Building Global Nutrition Policies in Health Care: Insights for Tackling Malnutrition from the Academy of Nutrition and Dietetics 2019 Global Nutrition Research and Policy Forum

Starving for knowledge. Addressing the place of clinical nutrition within undergraduate and postgraduate clinical training: A national survey of practicing clinicians

INTRODUCTION

Clinical Nutrition is finding its place within medical training. In response to IrSPEN's objectives and ESPEN's manifesto, IrSPEN distributed an electronic survey investigating attitudes to Clinical Nutrition and unmet educational needs.

METHODS

A 35-part questionnaire was designed and distributed to clinicians in Ireland. Questions elicited clinician demographics, education history and experience assessing and managing malnutrition. Descriptive statistics were reported, comparisons analysed using Chi-squared test and correlation between experience and confidence analysed with Spearman correlation coefficient.

RESULTS

Of 168 respondents, 41% (n = 58) were male and most practice medicine in an academic centre (87.5%). Fifty-eight (34.7%) were regularly involved in nutrition support. Despite 20% (n = 33) of respondents regularly managing patients on parenteral nutrition (PN) and a fifth (n = 34) regularly managing complications of obesity, few had confidence in assessment for artificial nutrition (15.7% (n = 26), enteral nutrition; 8% (n = 13), PN). Trainees were less confident than attending staff in assessing and managing artificial enteral feeding (p = 0.022) and complications of PN (p = 0.01). Over 70% respondents reported they received <2 h clinical nutrition education. Only 32% (n = 52) received any formal training within postgraduate training (PGT), more often GI trainees (p = 0.01). A striking 98% felt additional focus on nutrition education in PGT is required.

CONCLUSION

This survey elicits physician attitudes on nutrition education in undergraduate and postgraduate curricula in Ireland. Practicing physicians identify the need to increase clinical nutrition education. IrSPEN are actively engaging with Irish medical schools and training bodies to address these deficits with multidisciplinary engagement from expert physicians and allied dietetic colleagues.

COVID-19 and Sustainable Food Systems: What Should We Learn Before the Next Emergency

Three key transitions leading to a “safe and just” operating space, with a focus on food systems, emerged during the development of a Foresight study promoted by SCAR (Standing Committee on Agricultural Research1): (a) sustainable and healthy diets for all; (b) full circularity in the use of resources; (c) diversity as a key component of stable systems. As consequence of COVID-19, food emerged again as a central element of life, along with health, after decades in which food security was taken for granted, at least in most developed countries. The COVID-19 outbreak offered the opportunity for a reflection on the importance of resilience in emergencies. Sustainable and healthy diets for all, was shown, during the pandemic, to depend much more on social and economic conditions than on technical aspects of food production and processing. Agriculture and the agro-industry have now a potential to absorb, at least temporarily, workers laid out in other sectors; the pandemic could be an opportunity to re-think and re-value labor relationships in the sector as well as local productions and supply chains. A full circularity in food systems also would benefit from stronger links established at the territorial level and increase the attention on the quality of the environment, leading to the adoption of benign practices, regenerating rather than impoverishing natural resources. Diversity is a key component of a resilient system, both in the biophysical sphere and in the social sphere: new business models, new knowledge-sharing networks, new markets. The three transitions would operate in synergy and contribute to the resilience of the whole food system and its preparation for a possible next emergency. Science can support policy making; however, science needs to be better embedded in society, to have a clear direction toward the grand challenges, to address the social, economic, behavioral spheres, to aim clearly at the common good. We need to re-think the conundrum between competition and cooperation in research, devising ways to boost the latter without sacrificing excellence. We need to improve the way knowledge is generated and shared and we need to ensure that information is accessible and unbiased by vested interests.