Advancing Nutrition Education, Training, and Research for Medical Students, Residents, Fellows, Attending Physicians, and Other Clinicians: Building Competencies and Interdisciplinary Coordination

Pediatric Resident Nutrition Education Improves Confidence and Knowledge of Infant Formula Management

OBJECTIVE

(1) To examine pediatric residents' knowledge, practices, and confidence in the management of infant formula; and (2) to assess whether a targeted educational intervention improves knowledge, practices, and confidence in infant formula management using a posteducation survey.

METHODS

A pilot educational intervention study was conducted using preeducation and posteducation questionnaires. Differences in means between variables were evaluated using Student's t tests, and differences in medians were evaluated using Mann-Whitney tests.

RESULTS

A total of 17 and 18 residents completed surveys before and after educational intervention, respectively. Resident knowledge significantly improved after the education (P = 0.002). Residents' lack of confidence improved in all categories, including infant formula preparation and safety guidelines (P < 0.001).

CONCLUSIONS AND IMPLICATIONS

This pilot study suggests that pediatric residents may have knowledge gaps regarding infant formula and lack confidence in its management. Nutrition education shows promise for improving knowledge and confidence, although it needs to be replicated with a larger sample size and a more rigorous research design.

Nutrition Education and Practice in University Dental and Oral Health Programmes and Curricula: A Scoping Review

INTRODUCTION

Dentists and oral health practitioners have a potential role in supporting the prevention and management of noncommunicable diseases. However, the extent to which university education prepares practitioners to provide nutrition care is unclear. This scoping review identifies and synthesises the evidence related to university-level nutrition education provided to dental and oral health students globally.

METHODS

A scoping review identified relevant literature through search terms "dentistry," "oral health," or "oral hygiene"; "dental students" or "dental education"; "nutrition education" or "nutrition science." Articles were included that examined nutrition education in undergraduate oral health training; or nutrition knowledge, attitudes, confidence, or skills or dietary habits; experts' opinion papers; and position statements. No limitations on the publication years or languages of the articles were applied.

RESULTS

A total of 136 articles were included. Half were surveys of students (n = 49) or academic staff (n = 21). The remainder comprised reports of curriculum initiatives (n = 26), opinion papers or narrative reviews (n = 24), position statements (n = 6), curriculum development (n = 6) and curriculum guidelines (n = 9). While dental and oral health students and curriculum experts overwhelmingly recognised the importance of nutrition, most studies that assessed nutrition knowledge of students revealed limited knowledge. Students were not confident in their skills to provide nutrition care. Lack of nutrition experts on teaching teams and unclear expectations about developing nutrition competencies were identified as barriers to greater nutrition education.

CONCLUSION

Nutrition education in university dental and oral health degrees is highly variable. The potential for oral health professionals of the future to promote oral health through nutrition is unrealised.

Healthcare and non-healthcare professionals' knowledge about nutrition in older adults: a cross-sectional study

BACKGROUND

Malnutrition frequently affects older adults, increasing their risk for numerous diseases, as well as healthcare costs. Therefore, nutritional assessment and appropriate nutritional support addressed to meet individual nutritional needs and prevent malnutrition and its consequences should be a fundamental part of healthcare for older adults. This study aimed to compare the knowledge of nutrition guidelines for older adults between healthcare and non-healthcare professionals working with older adults.

METHODS

The study was conducted during May and June 2021 using a validated "Knowledge of nutrition guidelines for older adults" questionnaire designed by Andrija Stampar Teaching Institute of Public Health, Croatia. The study participants were recruited from various institutions providing care for older adults in Split-Dalmatia and Dubrovnik-Neretva County. The final convenience sample consisted of 214 participants (163 healthcare professionals and 51 non-healthcare professionals). The obtained results were analyzed using descriptive and inferential statistics. The associations between participants' characteristics and knowledge about the importance of nutrition in disease prevention and treatment, the assessment of nutritional status in older adults, and clinical nutrition were analyzed using multiple linear regression models.

RESULTS

Participants' overall knowledge of nutrition guidelines for older adults was moderate in both groups, with healthcare professionals scoring a median of 7.0 (IQR = 1.0) and non-healthcare professionals scoring a median of 6.0 (IQR = 2.0). Compared to non-healthcare professionals, healthcare professionals had lower knowledge about the importance of nutrition in disease prevention and treatment (β = - 0.16; p = 0.024). No statistically significant differences were found between healthcare and non-healthcare professionals in the level of knowledge about the assessment of nutritional status in older adults (β = - 0.02; p = 0.769) and clinical nutrition (β = 0.08; p = 0.267).

CONCLUSIONS

This study highlights gaps in knowledge regarding dietary guidelines for older adults among healthcare and non-healthcare professionals working with this specific population group. These findings suggest that targeted educational programs might be needed to improve understanding of geriatric nutrition.

Food sources of energy and nutrients among US college students: The Health Starts Here cohort study

Objective: Identifying the food sources contributing most to total energy percentage, macronutrients, vitamin and mineral consumption among college freshmen, and whether sex played a role. Participants: First-year undergraduate students (N = 269). Methods: Diet was assessed using a DHQ-III and estimated with food source composition tables. Nutrient intakes were expressed as a percentage of total dietary intakes for each food category. Mann-Whitney U tests were used to determine the differences between the two sexes for each food category. Results: A significant proportion of energy and nutrients is contributed by certain food categories, such as grain products, meat, poultry, fish; however, other less desirable sources of energy and nutrient are also identified, including sugary and sports drinks. Among female students, a greater portion of nutritional intakes came from healthier choices. Conclusions: A majority of total energy intake comes from food categories that are energy-dense but also provide essential nutrients.

Culinary Medicine and Teaching Kitchens: Dietitians Leading Innovative Nutrition Training for Physicians

The objective of this evaluation was to determine the impact of a pop-up Teaching Kitchen (TK) at a national cardiovascular conference. The 60-minute session was hosted in a hotel conference room and led by two registered dietitians. Participants prepared 12 recipes, enjoyed a family-style meal, and explored nutrition behaviour change strategies for patients. Using Likert-scaled and open-ended questions, pre-/post-online surveys assessed change in perceived nutrition counselling skills, attitudes, and confidence; post-survey also assessed effectiveness of session components and further training needs. Pre-survey response was 72% (18/25). Twenty-one participants attended the event (14 pre-registrants, six from waitlist, and five drop-ins); 81% completed the post-survey. Positive shifts were reported in nutrition competence, particularly attitudes towards using recipes in nutrition counselling, and increased skills and confidence discussing eating on a budget and SMART (Specific, Measurable, Achievable, Relevant, and Time-Bound) goal setting with patients. Components of the TK session that enhanced nutrition competence were key patient messages and the shared meal. Preparing and eating together in a hands-on format was most enjoyable. Promoting healthy eating behaviours requires understanding the complexity of individual and societal food literacy. With high physician interest, dietitians are well positioned to deliver culinary medicine interventions and support physicians' confidence in health promotion and chronic disease prevention and management.

Lifestyle Medicine in Medical Education: Maximizing Impact

The relationship between lifestyle behaviors and common chronic conditions is well established. Lifestyle medicine (LM) interventions to modify health behaviors can dramatically improve the health of individuals and populations. There is an urgent need to meaningfully integrate LM into medical curricula horizontally across the medical domains and vertically in each year of school and training. Including LM content in medical and health professional curricula and training programs has been challenging. Barriers to LM integration include lack of awareness and prioritization of LM, limited time in the curricula, and too few LM-trained faculty to teach and role model the practice of LM. This limits the ability of health care professionals to provide effective LM and precludes the wide-reaching benefits of LM from being fully realized. Early innovators developed novel tools and resources aligned with current evidence for introducing LM into didactic and experiential learning. This review aimed to examine the educational efforts in each LM pillar for undergraduate and graduate medical education. A PubMed-based literature review was undertaken using the following search terms: lifestyle medicine, education, medical school, residency, and healthcare professionals. We map the LM competencies to the core competency domains of the Accreditation Council for Graduate Medical Education. We highlight opportunities to train faculty, residents, and students. Moreover, we identify available evidence-based resources. This article serves as a "call to action" to incorporate LM across the spectrum of medical education curricula and training.

