental, promoting co-participation in the development of messages used in public national campaigns.3 2. Higher rates of obesity are observed in socioeconomically deprived groups who rely on food assistance programmes, in which nutritional quality could be improved through involvement of nutrition professionals.4 In order to influence behaviour, basic food literacy and financial management skills could be developed, while subsidies for healthier alternatives may complement taxes on less healthy foods.5 3. Advocating for better education on food science and nutrition from early learning sectors will promote increased awareness early in life.6 This could be augmented by reinstatement of initiatives like the healthy start programme. 4. Human health is multi-dimensional, therefore focussing on a single-metric risks oversimplifying this complexity and undervaluing the importance of healthy behaviours, even those not directly associated with weight.7 Instead, we should consider positive lifestyle habits, rather than a narrow focus on weight or BMI alone for the individual, informed by existing and accepted scientific findings.ConclusionAn integrated systems approach ought to be developed with a multipronged intervention strategy, targeting food production, supply and environments as well as marketing to improve availability of as well as accessibility to more nutrient-rich but less energy-dense foods. These combined with appropriate food education for consumers would enable more consistently healthy food choices.AcknowledgementsNNEdPro Virtual Core and Global Innovation Panel; Nutrition and COVID19 TaskforceReferences
      UK Government - Tackling obesity: empowering adults and children to live healthier lives. July 2020.
      Foresight, Obesity Systems Map. 2007.
      Language Matters: Language and diabetes. 2018.
      Fallaize R, Newlove J, White A, Lovegrove JA. Nutritional adequacy and content of food bank parcels in Oxfordshire, UK: a comparative analysis of independent and organisational provision. J Hum Nutr Diet 2020;33:477–486. https://doi.org/10.1111/jhn.12740
      Garcia A, Reardon R, Hammond E, Parrett A, Gebbie-Diben A. Evaluation of the ‘eat better feel better’ cooking programme to tackle barriers to healthy eating. International Journal of Environmental Research and Public Health 2017;14(4):380. doi:10.3390/ijerph14040380
      Oostindjer M, Aschemann-Witzel J, Wang Q, Skuland S, Egelandsdal B, Amdam G, et al. Are school meals a viable and sustainable tool to improve the healthiness and sustainability of childrens diet and food consumption' A cross-national comparative perspective. Critical Reviews In Food 2016.
      Salas-Salvado J, Bullo M, Babio N, Martinez-Gonzalez M, Ibarrola-Jurado N, Basora J, et al. Reduction in the incidence of type 2 diabetes with the mediterranean diet: results of the PREDIMED-Reus nutrition intervention randomized trial. Diabetes Care 2010;34(1):14–19. doi:10.2337/dc10-1288
      Keywords: Open access
      PubDate: 2022-04-12T05:37:01-07:00
      DOI: 10.1136/bmjnph-2022-nnedprosummit.21
      Issue No: Vol. 5, No. Suppl_1 (2022)
  • 15 Perspectives on sustaining, spreading and scaling-up of diabetes
           quality improvement interventions

    • Authors: Laur, C; Corrado, A. M, Grimshaw, J. M, Ivers, N.
      Abstract: BackgroundQuality Improvement (QI) evaluations rarely consider how a successful intervention can be sustained, nor how to spread or scale to other locations. A survey of authors of randomized trials of diabetes QI interventions included in an ongoing systematic review found that 78% of trials reported improved quality of care, but 40% of these trials were not sustained.ObjectiveTo explore why and how the effective diabetes QI interventions were sustained, spread or scaled.MethodsA qualitative approach was used, focusing on case examples. Diabetes QI program trial authors were purposefully sampled and recruited for interviews.
      Authors were eligible if they had completed the survey, agreed to follow-up, and had a completed a diabetes QI trial they deemed ‘effective’ by improving care for people living with diabetes. Snowball sampling was used if the participant indicated someone could provide a different perspective on the same trial. Interviews were transcribed verbatim. Inductive thematic analysis was conducted to identify factors associated with spread, and/or scale of the QI program. Case examples were used to show trajectories across projects and people.ResultsEleven of 44 eligible trialist participated. Four reported that the diabetes intervention was ‘sustained’ and nine were ‘spread,’ however interviews highlighted that these terms were interpreted differently over time. Participant stories highlighted the trajectories of how projects evolved and how research careers adapted to increase impact. Three interacting themes were identified: i) understanding the concepts of implementation, sustainability, spread and scale; ii) having the appropriate competencies; and iii) the need for individual, organisational and system capacity.ConclusionsTrialists need to think beyond local effectiveness to achieve population-level impact, particularly in nutrition. Early consideration of whether an intervention is feasible and sustainable once research funding ends is necessary to plan for sustainability, spread and/or scale of effective QI programs.
      Keywords: Open access
      PubDate: 2022-04-12T05:37:01-07:00
      DOI: 10.1136/bmjnph-2022-nnedprosummit.22
      Issue No: Vol. 5, No. Suppl_1 (2022)
  • 16 Effectiveness of a health promotion stand at a UK university to raise
           awareness on obesity-related weight bias and stigma: a pilot study

    • Authors: Naseer, F; Baird, J, Price, R, Douglas, P, Livingstone, B.
      Abstract: Nutrition Innovation Centre for Food and Health (NICHE), Ulster University, UKIntroductionWeight bias leads to the stigmatisation of individuals with obesity and has been associated with exacerbating psychological and physiological stress as well as further weight gain.1 2 As such, there is a need for interventions to effectively address weight bias and stigma-reduction.3 AimThe aim of this observational study was to evaluate the understanding of obesity-related weight bias and stigma amongst university students and staff.MethodA health promotion stand was set up in Ulster University on World Obesity Day 2020. Students and staff who engaged were presented with definitions of weight bias and stigma, associated consequences and the importance of person-first-language. Subsequently they were asked to translate the new knowledge into practical suggestions or advice to help combat weight bias/stigma. They were also given the option to sign a pledge to ameliorate weight bias/stigma. All suggestions were categorised into common sub-groups as shown in table 1.Results101 students and staff pledged their support and 83 gave a suggestion to minimise weight bias/stigma. In the latter group, the majority (71%) had a sound understanding of weight bias and stigma. However, 24 participants (29%) appeared to have confused the body acceptance initiative with reducing weight bias and stigma (table 1). This was further verified through their interaction and comments with the volunteers at the stall.Abstract 16 Table 1Suggestions to minimise weight bias and stigma (n=83) Comments relevant to minimising weight bias & stigma n=59 (71%) Treat individuals with obesity with respect & kindness. Show empathy 38 (64%) Use ‘Person-first Language’ 11 (19%) Promote education regarding consequences of weight bias/stigma 2 (3%) Judge less & understand obesity is a complex disease that requires various forms of treatment 7 (12%) Find a balance between ‘body confidence & glorifying a disease’ 1 (2%) Comments related to body acceptance initiative n=24 (29%) ‘Love your body’ 14 (58%) ‘Accept that everyone comes in different sizes’ 10 (42%) ConclusionThis pilot evaluation provides empirical evidence that ‘minimising weight bias/stigma’ and the ‘body acceptance initiative’ may be easily confused and even addressed interchangeably. Education initiatives to distinguish between these concepts is warranted to reduce weight-related stigma and improve access to care for individuals with obesity.References
      Pearl R. Weight bias and stigma: public health implications and structural solutions. Social Issues and Policy Review 2018;12(1):146–182. doi https://doi.org/10.1111/sipr.12043
      Stewart S, Ogden J. The role of BMI group on the impact of weight bias versus body positivity terminology on behavioral intentions and beliefs: an experimental study. Frontiers in Psychology 2019;10. doi: https://doi.org/10.3389/fpsyg.2019.00634
      World Health Organisation, 2017, Weight bias and obesity stigma: considerations for the WHO European Region, World Health Organisation (2017), viewed on 12 March 2020, http://www.euro.who.int/en/health-topics/noncommunicable-diseases/obesity/publications/2017/weight-bias-and-obesity-stigma-considerations-for-the-who-european-region-2017
      Keywords: Open access
      PubDate: 2022-04-12T05:37:01-07:00
      DOI: 10.1136/bmjnph-2022-nnedprosummit.23
      Issue No: Vol. 5, No. Suppl_1 (2022)
  • 17 Credibility and reach of nutrition influencers on social media

