Education in Nutrition big assent in the Curricula of EU Doctors
ESPEN launches the European "Manifesto" to fill the training gap
ESPEN (European Nutrition Society) launched the "Manifesto for the implementation of nutrition education", in Nice, during the ESPEN-NEMS (Nutrition Education in Medical Schools Initiative) meeting. 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.
Finally, ESPEN-NEMS manifest that:
1. Nutrition education is necessary in the training of healthcare professionals, including medical students and should be mandatory in all Medical Schools
2. Medical students need an evidence-based nutrition education to understand the importance of nutrition in health and disease
3. 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
4. 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 posible 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.
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