An exploration of self-perceived competence in providing nutrition care among physiotherapists in Ireland: a cross-sectional study

BACKGROUND

Integrating nutrition care into physiotherapy can address modifiable risk factors contributing to chronic diseases, providing comprehensive and effective patient care, and supporting a wellness-oriented approach to healthcare.

OBJECTIVE

To investigate physiotherapists' self-perceived confidence in their competence in nutrition care in Ireland.

METHODS

Cross-sectional study using data from a validated online survey tool. Four constructs of competence in nutrition care were assessed: knowledge, skill, communication and counseling, and attitude. Open-ended responses were collected to gather opinions on nutrition knowledge requirements. Participants were chartered physiotherapists representing public and private workplaces across geographical settings in Ireland.

RESULTS

447 physiotherapists completed the survey. Most were female (n = 364, 81%), in private practice (n = 136, 31%), and located in a city (n = 215, 48%) with a mean 17 years post-qualification experience. Participants' self-perceived confidence in nutrition care competence was positive (mean score of 107.2/175). However, knowledge (mean score of 18.5/35) and skills (mean score of 27.2/55) related to nutrition care received lower ratings. Age and years of practice were positively associated with higher confidence in providing nutrition care. Most participants (n = 314, 71%) agreed that additional nutrition education is needed. Three overarching themes were identified regarding nutrition knowledge requirements: importance of providing nutrition advice, stated knowledge needs for nutrition education and training, and feasibility of nutrition care within physiotherapy practice.

CONCLUSIONS

Physiotherapists in Ireland have confidence in provision of nutrition care but rated their knowledge and skills in nutrition as relatively low. Nutrition knowledge and skill are essential for physiotherapist practice as they can significantly impact patients' outcomes.

Behavioral Frameworks and Translational Applications of Culinary Medicine and Culinary Nutrition

Culinary medicine and culinary nutrition programs have emerged as innovative approaches to influencing dietary and lifestyle behavior change. These models vary in reported use of behavioral frameworks for planning purposes and attributing efficacy to current inconsistencies in format and delivery. This report aims to review current practice of behavior change theories in culinary medicine/culinary nutrition, delineate constructs that support positive outcomes, and describe future directions for translational applications in integrating the skills of chefs, nutrition educators, and medical professionals.

Prevention and Management of Malnutrition in Patients with Chronic Obstructive Pulmonary Disease: A Scoping Review

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is linked to altered nutritional status due to increased catabolism, leading to muscle mass loss. This study aims to identify and map available evidence regarding multidisciplinary interventions focused on prevention, diagnosis and nutrition education, as well as the role of diet, to prevent and manage malnutrition in patients with COPD.

METHODS

A scoping review was conducted using the Cochrane, PubMed/Medline, CINAHL, Embase, Scopus, and Web of Science databases. This study adhered to the Arksey and O'Malley framework and JBI methodology.

RESULTS

Of the 1761 records identified, 15 were included. Evidence suggests that the Malnutrition Universal Screening Tool and Mini Nutritional Assessment are the most suitable screening scale. Guidelines have highlighted that personalized nutritional counseling is a very common intervention as it allows for a consideration of all physical, psychological, and social aspects of the patient.

CONCLUSIONS

The role of healthcare professionals is crucial in the early identification of nutrition-related issues and in educating patients about the prevention and management of malnutrition, both in hospital and community settings. Key aspects include early malnutrition detection, personalized counseling and patient education, and a multidisciplinary approach. These findings provide a foundation for developing of targeted patient educational initiatives to improve the nutritional management of COPD patients.

A virtual culinary medicine intervention for ethnically diverse individuals with type 2 diabetes: development of the Nourishing the Community through Culinary Medicine

Virtual culinary medicine education interventions have the potential to improve dietary behaviors, nutrition knowledge, cooking skills, and health outcomes for ethnically diverse individuals with type 2 diabetes. The purpose of this study is to describe the adaptation of the Nourishing the Community through Culinary Medicine (NCCM) program for virtual delivery, and the protocol for pilot testing this intervention. The intervention includes five 90-min virtual NCCM sessions streamed live from a Teaching Kitchen. Feasibility outcomes are recruitment, retention, acceptability, and satisfaction. Short-term effectiveness outcomes are measured through self-administered questionnaires, including perceived health, average daily servings of fruits and vegetables, frequency of healthy food consumption, shopping, cooking, and eating behaviors, cooking self-efficacy, diabetes self-management, perceived barriers to healthy eating, and nutrition knowledge. Demographics and biometric outcomes are sourced from the patient's electronic medical records including glycosylated hemoglobin (HbA1c), Body Mass Index, and blood pressure. We will conduct a single-arm pilot study to test the feasibility and short-term effectiveness of NCCM program with individuals with type 2 diabetes.

Nutrition literacy level of medical personnel in tertiary hospitals: evidence from a cross-sectional study

BACKGROUND

Nutrition literacy (NL), stemming from health literacy, profoundly influences dietary habits and chronic diseases. Despite their pivotal societal role, scant research exists on NL levels among medical personnel. This study examined NL levels among tertiary hospital medical staff in Bengbu and identified influencing factors.

METHODS

Using cluster sampling, all Bengbu tertiary hospitals were selected, with 4-5 departments randomly chosen. A structured questionnaire assessed demographic characteristics, while the NL short-form scale (NL-SF12) evaluated NL. SPSS 26.0 and AMOS conducted statistical analysis, including confirmatory factor analysis and Cronbach's α for reliability. Chi-square tests and logistic regression analyzed group differences and influencing factors.

RESULTS

The NL-SF12 demonstrated robust reliability and validity. Of participants, 34.22% were male and 65.78% female; 41.03% were doctors and 42.16% nurses. Overall, 45.68% exhibited high NL. Females showed higher total NL (OR = 1.47, 95% CI: 1.08-1.98), cognition (OR = 1.66, 95% CI: 1.22-2.24), skills (OR = 1.48, 95% CI: 1.09-2.00), and interactive NL (OR = 2.21, 95% CI: 1.53-3.19) than males. Those with a master's or higher had higher total NL (OR = 2.20, 95% CI: 1.33-3.65) and cognition (OR = 3.23, 95% CI: 1.94-5.37) than those with an associate degree or less. Pharmacists, inspectors, and technicians had higher total NL (OR = 1.55, 95% CI: 1.06-2.26) and functional NL (OR = 1.49, 95% CI: 1.02-2.17). Gender, education level, and career were the influencing factors of nutrition literacy among medical personnel.

CONCLUSIONS

Female medical staff and those with a master's degree or higher showed higher nutrition literacy (NL), particularly in cognition and skills. Pharmacists, inspectors, and other technicians exhibited higher levels of total NL and functional NL. Gender, education level, and career were identified as significant influencing factors of nutrition literacy among medical personnel. Understanding and considering these factors are crucial for developing targeted strategies to enhance nutrition literacy among healthcare professionals. Future efforts to improve nutrition literacy through training and interventions should be tailored to the characteristics of different groups to effectively enhance the capabilities and proficiency of healthcare professionals in nutrition knowledge and practice.