    • Authors: Fernandez, M. A; Caretero, A, Jacob, E, Karatha, J, Raine, K. D.
      Abstract: BackgroundNutrition influencers can reach large segments of the public, regardless of formal training or credentials. Though social media is a popular source of nutrition information, it may not be credible. Furthermore, the perceived credibility of nutrition information may be enhanced through social validation (i.e., popularity of the public figure), yet this phenomenon has not been examined.ObjectiveTo examine the credibility of nutrition influencers’ websites in relation to their social media reach.MethodsNutrition influencers identified through a key word search on popular search engines: Yahoo! Google, and Bing who had active public websites and Instagram accounts were included. ‘Tips to Spot Misinformation’ developed for the public by the Dietitians of Canada and PEN: Practice Evidence-Based Nutrition were used to create a credibility score for each website. Based on scores, websites were categorized as having low, moderate, or high credibility. The reach of each influencer was ascertained by combining the total number of followers/subscribers from five popular social media platforms (Instagram, Facebook, Twitter, YouTube, and Pinterest).ResultsOf the 39 websites, there were 12 (31%) high, 13 (33%) moderate, and 14 (36%) low credibility sites, and the average number of followers for each group were 186 775, 547 088 and 2 153 515, respectively. There was a significant difference in followers between the three groups (p = 0.017) and a significantly lower number of followers for influencers with high credibility websites compared to low credibility websites (p = 0.022), with more than 10 times fewer followers.DiscussionPopular influencers with low credibility websites have enormous reach whereas influencers with highly credible websites lack the ability to reach large segments of the population. Further research is needed to understand how social validation influences the public’s eating behaviors and to identify strategies that will increase the visibility of highly credible information.
      Keywords: Open access
      PubDate: 2022-04-12T05:37:01-07:00
      DOI: 10.1136/bmjnph-2022-nnedprosummit.24
      Issue No: Vol. 5, No. Suppl_1 (2022)
  • 18 Mapping data opportunities relating to food, nutrition and health in
           the COVID-19 pandemic

    • Authors: Crocombe, D; Buckner, L, Vale, M. L. d, Macaninch, E, Almoosawi, S, Ray, S.
      Abstract: BackgroundThe COVID-19 pandemic has impacted the nutrition and health of individuals, households, and populations globally. Through exposing fragilities in food, health, and social welfare systems, the negative influence of COVID-19 continues to affect the global burden of malnutrition. The nature and scale of these impacts are not yet well understood thus the body of evidence for informing policy is limited. Collating and monitoring relevant data in real-time from multiple levels, sectors and sources is essential in preparing and responding to the ongoing COVID-19 pandemic.ObjectivesTo identify key data sources related to food, nutrition, and health indicators in the context of the COVID-19 pandemic.MethodsA COVID-19, food, nutrition and health framework was developed through multiple iterative rounds of online multidisciplinary discussions including the NNEdPro COVID-19 taskforce and the Swiss Re Institute’s Republic of Science, which comprised researchers and clinicians with expertise in data science, food, nutrition, and health.ResultsThe proposed framework encompasses five socio-ecological levels which were further sub-divided by six categories of the food and nutrition ecosystem, including food production & supply, food environment & access, food choices & dietary patterns, nutritional status & comorbidities, health & disease outcomes, health & nutrition services. A limited number of exemplar variables for the assessment of global status of food, nutrition and health are identified under each category.Abstract 18 Table 1Proposed data framework in relation to health, food, nutrition, and the COVID-19 pandemic Food Production & Supply Food Access Food Choices & Dietary patterns Nutritional status & comorbidities Health/disease outcomes Health & Nutrition Services Individual/Household Allotment use/gardening metrics; Policies and incentives Proportion of expenditure on food; Food bank use; Food insecurity; Coping strategy index; Social mobility (across generations and in the shorter term); Numbers moving into (and out of) poverty Food preferences; Food purchasing; Food preparation; Food consumption; Food waste; Breastfeeding Primary/secondary health care records Physical activity; Mental health; Wearable device data; Chronic disease management; Health insurance data Access to sanitation & potable water; Use of universal healthcare services; Use of nutrition/dietitian services; Use of mental health services Regional/National Production indices of specific food groups; Production values; Export/import quantities & values; Dietary energy supply adequacy; Share of dietary energy supply derived from cereals, roots and tubers;
      Protein supply; Protein supply of animal origin; Local food production; Organic agriculture;
      Policies and incentives for farmers; Local or Community initiatives Cereal import dependency; Population living in poverty; Un/Employment rates; Proportion of expenditure on food; Food prices (food basket & food groups); Food bank use;
      Financial aid for families; Food emergency services; Disruption food provision services (schools, community kitchens, etc.); Food delivery services Purchasing patterns (supermarkets, grocery stores, take away, restaurants);
      Food waste; Food advertisement; Supplement sales; Policies & incentives promoting specific foods Low birthweight; Stunting/wasting;
      Overweight & obesity; Micronutrient deficiencies Hospital admissions; Prescribed/OTC drugs purchasing;
      Mortality rates (disease-specific & all cause) Provision of sanitation services & potable water; Universal healthcare services; Nutrition/dietitian part of universal healthcare; Mental health part of universal healthcare; Healthcare services disruption; Hospital admission patterns Global UN Food and Agriculture Organisation (FAO) surveillance data Global Hunger Index; Global Food Security Index Global Dietary Database WHO, UNICEF and Global Nutrition Report surveillance data WHO and Global Burden of Disease and CDC (with regional equivalents) surveillance data Commonwealth Association of Dietitians and Nutritionists, European Federation of Associations of Dietitians (with regional equivalents) Discussion/ConclusionThis collaborative framework is the first step towards the development of a better understanding of the impact of COVID-19 on food, nutrition, and health systems. Limited data availability and disruption in routine data collection as well as other nutrition assessments during the pandemic are challenges that might limit the potential of the proposed framework. Next steps will include formal research and data gap analysis and the identification, as well as utilisation, of other indicators that ...
      Keywords: Open access
      PubDate: 2022-04-12T05:37:01-07:00
      DOI: 10.1136/bmjnph-2022-nnedprosummit.25
      Issue No: Vol. 5, No. Suppl_1 (2022)
  • 20 Lessons learned from the NNEdPro Nutrition and COVID-19 taskforce

