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Background & Aims: Nutrition education is not well represented in the medical curriculum. The aim of this original paper was to describe the Nutrition Education in Medical Schools (NEMS) Project of the European Society for Clinical Nutrition and Metabolism (ESPEN)., Methods: On 19 January 2020, a meeting was held on this topic that was attended by 51 delegates (27 council members) from 34 countries, and 13 European University representatives., Results: This article includes the contents of the meeting that concluded with the signing of the Manifesto for the Implementation of Nutrition Education in the Undergraduate Medical Curriculum., Conclusion: The meeting represented a significant step forward, moved towards implementation of nutrition education in medical education in general and in clinical practice in particular, in compliance with the aims of the ESPEN Nutrition Education Study Group (NESG)., Competing Interests: Conflict of Interest The authors declare they have no conflict of interest that might have interfered with the conception and preparation of this manuscript., (Copyright © 2021 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background & Aims: Nutrition education is necessary in the training of healthcare professionals, including medical students. However, recent surveys showed that there is a high variability within Medical Schools in different countries. The aim of this ESPEN position paper is to identify a minimum curriculum knowledge in nutrition that serves to improve the training of the future doctors and how to solve the main barriers of its implementation in university centres., Methods: In 2017, the ESPEN Executive Committee launched the Nutrition Education in Medical Schools (NEMS) Project and formed a core working group including members of the ESPEN Nutrition Education Study Group (NESG) and representatives of several European Medical Schools. This group met in Brussels, on 19th July 2018 and decided to prepare a position paper on this topic., Results: Five main learning objectives and twenty-one topics on human nutrition, within its three domains (basic, applied and clinical nutrition) were identified to be fulfilled at the end of training in all Medical Schools. The experts showed the following key factors for its implementation: establish a nutrition curriculum committee, use different models of integration of the contents in the curriculum (vertical and horizontal), have a multidisciplinary and experienced faculty, incorporate a variety of teaching models, and evaluate the programme periodically., Conclusions: Nutrition Education is necessary and should be mandatory in all Medical Schools. This position paper aims at improving this gap knowledge and gives some clues for a successful implementation of the changes in the medical curriculum at university centres., (Copyright © 2019 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

The requirements for and conditions of subspecialty training in paediatric gastroenterology, hepatology, and nutrition (PGHN) are rather variable across European countries. The European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) agreed on a training syllabus aimed to foster a harmonised European PGHN curriculum and to support national PGHN societies and governmental bodies to promote and establish high-quality training programmes and levels of certification in the field. The document provides PGHN training prerequisites and objectives and the basic knowledge elements to acquire the clinical, technical, and management skills needed. Guidelines and instruments for self-monitoring and appraisal are proposed, and a logbook is available online. These training standards are a first step towards a European certification and recognition as a specialist in PGHN.

Objective: To assess and develop consensus among a European panel of public health nutrition stakeholders regarding the competencies required for effective public health nutrition practice and the level of proficiency required in different practice contexts., Design: A modified Delphi study involving three rounds of questionnaires., Setting: European Union., Subjects: Public health nutrition workforce development stakeholders, including academics, practitioners and employers, from twenty European countries., Results: A total of fifty-two expert panellists (84 % of an initial panel of sixty-two Delphi participants) completed all three rounds of the Delphi study. The panellists rated the importance of fifty-seven competency units possibly required of a public health nutritionist to effectively practice (Essential competencies). Twenty-nine of the fifty-seven competency units (51 %) met the consensus criteria (≥66·7 % agreement) at the second round of the Delphi survey, with the highest agreement for competencies clustered within the Nutrition science, Professional, Analytical and Public health services competency domains. Ratings of the level of competencies required for different levels in the workforce indicated that for a public health nutrition specialist, advanced-level competency was required across almost all the twenty-nine competencies rated as essential. There were limited differences in rating responses between academics and employer panellists throughout the Delphi study., Conclusions: Competencies identified as essential can be used to review current public health nutrition practices and provide the basis for curriculum design and re-development, continuing education and workforce quality assurance systems in Europe. These are all important tools for systematic and strategic workforce development.