Development of the Competency Evaluation Scale for Clinical Nutritionists in China: A Delphi Study

Background: Clinical nutritionists are responsible for nutritional therapy in clinical practice, which significantly enhances patients' nutritional status. This study aims to develop and validate a competency evaluation scale to effectively assess the abilities of clinical nutritionists. Methods: The competency evaluation scale for clinical nutritionists was developed based on the iceberg model, utilizing literature review, semi-structured interviews, and the Delphi method. The weights of each indicator were calculated using the Analytic Hierarchy Process (AHP), and the validity and reliability of the scale were confirmed through questionnaire surveys. Results: The competency evaluation scale of clinical nutritionists comprised five primary indicators, twelve secondary indicators, and sixty-six tertiary indicators. The primary indicators, including professional theoretical knowledge, professional practical skills, humanistic practice ability, interpersonal communication ability, and professional development capability, have respective weights of 0.2168, 0.2120, 0.2042, 0.2022, and 0.1649. The Cronbach's α coefficients of the five dimensions of the scale were 0.970, 0.978, 0.969, 0.962, and 0.947, respectively. The results of the Exploratory Factor Analysis showed that the prerequisites for factor analysis were satisfied. Additionally, Bartlett's test of sphericity yielded a significance level of p < 0.001, confirming the scale's reliability and validity. Conclusions: The competency evaluation scale for clinical nutritionists developed in this study is of high scientific reliability and validity, which provides assessment criteria for the training and assessment of clinical nutritionists.

Evaluation of the Effect of Nutrition Education on Osteopathic Medical Students' Personal Nutrition Choices and Incorporation Into Future Medical Practice

CONTEXT

Our current research project evaluates the impact of nutrition education on the medical student's personal nutrition goals and the likelihood of incorporating nutrition needs into patient evaluation and treatment plans in future practice. The growing popularity of lifestyle medicine has further emphasized the importance of nutrition in the treatment of all patients, especially those suffering from chronic diseases. The paucity of formal medical nutrition education in medical school curricula leaves a significant gap in the knowledge base of physicians in practice.

OBJECTIVE

In an attempt to close the gap, we increased nutrition education in first-year osteopathic medical students by establishing a nutrition course emphasizing modern competencies and their importance in clinical practice.  Methods: The course evaluation utilized a two-group quasi-experimental pre-test/post-test study design. The intervention group consisted of medical students participating in the newly established course, and the control group consisted of second-year medical students who had not taken the course as part of their curriculum. Information was collected about students' knowledge, attitudes, behaviors around nutrition, their plans to pursue a residency with a focus on culinary medicine and incorporate medical nutrition into their medical practice in the future, and their intention to incorporate culinary medicine into future treatment plans. Participation rates within a voluntary culinary medicine interest group were also tracked.

RESULTS

 Students in the intervention group were 26% more likely to report that proper nutrition for patient care had been addressed in coursework. This suggests that medical students exposed to the medical nutrition course have received more training that is critical in proper patient care than students in the control group. Students in the intervention group were 93% more likely to believe that proper nutrition can be used to prevent disease. Lastly, significantly more students in the intervention group (33% more) intend to explore residency programs with a focus on culinary medicine than those students in the control group.

CONCLUSION

These results demonstrate that nutritional education promotes an awareness of the effectiveness of nutritional counseling in disease prevention and management. Furthermore, it will hopefully prompt future physicians to consider nutritional counseling during their clinical rotations, through residency, and into their independent practice. The presentation of nutrition in the first year of medical school is critical to develop increasing numbers of primary care physicians that promote the importance of nutrition and a healthy lifestyle for patients.

Nutrition Training in Medical Education Among Family Medicine Residents in North Carolina

Background

This study surveyed family medicine residents in North Carolina regarding the state of nutrition education in their residency training. In addition, the survey explored comfort levels with, and attitudes about, discussing nutrition with patients.

Methods

We administered an online questionnaire to family medicine residents in North Carolina (n = 384) asking about their history of nutrition training and their current attitudes about nutrition. The 24-item survey included both Yes and No and Likert-scale responses.

Results

All but one resident had received formal or informal nutrition training during their medical education. Residents overwhelmingly considered nutrition to be an important component of health care, although a majority felt physicians are inadequately trained in nutrition. Feeling comfortable discussing nutrition with patients regarding specific health conditions varied from 45% (gastrointestinal concerns) to 94% (cardiovascular disease) or 95% (diabetes) among residents.

Limitations

The volunteer sampling method used in the study may limit generalizability of the study findings to a broader population of family medicine residents. In addition, precisely defining "formal" and "informal" nutrition training on the survey questionnaire would help to clarify the role of nutrition education in shaping resident attitudes and practices.

Conclusion

This study shows that family medicine residents recognize the importance of nutrition education but do not feel adequately trained to provide it to patients. Given the abundance of evidence linking nutrition and health as well as an apparent interest among family medicine residents in nutrition education, this study supports the integration of nutrition training in medical education. Suggestions for how to accomplish this objective are provided.

Increasing Trainee Comfort with Nutrition

OBJECTIVES

Nutrition counseling is necessary for the prevention and treatment of many chronic diseases. US survey data demonstrate that 61% of Internal Medicine (IM) residents receive little to no nutrition training. The objective of our study was to develop a curriculum to increase IM resident comfort and ability in conducting a nutritional assessment.

METHODS

Categorical IM residents at a large academic medical center participated in a curriculum that included a lecture, a small-group discussion, and a skills exercise. Residents completed pre- and posttest surveys that evaluated their attitudes and comfort level with nutritional assessment.

RESULTS

Eighty percent (84/105) of the residents participated in the curriculum and 48% (40/84) of them completed both pre- and postsession surveys. Residents who considered themselves moderately to extremely comfortable completing a nutritional assessment increased after the program (27.5% to 87.5%, P < 0.0001). The proportion of those who agreed or strongly agreed with the statement, "Nutritional counseling should be included in any routine appointment, just like diagnosis and treatment," increased from 62.50% to 80.00% (P = 0.012). The proportion of residents who considered lack of individual knowledge to be a barrier for nutrition counseling decreased from 65.79% to 42.11% (P = 0.0126).

CONCLUSIONS

This curriculum was successful in increasing IM resident comfort with conducting a nutritional assessment.

Practical strategies to manage obesity in type 2 diabetes

The rising phenomenon of obesity, a major risk factor for the development and progression of type 2 diabetes, is a complex and multifaceted issue that requires a comprehensive and coordinated approach to be prevented and managed. Although novel pharmacological measures to combat obesity have achieved unprecedented efficacy, a healthy lifestyle remains essential for the long-term success of any therapeutic intervention. However, this requires a high level of intrinsic motivation and continued behavioural changes in the face of multiple metabolic, psychological and environmental factors promoting weight gain, particularly in the context of type 2 diabetes. This review is intended to provide practical recommendations in the context of a holistic, person-centred approach to weight management, including evidence-based and expert recommendations addressing supportive communication, shared decision-making, as well as nutritional and pharmacological therapeutic approaches to achieve sustained weight loss.

Medical Nutrition Education for Health, Not Harm: BMI, Weight Stigma, Eating Disorders, and Social Determinants of Health

Effective nutrition training is fundamental to medical education. Current training is inadequate and can cause harm to students and patients alike; it leaves physicians unprepared to counsel on nutrition, places undue focus on weight and body mass index (BMI), can exacerbate anti-obesity bias, and increase risk for development of eating disorders, while neglecting social determinants of health and communication skills. Physicians and educators hold positions of influence in society; what we say and how we say it matters. We propose actionable approaches to improve nutrition education to minimize harm and pursue evidence-based, effective, and equitable healthcare.