    • Authors: Crocombe, D; Mcauliffe, S, Kohlmeier, M, Ray, S.
      Abstract: Acknowledgements: NNEdPro Nutrition and COVID-19 Taskforce (Named authors plus James Bradfield, Luke Buckner, Harrison Carter, Elaine Macaninch, Suzana Almoosawi, Timothy Eden, Emily Fallon, Claudia Mitrofan, Niky Raja, Sucheta Mitra, Matheus Abrantes, Lynn Haynes) and BMJ Nutrition, Prevention and Health. BackgroundNutritional issues relating to the COVID-19 pandemic span clinical nutrition in acute patients to impacts on global dietary patterns and food security. In March 2020, the NNEdPro Global Centre for Nutrition and Health established a rapid-response Nutrition and COVID-19 Taskforce to help the organisation navigate the initial phases of the pandemic and make a constructive contribution to the scientific landscape.1–3 ObjectivesTo highlight lessons learned over 6 months (March-September 2020) of the COVID-19 pandemic in understanding the role(s) of nutrition.MethodsCritical and constructive reflections from Taskforce co-chairs and lead scientific members based on a 6-month summative webinar and journal club examining the strength of evidence and key gaps.ResultsSuccesses in Taskforce operations include pooling a broad range of expertise including clinical medicine, nutrition and dietetics, research, public health, and communications. Pre-existing NNEdPro operations were predominantly online and dedicated virtual meetings supported the proactive collation of key resources relating to nutrition and COVID-19 with production of public-facing information summaries. Academic collaboration with partner organisations, including BMJ Nutrition, Prevention & Health, has focused research priorities and produced contributions to the scientific landscape.4 Challenges included managing the sense of urgency, particularly earlier in the pandemic and driven by an unease of the unknown, both at organisational level and in the need to translate nutrition knowledge to COVID-19 sensitive practice. A collaborative, scientific and politically neutral approach was intended to ensure the quality of outputs and the avoidance of hasty conclusions. Other challenges have been maintaining relevance to all geographic regions given the global variation of COVID-19 and maximising the reach of outputs to stakeholders who would benefit most from them. More recently the Taskforce has provided key inputs to consensus in a national guideline agency and global advisory bodies. Further progress will require involvement of researchers and innovators, policymakers, practitioners, patients and the public.Discussion/ConclusionThis Taskforce has already made a significant contribution to the scientific conversation about food and nutrition in the prevention and management of COVID-19. Future work should focus on multiple-stakeholder collaboration to transform research into positive action at all levels (from patient to policy) for the benefit of public health.References
      NNEdPro Global Centre for Nutrition and Health. COVID19: Useful resources. nnedpro.org.uk. [Online] [Cited: September 7, 2020.] https://www.nnedpro.org.uk/coronavirus.
      NNEdPro Global Centre for Nutrition and Health. COVID19: Nutrition Resources. nnedpro.org.uk. [Online] [Cited: September 7, 2020.] https://www.nnedpro.org.uk/covid-19nutrition-resources.
      NNEdPro Global Centre for Nutrition and Health. Combatting COVID-19: A 10-point summary on diet, nutrition and the role of micronutrients. nnedpro.org.uk. [Online] [Cited: September 7, 2020.] https://www.nnedpro.org.uk/post/combatting-covid-19.
      Dietary micronutrients in the wake of COVID-19: an appraisal of evidence with a focus on high-risk groups and preventative healthcare. McAuliffe, Shane, et al. s.l. : BMJ Nutrition, Prevention & Health, 2020, Vols. bmjnph-2020-000100. doi: 10.1136/bmjnph-2020-000100.
      Keywords: Open access
      PubDate: 2022-04-12T05:37:01-07:00
      DOI: 10.1136/bmjnph-2022-nnedprosummit.26
      Issue No: Vol. 5, No. Suppl_1 (2022)
  • 22 The influence of body mass index, glycemic control and vitamin D status
           on outcomes in patients admitted to intensive care with COVID-19: a single
           centre retrospective study

    • Authors: Eden, T; Neville, J, McAuliffe, S, Crocombe, D, Ray, S.
      Abstract: BackgroundCoronavirus disease 2019 (COVID-19) is an inflammatory syndrome caused by a novel coronavirus (SARS-CoV-2). Symptoms range from mild infection to severe acute respiratory distress syndrome (ARDS) requiring ventilation and intensive care (ICU).1 UK cases have exceeded 300,000 with a fatality rate of 13% necessitating>10,000 critical care admissions.2 Nutrition is important to immune function and influences metabolic risk factors such as obesity and glycaemic control. Poor nutritional status is associated with worse outcomes in ARDS and viral infections yet limited research has assessed pre-morbid nutritional status and outcomes in patients critically unwell with COVID-19.3 ObjectivesInvestigate the effect of body mass index, glycemic control and vitamin D status on outcomes in adult patients admitted to a ICU with COVID-19.MethodsRetrospective review of all patients admitted to a central London ICU between March-May 2020 with confirmed COVID-19. Electronic patient records data was analysed for patient demographics; co-morbidities; admission BMI; serum vitamin D concentration and plasma HbA1c. Serum vitamin D and HbA1c were measured on admission, or within one month of admission to ICU. Primary outcome was mortality. Secondary outcomes included time intubated, ICU stay duration, and ICU-related morbidity.ResultsN = 72 patients; 54 (75%) male, mean age 57.1 (± 9.8) years. Overall mortality was 24 (33%). The highest rate was observed in the overweight BMI range (25-29.9kg/m2) p-value
      Keywords: Open access
      PubDate: 2022-04-12T05:37:01-07:00
      DOI: 10.1136/bmjnph-2022-nnedprosummit.27
      Issue No: Vol. 5, No. Suppl_1 (2022)
  • 23 A qualitative study of the perceptions of low carbohydrate diets and
           their discussion on social media among dietitians in England

    • Authors: Bradfield, J; Butler, T, Skinner, R, Ray, S.
      Abstract: BackgroundLow carbohydrate diets (LCDs) have gained popularity among those seeking to lose weight and improve glycaemic control. They feature heavily in online discussions such as on social media. Evidence exists to support their use,1 but at present no universal definition of ‘low carbohydrate’ exists. Though the practices of dietitians around LCDs have been examined,2 3 none have assessed this in relation to use of social media.ObjectivesThe objective was to establish what a representative sample of dietitians in England believe, think and do with LCDs in their clinical practice.MethodsRecruitment of 10 dietitians working in weight management and/or diabetes in England took place online. They completed a short survey and a one-to-one, semi-structured interview using online teleconferencing. Interviews lasted 30 minutes and explored their knowledge, attitudes and practices towards LCDs, and how they are discussed online. Interviews were transcribed for content and thematic analysis.ResultsA number of themes became apparent, namely: (1) patient-centred care, (2) LCD community, (3) considered use of LCDs, (4) social media and (5) terminology. Each also had a number of sub-themes, such as individualisation, lack of dialogue and labelling of diets for the themes above.Abstract 23 Figure 1ThemesDiscussionOverall, the dietitians in this study were happy to use LCDs with their patients, in a safe and individualised manner. They expressed concerns about how the diets are sometimes represented online as a panacea and the inability to engage in respectful discussion with some of its proponents. These findings add to existing work completed in the area.2 3 ConclusionsThe dietitians in this study were happy to support patients to follow an LCD, in a safe and individualised manner such as under dietetic supervision. They considered them more useful for improving GC and medication reductions. A standard definition of LCDs would help patients and practitioners to communicate effectively. Additionally, education in online engagement could help improve dietitians overall confidence and practice in operating effectively in this environment.References
      Hallberg S, McKenzie A, Williams P, et al. Effectiveness and safety of a novel care model for the management of type 2 diabetes at 1 year: an open-label, non-randomized, controlled study. Diabetes Therapy 2018;9(2):613–621.
      Huntriss R, Boocock R, McArdle P. Dietary carbohydrate restriction as a management strategy for adults with type 2 diabetes: exploring the opinions of dietitians. Journal of Diabetes Nursing 2019;23:JDN104.
      McArdle P, Greenfield S, Avery, et al. Dietitians’ practice in giving carbohydrate advice in the management of type 2 diabetes: a mixed methods study. Journal of Human Nutrition and Dietetics 2016;30(3):385–393.
      Keywords: Open access
      PubDate: 2022-04-12T05:37:01-07:00
      DOI: 10.1136/bmjnph-2022-nnedprosummit.28
      Issue No: Vol. 5, No. Suppl_1 (2022)
  • Abstract duplication deleted

