Maternal malnutrition is pervasive throughout the world, notably in sub-Saharan Africa, including Ethiopia. This study examined the effect of community-based iron-folic acid supplementation (IFAS) nutrition education on IFAS knowledge and attitude among pregnant women in urban settings in South Ethiopia. A community-based quasi-experimental study was conducted among 198 randomly selected pregnant women attending antenatal care (ANC) (99 intervention and 99 control). We used a multistage sampling technique followed by systematic sampling to select the pregnant women. Pregnant women who participated in the intervention arm received six nutrition education sessions and counselling using a health belief model (HBM), while the control group received only routine ANC services. Baseline and endline data were collected during the ANC and compared. The data was analysed using statistical package for social sciences. Analyses of the effect of the intervention were done using difference-in-difference and generalised estimation equation to allow correlation of repeated observations over time. The results indicated a significant effect of intervention on maternal knowledge towards IFAS; with intervention, group levels increased by 35 percentage points (P < 0.001). The odds of being knowledgeable at the endpoint in the intervention group were 2.6 times higher than baseline (OR = 2.67, 95% CI 1.88–3.80). There was a significant (P = 0.001) change in proportion with a favourable attitude towards IFAS between the two time points. The community-based nutrition education intervention approach has significantly improved maternal knowledge and a favourable attitude towards IFAS among pregnant women. The HBM is effective in improving knowledge and attitude among pregnant women.

Food choice is complex and is heavily influenced by the environment one lives in(1). Pacific Island food environments, including those in Tonga, have changed considerably in recent years, making healthier food choice more challenging(2). A widespread nutrition transition across the region has contributed to an increase in the availability of, and accessibility to, highly-processed foods, and high rates of diet-related non-communicable diseases(3). While system change is needed to support the availability, accessibility and affordability of healthy foods, nutrition education plays an important role in supporting individuals, communities, and populations to navigate their rapidly changing food environments, and to encourage healthy food choice and behaviour change. Approaches to nutrition education in the Pacific Islands region vary and do not always consider the socio-cultural aspects of the food environment, especially when focusing on fruit and vegetable consumption. This work was driven by an intent to develop contextually appropriate nutrition education plans using a structured process, Design Online(4). However, to develop a nutrition education plan a critical analysis of the current motivators and facilitators for the behaviour are required. When reviewing the scientific literature there is limited information on determinants of food choice within Tonga, and more broadly within the Pacific Islands context. Therefore, the aim of this cohort study was to qualitatively explore and document the motivating and facilitating determinants of fruit and vegetable consumption in Tonga. Data collection took place during August and September 2023 on the main island of Tongatapu. Semi-structured interviews (n = 5 men, 3 women) and a focus group (n = 4 women) based on the most appropriate method of engaging with participants, were conducted in Tongan. Guiding questions were derived from Design Online and proposed within the following categories: motivating determinants and facilitating determinants. Interview responses were qualitatively analysed using an inductive content analysis model. Key categories for motivating determinants included health and nutrition knowledge, normal consumption patterns, availability and access, production, financial considerations and preferences, perceptions and practices. Key categories for facilitating determinants included education, community engagement, environmental factors, food preference, finance, and accessibility. While this work has explored motivating and facilitating determinants for fruit and vegetable consumption in Tonga with a small sample, it makes an important contribution to the limited literature. The findings of this study can be used to underpin activities, such as the design of nutrition education plans. The findings also provide a foundation for further exploration of determinants of food choice. This study was undertaken on the main island of Tongatapu, but it is of interest to explore determinants with communities who live in the outer islands, and at different time points during the year to reflect seasonality.

