Background Malnutrition continues to impact healthcare outcomes, quality of life and costs to healthcare systems. The implementation of nutrition care in healthcare practice may improve health outcomes for patients and the community. This paper describes the iterative development and implementation of nutrition medical education resources for doctors and healthcare professionals in England. These resources are part of the Nutrition Education Policy for Healthcare Practice initiative.Method Action research methodology was employed to develop and implement nutrition education workshops for medical students and doctors. The workshop was developed iteratively by an interdisciplinary project team, and the content was initially based on the General Medical Council outcomes for graduates. It was evaluated using quantitative evaluation tools and informal qualitative feedback captured from attendees using tools provided by the host organisations and developed by the roadshow team.Results A total of 6 nutrition education workshops were delivered to 169 participants. This simple educational package demonstrated potential for delivery in different healthcare settings; however, formal feedback was difficult to obtain. Evaluation results indicate that workshops were better received when delivered by doctors known to the participants and included local context and examples. Reported barriers to the workshops included difficulty for participants in finding the time to attend, beliefs that peers gave a low priority to nutrition and uncertainty about professional roles in the delivery of nutrition care.Conclusion A key outcome of this project was the development of resources for nutrition training of doctors, adapted to local needs. However, relatively low attendance and multiple barriers faced in the delivery of these workshops highlight that there is no ideal 'place' for nutrition training in current healthcare teaching. Interprofessional education, through relevant clinical scenarios may increase awareness of the importance of nutrition in healthcare, support the alignment of health professional roles and improve subsequent knowledge and skills.

Background and objective Doctors are well placed to facilitate nutrition care to support dietary improvements due, in part, to their regular contact with their patients. Limited literature exists which explores the perspective of patients regarding the nutrition care provided by medical professionals across the continuum of care. This article explores the perspective of patients regarding perceptions of nutrition advice and care received from doctors and expectations of this care, including key skills and attributes the patients perceive as important. Methods Six online focus groups were conducted with Australian service users (n=32). Results Framework analysis identified four key themes: perceptions of doctors' role in nutrition care, expectations and experiences; the importance of individualised care; barriers and enablers to nutrition care; and topics, skills and attributes perceived as important in nutrition care. Discussion Patients have a desire for individualised and collaborative nutrition care but experienced systemic barriers in practice.

SUPPORTING HEALTHY EATING in general practice is one of society's economic 'best buys' for improving population health. 1 People regularly engage with general practice in Australia, with an average of five visits per person per year and extensive engagement with priority populations. 2Practice guidelines for general practitioners (GPs) identify nutrition as a fundamental component of high-quality routine care. 3In Australia, the National Preventive Health Strategy and the National Obesity Strategy call for a 'big shift' in general practice to focus on healthy eating to build the world's best healthcare system.Clearly, GPs in Australia, New Zealand and other developed countries are expected to provide nutrition care.A fundamental problem is that while GPs recognise that nutrition is important, they also acknowledge that it is a superficially approached area of healthcare in general practice, and many doctors do not feel competent in addressing nutrition-related concerns. 4A recent international review of GPs' knowledge, skills and attitudes towards nutrition care showed that GPs are unlikely to be maximising the potential for nutrition care in clinical practice. 4 GPs face barriersBeyond education and training: Is a new paradigm required to better support general practitioners to feel competent in nutrition care?Focus

Background Significant research, regulatory bodies and even governmental resolutions have identified meaningful nutrition education for medical and other healthcare professionals as a priority. Doctors are well placed to provide nutrition care, yet nutrition education in medicine remains inadequate regardless of country, setting, or year of training. There remains a need to establish an accepted benchmark on nutrition competencies for medicine, as without consensus standards there is little likelihood of uniform adoption.Objective This study aimed to establish consensus on nutrition competencies using a Delphi process to inform a framework for nutrition education in medicine.Methods A three-round modified online Delphi survey of experts in healthcare practice, education and training, and experts by experience (service users) was conducted to provide a comprehensive consensus on nutrition competencies for medical practice.Results Fifty-two experts (15.1% response rate) participated in Round 1, 42 completed Round 2 and 47 completed Round 3. Participants included medical professionals, dietitians, academics working in health professions education and policymakers from Australia, New Zealand, the UK and Northern Ireland. Twenty-seven service users (57.5% response rate) completed the Round 1 questionnaire, 19 completed Round 2 and 16 completed Round 3. By consensus, 25 nutrition competencies for medicine were defined. The service user panel identified an additional seven skills and attributes considered important in the receipt of nutrition care. Competencies that achieved consensus broadly fell into themes of team-based care, communication, professionalism (eg, attributes) and health promotion and disease prevention. This informs broad skills that may be taught in a nutrition context but could be included in other domains.Conclusions The findings suggest doctors need the knowledge and skills to consider the findings from nutrition screening and assessment, coordinate nutrition care when an individual may benefit from further assessment or intervention and provide support for advice delivered by other experts as part of a multidisciplinary approach.