    • Keywords: Open access
      PubDate: 2022-04-12T05:37:01-07:00
      DOI: 10.1136/bmjnph-2022-nnedprosummit.29
      Issue No: Vol. 5, No. Suppl_1 (2022)
  • Consumption of industrial processed foods and risk of premenopausal breast
           cancer among Latin American women: the PRECAMA study

    • Authors: Romieu, I; Khandpur, N, Katsikari, A, Biessy, C, Torres-Mejia, G, Angeles-Llerenas, A, Alvarado-Cabrero, I, Sanchez, G. I, Maldonado, M. E, Porras, C, Rodriguez, A. C, Garmendia, M. L, Chajes, V, Aglago, E. K, Porter, P. L, Lin, M, His, M, Gunter, M. J, Huybrechts, I, Rinaldi, S, PRECAMA team
      Pages: 1 - 9
      Abstract: Ultra-processed food intake has been linked to an increased risk of breast cancer in Western populations. No data are available in the Latin American population although the consumption of ultra-processed foods is increasing rapidly in this region.We evaluated the association of ultra-processed food intake to breast cancer risk in a case–control study including 525 cases (women aged 20–45 years) and 525 matched population-based controls from Chile, Colombia, Costa Rica and Mexico. The degree of processing of foods was classified according to the NOVA classification.Overall, the major contributors to ultra-processed food intake were ready-to-eat/heat foods (18.2%), cakes and desserts (16.7%), carbonated and industrial fruit juice beverages (16.7%), breakfast cereals (12.9%), sausages and reconstituted meat products (12.1%), industrial bread (6.1%), dairy products and derivatives (7.6%) and package savoury snacks (6.1%). Ultra-processed food intake was positively associated with the risk of breast cancer in adjusted models (OR T3-T1=1.93; 95% CI=1.11 to 3.35). Specifically, a higher risk was observed with oestrogen receptor positive breast cancer (ORT3-T1=2.44, (95% CI=1.01 to 5.90, P-trend=0.049), while no significant association was observed with oestrogen receptor negative breast cancer (ORT3-T1=1.87, 95% CI=0.43 to 8.13, P-trend=0.36).Our findings suggest that the consumption of ultra-processed foods might increase the risk of breast cancer in young women in Latin America. Further studies should confirm these findings and disentangle specific mechanisms relating ultra-processed food intake and carcinogenic processes in the breast.
      Keywords: Open access
      PubDate: 2022-06-22T07:18:08-07:00
      DOI: 10.1136/bmjnph-2021-000335
      Issue No: Vol. 5, No. 1 (2022)
  • Overweight and obesity as risk factors for COVID-19-associated
           hospitalisations and death: systematic review and meta-analysis

    • Authors: Sawadogo, W; Tsegaye, M, Gizaw, A, Adera, T.
      Pages: 10 - 18
      Abstract: ObjectiveTo quantify the current weight of evidence of the association between overweight and obesity as risk factors for COVID-19-related hospitalisations (including hospital admission, intensive care unit admission, invasive mechanical ventilation) and death, and to assess the magnitude of the association and the potential dose–response relationships.DesignPubMed, Embase, Cochrane, Web of Sciences, WHO COVID-19 database and Google Scholar were used to identify articles published up to 20 July 2021. Peer-reviewed studies reporting adjusted estimates of the association between overweight or obesity and COVID-19 outcomes were included. Three authors reviewed the articles and agreed. The quality of eligible studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. Random-effects meta-analysis was used to estimate the combined effects.ResultsA total of 208 studies with 3 550 997 participants from over 32 countries were included in this meta-analysis. Being overweight was associated with an increased risk of COVID-19-related hospitalisations (OR 1.19, 95% CI 1.12 to 1.28, n=21 studies), but not death (OR 1.02, 95% CI 0.92 to 1.13, n=21). However, patients with obesity were at increased risk of both COVID-19-related hospitalisations (OR 1.72, 95% CI 1.62 to 1.84, n=58) and death (OR 1.25, 95% CI 1.19 to 1.32, n=77). Similarly, patients with extreme obesity were at increased risk of COVID-19-related hospitalisations (OR 2.53, 95% CI 1.67 to 3.84, n=12) and death (OR 2.06, 95% CI 1.76 to 3.00, n=19). There was a linear dose–response relationship between these obesity categories and COVID-19 outcomes, but the strength of the association has decreased over time.ConclusionBeing overweight increases the risk of COVID-19-related hospitalisations but not death, while obesity and extreme obesity increase the risk of both COVID-19-related hospitalisations and death. These findings suggest that prompt access to COVID-19 care, prioritisation for COVID-19 vaccination and other preventive measures are warranted for this vulnerable group.
      Keywords: Open access, COVID-19
      PubDate: 2022-06-22T07:18:08-07:00
      DOI: 10.1136/bmjnph-2021-000375
      Issue No: Vol. 5, No. 1 (2022)
  • Potential effect of real-world junk food and sugar-sweetened beverage
           taxes on population health, health system costs and greenhouse gas
           emissions in New Zealand: a modelling study

    • Authors: Grout, L; Mizdrak, A, Nghiem, N, Jones, A. C, Blakely, T, Ni Mhurchu, C, Cleghorn, C.
      Pages: 19 - 35
      Abstract: Poor diet is a major risk factor for excess weight gain and obesity-related diseases, including cardiovascular diseases, type 2 diabetes mellitus, osteoarthritis and several cancers. This paper aims to assess the potential impacts of real-world food and beverage taxes on change in dietary risk factors, health gains (in quality-adjusted life years (QALYs)), health system costs and greenhouse gas (GHG) emissions as if they had all been implemented in New Zealand (NZ). Ten taxes or tax packages were modelled. A proportional multistate life table model was used to predict resultant QALYs and costs over the remaining lifespan of the NZ population alive in 2011, as well as GHG emissions. QALYs ranged from 12.5 (95% uncertainty interval (UI) 10.2 to 15.0; 3% discount rate) per 1000 population for the import tax on sugar-sweetened beverages (SSB) in Palau to 143 (95% UI 118 to 171) per 1000 population for the excise duties on saturated fat, chocolate and sweets in Denmark, while health expenditure savings ranged from 2011 NZ$245 (95% UI 188 to 310; 2020 US$185) per capita to NZ$2770 (95% UI 2140 to 3480; US$2100) per capita, respectively. The modelled taxes resulted in decreases in GHG emissions from baseline diets, ranging from –0.2% for the tax on SSB in Barbados to –2.8% for Denmark’s tax package. There is strong evidence for the implementation of food and beverage tax packages in NZ or similar high-income settings.
      Keywords: Open access
      PubDate: 2022-06-22T07:18:08-07:00
      DOI: 10.1136/bmjnph-2021-000376
      Issue No: Vol. 5, No. 1 (2022)
  • Food insecurity and mens perpetration of partner violence in a
           longitudinal cohort in South Africa