Schools provide a unique opportunity to educate and motivate Pacific Island students and the wider Pacific Island community about food systems, food production activities (e.g., gardening and cooking) and to focus on the knowledge and skills needed to make healthy and sustainable food choices. Recent work(1) has identified limited access to appropriate and credible learning and teaching resources and varying integration of food and nutrition in the curriculum across the Pacific Islands (P.I) region. Teachers reported an ardent desire to incorporate nutrition into the curriculum, but were not sure how to do this, or where to source assistance, including credible learning materials. Stakeholders also reported requiring assistance to develop contextualised learning materials, and that there were limited options for upskilling in food, nutrition and agriculture. Recommendations from this work included the development of a tool to assist teachers to bridge the gap between understanding the benchmark or learning outcomes provided in curriculum and designing engaging and authentic activities and assessment to meet these. Therefore, this project aimed to identify food and nutrition curriculum materials available for Pacific Island educators, to inform the development of a web-based resource. In 2022, a systematic desk-based scoping activity was undertaken to identify any resources available to teach food and nutrition in Pacific Island schools (primary and secondary level) and professional development opportunities relevant for educators. The mapping identified over 70 resources, with resources from almost all countries identified. Some are available for specific countries, but few that are designed for use regionally. Some of these resources are directly aligned to food-based dietary guidelines, while others appear to be developed for specific activities by non-governmental organisations. Very few professional development activities were identified. Once a resource was identified, the project team used the CRAAP test(2) to evaluate the credibility of this. If deemed credible, the resource was tagged with key words (e.g., Tonga, gardening) and added for inclusion. The key resource categories (for tagging) were cooking, ocean and waterway foods, food in schools, food safety, healthy eating, sustainability, pacific research, teaching practice, gardening and WASH. A web designer developed the web-based resource through collaboration with the project team. Users can search for resources by country and/or topic. Based on the mapping of professional development activities, a professional development activity based on assessing the credibility of information was developed and added to the L&T toolkit. Users of the hub can share resources (their own) or identify other resources that could be added to the hub. There are limited resources and opportunities for Pacific Island food and nutrition teachers to upskill in food and nutrition education. School educators may benefit from more food and nutrition resources and professional development activities to complement those that are currently available.

In New Zealand, the community-based service, Green Prescription (GRx), has a preventative health focus, supporting clients to make lifestyle changes including improving nutrition literacy, which is known to improve health and reduce chronic disease risk and outcomes (1,2). Fourteen GRx services operate in New Zealand, each with staff who have backgrounds in health and/or exercise. Some staff are degree-qualified nutritionists and/or dietitians. Responsibilities of staff may include providing clients with information about nutrition. We aimed to identify the extent of nutrition information delivery in GRx including successes, challenges, and perspectives of staff and clients. An invitation was extended to all 14 GRx services inviting participation from both staff and clients. Semi-structured interviews were conducted with a convenience sample of 15 GRx staff and 18 clients, representing nine and five GRx services respectively. Interviews were completed in-person, over video call, and by phone. Responses from clients and staff revealed both positive and challenging aspects of nutrition information delivery from GRx services. Thematic analysis identified factors that enhance or diminish the delivery of nutrition information including capacity of staff and appropriateness of information. One theme highlighted was expectations from both clients and staff about what is needed, beneficial and feasible. An expectation identified was for GRx staff to provide meal plans and tailored nutrition advice. Provision of this is dependent on the capacity of nutrition-qualified staff as well as confidence of non-nutrition-qualified staff delivering information beyond basic nutrition guidelines. Client respondents reported they benefit from nutrition information but are challenged when their dietary needs require more specific input, which may be beyond the capacity of GRx. From a staff perspective, there is an expectation that clients possess a certain level of basic nutrition literacy and the effect of nutrition on health. However, staff responses identified there is a vast range of nutrition knowledge among clients; limited foundational knowledge, while simultaneously having in-depth understanding of certain nutrition topics. Provision of information is further complicated by misconceptions about nutrition and limited knowledge about specific health conditions where nutrition plays a significant role. Factors that impact the practical implementation of eating more healthfully were identified by both clients and staff, demonstrating there needs to be both sensitivity and adaptability about what is feasible for clients and achievable in GRx service delivery. Greater focus on determining the nutrition literacy a person has and communicating what is practical in both service delivery and clients’ circumstances would aid in aligning the expectations of supporting clients well with nutrition education and enhance available resources within Green Prescription services.

Lack of nutrition knowledge and poor dietary practices have profound adverse implications on nutritional status particularly among displaced children. Evidence of the effectiveness of nutrition education interventions in improving the nutritional status of internally displaced schoolchildren in Cameroon is scarce. The study objective was to assess the effects of nutrition education on the nutritional status of internally displaced schoolchildren in the West and Littoral Regions of Cameroon. A pre-test-post-test randomised experimental study design was used with an experimental and control group of 160 children from ten primary schools and their caregivers. Anthropometric, biochemical, and clinical signs of malnutrition, dietary, and health status of the children were evaluated, and the caregiver’s nutrition knowledge was assessed in both groups at baseline and end-line with the aid of standard anthropometric and biochemical equipment and recorded in pretested questionnaires. Nutrition education was carried out only with the caregivers of children in the test group. In the test group, significant beneficial outcomes were noticed only for Bitot’s spot (p = 0.047), pallor (0.025), frequency of consumption of fruits (p = 0.002) and vegetables (p = 0.036), caregiver’s nutrition knowledge (p = 0.000), all health-seeking practices of the children (p < 0.05) except immunisation (p = 0.957). No significant change was seen in any of the parameters studied among the participants in the control group. Nutrition education alone was not effective in improving the nutritional status of the children and should be implemented together with other food-based nutrition interventions to improve the nutritional status of internally displaced schoolchildren in the West and Littoral Regions of Cameroon.