Objectives: The youth unemployment rate in Australia is more than double the national average. Policies and programs to address barriers and improve youth engagement in education and employment are essential to achieve many of the United Nations' Sustainable Development Goals (SDGs). The aim of this mixed-methods study was to evaluate the OzHarvest Nourish Program, a free, hospitality-focused pathway to support employment and engagement for young people aged 16-25 years.Study design: Mixed-methods study.Methods: An online survey, workshop and semi-structured interviews with staff, volunteers, participants, and broader stakeholders were conducted using a qualitative, exploratory approach. Ethics approval was granted by the Griffith University Human Research Ethics Committee (#2022/492).Results: Five key themes were identified from interview data and a logic model was developed. Participants described significant benefits of participation, including improved food security, self-efficacy, and communication skills, reduced social isolation, and greater hope for the future.Conclusions: The Nourish Program is a transformative service that is improving wellbeing outcomes for program participants. Additional resourcing, including adequate funding, may be required to maximise program impact and support sustainability.

Background Contemporary research now includes effort to generate impact beyond the creation of new knowledge. Methods This report provides an illustrative case study of tactful research planning and dissemination for impact and provides an emerging pathway for others to holistically track reach, spread and uptake, to create a nuanced impact narrative. Results Nutrition Competence Tool (NutComp) is a validated tool that assesses the self-perceived competence of health professionals in providing nutrition care. Since open-access publication in 2015, it has been used by researchers and health professionals in 28 countries across 6 continents. The reach, spread, uptake and impact of NutComp are summarised, including indicators to support impact tracking for knowledge. Conclusion Given the complex phenomenon of research impact, careful planning is required to capture and attribute research impact.

Advances in digital technologies impact several aspects of nutrition and healthcare science and practice. During the COVID-19 pandemic, the NNEdPro Nutrition and COVID-19 task force, supported by the BMJ Nutrition Prevention and Health journal, produced and curated evidence-based digital repositories of nutrition-related resources and educational nutrition-related materials for healthcare professionals, policymakers and the public, tailored to different geographical regions. International research collaborations increasingly use virtual platforms to link and analyse multiple sources of data from across sectors (relating to food, nutrition, and health) with potential to gain important insights into health impact and risk prediction. National and international nutrition education initiatives based on virtual networks, including the CAN DReaM (Creating Alliances Nationally to Address Disease-Related Malnutrition) project in Canada, and the Education and Research in Medical Nutrition Network (ERIMNN) in the UK, have the potential to make nutrition education more accessible across wide geographical regions. The rise of digital social media platforms allows for rapid dissemination of information at an unprecedented scale. Whilst this has been used to have a positive impact, it also carries a risk of harm through targeted misinformation and exploitative practice. For example, the recent WHO report into the digital marketing of breast milk substitute products revealed the predatory tactics that target vulnerable women and exploit parental health anxieties to promote a multi-billion dollar industry. On this topic, discussion in the Middle East and Pan-Africa regional networks satellite event of the Summit highlighted the need for health professionals to employ ‘traffic control on the digital information highway’. Perhaps one of the more tangible examples of digital technology empowering healthcare practice is the proliferation of digital smart phone apps, particularly as tools in the management of chronic health conditions. Diet and lifestyle management support apps have entered the chronic disease management space. Some that utilise artificial intelligence are in development, and in some cases in clinical trials, and clinical practice. One such app designed by Diabetes Digital Media has been integrated into some NHS weight management services in the UK. These technologies aim to better understand behaviour and lifestyle change, improve patient engagement and the sustainability of lifestyle changes, and allow granular data collection and remote monitoring of outcome variables. In developed countries, digital data platforms have been used to explore the intersection at which social determinants of health meet nutrition-related genomics and health outcomes. The challenge of severe health inequities relates closely to societal frictions and conflicts, economic market forces, and the health of education and food systems. To have the greatest impact on nutrition globally, digital technologies must account for and address health inequities that underlie the risk of malnutrition and poor health of millions of people. Furthermore, health systems do not operate in isolation. Empowering individuals and populations to live healthy lives requires a collective buy-in from the education sector. Therefore, at the Summit, several digitally-assisted educational schemes based in primary schools, community settings, medical schools, and healthcare systems in various global regions were showcased. Measuring and validating the safety and efficacy of novel digital technologies for better nutrition and health is essential for ensuring positive impacts.