In June 2010, the WHO Regional Office for Europe, in co-operation with the WHO Collaborating Centre for Nutrition at the Department of Endocrinology, Jagiellonian University, Collegium Medicum, organized in Krakow the 1st Conference of the WHO European Collaborating Centres for Nutrition. Taking part were representatives of the WHO Regional Office for Europe Nutrition, Dr Joao Breda (Programme Manager - Nutrition, Physical Activity and Obesity Programme) and representatives of the WHO Collaborating Centres for Nutrition from Denmark, Greece, Holland, the UK and Poland, as well as representatives of co-operating institutes from Portugal, Switzerland and the UK. The main objective of the meeting was to discuss the ongoing work of each Collaborating Centre and the development of a strategic plan for the coming years in the most important areas of interest: the prevention of obesity, type 2 diabetes and other NCD, nutrition and inequalities, capacity building in nutrition as well as micronutrient deficiencies (namely iodine deficiency). A final report summarising the Network Meeting is being prepared and will be released in due course.

The 7th Abbott-SENPE Forum is structured facing the new regulations of the European Space of High Education regarding the studies on Nutrition in the different degrees (Medicine, Pharmacology, Nutrition, Nursing) and post-doctoral education. A multi-professional and multidisciplinary discussion on the current situation of university education on nutrition, and its capabilities and limitations, is carried out. The value of the role of continuous medical education, the inhouse training programme, masters, and of scientific societies is also assessed. It is concluded that there is a need to urge academic authorities, the National Commission of Medical Specialties, the persons in charge of continuous medical education, and scientific societies of the importance of the studies relating to nutrition, feeding, and dietetics at both pre-graduate and post-graduate educational levels, and to implement and develop these studies in their areas of influence.

This report describes the European Nutrition Leadership Programme (ENLP), an annual one week seminar aimed at nutrition scientists starting out on their careers as future leaders in the field of nutrition. It marks the 15th anniversary of the programme which is designed to teach leadership, communication, team building and networking skills. The seminar is currently organised by the University of Wageningen with support from the food industry and a network of European universities. It is held each spring in Luxembourg and has generated an active alumni network of several hundred nutrition scientists since it first began in 1994. www.enlp.eu.com

Background: Nutrition communication by means of nutrition and health claims and otherwise, holds the potential to contribute to public health by stimulating informed healthier food choices and enhanced health-focussed competition in the market place, provided that the health messages are trustworthy (i.e. scientifically substantiated) and correctly used and interpreted by the consumer. Not surprisingly, these two considerations constitute the cornerstone of the new EU legislation on nutrition and health claims, in which evidence for consumer understanding of nutrition and health claims is a new requirement., Aim of the Study: To review some of the key issues in consumer understanding of nutritional communication as a basis for reflection on the consumer understanding element of the new EU legislation on nutrition and health claims., Conclusions: There is a need for more methodologically advanced research in consumer understanding of nutrition and health claims as a basis for truly assessing the real-life use of such information and its actual effect on consumer food choices. Such approaches are pertinent in light of the evaluation and approval process of (new) nutrition and health claims as required under the new EU legislation on nutrition and health claims.

Capacity development in nutrition is a process whereby individuals, groups, institutions, organizations and societies enhance their abilities to identify and meet challenges in a sustainable manner. To address these issues, in 2001 the UN System Standing Committee on Nutrition (SCN) established a Working Group on Capacity Development under the joint coordination of the United Nations University (UNU) and the International Union of Nutritional Sciences. Several regional professional networks have developed under this working group, the latest for the Central and Eastern Europe (CEE) countries. Ten CEE countries formed a network in 2006 and identified major nutritional challenges in the region, which included: irregular meal patterns; low consumption of fruits/vegetables, milk products and fish; low intake of some micronutrients; and high intakes of fat, sugar and salt. Public policies in nutrition were either weak or absent. Some countries had recently developed nutrition plans. Higher education in nutrition was seen as very important for public nutrition work by professionals in the region, who considered it a prerequisite for reversing the negative trend of the nutrition transition. The network will continue to work on issues that are still not covered adequately. Its activities to date and prospects for the future are assessed against ten principles for good capacity development suggested by the United Nations Development Programme.