Georgia lies to the northeast of Türkiye, having a western border on the Black Sea. With a population of some 3·73 million, Georgia has a tradition of gastronomic excellence dating back millennia. However, changing lifestyles and external influences have, as elsewhere, led to problems of suboptimal nutrition, and lifestyle-related diseases and disorders prevail. There is considerable scope for improving the focus on public health (PH) and nutrition in Georgia. With this in mind, the Georgian Nutrition Society teamed up with The Nutrition Society of the UK and Ireland and the Sabri Ülker Foundation, a PH charity based in Istanbul, Türkiye, to host a conference and workshops in Tbilisi, Georgia. The primary purpose was to review the current status of PH and nutrition in Georgia with reference to the situation elsewhere, to share examples of best practice and to identify opportunities for improvement. A particular highlight was the presentation of a programme of nutrition education for family physicians recently implemented in Türkiye. This summary of the proceedings is intended as a blueprint for action in Georgia and also to inspire others to consider how PH might be improved via a focus on balanced nutrition.

Nutritional education is pivotal in the medical nutritional therapy of type 2 diabetes mellitus (T2DM). The extended parallel process model (EPPM) is a health education method for inducing desirable health behaviours. The present study aimed to investigate the effect of nutritional education based on the EPPM in T2DM patients on knowledge, attitude, practice, anthropometric indices, glycaemic factors, lipid profile and adherence to the diabetic diet. A randomised, double-blind, controlled, factorial field trial was designed for T2DM patients aged 30–59 years (n 88). Participants were randomly allocated into four groups to receive EPPM-based nutritional education through gain framed message (GFM), loss framed message (LFM), their combination (G\LFM) or usual diabetic education in the control group (CG). Participants were assessed before and after the study duration. After 3 months of intervention, eighty participants finished the study. The EPPM-based intervention increased participants’ knowledge, behavioural intention, perceived sensitivity, severity, self-efficacy (P < 0·001 for all) and response efficacy (P = 0·029) in comparison with CG. GFM (P = 0·004) and G\FLM (P = 0·034) reduced carbohydrate intake and LFM (P = 0·034) and G\LFM (P = 0·047) decreased fat intake. Between-group analysis indicated interventions reduced weight (P = 0·046), BMI (P = 0·038), fasting blood sugar (P = 0·030), 2-hour postprandial blood glucose (P = 0·027) and TAG (P = 0·002) in comparison with the CG. Results were NS for protein intake, waist and hip circumference, waist:hip ratio, HbA1c, total cholesterol, LDL and HDL. Nutritional education based on EPPM could increase the knowledge and awareness of T2DM patients. Also, it could be beneficial for blood glucose amendment. Further investigations are recommended.

Autism spectrum disorder (ASD) is a complex group of neurodevelopmental disorders characterised by impaired social communication and restricted interests/repetitive behaviours. In this regard, sensory processing difficulties and delayed oral motor skills often predispose individuals with ASD to food selectivity (FS). It is usually associated with repetitive eating patterns that can lead to multiple malnutrition conditions. The objective of this narrative review is to present an overview about the existing nutritional interventions aiming at promoting a healthy eating pattern and addressing food selectivity among individuals with ASD. Regarding the interventions targeting nutrition education, the majority of the analysed studies failed to demonstrate their effectiveness. On the other hand, many educational interventions involving taste or cooking sessions, as well as behavioural interventions for FS, demonstrated effective results. Moreover, multidisciplinary in tailoring such programmes, including psychology speech therapy and nutritional skills, is acknowledged as a key approach.

We reviewed the available research and gave an overview of the effects of nutrition education interventions (NEIs) on medical students’ and residents’ knowledge of nutrition, attitudes towards nutrition care, self-efficacy, dietary practices and readiness to offer nutrition care. From 28 May through 29 June 2021, we searched Google Scholar, PubMed, ProQuest, Cochrane and ProQuest to retrieve 1807 articles. After conducting de-duplication and applying the eligibility criteria and reviewing the title and abstract, 23 papers were included. The data were descriptively and narratively synthesised, and the results were displayed as frequencies, tables and figures. Twenty-one interventions were designed to increase participants’ knowledge of nutrition-related topics, and eighteen studies found that nutrition knowledge had significantly improved post-intervention. Only four of the eleven studies that reported on attitudes about nutrition post-intervention showed a meaningful improvement. The self-efficacy of participants was examined in more than half of the included studies (n 13, 56⋅5 %), and eleven of these studies found a significant increase in the participants’ level of self-efficacy to offer nutrition care post-intervention. At the post-intervention point, seven interventions found that dietary and lifestyle habits had significantly improved. The review demonstrated the potential of NEIs to enhance participants’ dietary habits and nutrition-related knowledge, attitudes and self-efficacy. Reduced nutrition knowledge, attitude and self-efficacy scores during the follow-up, point to the need for more opportunities for medical students and residents to learn about nutrition after the intervention.