    • Authors: Hatcher, A. M; Neilands, T. B, Rebombo, D, Weiser, S. D, Christofides, N. J.
      Pages: 36 - 43
      Abstract: BackgroundAlthough food insecurity has been associated with intimate partner violence (IPV), few studies examine it longitudinally or among male perpetrators.MethodsWe used secondary data from a trial that followed 2479 men in a peri-urban settlement in South Africa (February 2016–August 2018). Men self-completed questionnaires at baseline (T0), 12 months (T1) and 24 months (T2) on food security, household type, relationship status, childhood abuse exposure, alcohol use, and perpetration of physical and/or sexual IPV. Cross-lagged dynamic panel modelling examines the strength and direction of associations over time.ResultsAt baseline, rates of IPV perpetration (52.0%) and food insecurity (65.5%) were high. Food insecure men had significantly higher odds of IPV perpetration at T0, T1 and T2 (ORs of 1.9, 1.4 and 1.4, respectively). In longitudinal models, food insecurity predicted men’s IPV perpetration 1 year later. The model had excellent fit after controlling for housing, relationship status, age, childhood abuse and potential effect of IPV on later food insecurity (standardised coefficient=0.09, p=0.031. root mean squared error of approximation=0.016, comparative fit index=0.994). IPV perpetration did not predict later food security (p=0.276).ConclusionFood insecurity had an independent, longitudinal association with men’s IPV perpetration in a peri-urban South African settlement. These findings suggest food security could be a modifiable risk factor of partner violence.Trial registration number NCT02823288.
      Keywords: Open access
      PubDate: 2022-06-22T07:18:08-07:00
      DOI: 10.1136/bmjnph-2021-000288
      Issue No: Vol. 5, No. 1 (2022)
  • Bridging the gap between science and society: long-term effects of the
           Healthy Lifestyle Community Programme (HLCP, cohort 1) on weight and the
           metabolic risk profile: a controlled study

    • Authors: Anand, C; Kranz, R.-M, Husain, S, Koeder, C, Schoch, N, Alzughayyar, D.-K, Gellner, R, Hengst, K, Englert, H.
      Pages: 44 - 54
      Abstract: BackgroundThe potential of adopting a healthy lifestyle to fight non-communicable diseases (NCDs) is not fully used. We hypothesised that the Healthy Lifestyle Community Programme (HLCP, cohort 1) reduces weight and other risk markers compared with baseline and control.Methods24-month, non-randomised, controlled intervention trial. Intervention: intensive 8-week phase with seminars, workshops and coaching focusing on a healthy lifestyle (eg, plant-based diet, physical activity, stress management) and group support followed by a 22-month alumni phase. Weight reduction as the primary outcome and other NCD risk parameters were assessed at six time points. Participants were recruited from the general population. Multiple linear regression analyses were conducted.Results143 participants (58±12 years, 71% female) were enrolled (91 in the intervention (IG) and 52 in the control group (CG)). Groups’ baseline characteristics were comparable, except participants of IG were younger, more often females, overweight and reported lower energy intake (kcal/day). Weight significantly decreased in IG at all follow-ups by –1.5 ± 1.9 kg after 8 weeks to –1.9 ± 4.0 kg after 24 months and more than in CG (except after 24 months). Being male, in the IG or overweight at baseline and having a university degree predicted more weight loss. After the intervention, there were more participants in the IG with a ‘high’ adherence (+12%) to plant-based food patterns. The change of other risk parameters was most distinct after 8 weeks and in people at elevated risk. Diabetes-related risk parameters did not improve.ConclusionThe HLCP was able to reduce weight and to improve aspects of the NCD risk profile. Weight loss in the IG was moderate but maintained for 24 months. Participants of lower educational status might benefit from even more practical units. Future interventions should aim to include more participants at higher risk.Trial registration numberDRKS00018821.
      Keywords: Open access, Implementing Effective Interventions in Healthcare
      PubDate: 2022-06-22T07:18:08-07:00
      DOI: 10.1136/bmjnph-2021-000340
      Issue No: Vol. 5, No. 1 (2022)
  • Body weight, diabetes incidence vascular events and survival 15 years
           after very low calorie diet in community medical clinics in the UK

    • Authors: Paisey, R; Daniels, C, Howitt, W, Greatorex, D, Campbell, C, Paisey, C, Paisey, R, Frost, J, Bromige, R.
      Pages: 55 - 61
      Abstract: ObjectiveTo assess weight loss maintenance, diabetes status, mortality and morbidity 15 years after a very low calorie diet programme (VLCD) in patients with obesity.DesignGeneral practice data bases were interrogated for subjects coded for group therapy with VLCD in the 1990s. Causes of death, occurrence of vascular disease and remission or development of diabetes were ascertained from patient records and national stroke and cardiovascular disease data bases.Results325 subjects engaged in the programme and had sufficient data for analysis. Baseline characteristics were: age 47.8±12. 8 years; body mass index (BMI) 36.1±6.8 kg/m2; 79.1% female/20.9% male; 13.5% had type 2 diabetes. After 15±4 years weight had changed from 97.9±19 kg at baseline to 100±20.8 kg. 10 with diabetes at baseline were in remission at 3 months, but only two remained in remission at 5 years. 50 new cases of type 2 diabetes and 11 of impaired fasting glucose developed during follow-up. Only 5.9% who remained healthy at follow-up had maintained>10% body weight reduction. Neither diabetes incidence nor diabetes free survival were related to percentage body weight lost during VLCD. Only baseline BMI was related to development of new impaired fasting glucose or diabetes by 15 years (p=0.007). 37 subjects had a cardiovascular event. Age (p=0.000002) and degree of weight loss after VLCD (p=0.03) were significantly associated with subsequent vascular events.ConclusionLong-term maintenance of weight loss after VLCD was rare in this single centre retrospective study 15 years later. Glucose intolerance developed in 21.4%. Lasting remission of type 2 diabetes or prevention of later glucose intolerance were not achieved. Vascular events were more frequent in those who lost most weight. Risk management during weight regain should be studied in future to assess potential for reduction in adverse cardiovascular outcomes.
      Keywords: Open access
      PubDate: 2022-06-22T07:18:08-07:00
      DOI: 10.1136/bmjnph-2021-000363
      Issue No: Vol. 5, No. 1 (2022)
  • Longitudinal study of the effects of price and promotion incentives on
           purchases of unhealthy foods: evidence for restricting food promotions