European policymakers need more information on policy responses to obesity that stakeholders judge effective and acceptable. The Policy Options for Responding to the Growing Challenge of Obesity Research Project gathered such intelligence by interviewing key stakeholder groups in nine countries. Interviews used an innovative multi-criteria mapping (MCM) methodology that gathers quantitative and qualitative information on the stakeholders' perceptions and judgements. Aggregating across all participants, a comprehensive portfolio of policy measures, integrated into a coherent programme, would be well-supported by broad coalitions of stakeholders. Those portfolios should include measures (i) to provide improved educations in schools and to the general adult population; (ii) measures to improve access to and incentives for physical activity; (iii) measures to improve information about both foods and physical activity and (iv) changes to the supply of and demand for foodstuffs. There was little support for fiscal measures and technological 'fixes'; they were judged ineffective and unacceptable. Significant differences were found across European regions, and across different stakeholder perspectives, but not across genders. There is a strong case for improved monitoring of body mass index levels, dietary habits and physical activity. An MCM study can effectively cover several countries, rather than being confined to just one, and generate both national and cross-national policy analyses and proposals.

Nutritional support provision does not happen by accident. Clinical dimensions include screening and assessment, estimation of requirements, identification of a feeding route and the subsequent need for monitoring. Patients may need different forms of nutritional intervention during the course of their illness. Furthermore, these may need to be provided in different locations as their clinical status changes. If this is not properly managed there is potential for inappropriate treatment to be given. Clinical processes can only be effectively implemented if there is a robust infrastructure. The clinical team need to understand the different elements involved in effective service provision and this depends on bringing together disciplines which do not feature overtly on the clinical agenda including catering, finance and senior management. Excellent communication skills at all levels, financial awareness and insight into how other departments function are fundamental to success. Practice needs to be reviewed constantly and creativity about all aspects of service delivery is essential. Finally, it is important that key stakeholders are identified and involved so that they can support any successes and developments. This will raise awareness of the benefits of nutritional intervention and help to ensure that the right resources are available when they are needed.

WebCT, a web-based virtual learning environment (VLE) and Interactive TV (ITV) are relatively new technologies that are used to deliver distance education at the Faculty of Health Sciences, Stellenbosch University. This study explores how effective current approaches to instructional design and interaction have been in utilizing these two technologies to support interaction and what lessons can be learnt. Five focus-group interviews were held with students and lecturers to assess the perceived quality of student-lecturer/student-student interactions. All students were invited to complete a questionnaire at the end of every module to assess their perceptions of interaction. Interaction was highly valued by students and lecturers participating in distance-learning programmes utilizing either VLE or ITV. Students rated courses using both technologies as moderately interactive. Significant differences between VLE and ITV were detected in student-lecturer and student-student interactions, use of additional modes of communication, instructional design, technological interactivity and social rapport activities. The groups did not differ across a number of likely barriers to interaction and both also reported the need for more flexible and better paced instructional designs.

Cancer is a major cause of morbidity and mortality throughout the world. It is the second most frequent cause of death in Europe and is becoming the leading cause of death in old age. Patients with cancer will develop a large number of physical symptoms. Malnutrition and weight loss are common and are due to a variety of mechanisms involving the tumour, the host response to the tumour, and anticancer therapies. Inadequate intake of energy and nutrients alone is unable to account for the substantial changes in nutritional status seen in patients with cancer. In advanced cancer, cachexia often occurs. This complex multifactorial syndrome is associated with metabolic abnormalities, anorexia, early satiety and reduced food intake, depletion of lean body mass, muscle weakness, oedema, fatigue, impaired immune function, and declines in attention span and concentration. The development and implementation of screening and assessment tools is essential for effective nutritional intervention and management of patients with cancer. Proactive nutritional interventions should ideally form an integral part of cancer therapy, with the aim of improving clinical outcomes and quality of life. This supplement brings together a collection of papers discussing various topics regarding nutrition in cancer.