Optimum nutrition plays a major role in the achievement and maintenance of good health. The Nutrition Society of the UK and Ireland and the Sabri Ülker Foundation, a charity based in Türkiye and focused on improving public health, combined forces to highlight this important subject. A hybrid conference was held in Istanbul, with over 4000 delegates from sixty-two countries joining the proceedings live online in addition to those attending in person. The primary purpose was to inspire healthcare professionals and nutrition policy makers to better consider the role of nutrition in their interactions with patients and the public at large to reduce the prevalence of non-communicable diseases such as obesity and type 2 diabetes. The event provided an opportunity to share and learn from different approaches in the UK, Türkiye and Finland, highlighting initiatives to strengthen research in the nutritional sciences and translation of that research into nutrition policy. The presenters provided evidence of the links between nutrition and disease risk and emphasised the importance of minimising risk and implementing early treatment of diet-related disease. Suggestions were made including improving health literacy and strengthening policies to improve the quality of food production and dietary behaviour. A multidisciplinary approach is needed whereby Governments, the food industry, non-governmental groups and consumer groups collaborate to develop evidence-based recommendations and appropriate joined-up policies that do not widen inequalities. This summary of the proceedings will serve as a gateway for those seeking to access additional information on nutrition and health across the globe.

The unsettling worldwide prevalence of obesity and obesity-related illnesses seems to be well-understood. What seems to be lacking, however, is a strategy of how best to fix the issue. Meagre nutrition content in medical school curricula may contribute to limited primary care physician (PCP) knowledge of the role nutrition has in health ailments and the understanding of a registered dietitian nutritionist (RDN) scope of practice. In USA, RDN are health care practitioners specialised in nutrition and who are experts in treating obesity and obesity-related illnesses. An increased RDN involvement in patient care has been shown to promote improvements in nutrition-related clinical outcomes. Therefore, enhanced collaboration between PCP and RDN has the potential to ameliorate the obesity epidemic. Tactics to promote collaboration may include enhancing nutrition education in medical school and providing nutrition-focussed continuing education for practicing physicians. The seriousness of the obesity epidemic underscores the need for interprofessional collaboration between PCP and allied health professionals who are uniquely trained to address obesity and obesity-related illnesses.

In Bangladesh, only 34 % of the children aged 18–23 months old are given minimum acceptable diets of complementary foods. Objective of the study was to find the effects of complementary feeding counselling on nutritional status among 6–23 months old children of poor families. This was a community-based randomised control trial. A total of 192 children in two groups were randomly selected. Nutrition education was given for a period of 4 months with post-intervention follow-up for 2 months. After 4 months of intervention, the difference in height for age Z score, weight for height Z score and weight for age Z score were significantly higher in the intervention group than in the control group (1·01 ± 0·31 v. 0·19 ± 0·01, P =< 0·001; 1·34 ± 0·15 v 0·72 ± 0·11, P =< 0·001; 1·5 ± 0·24 v. 0·62 ± 0·04, P =< 0·001). Mid-upper arm circumference Z score also improved in the intervention group than in the control group (0·95 ± 0·03 v. 0·57 ± 0·12, P =< 0·001). Morbidity of the children in the intervention group significantly reduced than in the control group (49 % v 80·20 %, P =< 0·001). Higher feeding frequency (3–4 times) (71·9 % v. 45·8 %) and energy intake increased in the intervention group than in the control group. Promotion of complementary feeding from the family foods can improve the nutritional status of 6–23 months old children of poor families within a short period.

COVID-19 has further exacerbated trends of widening health inequalities in the UK. Shockingly, the number of years of life lived in general good health differs by over 18 years between the most and least deprived areas of England. Poor diets and obesity are established major risk factors for chronic cardiometabolic diseases and cancer, as well as severe COVID-19. For doctors to provide the best care to their patients, there is an urgent need to improve nutrition education in undergraduate medical school training.