Background There is a critical lack of medical workforce internationally, and this is particularly notable in rural and remote Australia where strategies to address workforce shortages are urgently required. This pilot study aimed to implement and evaluate a Virtual Integrated Practice (VIP) Program in the Australian rural primary care setting. Methods The VIP model was developed using co-creation methodology and involves an urban GP joining a rural general practice team to provide ongoing care to patients remotely via secure telehealth. The pilot study was conducted in two western Queensland general practices, commencing in October 2021 with one rural practice and extending to an additional rural practice from November 2022. Evaluation included a retrospective review of service, billing and cost data, and an online survey for patients. Ethical approval was obtained from the University of Queensland Human Research Ethics Committee (Project number: 2021/HE002434). Results There were 1468 services provided through to December 2022, including general consults (n = 1197), therapeutic procedures (n = 68), mental health treatment plans (n = 68) and chronic disease management plans (n = 59). Patients were predominantly female (73.1%) and did not have their appointment at the practice (57.8%). Among 1282 occasions of service, less than 20% of consultations (n = 224) required support from staff (e.g., a nurse), and more than half were repeat patient encounters (53.0%). Survey respondents (n = 45) indicated that they were satisfied (9.3%) or highly satisfied (90.7%) with the care provided, and importantly, 95.5% of respondents reported that the service improved their access to the GP. More than 20% of respondents indicated that they would attend the Emergency Department if virtual care was not available. Conclusions Data from this pilot study has informed translation to an additional 20 vulnerable rural general practices in three further rural regions in Queensland in 2023 and evaluation is ongoing. This pilot study demonstrates the feasibility and acceptability of an innovative, digitally supported community-focussed, healthcare initiative to arrest the decline in rural general practice workforce, improve patient care access and support rural practice viability.

BACKGROUND Poor diet is implicated in multiple chronic diseases. While doctors may be well-placed to facilitate nutrition care, nutrition remains a low priority in medical education internationally. Consensus is required on nutrition competencies as a benchmark for education with a regulatory framework to ensure implementation. The aim of this qualitative study was to explore work roles, attitudes, barriers, and enablers in the delivery of nutrition care amongst a cohort of Australian and UK doctors. METHODOLOGY Semi-structured interviews were conducted with primary care doctors/GPs (n=14) and medical specialists (n=8) based in Australia and the United Kingdom to explore work roles, attitudes, barriers and enablers in the delivery of nutrition care. RESULTS Framework analysis identified five key themes: 1) Knowledge and skills in nutrition to support medical nutrition care, 2) The delivery of nutrition education, 3) Multidisciplinary and interdisciplinary care, 4) Systemic barriers and facilitators to care and, 5) The need for a paradigm shift. Participants acknowledged nutrition as an important component of medical care but recognised they are currently ill-equipped to support such care, identifying limitations to the systems supporting integrated care. Participants identified that nutrition sits within both a health promotion and medical/treatment model, but they currently work only within the latter. CONCLUSION Participants highlighted a lack of knowledge and training around nutrition, without which change is not possible. Efforts to improve the nutrition capacity of the medical workforce must be matched by increased investments in primary prevention, including nutrition - a paradigm shift from the medical model. This article is protected by copyright. All rights reserved.

