Strategic planning for I-KANN-25 and the BMJ Nutrition, Prevention & Health

For NNEdPro strategic planning, Summit delegates were grouped into topics based on their background and experience. Each group discussed how their topic should be represented in I-KANN-25 and the new BMJ journal. Group discussions were summarised, with attendees listed in table 1.

Nutrition as a hard science

Nutrition science is complex but significant advances have been made in uncovering evidence of the effects of many dietary constituents, including the use of vitamin C to eradicate scurvy. The science has led to the formation of dietary guidelines, but due to complexity of the science, population-level guidelines are limited in their ability to maximise individual nutritional health. Keynote speaker, Dr Fiona Godlee, highlighted the need for sound nutrition science in the field of preventive medicine and emphasised that nutrition and lifestyle diseases, drawing on the example of non-alcoholic fatty liver disease, are prevalent and present a huge cost to healthcare systems. Despite this, nutrition training for doctors is relatively non-existent, resulting in an unsustainable culture of ‘a pill for every ill’ for both treatment and prevention. Nutrition scientists, doctors and other healthcare professionals must assess gaps in knowledge and develop innovative means to individualise nutrition advice, a message that was echoed by Professor Martin Kohlmeier, inaugural editor of BMJ Nutrition, Prevention & Health. Professor Kohlmeier highlighted the significant accomplishments made in nutrition research, including the potential role of vitamin D supplementation in reducing the risk of developing influenza A. Professor Kohlmeier also proposed that the strength of nutrition as a science lies in the ability to continually question findings and develop further research. Professor Daniele Del Rio used the example of polyphenols to illustrate this point. In research settings, polyphenols have been shown to have beneficial effects on inflammation, cell growth, brain function and urinary tract infection. When these potential effects are studied within human subjects, however, there is variability in outcomes. As a hard science, there is a need for knowledge creation within the science of nutrition to be individualised in its delivery.

Nutrition and implementation education

While nutrition is an established hard science, strategies are required to promote the use of new interventions into routine practice, once proven effective. In particular, there is a need for nutrition training of multidisciplinary healthcare professionals to enhance delivery and translation of nutrition evidence. This is a central theme of NNEdPro’s ‘Nutrition Education Policy for Healthcare Practice’ (NEPHELP) project. NEPHELP is core funded by the 2017 Medical Nutrition Industry (MNI) grant—awarded to NNEdPro and the British Dietetic Association. Professor Sumantra Ray (SR) highlighted that a central objective of this project is to evaluate current nutrition education provided to the healthcare workforce, identify gaps in nutrition education provision and develop a tailored learning package. Dr Rajna Golubic gave an overview of preliminary results of the evaluation, which showed that doctors feel nutrition training during their medical degree was minimal, and either informal or entirely absent during their career development. Doctors also felt that responsibility for nutrition should lie with dietitians, but continuous nutrition training is required to ensure best practice.

For example, an area that would benefit from clarification is the treatment of cow’s milk protein allergy (CMPA). CMPA is a common food allergy in infants and young children and current guidelines advise strict exclusion of cow’s milk protein from the diet. However, Pauline Douglas, RD, pointed out that overprescription of amino acid formulas is a huge cost to the National Health Service and is not benefiting children who may have improved quality of life through tolerance development. NNEdPro’s project to investigate healthcare practitioner knowledge, attitudes and practices towards identification and management of CMPA, while developing a model for improvement, has found a lack of consensus in management pathways and disagreement on best practice.

Meeting global nutrition challenges

The Summit finished with a broader consideration of global nutrition-related issues in specific contexts or populations. The presentations within this section highlighted the combined importance of collaboration, education and innovation to address these issues. Developing stakeholder collaboration has been a long-standing key strategy for NNEdPro and GODAN in their aim to create a network of open data in nutrition. Nida Ziauddeen provided an overview of the network’s goal of open, accessible data across food systems, which enables efficiency within the nutrition and public health field and can help inform policy. Dr John Ingram illustrated that stakeholder engagement is also key across the food system, where an understanding of the different actors involved and their interactions, by way of a ‘food systems perspective’, is fundamental to improving nutrition outcomes. The National Institute for Agricultural Botany Innovation Farm, as described by Dr Lydia Smith, is a key example of the success of collaboration in achieving common goals. The farm is a knowledge transfer initiative comprising stakeholders within science, academia and industry. The farm supports the translation of plant science discoveries into practical applications to address the issues of food security, climate change, sustainable resources, and health and nutrition.

The importance of education as a tool for addressing nutrition issues was evident at the NNEdPro Summit. Professors Eleanor Beck and Caryl Nowson from NNEdPro’s Australia and New Zealand Network (ANZ Network) stressed that both collaboration and education are key to achieving nationwide adoption of nutrition competencies within Australian medical curriculum. This is a necessary step in the ANZ Network goal to strengthen the nutrition competence of medical professionals in Australia and New Zealand. Professor Nowson explained that collaboration across universities is necessary for respected professional bodies to recognise that medical graduates are not meeting basic competencies required to assist patients from a nutrition perspective. Professor Beck also notes that educators can begin to make local efforts to promote nutrition education even before any changes are achieved in policy or curriculum. Lunchtime lectures, web-based learning such as Monash University Food as Medicine courses10 and relevant student research projects should be considered to stimulate interest in nutrition education outside of formal curriculum. Dr Nitya Rao and Dr Shailaja Fennell from the Transforming India’s Green Revolution by Research and Empowerment for Sustainable Food Supplies group highlighted that education is needed to address gender inequity issues within India by improving the health and nutrition literacy of women and youth, proposing implementation of innovation kitchens/workshops within rural communities in India.

Lastly, the Summit emphasised that innovation is at the forefront in addressing complex global nutrition issues where current intervention or efforts are not proving effective. The use of the novel nanoiron supplement, iron hydroxide adipate tartrate (IHAT), exemplified this. IHAT is used for the treatment of iron deficiency anaemia in young children within the Gambia, as described by lead researcher of the IHAT-GUT trial, Dr Dora Pereira. Current supplementation with soluble iron may be associated with increased risk of infection due to how readily available the iron is to the cell, and therefore to any potential pathogens present. IHAT is effectively absorbed while remaining nanoparticulate in the gut, similar to the iron in foods we eat, resulting in a slower release of iron, with less risk of infection for vulnerable populations. Innovation in technology can also enhance the ability to reach wider, global audiences for research or education purposes, such as through web-based applications and social media, if adopted effectively by public health researchers and educators. Dr Fennell proposed the use of mobile applications to assist the mapping of demand for education, training and skilling programmes in different rural and periurban communities in India, and using social media to connect interested groups and improve the availability of information. Similarly, Professor Nowson suggested the value of an online platform to monitor and record the development of nutritional competencies within Australian medical courses.

Conclusions and next steps

The 2018 NNEdPro Summit reiterated that nutrition is indeed a hard science, both from the perspective of the required scientific rigour needed to properly research diet and nutrition, through to the challenges with knowledge dissemination. However, through a combined focus on research as well as accurate implementation and translation into medical education and patient facing information, nutrition can be reliable in its messaging. Throughout all of these discussions, an underlying message was the need for valid and reliable data to inform decisions at the individual, local and global levels. This need led to the topic of the 2019 Summit: ‘Closing the Gap: Data-based Decisions in Food, Nutrition and Health Systems’.