    • Authors: Kopasker, D; Ejebu, O.-Z, Norwood, P, Ludbrook, A.
      Pages: 62 - 71
      Abstract: ObjectivesTaxes and restrictions on promotions have recently been proposed as policy instruments to reduce consumption of unhealthy foods. The objective of this study is to add to the limited evidence on the comparative effectiveness of price changes, price promotions and volume promotions in changing household purchasing of unhealthy foods, using biscuits, crisps and savoury snacks as examples.DesignLongitudinal regression analysis of consumer microdata.SettingSecondary data on itemised household purchases of biscuits, crisps and savoury snacks from 2006 to 2012.ParticipantsSample of 3024 households in Scotland.Main outcome measuresChanges in the number of calories (kcal) purchased in the product category by a household caused by changes in the price for the product category, any temporary in-store price promotions and any temporary in-store volume promotions. Changes are measured at the mean, median, 25th percentile and 75th percentile of the household purchasing distribution for the full sample. Subgroup analyses were conducted by household income band and for households with and without children.ResultsBetween product categories, the scale of purchasing response to incentives varies significantly. Within product categories, the mean calories (kcal) purchased by a household are more responsive to any volume promotion than to price or any price promotion for all product categories. As the volume of items purchased increases, households are less responsive to price, less responsive to any volume promotion and more responsive to any price promotion. Statistically significant differences are observed between household income groups in their response to price and promotion incentives within the biscuits category only. In cases where statistically significant differences are observed, households with children are more responsive to promotion and price incentives than households without children.ConclusionsFor all product categories analysed (biscuits, crisps and savoury snacks), household purchasing is most responsive to any volume promotion. Therefore, assuming the response of consumers to incentives remains constant following legislation, the most effective policy instrument to reduce the calorie intake from these products may be a ban on volume promotions.
      Keywords: Open access
      PubDate: 2022-06-22T07:18:08-07:00
      DOI: 10.1136/bmjnph-2021-000323
      Issue No: Vol. 5, No. 1 (2022)
  • Changes to local area public sector spending and food purchasing in
           England: a longitudinal ecological study

    • Authors: Jenkins, R. H; Vamos, E. P, Taylor-Robinson, D, Mason, K. E, Laverty, A. A.
      Pages: 72 - 86
      Abstract: ObjectivesChanges in public sector service spending may influence food consumption. We make use of changing local authority (LA) expenditure in England to assess impacts on food purchasing. We examine total LA service spending and explore two potential pathways: highways and transport spending which may affect access to food; and housing service expenditure which may affect household resources available to purchase foods.DesignLongitudinal panel survey at the LA level (2008–2015) using fixed effects linear regression.Setting324 LAs in England.Main exposureExpenditure per capita on total LA services, highways and transport services, and housing services.Main outcome measuresLA area estimates of purchasing of fresh fruits and vegetables, high in fat, sugar and salt (HFSS) foods, and takeaways at home, expressed as a percentage of total food and drink expenditure.ResultsTotal LA service spending decreased by 17% on average between 2008 and 2015. A 10% decrease in total LA spending was associated with a 0.071 percentage point decrease in HFSS (95% CI –0.093 to –0.050) and a 0.015 percentage point increase in takeaways (95% CI 0.006 to 0.024). A 10% decrease in highways and transport expenditure was associated with a 0.006 percentage point decrease in fruit and vegetable purchasing (95% CI –0.009 to –0.002) and a 0.006 percentage point increase in takeaway purchasing (95% CI 0.001 to 0.010). These associations were seen in urban areas only when analyses were stratified by rural/urban area status. A 0.006 percentage point decrease in HFSS purchasing was also seen with a 10% decrease in housing expenditure (95% CI –0.010 to –0.002).ConclusionChanges in LA spending may have impacts on food purchasing which are evident at the area level. This suggests that in addition to more prominent impacts such as foodbank use, austerity measures may have mixed impacts on food purchasing behaviours among the wider population. Individual-level research is needed to further elucidate these relationships.
      Keywords: Open access
      PubDate: 2022-06-22T07:18:08-07:00
      DOI: 10.1136/bmjnph-2021-000346
      Issue No: Vol. 5, No. 1 (2022)
  • 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

    • Authors: Rojas Huayta, V. M; Galvez-Davila, R, Calvo-Torres, O, Cardozo Alarcon, V, Aparco, J. P, Silva Fhon, J. R, Estrada-Acero, B, Jaimes-Velasquez, C, Cespedes-Panduro, B, Espinoza-Bernardo, S, Dolores-Maldonado, G, Ramirez Ramirez, R, Gallo Ruelas, M, Arteaga-Romero, I, Higa, A. M.
      Pages: 87 - 97
      Abstract: ObjectiveThe objective of this study is to assess changes in the dimensions of the food system and consumption associated with body weight variations during the first month’s lockdown in Peruvian adults in Metropolitan Lima.MethodsA cross-sectional study conducted during the first months of lockdowns in Peru. 694 adults completed a web-based survey about changes experienced in the process of acquiring food during lockdown, changes in their intake and self-perceived body weight. A multinomial logistic regression analysis was conducted to evaluate the factors associated with changes in body weight.ResultsWeight gain was perceived in 38% of the participants and 22.8% perceived weight loss. 39.2% did not perceive changes in their weight. Risk factors for body weight gain were increased alcohol consumption (OR=4.510, 95% CI 1.764 to 11.531) and decreased fruit consumption (OR=2.129, 95% CI 1.290 to 3.515), while decreasing cereal intake (OR=0.498, 95% CI 0.269 to 0.922) and choosing nutritious food as a driver for purchase (OR=0.512, 95% CI 0.320 to 0.821) were found to be protective against gaining weight. Decreasing food intake during the pandemic (OR=2.188, 95% CI 1.348 to 3.550) and having to miss important foods (OR=2.354, 95% CI 1.393 to 3.978), were associated with weight loss.ConclusionsDuring confinement, weight gain was mostly associated with food consumption and personal food system factors. Meanwhile, weight loss was associated with external food system factors.
      Keywords: Open access, COVID-19
      PubDate: 2022-06-22T07:18:08-07:00
      DOI: 10.1136/bmjnph-2021-000416
      Issue No: Vol. 5, No. 1 (2022)
  • Cost-effectiveness of vitamin D3 supplementation in older adults with
           vitamin D deficiency in Ireland

    • Authors: Lacey, L. F; Armstrong, D. J, Royle, E, Magee, P, Pourshahidi, L. K, Ray, S, Strain, J. J, McSorley, E.
      Pages: 98 - 105
      Abstract: BackgroundThis study investigated the cost-effectiveness of vitamin D3 supplementation in older adults in Ireland, with year-round vitamin D deficiency (serum 25-hydroxyvitamin D concentration
      Keywords: Open access
      PubDate: 2022-06-22T07:18:08-07:00
      DOI: 10.1136/bmjnph-2021-000382
      Issue No: Vol. 5, No. 1 (2022)
  • Global architecture for the nutrition training of health professionals: a
           scoping review and blueprint for next steps