With this imperative, the Association for Nutrition established an Interprofessional Working Group on Medical Education (AfN IPG) to develop a new, modern undergraduate nutrition curriculum for medical doctors. The AfN IPG brought together expertise from nutrition, dietetic and medical professionals, representing the National Health Service (NHS), royal colleges, medical schools and universities, government public health departments, learned societies, medical students, and nutrition educators. The curriculum was developed with the key objective of being implementable through integration with the current undergraduate training of medical doctors.

Through an iterative and transparent consultative process, thirteen key nutritional competencies, to be achieved through mastery of eleven graduation fundamentals, were established. The curriculum to facilitate the achievement of these key competencies is divided into eight topic areas, each underpinned by a learning objective statement and teaching points detailing the knowledge and skills development required. The teaching points can be achieved through clinical teaching and a combination of facilitated learning activities and practical skill acquisition. Therefore, the nutrition curriculum enables mastery of these nutritional competencies in a way that will complement and strengthen medical students’ achievement of the General Medical Council (GMC) Outcome for Graduates.

As nutrition is an integrative science, the AfN IPG recommends that the curriculum is incorporated into initial undergraduate medical studies before specialist training. This will enable our future doctors to recognise how nutrition is related to multiple aspects of their training, from physiological systems to patient-centred care, and acquire a broad, inclusive understanding of health and disease. In addition, it will facilitate medical schools to embed nutrition learning opportunities within the core medical training, without the need to add in a large number of new components to an already crowded programme or with additional burden for teaching staff.

The undergraduate nutrition curriculum for medical doctors is designed to support medical schools to create future doctors who will understand and recognise the role of nutrition in health. Moreover, it will equip frontline staff to feel empowered to raise nutrition-related issues with their patients as a fundamental part of enhanced care and to appropriately refer on for nutrition support with a registered associate nutritionist/registered nutritionist (ANutr/RNutr) or registered dietitian (RD) where this is likely to be beneficial.

Habitual dietary intakes and nutrition behaviours developed during childhood and adolescence pave the way for similar behaviours to manifest in adulthood. Childhood obesity rates have now reached a point where one in six children globally are classified as overweight or obese. Schools have the unique ability to reach almost all children during key developmental stages, making them an ideal setting for influencing children’s nutrition behaviours. Evidence suggests the school food environment is not always conducive to healthy food choices and may be obesogenic. The aim of this narrative review is to explore factors that influence the healthy food and drink environment in and around schools in New Zealand. The review focused on evidence from New Zealand and Australia given the close resemblance in education systems and school food guidance. Using the Analysis Grid for Environments Linked to Obesity (ANGELO) framework, the school food environment was categorised into the following domains: economic, political, physical and socio-cultural factors. Findings suggest that food policies are not utilised within schools, and guidelines to improve the school food environment are not well implemented. Canteen profit models, lack of staff support and resources, and higher availability of low-cost unhealthy foods are among barriers that hinder implementation. This review highlights recommendations from existing evidence, including canteen pricing strategies, restriction of unhealthy foods and using peer modelling in a time-scarce curriculum to improve the school food environment. Key areas for improvement, opportunities to enhance policy implementation and untapped avenues to improve the food and nutrition behaviours of children are highlighted.

The present study examined the effect of picture-based nutrition education on knowledge and adherence to pre-conception iron–folic acid supplement (IFAS) in Ethiopia, a country where there is a high burden of neural tube defects (NTDs) and anaemia. In eastern Ethiopia, a parallel randomised controlled trial design was employed among women planning to get pregnant. The interventional arm (n 122) received a preconception picture-based nutrition education and counselling along with an IFAS and the control arm (n 122) received only a preconception IFAS. The effects of the intervention between-group differences were assessed using a χ2 and independent sample t-test. Bivariate and multivariable linear regression model was fitted to detect independent variables affecting the outcome. The outcome measures regarding the knowledge and adherence to the IFAS intake during the three months of the intervention period were deteremined. It was observed that large proportion of women in the intervention group (42⋅6 %) had an adherence to IFAS compared to the control group (3⋅3 %); (P < 0⋅0001). Based on bivariate and multivariable linear regression analyses, among NTDs affecting pregnancy, the history of spontaneous abortion and knowledge were independently associated with adherence to the IFAS (P < 0⋅05). Preconception nutrition education with regular follow-ups could be effective in improving knowledge and adherence to the IFAS intake. This intervention is very short, simple, cost-effective and has the potential for adaptation development to a large-scale implementation in the existing healthcare system in Ethiopia to prevent NTDs and adverse birth outcomes among women who plan to get pregnant. This clinical trial was registered on 6 April 2021 under the ClinicalTrials.gov with an identifier number PACTR202104543567379.