There and Back Again: A Forty-Year Perspective on Physician Nutrition Education

Medical education faces an urgent need for evidence-based physician nutrition education. Since the publication of the 1985 National Academies report "Nutrition Education in the United States Medical Schools," little has changed. Although several key efforts sought to increase nutrition content in undergraduate medical education over the past 40 y, most medical schools still fail to include the recommended minimum of 25 h of nutrition training. Without foundational concepts of nutrition in undergraduate medical education, graduate medical education unsurprisingly falls short of meeting patient needs for nutritional guidance in clinical practice. Meanwhile, diet-sensitive chronic diseases continue to escalate, although largely preventable and treatable by nutritional therapies and dietary lifestyle changes. Fortunately, recent recognition and adoption of Food is Medicine programs across the country increasingly connect patients with healthy food resources and nutrition education as core to their medical care, and physicians must be equipped to lead these efforts alongside their dietitian colleagues. Filling the gap in nutrition training will require an innovative and interprofessional approach that pairs nutrition with personal wellness, interprofessional practice, and community service learning. The intersectional benefits of connecting these domains will help prepare future physicians to address the social, behavioral, and lifestyle determinants of health in a way that recognizes nourishing food access as a core part of clinical practice. There are numerous strategies to integrate nutrition into education pathways, including didactic and experiential learning. Culinary medicine, an evidence-based field combining the culinary arts with nutritional science and medicine, is 1 promising educational framework with a hands-on, interprofessional approach that emphasizes community engagement. Advancing the critical need for widespread adoption of nutrition education for physicians will require support and engagement across societal stakeholders, including co-leadership from registered dietitian nutritionists, health system and payor reform, and opportunities for clinical innovation that bring this essential field to frontline patient care.

Educommunication in nutrition and neurodegenerative diseases: a scoping review protocol

INTRODUCTION

Neurodegenerative diseases affect the nervous system and are characterised by the deterioration and/or death of neurons. Nutrition care is essential for maintaining an adequate nutritional status, which influences the prognosis and survival of patients with neurological diseases. Caregivers participate assiduously in the care of these patients and must be integrated into the multidisciplinary team. They often need specific training or knowledge regarding food and nutrition to perform their roles with patients. Health educommunication is a learning tool that can positively influence the appropriation of the theme and the construction of care autonomy. This scoping review (ScR) will map educommunication actions/strategies in nutrition and neurodegenerative diseases.

METHODS AND ANALYSIS

This ScR will be designed based on the methodology of Arksey and O'Malley and will follow the methodological guidance for conducting a Joanna Briggs Institute ScR. The research question addressed by the scoping review will be: what actions/strategies for educommunication in nutrition and neurodegenerative diseases have been developed for patients or caregivers? Many search sites it will be used in this review, such as electronic databases (Embase, PubMed/MEDLINE, Scopus, Web of Science), Google Scholar and grey literature sources. No restrictions of date or language will be applied to the search strategy. Two reviewers will independently screen all abstracts and full-text studies for inclusion. Data, including the study design, objective, study population, neurodegenerative diseases, nutrition topics and educommunication strategies will be logically organised and tabulated in Microsoft Excel.

ETHICS AND DISSEMINATION

The data used for this review are from secondary sources and available to the public; thus, no ethical approval and human consent will be required for this study. Dissemination of the results will be published in a peer-reviewed journal and presented at conferences.

"Food Is Medicine" Strategies for Nutrition Security and Cardiometabolic Health Equity: JACC State-of-the-Art Review

"Food Is Medicine" (FIM) represents a spectrum of food-based interventions integrated into health care for patients with specific health conditions and often social needs. Programs include medically tailored meals, groceries, and produce prescriptions, with varying levels of nutrition and culinary education. Supportive advances include expanded care pathways and payment models, e-screening for food and nutrition security, and curricular and accreditation requirements for medical nutrition education. Evidence supports positive effects of FIM on food insecurity, diet quality, glucose control, hypertension, body weight, disease self-management, self-perceived physical and mental health, and cost-effectiveness or cost savings. However, most studies to date are quasiexperimental or pre/post interventions; larger randomized trials are ongoing. New national and local programs and policies are rapidly accelerating FIM within health care. Remaining research gaps require rigorous, iterative evaluation. Successful incorporation of FIM into health care will require multiparty partnerships to assess, optimize, and scale these promising treatments to advance health and health equity.

Nourishing the Mind: How Food Security Influences Mental Wellbeing

Food insecurity is a significant public health problem worldwide and critical to mental health. There is a complex relationship between food security and mental health. We carried out a narrative review study aiming to address how food insecurity impacts mental wellbeing by focusing on the mental health repercussions of food insecurity, recognizing its pivotal role in attaining Sustainable Development Goals 2 (on hunger) and 3 (on enhancing global wellbeing). A comprehensive search was conducted on PubMed and Google Scholar, incorporating Google searches for pertinent reports and policy documents. To address these questions, we emphasized and elucidated the interconnectedness between food security and mental health. The review shows that food security and mental health share a profound relationship influenced by multifaceted factors like socioeconomic conditions, access to nutritious food, and societal inequalities. We then provide recommendations for integrating food security into mental health strategies based on the insights and conclusions drawn. Strategies ranging from sustainable farming practices to urban agriculture initiatives and digital mental health services demonstrate avenues for enhancing food safety and mental wellbeing. This highlights the need for collaborative interdisciplinary efforts and systemic reforms to address these interconnected challenges.

Growth and development impact of sustainable nutrition education: An experimental study

Healthy societies are formed by learning and maintaining sustainable healthy eating behaviors from childhood. The aim of this study was to determine the effect of short-term sustainable nutrition education on growth and development parameters of preschool children. This study is an experimental design with pretest-posttest control group. This study was carried out in two kindergartens between February 2022 and June 2023 in Turkey. The education group received 4 months of dietary behavior training. The dietary scale and anthropometric measurements were administered at the first and last meetings. Data were analyzed with 95% confidence interval. The study was completed with 174 children. A statistically significant difference was found, especially in body weight (p < 0.05) and body weight percentile values (p < 0.05) in the posttest of the education group. A statistically significant difference (p < 0.05) was found between the groups in the eating behavior scale posttest score. Nutrition education in schools is important in promoting healthy eating habits. Nutrition education improves eating behavior positively. To maintain healthy eating behaviors, however, the continuity of education is necessary. In addition, as growth and development are physical processes, it is recognized that growth and development cannot be assessed by nutrition alone.

Implementation and participation of an online nutrition curriculum for pediatric gastroenterology fellows

Our team of nutrition experts developed an online nutrition curriculum consisting of 21 modules to serve as a resource for a stand-alone nutrition curriculum or as a supplement to existing nutrition electives during the Pediatric Gastroenterology fellowship. From April 2020 through January 2023, 2090 modules were completed by 436 fellows from 75 different programs across North America. The program was accessed most during tight restrictions on in-person learning during the COVID-19 pandemic. Overall, participants posttest scores improved from baseline pretest scores indicating retention of information from the modules. The overall success of this program suggests that there should be continued efforts to develop and offer online learning opportunities in clinical nutrition. There is an opportunity to expand the audience for the curriculum to include pediatric gastroenterologists from across the globe.

