NUTRITION EDUCATION IS A GREAT ABSENTEE IN THE CURRICULUM OF EUROPEAN DOCTORS

ESPEN LAUNCHES THE EUROPEAN MANIFESTO TO FILL THE TRAINING GAP

Nice, January 22 2020 – “During the medical training at the University the students should receive mandatory information about human nutrition in its three different domains, including basic nutrition, applied or public health nutrition and clinical nutrition”, as indicated in the “Manifesto for the Implementation of Nutrition Education” just released in Nice during the ESPEN-NEMS meeting.

“The way to organise these themes in the curriculum, also including novel teaching tools, internet resources and e-learning, will depend on each University centre, taking into consideration the different possible models of teaching (parallel, integrated or case-solving based), the availability of teachers and the distribution of time and credits with the rest of teaching subjects” the Manifesto says.

Although the teaching of nutrition is an essential element of medical training, a recent survey (1) has shown that there is an extreme variability in the educational standards of this subject in medical schools worldwide. As a consequence, there are differences in the access and quality of treatments received by patients.

Worldwide, more than 2 billion adults are overweight, 600 million obese and 462 million malnourished. These conditions contribute to 60% of cardiovascular death and 35% of tumor death. Even less known is that 35% of hospitalised patients develop disease-related malnutrition, a real ‘disease in a disease’.

“Weight loss in chronic, oncological, elderly and frail patients is an underestimated and under-diagnosed problem” Professor Rocco Barazzoni, ESPEN Chairman, explains. “Loss of weight and muscle mass leads to a higher rate of complications, worse response to therapies, higher mortality and increase in healthcare expenditures. This occurs in spite of the well documented positive and cost-effective impact of nutritional therapy on treatment side effects and disease outcomes.

“Implementing training is urgent” echoes Professor Maurizio Muscaritoli, Coordinator of the NEMS initiative together with the Spanish Professor Cristina Cuerda. “Learning nutrition is mandatory for future doctors. Seeking political support, forming ad hoc committees for the development of curricula and teaching modalities are among the key factors to allow for the implementation of nutrition training in universities”.

“Nutrition education in undergraduate medical schools is heterogeneous and largely under-powered” Professor Cuerda says, and adds: “teachers and students believe that the time dedicated to nutrition teaching is insufficient and far from what would be needed”.

The recently published ESPEN position paper (2) has identified the “minimum curriculum knowledge” in nutrition that serves to improve the training of the future doctors. This has been transferred into the Manifesto which was issued and signed by the 51 participants, including delegates of 13 European Medical Schools, representing 34 countries.

1. Cuerda et al – A clinical nutrition education in medical schools: results of an ESPEN survey – Clin Nutr (2017);36:915-6
2. Cuerda et al – Nutrition education in medical schools (NEMS). An ESPEN position paper – Clinical Nutrition (2019); 38: 969-974

ESPEN (European Society for Clinical Nutrition and Metabolism) is an organization dedicated to all issues relevant to the field of clinical nutrition and metabolism and promotes: basic and clinical research, basic and advanced education and organization of consensus statements about clinical care and care quality control.
NEMS is an initiative of the ESPEN Nutrition Education Study Group (NESG)

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NUTRITION EDUCATION IN MEDICAL SCHOOLS (NEMS) INITIATIVE

Manifesto for the Implementation of Nutrition Education
in the Undergraduate Medical Currriculum

The NEMS Manifesto

Nutrition is a broad, interdisciplinary field, encompassing a large variety of scientific, cultural, social and political aspects. Human Nutrition is identified by three major domains, namely Basic, Applied and Clinical Nutrition. Human nutrition is an intrinsically complex topic, ranging from agriculture and zootechnics to food technology, from nutrition in different physiological states (growth, pregnancy, breast-feeding, aging), to the nutritional approach to acute and chronic diseases, from birth to the end of life.

At present, and due to its innate complexity, the nutritional field is often dominated by confusion: researchers, clinicians, patients and media have inconsistent ideas related to nutritional issues in health and disease. The complexity of the matter and the apparent confusion, however, should not represent an obstacle in acknowledging the relevance of nutrition in both preventive and clinical medicine.

The prevalence of obesity and related complications and the mortality rates due to NCDs such as cardiovascular diseases, cancer, diabetes or COPD are steadily increasing and cause > 60% of diseases burden. Conversely, the rates of disease-related malnutrition (under-nutrition) have remained substantially unchanged since the 1970s. Malnutrition still causes high rates of complications, mortality and healthcare costs and about 12% or more of hospital expenditure.

While research has clearly documented that nutrition can positively impact on disease onset, prognosis, treatment side effects and outcomes, there is a great neglect regarding the prevention, diagnosis and treatment of malnutrition (including over- and under-nutrition) and low priority is currently given to nutritional activities by other disciplines in the competition for healthcare budget.

The training of healthcare professionals (HCPs), and in particular of medical doctors, becomes crucial both for a correct take-up of the problem and for effectively combating the confounding environment that prevails in the domains of Human Nutrition. Currently, (Clinical) Nutrition education in undergraduate Medical Schools is heterogeneous and largely underpowered.

Medical students are trained to consider the scientific evidence for pharmaceutical decision-making and clinical guidelines promoted by scientific institutions in specialties such as cardiology or surgery, while the evidence for nutritional interventions and the guidelines in Clinical Nutrition are often underevaluated.

ESPEN
NUTRITION EDUCATION IN MEDICAL SCHOOLS (NEMS) INITIATIVE*
Manifesto for the Implementation of Nutrition Education
in the Undergraduate Medical Currriculum
The NEMS Manifesto

Based on the previous arguments, we manifest that:

• Nutrition education is necessary in the training of healthcare professionals, including medical students and should be mandatory in all Medical Schools

• Medical students need an evidence-based nutrition education to understand the importance of nutrition in health and disease

• During the medical training at the University the students should receive mandatory information about human nutrition in its three different domains, including basic nutrition, applied or public health nutrition and clinical nutrition

• The way to organise these themes in the curriculum (i.e. vertical or horizontal integration of traditional classes, seminars and/or clinical practice sessions), also including novel teaching tools, internet resources and e-learning, will depend on each University centre, taking into consideration the different possible models of teaching (parallel, integrated or case-solving based), the availability of teachers and the distribution of time and credits with the rest of teaching subjects.