Disease-related undernutrition is significant in European hospitals but is seldom treated. In 1999, the Council of Europe decided to collect information regarding Nutrition programmes in hospitals and for this purpose a network consisting of national experts from 12 of the Partial Agreement member states was established. The aim was to review the current practice in Europe regarding hospital food provision, to highlight deficiencies and to issue recommendations in improve the nutritional care and support of hospitalised patients. The data collection regarding the nutritional care providers and their practices of nutritional care and support showed that the use of nutritional risk screening and assessment, and of nutritional support and counselling was sparse and inconsistent, and that the responsibilities in these contexts were unclear. Besides, the educational level with regard to nutritional care and support was limited at all levels. All patients have the right to expect that their nutritional needs will be fulfilled during a hospitalisation. Optimal supply of food is a prerequisite for an optimal effect of the specific treatment offered to patients. Hence, the responsibilities of staff categories and the hospital management with respect to procuring nutritional care and support should be clearly assigned. Also, a general improvement in the educational level of all staff groups is needed.

Effective population-based strategies require people trained and competent in the discipline of Public Health Nutrition. Since 1997, a European Master's Programme in Public Health Nutrition has been undergoing planning and implementation, by establishing initial quality assurance systems with the aid of funding from the European Commission (DG SANCO/F3). Partners from 17 European countries have been involved in the process. A European Network of Public Health Nutrition has been developed and accredited by the European Commission.

In 1999 the Council of Europe decided to collect information regarding Nutrition programmes in hospitals and for this purpose a network consisting of national experts from eight of the Partial Agreement member states was established. The aim was to review the current practice in Europe regarding hospital food provision, to highlight deficiencies and to issue guidelines to improve the nutritional care and support of hospitalized patients. Five major problems seemed to be common in this context: 1) lack of clearly defined responsibilities; 2) lack of sufficient education; 3) lack of influence of the patients; 4) lack of co-operation among all staff groups; and 5) lack of involvement from the hospital management. To solve the problems highlighted, a combined 'team-effort' is needed from national authorities and all staff involved in the nutritional care and support, including hospital managers., (Copyright 2001 Harcourt Publishers Ltd.)

Good nutrition is the basis of good health and poor nutrition is directly linked with certain illnesses, such as heart disease. A great deal of research on nutrition is carried out every year, but little may actually be read by health staff. A project aimed at ensuring that the latest information reaches those who need it is now running in 24 European countries.

Background: Weight loss is a common problem in patients with Alzheimer's Disease (AD). It is a predictive factor of mortality and it decreases patients' and caregivers' quality of life., Objective: To determine if a nutritional education program can prevent weight loss in AD patients., Subjects: 151 AD patients and their caregivers were enrolled to follow the intervention and 74 AD patients and their caregivers constituted a control group., Method: Caregivers in the intervention group followed 9 nutritional sessions of one hour each, over one year. Caregivers in the control group didn't follow any sessions but were offered advice provided in a normal follow-up. Patients weight, nutritional state, cognitive function, autonomy, mood, behaviour disorders at baseline and at 6- and 12-month follow-up. Caregivers burden, nutritional and AD knowledge at the baseline and at the 12-month follow-up., Results: During the year follow-up, the mean weight increased in the intervention group (0.7+/-3.6 kg) whereas it decreased in the control group (-0.7+/-5.4 kg) (p<0.05). The nutritional status (MNA) was maintained in the intervention group (0.3+/-2.6) whereas it decreased significantly in the control group (-1.0+/-3.4) (p<0.005). After adjustment for baseline differences between the two groups (caregiver age, nutritional state, eating behaviour disorders, depression), the weight change between the two groups was not significant (0.6+/-0.4 kg vs. -0.6+/-0. 6 kg respectively in intervention group and control group). However, the percentage of patients with significant weight loss is decreased. The MMSE change became significant between the two groups: -2.3+/-0.3 vs. -3.4+/-0.4 respectively in intervention group and control group (p<0.05)., Conclusions: These results suggest that a nutritional educational program intended for caregivers of AD patients could have a positive effect on patients weight and cognitive function.