Action to incorporate evidence-based nutrition concepts in medical education programs is essential Dietary risk — especially diets high in sodium, low in whole grain, and those with low fruit intake — is third in its contribution to preventable disease in Australia, contributing 5.4% to total disease burden.2, 3 In Australia, general practices provide more than 189 million services each year, and almost 90% of the population see a general practitioner at least once each year.4 International studies estimate that 16–24% of general practice consultations feature some aspect of nutrition,5 and there is evidence that individuals may have a preference for dietary intervention before the use of medication for conditions such as type 2 diabetes.6 Brief training in nutrition care can improve health professionals’ practice,7 and nutrition is highlighted as a key outcome in the recently published Australian National Preventive Health Strategy,8 which seeks to develop a health professional workforce competent in preventive health strategies. The global COVID-19 pandemic and climate-related natural disasters have revealed increasing health and social inequalities, such as food security. Food security is dramatically affected by socio-economic status and includes access to sufficient, safe and nutritious food that is culturally appropriate. To minimise dietary risk from non-communicable diseases (NCDs), all health professionals should consider the effects of climate change and social inequity on food systems and food security, and the role of nutrition in chronic disease, as part of their practice.9 Despite long-standing recognition, evidence and multiple efforts, nutrition has not entered mainstream medical education in measurable and sustainable ways. In 2012, a letter published in The Medical Journal of Australia urged medical schools to adopt a nutrition competency framework.10 The framework aligned with the Medical Graduate Competency Framework11 developed at that time by Medical Deans Australia and New Zealand, and aimed to improve both prevention and treatment of nutrition-related diseases.12 A decade on, a systematic review highlighted that, internationally, nutrition content is still limited within medical education.13 Multiple studies of both medical students and practitioners show that doctors see nutrition care as part of their job and have a desire to engage in this care. However, many still lack confidence in their nutrition skills, which acts as a significant barrier to taking a proactive approach to nutrition as a component of comprehensive health care.14-16 The most concerning aspect of contemporary research on this topic is the almost total reliance on personal experience rather than effective medical education to inform nutrition care.16 Efforts to embed nutrition in medical curricula and practice have been met with multiple barriers, including perceived lack of time and a low priority for nutrition education, inadequate teaching materials, lack of knowledge and skills, inadequate remuneration, lack of confidence to provide nutrition care, and lack of nutrition expert teachers.16, 17 The barriers, especially where expert teachers may not sit within medical schools, may have also limited advocacy for inclusion of content in accreditation standards. Despite mandated nutrition education in the United States since 1990,18 it was still deemed necessary that Congress set a precedent, calling on medical schools and other health education providers to cover meaningful content on nutrition and diet, related to the mounting personal and financial burden of diet-related disease.19 The accreditation standards for primary medical courses in Australia and New Zealand20 specify that medical practitioners need only to “explain environmental and lifestyle choices and advocate for healthy lifestyle choices” and dietary investigation may be implied in words around eliciting thorough histories including “lifestyle features”. Having a medical workforce equipped with evidence-based knowledge and skills in nutrition would align with the objectives of the National Preventive Health Strategy to significantly decrease the overall burden of disease by addressing the wider determinants of health, including access to, and consumption of, a healthy diet. Critically, this would improve population health outcomes, contributing to economic and social benefits, including gross domestic productivity.8 Therefore, future medical education must incorporate a focus on nutrition as both prevention and treatment for disease. The opportunity for doctors to support patients with their diet is critical in primary care, given doctors’ greater contact over time with patients compared with other health professionals. Patients perceive doctors as a trusted source of information and express preference to receive their nutrition information from doctors rather than other professionals, even dietitians.14 Teaching nutrition within the medical education environment sensitises students to the relevance of nutrition in the prevention and treatment of disease.21 It provides opportunities to recognise when referral to experts such as dietitians is required, and empowers doctors to advocate for and reinforce the importance of nutrition to patients.22 Although there are systemic barriers