    • Authors: Lepre, B; Trigueiro, H, Johnsen, J. T, Khalid, A. A, Ball, L, Ray, S.
      Pages: 106 - 117
      Abstract: BackgroundThis paper provides an overview of capacity-building efforts in the context of nutrition education for medical and healthcare professionals.MethodsContent analysis of eighteen reports related to nutrition education and capacity building, and interviews with key personnel from the WHO and NNEdPro Global Centre for Nutrition and Health were synthesised. Recommendations to improve nutrition education and subsequent nutrition capacity of healthcare professionals were identified based on policy guidance and interviews.FindingsMost included documents noted the importance of nutrition education and capacity building for medical and healthcare professionals. Healthcare professionals and the ‘health sector’ were positioned as central to achieving improved public health, and the promotion of nutrition knowledge and awareness in the general population.ConclusionIncreased focus on nutrition education and capacity of the health workforce are key to improvements in population health and well-being. The WHO is well placed to support global nutrition education.RecommendationsKey recommendations from the literature review and interviews include improved global data collection mechanisms, a pledge from governments to prioritise nutrition education and capacity building, along with implementation of standardised nutrition curricula for all healthcare sectors. This would include the development and expansion of on-line resources.
      Keywords: Open access
      PubDate: 2022-06-22T07:18:08-07:00
      DOI: 10.1136/bmjnph-2021-000354
      Issue No: Vol. 5, No. 1 (2022)
  • Dietary factors that affect the risk of pre-eclampsia

    • Authors: Perry, A; Stephanou, A, Rayman, M. P.
      Pages: 118 - 133
      Abstract: Pre-eclampsia affects 3%–5% of pregnant women worldwide and is associated with a range of adverse maternal and fetal outcomes, including maternal and/or fetal death. It particularly affects those with chronic hypertension, pregestational diabetes mellitus or a family history of pre-eclampsia. Other than early delivery of the fetus, there is no cure for pre-eclampsia. Since diet or dietary supplements may affect the risk, we have carried out an up-to-date, narrative literature review to assess the relationship between nutrition and pre-eclampsia. Several nutrients and dietary factors previously believed to be implicated in the risk of pre-eclampsia have now been shown to have no effect on risk; these include vitamins C and E, magnesium, salt, -3 long-chain polyunsaturated fatty acids (fish oils) and zinc. Body mass index is proportionally correlated with pre-eclampsia risk, therefore women should aim for a healthy pre-pregnancy body weight and avoid excessive gestational and interpregnancy weight gain. The association between the risk and progression of the pathophysiology of pre-eclampsia may explain the apparent benefit of dietary modifications resulting from increased consumption of fruits and vegetables (≥400 g/day), plant-based foods and vegetable oils and a limited intake of foods high in fat, sugar and salt. Consuming a high-fibre diet (25–30 g/day) may attenuate dyslipidaemia and reduce blood pressure and inflammation. Other key nutrients that may mitigate the risk include increased calcium intake, a daily multivitamin/mineral supplement and an adequate vitamin D status. For those with a low selenium intake (such as those living in Europe), fish/seafood intake could be increased to improve selenium intake or selenium could be supplemented in the recommended multivitamin/mineral supplement. Milk-based probiotics have also been found to be beneficial in pregnant women at risk. Our recommendations are summarised in a table of guidance for women at particular risk of developing pre-eclampsia.
      Keywords: Open access
      PubDate: 2022-06-22T07:18:08-07:00
      DOI: 10.1136/bmjnph-2021-000399
      Issue No: Vol. 5, No. 1 (2022)
  • Serious vitamin D deficiency in healthcare workers during the COVID-19

    • Authors: Funaki, T; Sanpei, M, Morisaki, N, Mizoue, T, Yamaguchi, K.
      Pages: 134 - 136
      Keywords: Open access, COVID-19, Nutrition Interactions with COVID-19
      PubDate: 2022-06-22T07:18:08-07:00
      DOI: 10.1136/bmjnph-2021-000364
      Issue No: Vol. 5, No. 1 (2022)
  • Child nutritional status as screening tool for identifying undernourished
           mothers: an observational study of mother-child dyads in Mogadishu,
           Somalia, from November 2019 to March 2020

    • Authors: Zacks, R; Ververs, M, Hwang, C, Mahdi, A, Leidman, E.
      Abstract: BackgroundActive screening of only pregnant and lactating mothers (PLMs) excludes other mothers of reproductive age susceptible to undernutrition. Our analysis evaluated if mothers presenting with wasted children were more likely to be undernourished themselves.MethodsThe observational study enrolled mother and child dyads presenting to an outpatient facility in Mogadishu, Somalia, between November 2019 and March 2020. Trained nurses recorded lower extremity oedema for children aged 6–59 months, parity and gestational status for women aged 19–50 years and age, access to care, height/length, mid-upper arm circumference (MUAC) and weight for both. Weight-for-height z-score (WHZ) for children and body mass index (BMI) for mothers were calculated using standard procedures. Wasting was defined as WHZ
      Keywords: Open access
      PubDate: 2022-07-07T23:55:40-07:00
      DOI: 10.1136/bmjnph-2021-000302
      Issue No: Vol. 4, No. 2 (2022)
  • Comparing McDonalds food marketing practices on official Instagram
           accounts across 15 countries

    • Authors: Cassidy, O; Shin, H. W, Song, E, Jiang, E, Harri, R, Cano, C, Vedanthan, R, Ogedegbe, G, Bragg, M.
      Abstract: BackgroundSocial media advertising by fast food companies continues to increase globally, and exposure to food advertising contributes to poor diet and negative health outcomes (eg, cardiovascular disease). McDonald’s—the largest fast food company in the world—operates in 101 countries, but little is known about their marketing techniques in various regions. The objective of this study was to compare the social media advertising practices of McDonald’s—the largest fast food company in the world—in 15 high-income, upper-middle-income and lower-middle-income countries.MethodsWe randomly selected official McDonald’s Instagram accounts for 15 high-income, upper-middle-income and lower-middle-income countries. We captured all the screenshots that McDonald’s posted on those Instagram accounts from September to December 2019. We quantified the number of followers, ‘likes’, ‘comments’ and video views associated with each account in April 2020. We used content analysis to examine differences in the marketing techniques.ResultsThe 15 accounts collectively maintained 10 million followers and generated 3.9 million ‘likes’, 164 816 comments and 38.2 million video views. We identified 849 posts. The three lower-middle-income countries had more posts (n=324; M, SD=108.0, 38.2 posts) than the five upper-middle-income countries (n=227; M, SD=45.4, 37.5 posts) and seven high-income countries (n=298; M, SD=42.6, 28.2 posts). Approximately 12% of the posts in high-income countries included child-targeted themes compared with 22% in lower-middle-income countries. Fourteen per cent of the posts in high-income countries included price promotions and free giveaways compared with 40% in lower-middle-income countries.ConclusionsSocial media advertising has enabled McDonald’s to reach millions of consumers in lower-middle-income and upper-middle-income countries with disproportionately greater child-targeted ads and price promotions in lower-middle-income countries. Such reach is concerning because of the increased risk of diet-related illnesses, including cardiovascular disease, in these regions.
      Keywords: Open access, Press releases
      PubDate: 2022-07-07T02:55:32-07:00
      DOI: 10.1136/bmjnph-2021-000229
      Issue No: Vol. 4, No. 2 (2022)
  • The role of trained champions in sustaining and spreading nutrition care
           improvements in hospital: qualitative interviews following an
           implementation study