Development of a Culinary Medicine Curriculum to Support Nutrition Knowledge for Gastroenterology Fellows and Faculty

Gastroenterologists encounter many nutrition-related disorders in their practice, yet the nutritional needs of patients with chronic gastrointestinal (GI) and liver disease are largely unaddressed by treating physicians, due to suboptimal nutrition education. To address this gap, we developed and piloted a culinary medicine course for a GI fellowship training program. The objective of this study is to describe the development, implementation, and acceptability of the course. A registered dietitian, a chef instructor, and a gastroenterology clinical professor trained in culinary medicine developed the four-class tailored curriculum and delivered the classes remotely. Each class had a theme related to commonly encountered GI disorders and included hands-on meal preparation, a nutrition lecture, and a patient case study discussion. Post-course feedback surveys were disseminated. Twenty-three GI physicians enrolled in the course and the attendance rates in classes 1-4 were 83%, 65%, 61%, and 48%, respectively. Among 15 completed feedback surveys, 80% reported that the class contents were either moderately or extremely useful and all endorsed the curriculum for other gastroenterologists. Future studies of culinary medicine programs tailored to medical specialties should identify strategies to maintain engagement and assess the impact on nutrition knowledge, competencies, and translation of these new skills to clinical practice.

Does power distance in healthcare teams linked to patient satisfaction? A multilevel study of interprofessional care teams in a referral hospital in Indonesia

BACKGROUND

Interprofessional care teams collaborate to provide care to patients in hospitals to ensure their full recovery. To provide quality patient care, healthcare workers must have a comprehensive understanding of each other's roles and collaborate effectively. Good interpersonal skills are also essential for maintaining cooperative and collaborative relationships, listening, and respecting other team member's values and positions. Therefore, this study aimed to investigate the effect of power distance in interprofessional care on patients' satisfaction.

METHOD

A quantitative study was conducted in a hospital by using a questionnaire instrument to collect information from patients and members of the interprofessional care team. The respondents included 10 geriatric, 19 palliative, 36 cancer, 8 burn, and 18 medical intermediate care (MIC) teams. Subsequently, a hierarchical regression analysis was conducted to examine whether interprofessional care could significantly predict the relationship between team power distance and patient satisfaction.

RESULTS

The measurement of the effect of power distance in interprofessional care among doctors, nurses, pharmacists, and nutritionists on patient satisfaction revealed nonsignificant results. However, the final analysis indicated negative coefficients with regard to power distance for nutritionists (-0.033098), nurses (-0.064912), and pharmacists (-0.006056). These findings indicated that the power distance associated with these professions was linked with decreased patient satisfaction.

CONCLUSIONS

The results suggested that power distance within an interprofessional care team can reduce patient satisfaction.

The Time is Ripe: The Case for Nutrition in Graduate Medical Education in the United States

A poor-quality dietary pattern is a leading risk factor for chronic disease and death in the United States, and the costs of medical care continue to unsustainably rise. Despite this reality, nutrition training for physicians fails to adequately prepare for them to address the complex factors that influence diet-related disease. Expanding nutrition education for physicians-in-training is imperative to equip them for the growing demand of food is medicine services and is also supported by recent policy efforts in the United States as well as the governing bodies of graduate and undergraduate medical education. A multisector approach that links graduate medical education, clinical care delivery innovation, and health and food policy experts provides momentum to advance nutrition education as a core strategy for food is medicine expansion globally.

Storied reflections: Development of a longitudinal interdisciplinary curriculum to improve patient-provider communication

Objective

This article details the development of an interdisciplinary graduate medical education (GME) narrative curriculum.

Methods

Descriptive statistics were conducted for the narrative session surveys. Two separate qualitative analyses were conducted. First, content and thematic analyses of the open-ended questions in the survey using NVIVO software occurred. Second, an inductive analysis of the participants' 54 stories was performed to identify unique themes not related to the prompt topics.

Results

Quantitative survey results demonstrated that 84% of learners' felt the session benefited their personal or professional sense of wellbeing and resilience, 90% of learners believed the sessions aided in their ability to listen more effectively, and 86% of learners could apply what they practiced or witnessed. Qualitative analysis of survey data showed learners focused on patient care and listening. Thematic analysis of participants' narratives revealed strong feelings and emotions, struggles with time management, increase in self- and other-awareness, and challenges managing job-life balance.

Conclusion

The longitudinal interdisciplinary Write-Read-Reflect narrative exchange curriculum is cost-effective, sustainable, and demonstrably valuable to learners and their program directors across multiple disciplines.

Innovation

The program was designed for 4 graduate programs' learners to simultaneously experience a narrative exchange model to improve patient-provider communication, support professional resilience, and deepen relationship-centered care skills.

Eat to Treat: The Methods and Assessments of a Culinary Medicine Seminar for Future Physicians and Practicing Clinicians

Nutrition-associated chronic disease is an epidemic in the United States (US), yet most medical schools lack adequate nutrition education. We developed a six-session culinary medicine (CM) seminar entitled "Eat to Treat: A Nutrition Course for Future Clinicians" that teaches culinary skills, nutrition science, and counseling techniques to improve clinical nutrition management. The seminar was offered in-person to first-year medical students in a medical school-based teaching kitchen from 2017 to 2019. A virtual three-session course was also offered to practicing clinicians in 2020. Voluntary self-efficacy questionnaires were collected at the beginning of the first and last sessions of the student seminar, and paired t-tests determined the course's effect on survey items. A total of 53 first-year medical students attended the program over five semesters, and 39 students (73.6%) completed both surveys. All except one measure of self-efficacy were significantly higher at session 6 than session 1 (p < 0.05). A post-course survey was utilized for the clinician seminar and of the 31 participants, 14 completed the surveys; 93% and 86% of respondents agreed the course was clinically relevant and improved their confidence, respectively. We developed a CM curriculum that improved nutrition knowledge and confidence among a professionally diverse cohort and may represent a scalable education model to improve nutrition education in US medical schools.

Physician Nutrition Advice and Referrals to Registered Dietitians

PURPOSE

This study aims to examine the frequency and content of healthcare providers' nutrition recommendations and referrals Registered Dietitian Nutritionists (RDN).

METHODS

Physicians, physician assistants, nurses, and other providers (> 18 years of age) currently practicing primarily in the United States received an email survey that assessed dietary recommendations for diabetes, hypertension, dyslipidemia, overweight/obesity, and general wellbeing, frequency and comfort level of providing nutrition advice, and RDN referrals. Chi-square and Student's t-tests were used for analysis.

RESULTS

154 physicians (61%), registered nurses/nurse practitioners/physician assistants (19.5%), and other providers (19.5%) were included. Those with nutrition education gave nutrition advice more than those without for some, but not all, conditions (P = .01). The Mediterranean diet was most frequently recommended, except for hypertension. The DASH diet was recommended to 47.7% of patients with hypertension. More providers gave dietary advice than referred to RDNs. Dietary advice was associated with RDN referrals for diabetes (P = .01) and wellbeing (P = .05). Providers with an RDN in their practice provided advice for diabetes more than those without (P = .01).

CONCLUSION

Healthcare providers gave nutrition recommendations consistent with evidence-based guidance. RDN referrals occur in conjunction with dietary recommendations, not as replacement.

Application of an Interactive, Hands-On Nutritional Curriculum for Pediatric Residents

Currently, there exists a scarcity of suitable nutrition training resources for the primary care physician (PCP) and a paucity of educational materials for pediatric residency programs. Barriers to nutritional education include: a lack of well-defined competencies, a dearth of centralized resources for nutritional education, and a reliance on didactic teaching methodology. Because PCPs often cite a lack of confidence as a primary reason for not providing nutritional counseling, we created an interactive 3-pronged nutritional curriculum for pediatric residents with the aim of increasing their confidence to provide nutritional counseling to patients. This curriculum included an in-person visit to a local supermarket, an online, interactive case during the resident's continuity clinic, and an interactive lecture. There was a statistically significant change in pediatric residents' confidence to manage issues of outpatient nutrition management. We find this particularly relevant as increasing physician confidence is key to increasing nutritional counseling in a clinical setting.