to such care in general practice, such as consultation time and limited access to dietetic services,23 including nutrition care in primary health settings has been found to be cost-effective for a range of clinical outcomes, warranting increased investments into primary prevention.24 Consensus on essential nutrition knowledge and skills for doctors is progressing. The international literature describes that many of the potential areas of nutrition competency fall into themes of clinical practice, health promotion and disease prevention, communication, working as a multidisciplinary team, and professional practice.17 These themes are broader than nutrition, yet could incorporate relevant nutrition context. The inclusion of nutrition in existing elements of topics would limit additional content in busy curricula and would integrate concepts of nutrition which underpin both prevention and treatment of disease. There is opportunity for vertical and horizontal integration of nutrition into existing medical curricula without adding time or material, and successful examples of this have been implemented.25 If taught by nutrition-trained academics such as dietitians, this would enhance understanding of scope of practice. Specifically, competencies may include the need for doctors to be able to identify when an individual might benefit from referral for specialist advice and to provide support as part of a multidisciplinary approach to nutrition care. Underpinning concepts must include food knowledge — and the relationship of nutrients and, therefore, food with disease — and nutrition could be used as an integrated example in teaching evidence-based practice (Box).23 Consensus on nutrition knowledge and skills may be furthered by engaging in discussion with medical and health care professionals to integrate interprofessional and multidisciplinary approaches into nutrition education. Consensus on nutrition competencies will provide a benchmark for development of accreditation mechanisms to address the dearth in nutrition education in medical training. Shaded areas represent content that may be integrated into existing curricula. Two factors identified as critical to the success of nutrition in medical education include i) demonstrated relevance of nutrition course material to the practice of medicine, and ii) positive role modelling.21 Yet, students in medical schools identify that they do not have medical nutrition role models.16 Nutrition is not a recognised medical specialty training program in Australia, limiting potential mentors, and the contributions of dietitians to nutrition education is somewhat ad hoc.14 For successful teaching and role modelling, strong relationships are required between dietitians and medical professionals who will model nutrition care at universities and in practice. To achieve delivery of appropriate nutrition care by medical practitioners, including an understanding of when to refer to experts such as dietitians, medical programs must have mandated nutrition knowledge and skills as part of the curricula. International reviews identify that only 44% of regulatory standards for medicine, such as curriculum guidance and accreditation standards, include nutrition content or requirements.26 Therefore, where there is an opportunity for a mandated framework of minimum nutrition standards to provide incentives, most countries do not include such regulation. Without incentive, it is unlikely that medical education providers will pursue curriculum changes. Accreditation bodies need to ensure nutrition is included in accreditation requirements in entry-level medical programs so that the nutrition curricula are adequate, authentic, inclusive and evidence-based. The review of the Australian Medical Council accreditation standards — being undertaken at the time of writing — may provide such opportunities. Challenges in health care include an ageing population, rising health care costs with improving technology and new drugs, predominance of NCDs, and health-related effects of climate change, including inequity. There is a need to focus on cost-effective strategies to prevent NCDs, and to keep people with NCDs well. Medical professionals are in a prime position to signal the importance of nutrition in health and wellbeing as well as working within multidisciplinary teams to provide nutrition care. Even though experience provides opportunities to learn, mandating minimum standards will ensure a threshold of nutrition learning to build on in practice. Nutrition education should be prioritised in order to educate medical professionals who are competent to practise in the current health environment. This work is undertaken in partnership with the Australian and New Zealand Network, and Virtual Core of the NNEdPro Global Institute for Food, Nutrition and Health (Cambridge, UK), linked with its Nutrition Education Policy in Healthcare Practice (NEPHELP) initiative. We acknowledge the specific contributions of NNEdPro colleagues and collaborators, including Sumantra Ray, to this article. Open access publishing facilitated by University of Wollongong, as part of the Wiley - University of Wollongong agreement via the Council of Australian University Librarians. No relevant disclosures. Not commissioned; externally peer reviewed.