    • Authors: Laur, C; Bell, J, Valaitis, R, Ray, S, Keller, H.
      Abstract: BackgroundMany patients are already malnourished when admitted to hospital. Barriers and facilitators to nutrition care in hospital have been identified and successful interventions developed; however, few studies have explored how to sustain and spread improvements. The More-2-Eat phase 1 study involved five hospitals across Canada implementing nutrition care improvements, while phase 2 implemented a scalable model using trained champions, audit and feedback, a community of practice with external mentorship and an implementation toolkit in 10 hospitals (four continuing from phase 1). Process measures showed that screening and assessment from phase 1 were sustained for at least 4 years. The objective of this study was to help explain how these nutrition care improvements were sustained and spread by understanding the role of the trained champions, and to confirm and expand on themes identified in phase 1.MethodsSemistructured telephone interviews were conducted with champions from each phase 2 hospital and recordings transcribed verbatim. To explore the champion role, transcripts were deductively coded to the 3C model of Concept, Competence and Capacity. Phase 2 transcripts were also deductively coded to themes identified in phase 1 interviews and focus groups.ResultsTen interviews (n=14 champions) were conducted. To sustain and spread nutrition care improvements, champions needed to understand the Concepts of change management, implementation, adaptation, sustainability and spread in order to embed changes into routine practice. Champions also needed the Competence, including the skills to identify, support and empower new champions, thus sharing the responsibility. Capacity, including time, resources and leadership support, was the most important facilitator for staying engaged, and the most challenging. All themes identified in qualitative interviews in phase 1 were applicable 4 years later and were mentioned by new phase 2 hospitals. There was increased emphasis on audit and feedback, and the need for standardisation to support embedding into current practice.ConclusionTrained local champions were required for implementation. By understanding key concepts, with appropriate and evolving competence and capacity, champions supported sustainability and spread of nutrition care improvements. Understanding the role of champions in supporting implementation, spread and sustainability of nutrition care improvements can help other hospitals when planning for and implementing these improvements.Trial registration numberNCT02800304, NCT03391752.
      Keywords: Open access, Implementing Effective Interventions in Healthcare
      PubDate: 2022-07-04T01:45:25-07:00
      DOI: 10.1136/bmjnph-2021-000281
      Issue No: Vol. 4, No. 2 (2022)
  • Impact evaluation of the efficacy of different doses of vitamin D
           supplementation during pregnancy on pregnancy and birth outcomes: a
           randomised, controlled, dose comparison trial in Pakistan

    • Authors: Nausheen, S; Habib, A, Bhura, M, Rizvi, A, Shaheen, F, Begum, K, Iqbal, J, Ariff, S, Shaikh, L, Raza, S. S, Soofi, S. B.
      Abstract: BackgroundVitamin D deficiency during pregnancy is a public health problem in Pakistan and is prevalent among most women of reproductive age in the country. Vitamin D supplementation during pregnancy is suggested to prevent adverse pregnancy outcomes and vitamin D deficiency in both the mother and her newborn.MethodsWe conducted a double-blinded, randomised controlled trial in Karachi, Pakistan to evaluate the effect of different doses of vitamin D supplementation during pregnancy on biochemical markers (serum 25(OH)D, calcium, phosphorus and alkaline phosphatase) in women and neonates, and on pregnancy and birth outcomes (gestational diabetes, pre-eclampsia, low birth weight, preterm births and stillbirths).ResultsPregnant women (N=350) in their first trimester were recruited and randomised to three treatment groups of vitamin D supplementation: 4000 IU/day (group A, n=120), 2000 IU/day (group B, n=115) or 400 IU/day (group C, n=115). Women and their newborn in group A had the lowest vitamin D deficiency at endline (endline: 75.9%; neonatal: 64.9%), followed by group B (endline: 84.9%; neonatal: 73.7%) and then the control group (endline: 90.2%; neonatal: 91.8%). Vitamin D deficiency was significantly lower in group A than in group C (p=0.006) among women at endline and lower in both groups A and B than in the control group (p=0.001) in neonates. Within groups, serum 25(OH)D was significantly higher between baseline and endline in group A and between maternal baseline and neonatal levels in groups A and B. Participant serum 25(OH)D levels at the end of the trial were positively correlated with those in intervention group A (4000 IU/day) (β=4.16, 95% CI 1.6 to 6.7, p=0.002), with food group consumption (β=0.95, 95% CI 0.01 to 1.89, p=0.047) and with baseline levels of serum 25(OH)D (β=0.43, 95% CI 0.29 to 0.58, p
      Keywords: Open access
      PubDate: 2022-06-29T06:25:20-07:00
      DOI: 10.1136/bmjnph-2021-000304
      Issue No: Vol. 4, No. 2 (2022)
  • Assessments of risk of bias in systematic reviews of observational
           nutritional epidemiologic studies are often not appropriate or
           comprehensive: a methodological study

    • Authors: Zeraatkar, D; Kohut, A, Bhasin, A, Morassut, R. E, Churchill, I, Gupta, A, Lawson, D, Miroshnychenko, A, Sirotich, E, Aryal, K, Azab, M, Beyene, J, de Souza, R. J.
      Abstract: BackgroundAn essential component of systematic reviews is the assessment of risk of bias. To date, there has been no investigation of how reviews of non-randomised studies of nutritional exposures (called ‘nutritional epidemiologic studies’) assess risk of bias.ObjectiveTo describe methods for the assessment of risk of bias in reviews of nutritional epidemiologic studies.MethodsWe searched MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews (Jan 2018–Aug 2019) and sampled 150 systematic reviews of nutritional epidemiologic studies.ResultsMost reviews (n=131/150; 87.3%) attempted to assess risk of bias. Commonly used tools neglected to address all important sources of bias, such as selective reporting (n=25/28; 89.3%), and frequently included constructs unrelated to risk of bias, such as reporting (n=14/28; 50.0%). Most reviews (n=66/101; 65.3%) did not incorporate risk of bias in the synthesis. While more than half of reviews considered biases due to confounding and misclassification of the exposure in their interpretation of findings, other biases, such as selective reporting, were rarely considered (n=1/150; 0.7%).ConclusionReviews of nutritional epidemiologic studies have important limitations in their assessment of risk of bias.
      Keywords: Open access
      PubDate: 2022-04-24T04:45:32-07:00
      DOI: 10.1136/bmjnph-2021-000248
      Issue No: Vol. 4, No. 2 (2022)
  • Plant-based dietary quality and depressive symptoms in Australian vegans
           and vegetarians: a cross-sectional study

    • Authors: Lee, M. F; Eather, R, Best, T.
      Abstract: Plant-based dietary patterns (vegan and vegetarian) are often considered ‘healthy’ and have been associated with broad health benefits, including decreased risk of obesity and ill health (cardiovascular disease, blood glucose and type II diabetes). However, the association between plant-based diets and mood disorders such as depression remains largely equivocal. This cross-sectional study of 219 adults aged 18–44 (M=31.22, SD=7.40) explored the associations between an estimate of overall plant-based diet quality and depression in vegans (n=165) and vegetarians (n=54). Overall plant-based diet quality was associated with depressive symptoms in vegans and vegetarians F(1, 215)=13.71, p
      Keywords: Open access
      PubDate: 2022-04-24T04:45:32-07:00
      DOI: 10.1136/bmjnph-2021-000332
      Issue No: Vol. 4, No. 2 (2022)
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