Scientists in basic research and epidemiology deliver messages to policy makers. Effective population based strategies then require people trained and competent in the discipline of Public Health Nutrition (PHN). Since 1997, a European Master's Programme in PHN has been undergoing planning and implementation with the aid of funding from the European Commission (DGV). PHN is used as a broad term covering Nutrition and Physical Activity as well as Health Promotion and Disease Prevention. The partners in this project are academic departments from 17 countries. The students will undertake core modules and electives for a year and a half, followed by a research project for six months. In order to set up formalised procedures for the evaluation of the quality assurance of individual modules from across Europe, a quality assurance system has been set up. The academic year 1999-2000 will allow an opportunity for Universities and Institutes to start new modules, to develop other modules, assess the movement of students between modules, tackle funding issues and allow further marketing of the programme. Future activities include strengthening of the European Network for Public Health Nutrition (ENPHN), the establishment of a consortium with universities, the co-ordination of programme activities with other European Master's Programmes in Public Health, and the incorporation of new Member States from Eastern Europe. We can look forward to a new brand of professionals, who are truly European in their training, but who also have an integrated view of nutrition and physical activity, health promotion and disease prevention and who are prepared for policy making, action planning, implementation and evaluation.

Background: Certain cancers are more common among African Americans (AA). Fruit and vegetables (F&V) reduce cancer risk, but Americans, and African Americans in particular, do not meet the "5 A Day" goal. Scouting organizations, particularly urban Boy Scout groups that target inner-city youth, provide promising channels for nutritional behavioral change programs., Methods: Focus groups were conducted with urban Boy Scouts and their parents to identify factors influencing F&V consumption and evaluate potential intervention activities. Twenty-four-hour dietary recalls were collected from 85 area Boy Scouts. A national data set was used to obtain values for F&V consumption by African American and European American (boys age 0-16)., Results: Vegetable preferences were low and a negative peer influence for vegetables was reported. The group has limited food-preparation skills, but both parents and scouts reported that F&V were available in their homes. Use of goal setting and use of problem-solving techniques were limited. The local scouts' mean F&V intake was 3.2 servings per day. Ethnic differences in F&V consumption were identified in the national data., Conclusions: Based on these results and previous interventions in schools, an overall structure for the intervention was developed to include eight weekly troop sessions and two camping sessions, parent newsletters, seven weekly home badge assignments, and ten comic books.

Previous studies have highlighted the diversity of levels of nutrition teaching in European Dental Schools, ranging from extensive courses in Scandinavia and the Netherlands to little or none in some other countries. A current survey has shown that whilst on average there has been a small increase in nutrition teaching since 1989, the profile over all is unchanged. The major exception however, is the UK, where nutrition teaching has improved substantially since the introduction of the extended preclinical curriculum in 1990. Despite improved living standards and better nutrition in much of Europe, nutrition is still an essential component of the dental curriculum. New problems such as erosion and obesity have arisen as a result of a diet of affluence and modern lifestyles. European Union guidelines on nutrition teaching would be helpful.

The availability of food and the nutritional status of western Europeans have never been so good as in recent decades. However, we have not to go back too long to see that severe malnutrition also occurred in parts of western Europe. An example was the malnutrition and starvation causing high death rates in the western Netherlands in the early months of 1945, just before the end of the Second World War. Today there is an abundance of food in western Europe. Nevertheless we do warn people that the food, nutritious and delicious as it is, may be hazardous to health. Degenerative diseases like cardiovascular diseases, cancer, diabetes, obesity, osteoporosis and hypertension are very prevalent in our society. It is very likely that certain nutrients in foods do contribute both to the causes and prevention of these diseases. In this paper some new findings of the role of diet in health will be reviewed. This will be followed by a brief discussion on the status of nutrition research and training in Europe. Finally attention is asked for the need to start building-up a programme for nutritional leadership in Europe.