In 2012, the World Health Assembly (WHA) endorsed global targets to reduce malnutrition in all its forms by 2025. The specific six nutrition targets aim to reduce low birth weight, stunting, wasting and anaemia in women of reproductive age;stop the rise of overweight in children under five years of age;and increase exclusive breastfeeding.1 In the following year, global targets for nutrition-related non-communicable diseases (NCDs) were further established, including halting the rise of diabetes and obesity in all age groups.2 Unfortunately, the world is off course to meet these targets with the exception of exclusive breastfeeding.3 On top of this, the Covid-19 pandemic has put enormous pressures on already strained food and healthcare systems contributing to increases in food insecurity and malnutrition worldwide.4 Malnutrition imposes high economic and social costs on individuals, families, and countries5;and effectively implementing preventative and curative actions to curb alarmingly high rates of malnutrition is still urgently needed.

Background:This paper provides an overview of capacity-building efforts in the context of nutrition education for medical and healthcare professionals. Methods:Content 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. Findings:Most 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. Conclusion:Increased 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. Recommendations:Key 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.

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.

The six key action areas, outlined in the Work Programme of the UN Decade of Action on Nutrition, provide a blueprint for sustained nutrition action and are positioned within the 2030 Agenda for Sustainable Development, particularly Target 2.2, ending all forms of malnutrition by 2030.5 Five years on from when the Nutrition Decade was proclaimed, hunger and malnutrition remain problems of huge scale with diet-related health costs linked to mortality and non-communicable diseases projected to exceed USD 1.3 trillion per year.2 Although the change to date has been modest, the remaining years of the Nutrition Decade present an unprecedented opportunity for accelerated efforts. The NNEdPro Global Centre is an award-winning interdisciplinary think-tank, training academy and knowledge network anchored in Cambridge, UK.6 The work of NNEdPro focuses on developing adaptable and scalable models for nutrition education and combining clinical and public health knowledge with leadership training to aid and evaluate implementation in education, health care and community settings globally. [...]the unaffordability of eating well is exacerbated by the pandemic and highlights the need to revitalize nutrition commitments and strengthen accountability for such action.2 There is also a need to consider the impact of trade and investment policies on food systems and maximise action to improve food security and nutrition, and invest responsibly into agriculture and food systems.22 In Action Area 5, Safe and supportive environments for nutrition at all ages, there remains scope to scale-up and further strengthen country level action by improving food offered in public institutions (e.g., school, prison, and hospital settings), considering regulatory approaches to shape food price and availability, and subsequently food choice, and supporting the use of the Voluntary Guidelines on Food Systems and Nutrition of the Committee of World Food Security,23 as discussed at the Summit. The food system accounts for more than one-third of global greenhouse gas emissions, and conversely, the present environmental crisis also places additional strain on the food and healthcare systems.18 Diet-related greenhouse gas emissions are estimated to exceed USD 1.7 trillion per year by 2030 based on current food consumption patterns.18 The resources required to sustain current food systems are vast;food production consumes over 50% of the planets habitable land surface and 70% of freshwater.19 Health care systems constitute a large sector which requires considerable amounts of energy and resources and produces substantial emissions and waste.20 For example, in 2012 alone, the European health system produced 24.7 million tonnes of carbon dioxide emissions, the equivalent of the total greenhouse gas emissions of the entire country of Croatia that same year.21 In the context of the Nutrition Decade, we need increased recognition of the role of agriculture and food systems to promote crop diversification, to create healthy food environments, and to implement measures to ensure food safety standards.

Policies and guidance alone will likely be insufficient to achieve significant changes in nutrition and health outcomes and a global shift in behaviour is needed. Developing workforce capacity to communicate, implement and scale up effective nutrition interventions is crucial. It is important to ensure that frontline workers, who are in contact with thousands of people every day, have the necessary knowledge, skills and competencies to approach nutrition in an informed, integrated and sensitive way. Despite this need, research in the UK has shown that nutrition training for healthcare professionals is limited and medical students and junior doctors lack confidence and feel underprepared to advise patients on nutrition. Gaps in nutrition capacity development for health professionals might not be a problem only in the UK, with a recent literature review showing that only 44% of medical accreditation and curriculum guidance available internationally integrated nutrition as a content area. Limited nutrition education and training represent a missed opportunity for appropriate action on nutrition. Several initiatives led by organisations in the UK and globally to address this gap were discussed during the 7th Summit. The FAO elearning Academy, for example, offers free multilingual elearning courses with the aim to prepare professionals to design policies and programmes targeting agriculture, food, nutrition, and health, and transfer the multi- and trans-disciplinary competencies, that are needed. The Nutrition Education Policy in Healthcare Practice (NEPHELP) was another example discussed. NEPHELP delivers workshops that are sensitive to real-world challenges faced by health professionals and promotes the development of nutrition champions that share their learning with others. Culinary Medicine UK also supports medical students and healthcare professionals. It uses a bespoke kitchen as a classroom to teach nutrition through realistic clinical cases and offers opportunities to practice consultation skills. Advocacy in this area has been campaigned by different groups in the UK, including the Nutrition Implementation Coalition, formed by groups such NNEdPro, Culinary Medicine UK, Nutritank and Education and Research in Medical Nutrition Network (ERimNN). An important step in integrating more nutrition content into medical doctors and allied health professionals' education training would be the inclusion of nutrition as a mandatory requirement in accreditation standards, which could act as an incentive for education institutions. Nutrition should be integrated as a cross-cutting theme aligned with core competencies and roles already considered in current standards for health professionals. The UK achieved an important milestone in this domain in 2021 with the launch of the Association for Nutrition Undergraduate Curriculum in Nutrition for Medical doctors. An assessment of the needs and barriers will be conducted with relevant stakeholders to facilitate the implementation of the new curriculum across universities in the UK. In addition to formal education and training in nutrition, another way of supporting nutrition best practices is through curation of relevant research being produced in many parts of the world and their publication free of cost in channels such as BMJ Nutrition, Prevention and Health Journal.