Nutritional Considerations for Bladder Storage Conditions in Adult Females

BACKGROUND

Clinical guidelines developed by urologic, urogynecologic, and gynecologic associations around the globe include recommendations on nutrition-related lifestyle and behavioral change for bladder storage conditions. This study identified and compared clinical guidelines on three urological conditions (interstitial cystitis/bladder pain syndrome (IC/BPS), overactive bladder, and stress urinary incontinence) affecting adult women.

METHODS

A three-step process was employed to identify the guidelines. Next, a quality assessment of the guidelines was conducted employing the Appraisal of Guidelines Research and Evaluation (AGREE II) International tool. (3) Results: Twenty-two clinical guidelines, prepared by seventeen groups spanning four continents, met the inclusion criteria. The AGREE II analyses revealed that most of the guideline development processes complied with best practices. The most extensive nutrition recommendations were for women with IC/BPS. Dietary manipulation for the other two storage LUTS primarily focused on the restriction or limitation of specific beverages and/or optimal fluid intake. (4) Conclusion: Clinical guidelines for IC/BPS, overactive bladder, and stress urinary incontinence include nutrition recommendations; however, the extent of dietary manipulation varied by condition. The need to ensure that clinicians are informing patients of the limitations of the evidence supporting those recommendations emerged. Furthermore, given the need to treat nutrition-related comorbid conditions as a strategy to help mitigate these three urological disorders, the value of referral to a dietitian for medical nutrition therapy is apparent.

"Zoom"ing to the Kitchen: A Novel Approach to Virtual Nutrition Education for Medical Trainees

While nutritional interventions are first-line therapy for many chronic diseases, most medical trainees receive minimal nutrition education, leaving them unprepared to address nutritional issues with patients. An interactive, single-session, virtual nutrition curriculum was taught online to 80 physician assistant (PA) students. Topics included plant-based nutrition, dietary history-taking and counseling, and culinary medicine. Students were surveyed before, immediately after, and four weeks after the curriculum to assess changes to nutrition-related knowledge, attitudes, confidence, and personal dietary behaviors. Seventy-three PA students (91%) completed the pre-survey, 76 (95%) completed the post-survey, and 42 (52.5%) completed the delayed post-survey. Knowledge scores increased immediately post-intervention (48.9% to 78.9%; p < 0.001) and persisted four weeks later (78.9% to 75.8%; p = 0.54). Post-intervention, students felt more confident in dietary history-taking (55% vs. 95%; p = 0.001) and nutrition counseling (53% vs. 84%; p = 0.003) and agreed that dietary changes alone could reverse type 2 diabetes (74% vs. 97%; p = 0.027) and coronary artery disease (66% vs. 92%; p = 0.039). Curricula using virtual teaching kitchens may be a scalable approach to nutrition education for medical trainees.

Impact of Culinary Medicine Course on Confidence and Competence in Diet and Lifestyle Counseling, Interprofessional Communication, and Health Behaviors and Advocacy

Most physicians report inadequate training to provide diet and lifestyle counseling to patients despite its importance to chronic disease prevention and management. To fill the nutrition training gap, elective Culinary Medicine (CM) courses have emerged as an alternative to curriculum reform. We evaluated the impact of an interprofessional CM course for medical and health professional students who experienced the hands-on cooking component in person or a in mixed-mode format (in-person and via Zoom) at the University of Utah from 2019-2023 (n = 84). A factorial ANOVA assessed differences between educational environment and changes between pre- and post-course survey responses related to diet and lifestyle counseling, interprofessional communication, and health behaviors and advocacy. Qualitative comments from post-course surveys were analyzed on a thematic level. Students rated themselves as having greater confidence and competence in diet and lifestyle counseling (p < 0.05) and increased ability to prepare eight healthy meals (p < 0.05). Additionally, a Mann-Whitney two-sample rank-sum test was used to compare data from exit survey responses from medical students who took the CM course (n = 48) and did not take the CM course (n = 297). Medical students who took CM were significantly more likely to agree that they could counsel patients about nutrition (p < 0.05) and physical activity (p < 0.05). CM courses may improve students' confidence to provide diet and lifestyle counseling.

The Role of the Neonatal Registered Dietitian Nutritionist: Past, Present, and Future

Neonatal registered dietitian nutritionists (RDNs) are critical members of the neonatal intensive care unit (NICU) team due to their unique skillset of growth assessment, nutrition evaluation, and implementation of nutrition best practices. There is a paucity of data on appropriate staffing of neonatal RDNs in NICUs to promote improved patient outcomes. Here, the authors describe current neonatal RDN staffing and responsibilities in the US NICUs.

Impacts of nutrition counseling on depression and obesity: A scoping review

This scoping review aims to evaluate the impact of nutrition counseling on mental health and wellbeing among people affected by obesity. Depression and obesity are major sources of morbidity and mortality worldwide. The prevalence of obesity is higher in patients with severe or suboptimally managed depression. Change in dietary quality prompted by nutrition counseling may pose a unique opportunity for intervention. Of the 1745 studies identified, 26 studies (total n = 6727) met inclusion criteria. Due to the heterogeneity of methods and outcome reporting, it was not possible to perform meta-analysis. Across all included studies, 34 different scales were used to quantify mental health/wellbeing. Eleven studies (42.3%) reported statistically significant findings between intervention and control groups. Only two of these studies assessed nutrition counseling independently rather than as part of a multidisciplinary intervention. Overall, many studies have examined the role of nutrition counseling on mental health/wellbeing in individuals affected by obesity. However, due to inconsistency in study methodologies and outcome measurement tools, it is challenging to draw robust or clinically meaningful conclusions about the effects of nutrition counseling on mental health in this population.

Undergraduate Medical Students' Perceptions of Nutrition Education at the Northern Ontario School of Medicine

The objective of this evaluation was to determine Northern Ontario School of Medicine (NOSM) undergraduate medical education (UME) students' perceptions of the curriculum related to their nutrition knowledge, attitudes, and counseling self-efficacy/confidence. A 16-item electronic survey (Qualtrics^©) was developed, and it included nutrition competency statements, adult and pediatric nutrition assessment and counseling confidence, and nutrition curriculum satisfaction. Students in Years 2, 3, and 4 (n = 192, 66%-73% female) were invited to answer the survey. Of the 61 respondents, 50.8% were Year 2, 34.9% Year 3, and 10.6% Year 4. Overall, 72.1% of the respondents were dissatisfied. Respondents perceived they were least competent in strategies to prevent and treat disease (72.1%), in applying basic dietary strategies (65.6%), and in ethics and nutrition management (62.3%), whereas 52.5% felt competent in the team approach to nutrition care. Respondents reported lowest confidence (less than 10%-15%) in specialized nutrition support, cancer care, renal nutrition, and mental health/eating disorders for both populations. NOSM medical learners reported curriculum dissatisfaction, nutrition incompetence, and poor levels of perceived confidence in nutrition management. Results will be used to inform nutrition curriculum enhancements and future outcome evaluations. Current and future physicians with enhanced nutrition knowledge, awareness of the Registered Dietitian (RD) roles, and an understanding of when to refer patients to an RD can provide better patient-centred care.

Virtual teaching kitchen classes and cardiovascular disease prevention counselling among medical trainees

BACKGROUND

Hands-on culinary medicine education for medical trainees has emerged as a promising tool for cardiovascular health promotion.

PURPOSE

To determine whether virtual culinary medicine programming associates with Mediterranean diet (MedDiet) adherence and lifestyle medicine competencies among medical trainees across the USA.