Competency framework development in health professions has downstream implications for all relevant stakeholders, from the professionals themselves, to organisations, and most importantly end users of services. However, there is little guidance related to what stakeholders might be involved in the competency development process, and when. This review aimed to systematically review literature related to competency framework development methodology in health, to identify the breadth and purpose of key stakeholders commonly involved in the process. Studies were identified using five electronic databases (MEDLINE, PubMed, CINAHL, EMBASE, and ERIC) and a search of websites of organisations involved in curriculum or regulation using keywords related to competency frameworks. The total yield from all databases was 10,625 results, with 73 articles included in the final review. Most articles were from Australia (30%) and were conducted in the nursing (34%) profession. Unsurprisingly, practitioners (86%) and academics (75%) were typically engaged as stakeholders in competency framework development. While many competency frameworks were described as patient-focused, only 14 (19%) studies elected to include service users as stakeholders. Similarly, despite the multi-disciplinary focus described in some frameworks, only nine (12%) studies involved practitioners from other professions. Limiting the conceptualisation of competence to that determined by members of the profession itself may not provide the depth of insight required to capture the complexity of healthcare and address the needs of important stakeholder groups. Future methodology should attempt to engage a variety of relevant stakeholders such as external health professions and the community to match professional education to health service demands. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=128350.

Objective Globally, 11 million deaths are attributable to suboptimal diet annually, and nutrition care has been shown to improve health outcomes. While medically trained clinicians are well-placed to provide nutrition care, medical education remains insufficient to support clinicians to deliver nutrition advice as part of routine clinical practice. Competency standards provide a framework for workforce development and a vehicle for aligning health priorities with the values of a profession. Although, there remains an urgent need to establish consensus on nutrition competencies for medicine. The aim of this review is to provide a critical synthesis of published nutrition competencies for medicine internationally. Design Integrative review. Data sources CINAHL, Medline, Embase, Scopus, Web of Science and Global Health were searched through April 2020. Eligibility criteria We included published Nutrition Competency Frameworks. This search was complemented by handsearching reference lists of literature deemed relevant. Data extraction and synthesis Data were extracted into summary tables and this matrix was then used to identify common themes and to compare and analyse the literature. Miller’s pyramid, the Knowledge to Action Cycle and the Dreyfus model of skill acquisition were also used to consider the results of this review. Results Using a predetermined search strategy, 11 articles were identified. Five common themes were identified and include (1) clinical practice, (2) health promotion and disease prevention, (3) communication, (4) working as a team and (5) professional practice. This review also identified 25 nutrition competencies for medicine, the majority of which were knowledge-based. Conclusions This review recommends vertical integration of nutrition competencies into existing medical education based on key, cross-cutting themes and increased opportunities to engage in relevant, skill-based nutrition training.

Abstract: In 2017, 11 million deaths were attributable to diet-related risk factors, yet dietary improvements could potentially prevent one in every five deaths that occur globally. Addressing global nutrition challenges requires multi-sectoral action to strengthen the health system response for nutrition and reshape the food system to support healthy sustainable diets for all. The UN Decade of Action on Nutrition presents an opportunity to unify the aspirations of the nutrition and agriculture community to achieve food systems transformation and end malnutrition in all its forms. The aim of this paper is to describe the development and impact of an innovative technology-based, multi-stakeholder knowledge hub, the International Knowledge Application Network Hub in Nutrition 2025 (iKANN). iKANN is an open access, online portal with bespoke e-learning, a collation of openly available knowledge resources with commentary and guidance and interactive sections for workforce capacity building. Information related to the first very timely thematic evidence collection of ‘Covid-19 and Nutrition’ is available, with the second and third thematic evidence collections, ‘Cardiometabolic Disease and Nutrition’ and ‘Nutrition and Food Security’ to follow in early 2021. The initiative seeks to platform translatable information and training at a global level, drive the implementation of knowledge into policy and practice and bridge the gap between the agricultural and human nutrition communities to foster collaborative change. The next step for the iKANN initiative is the dissemination of its existence and to continue to populate and curate the evidence and information available. We anticipate the evolution of this important platform will be organic and encourage you to become a member today.