METHOD

A total of 1433 medical trainees across 19 sites over a 12-month period were included. The Cooking for Health Optimisation with Patients-Medical Trainees survey composed of 61 questions regarding demographics, nutritional attitudes, dietary habits including MedDiet score and lifestyle medicine counselling competencies. Multivariable logistic regression assessed the association of virtual culinary medicine education with MedDiet intake and nutritional attitudes.

RESULTS

There were 519 medical trainees who participated in virtual culinary medicine education and 914 medical trainees who participated in their standard nutrition curricula. More than one-half of participants were women (n=759) and the mean age was 27 years old. Compared with students enrolled in traditional nutrition curricula, participants in virtual culinary medicine education were 37% more likely to adhere to MedDiet guidelines for fruit intake (OR 1.37, 95% CI 1.03 to 1.83, p=0.03). Virtual culinary medicine education was associated with higher proficiency in lifestyle medicine counselling categories, notably recommendations involving fibre (OR 4.03; 95% CI 3.05 to 5.34), type 2 diabetes prevention (OR 4.69; 95% CI 3.51 to 6.27) and omega fatty acids (OR 5.21; 95% CI 3.87 to 7.02). Virtual culinary medicine education had a similar, although higher magnitude association with MedDiet counselling competency (OR 5.73, 95% CI 4.26 to 7.70) when compared with historical data previously reported using hands-on, in-person culinary medicine courseware (OR 4.97, 95% CI 3.89 to 6.36).

CONCLUSIONS

Compared with traditional nutritional educational curricula, virtual culinary medicine education is associated with higher MedDiet adherence and lifestyle medicine counselling competencies among medical trainees. Both virtual and hands-on culinary medicine education may be useful for cardiovascular health promotion.

Clinical interventions to increase vegetable intake in children

PURPOSE OF REVIEW

Eating behaviors and dietary patterns begin in early childhood and persist into adolescence and adulthood, affecting lifelong acute and chronic disease risk. Vegetables provide a high density of necessary vitamins, minerals, and fiber. Dietary intake data show that children of all ages consume below the recommended range for vegetables. Pediatric providers are optimally positioned to promote vegetable intake in childhood. This review seeks to summarize lessons learned from behavioral interventions useful in the pediatric primary care setting to improve vegetable intake.

RECENT FINDINGS

Ten published studies tested behavioral interventions in primary care to increase child vegetable intake. Strategies tested include teaching healthy eating behaviors and role modeling to parents of infants, and motivational interviewing paired with frequent office visits and reminders for families of older children and adolescents. Some strategies suggested positive change, despite study quality being limited by underpowered samples, heterogeneity of outcome measures, and statistical analytic approach.

SUMMARY

Increased vegetable intake was achieved in infants through parental role-modeling when providers emphasized healthy dietary choices in parents. Older children increased their vegetable intake with motivational interviewing and frequent reminders from providers. Despite the high prevalence of inadequate vegetable intake among children, at present, there is only a modest body of literature to help guide pediatric providers in implementing practice-based interventions to improve vegetable intake in childhood, highlighting a need for high-quality research in this area.

Good nutrition across the lifespan is foundational for healthy aging and sustainable development

Ensuring healthy lives and promoting wellbeing across the age spectrum are essential to sustainable development. Nutrition is at the heart of the World Health Organization (WHO) Sustainable Development Goals, particularly for Sustainable Development Goal 2/Subgoal 2, which is to End all forms of malnutrition by 2030. This subgoal addresses people of all ages, including targeted groups like young children and older adults. In recent decades, there have been marked advances in the tools and methods used to screen for risk of malnutrition and to conduct nutritional assessments. There have also been innovations in nutritional interventions and outcome measures related to malnutrition. What has been less common is research on how nutritional interventions can impact healthy aging. Our Perspective article thus takes a life-course approach to consider what is needed to address risk of malnutrition and why, and to examine how good nutrition across the lifespan can contribute to healthy aging. We discuss broad-ranging yet interdependent ways to improve nutritional status worldwide-development of nutritional programs and policies, incorporation of the best nutrition-care tools and methods into practice, provision of professional training for quality nutritional care, and monitoring health and economic benefits of such changes. Taken together, our Perspective aims to (i) identify current challenges to meeting these ideals of nutritional care, and to (ii) discover enabling strategies for the improvement of nutrition care across the lifespan. In harmony with the WHO goal of sustainable development, we underscore roles of nutrition to foster healthy human development and healthy aging worldwide.

A Heart-Healthy Diet for Cardiovascular Disease Prevention: Where Are We Now?

Purpose of Review

The relationship between cardiovascular health and diet is evolving. Lifestyle modifications including diet changes are the primary approach in managing cardiometabolic risk factors. Thus, understanding different diets and their impact on cardiovascular health is important in guiding primary and secondary prevention of cardiovascular disease (CVD). Yet, there are many barriers and limitations to adopting a heart healthy diet.

Recent Findings

Diets rich in fruits, vegetables, legumes, whole grains, and lean protein sources, with minimization/avoidance of processed foods, trans-fats, and sugar sweetened beverages, are recommended by prevention guidelines. The Mediterranean, DASH, and plant-based diets have all proven cardioprotective in varying degrees and are endorsed by professional healthcare societies, while other emerging diets such as the ketogenic diet and intermittent fasting require more long-term study. The effects of diet on the gut microbiome and on cardiovascular health have opened a new path for precision medicine to improve cardiometabolic risk factors. The effects of certain dietary metabolites, such as trimethylamine N-oxide, on cardiometabolic risk factors, along with the changes in the gut microbiome diversity and gene pathways in relation to CVD management, are being explored.

Summary

In this review, we provide a comprehensive up-to-date overview on established and emerging diets in cardiovascular health. We discuss the effectiveness of various diets and most importantly the approaches to nutritional counseling where traditional and non-traditional approaches are being practiced, helping patients adopt heart healthy diets. We address the limitations to adopting a heart healthy diet regarding food insecurity, poor access, and socioeconomic burden. Lastly, we discuss the need for a multidisciplinary team-based approach, including the role of a nutrition specialist, in implementing culturally-tailored dietary recommendations. Understanding the limitations and finding ways to overcome the barriers in implementing heart-healthy diets will take us miles in the path to CVD prevention and management.

Nutrition Education to Reduce Metabolic Dysfunction for Spinal Cord Injury: A Module-Based Nutrition Education Guide for Healthcare Providers and Consumers

Spinal cord injury (SCI) results in a high prevalence of neurogenic obesity and metabolic dysfunction. The increased risk for neurogenic obesity and metabolic dysfunction is mainly due to the loss of energy balance because of significantly reduced energy expenditure following SCI. Consequently, excessive energy intake (positive energy balance) leads to adipose tissue accumulation at a rapid rate, resulting in neurogenic obesity, systemic inflammation, and metabolic dysfunction. The purpose of this article is to review the existing literature on nutrition, dietary intake, and nutrition education in persons with SCI as it relates to metabolic dysfunction. The review will highlight the poor dietary intakes of persons with SCI according to authoritative guidelines and the need for nutrition education for health care professionals and consumers. Nutrition education topics are presented in a module-based format with supporting literature. The authors emphasize the role of a diet consisting of low-energy, nutrient-dense, anti-inflammatory foods consistent with the Dietary Guidelines for Americans' MyPlate to effectively achieve energy balance and reduce the risk for neurogenic obesity and metabolic dysfunction in individuals with SCI.

What Do People Know about Food, Nutrition and Health?-General Nutrition Knowledge in the Austrian Population

BACKGROUND

Only limited information is available on the nutrition knowledge of the general Austrian population and how this relates to the nutrition knowledge of health professionals (medical doctors, pharmacists, nutritionist, dieticians) and school teachers.

METHODS

Adolescents and adults at the age of 14-75 years (n = 1000), medical doctors (n = 307), pharmacists (n = 295), nutritionists (n = 124), dieticians (n = 160) and school teachers (n = 873) completed an online survey using a German version of the General Nutrition Knowledge Questionnaire-Revised (GNKQ-R) including self-reported data on sex, age, BMI, and health status. Adolescent and adult participants were recruited by a research agency to be representative for the Austrian population for age, sex, and education. A convenience sample was used for health professionals (medical doctors, pharmacists, nutritionist, dieticians) and school teachers. All participants completed a computer-assisted web-based interviewing (CAWI) survey.

RESULTS

Total scores for nutrition knowledge of the general population (61.4%) were significantly lower than scores from all other groups (medical doctors 81.3%, pharmacists 83.0%, dieticians 87.5%, nutritionists 85.6%, school teachers 74.5%). The main drivers for better nutritional knowledge were female sex, higher age, and higher level of education, while BMI classification and self-reported health status had no impact. In regard to single questions, the most striking result was the misclassification of sugar as the nutrient with the most calories by 41.4% of the general population while only 29.0% correctly identified fat to be the nutrient with the most calories.

CONCLUSIONS

The nutritional knowledge of the general population should be significantly improved in order to lay a basis for better dietary behavior. In view of the relatively low scores of teachers, their nutrition education should be improved in order to enable transfer of sound education in schools.

'What do doctors think they need to know about nutrition?'-a qualitative study of doctors with formal nutrition training

BACKGROUND

Doctors are on the frontline of patient care and in an ideal position to provide nutritional advice, yet can feel ill-equipped to do so. The aim of this study was to explore the nutrition knowledge, skills and practice required for nutrition-competent medical graduates, and their role in providing nutrition advice and care, from the perspective of doctors with formal nutrition training.

METHODOLOGY

We conducted an exploratory qualitative research study. A purposive sample of 12 medical doctors and students with formal nutrition training across Australia participated in in-depth semi structured interviews. Data were analysed thematically.

RESULTS

There were four main themes identified: 1. Identifying the role of doctors in nutrition care; 2. Understanding the interrelatedness of the social determinants of health and nutrition status is key; 3. Optimising nutrition care through multidisciplinary collaboration; and 4. Providing evidence-based nutrition care.

CONCLUSION

This exploratory study suggests that doctors consider that nutrition competent medical graduates require skills in referring to dietitians, an understanding and application of the social determinants of health, and practise applying multidisciplinary and evidence-based nutrition care.

Training of Registered Dietitian Nutritionists to Improve Culinary Skills and Food Literacy

OBJECTIVE

To understand if a culinary medicine training program increases food literacy, culinary skills, and knowledge among practicing registered dietitian nutritionists (RDN).

METHODS

Prepost study design evaluating pilot test of RDN train-the-trainer curriculum from September, 2019 to January, 2020.

RESULTS

On average, results indicate an increase in culinary nutrition skills (mean difference, 6.7 ± 4.4; P < 0.001; range, 10-30) and a significant increase in 5 of the 8 food literacy factors. Through process evaluation, RDNs rated the training as extremely useful to their practice (mean, 4.4 ± 0.3).

CONCLUSIONS AND IMPLICATIONS

Registered dietitian nutritionist participants increased culinary nutrition skills with statistically significant scores across all individual measures. This study describes an RDN training curriculum in culinary medicine across a diverse group of practicing RDNs from a large county health care system. Culinary medicine shows a promising impact on promoting nutrition skills and confidence; however, it warrants further assessment.

Expanding Integrated Competency-Focused Health Worker Curricula for Maternal Infant and Young Child Nutrition

Maternal, infant, and young child nutrition (MIYCN) is important for health, survival, productivity, and development. Knowledgeable, skilled health workers are vital to provide quality care, improve health outcomes, and meet global nutrition targets. When nutrition is not adequately addressed in pre-service curricula, health workers may not be equipped with the knowledge, skills and confidence required to deliver nutrition services and accurate information free of commercial influence. Curriculum review, revision, and competency structuring provides an opportunity to benchmark course topics and content to global standards, to increase focus on learner outcomes, and to facilitate mutual recognition of qualifications across countries and regions. This paper discusses a multistage process to map an existing curriculum, analyse expected competencies, and recognize broader factors when developing a competency-focused curriculum in pre-service education that includes MIYCN. Examples of tools are provided which can be used for review and discussion of curricula and competency at local and national level and to integrate skills such as communication and counselling.

Bringing the "Joy of Healthy Eating" to Advanced Medical Students: Utilizing a Remote Learning Platform to Teach Culinary Medicine: Findings from the First Online Course Based on the ACLM's Whole-Food Plant-Based Culinary Medicine Curriculum

Over 80% of chronic disease is caused by lifestyle practices, including an unhealthy diet. Despite this, most medical students in the United States graduate having received minimal nutrition education, guidance towards improving their nutrition, or skills needed to coach patients to adopt a healthier diet. This study aimed to educate fourth-year medical students in evidence-based knowledge regarding a delicious, whole-food plant-based diet while introducing practical culinary skills and patient coaching skills. We adapted an open-source culinary medicine curriculum designed for in-person teaching of pre-clinical medical students to provide a novel 1-month online elective to fourth-year medical students. We used a 26-item pre/post questionnaire to assess change in evidence-based knowledge regarding nutrition, culinary skills, patient coaching skills, and attitudes toward a whole-food plant-based diet. In addition, we reviewed narrative comments by the student participants, course directors, and medical-school administrators. Scores in all 4 domains were tested, and for all individual questions, they showed statistically significant improvement following the course. Most narrative responses were positive, and areas for improvement were also identified. We successfully adapted an open-source whole-food plant-based culinary medicine curriculum for advanced medical students into a 1-month elective taught on a virtual platform. This course filled a need for training in nutrition and counseling for these students as they start their professional careers.

A Place for Plant-Based Nutrition in US Medical School Curriculum: A Survey-Based Study

Purpose. To evaluate medical students' and family medicine residents' perceptions of their current degree of nutrition training in general and regarding a whole-foods, plant-based (WFPB) diet. Methods. An original survey instrument was administered to medical students and family medicine residents. Quantitative and qualitative data were collected to evaluate perceptions of nutrition education in medical training, a WFPB diet, and ideas for nutrition-focused curricular reform. Results. Of the 668 trainees surveyed, 200 responded (response rate = 30%). Of these, 22% agreed that they received sufficient nutrition education in medical school and 41% agreed that a WFPB diet should be a focus. Respondents with personal experiences with a plant-based diet were more willing to recommend it to future patients. Common ideas for curricular reform were instruction on a WFPB diet along with other healthy dietary patterns, patient counseling, a dedicated nutrition course, and electives. Conclusions. Nutrition education in US medical training needs improvement to address the growing burden of obesity-related chronic disease. Proper nutrition and lifestyle modification should therefore play a larger role in the education of future physicians. A focus on plant-predominant diets, such as the WFPB diet, may be an acceptable and effective addition to current medical school curriculum, and deserves further study.

Incorporating Nutrition Counseling into Lifestyle Medicine

Despite considerable evidence that plant-based diets can significantly improve health, medical professionals seldom discuss this with their patients. This issue might occur due to minimal training received in medical education, lack of time, and low self-efficacy for counseling patients about diet. Nutrition and lifestyle change should be considered a core competency for all physicians and health professionals looking for cost-effective ways to improve patient health outcomes and reduce nutrition-related chronic diseases. Strategies for health professionals to acquire nutrition counseling skills in medical training and clinical practices are discussed.