MAPPING DATA OPPORTUNITIES RELATING TO FOOD, NUTRITION AND HEALTH IN THE COVID-19 PANDEMIC

Background The COVID-19 pandemic has impacted the nutrition and health of individuals, households, and populations globally. Through exposing fragilities in food, health, and social welfare systems, the negative influence of COVID-19 continues to affect the global burden of malnutrition. The nature and scale of these impacts are not yet well understood thus the body of evidence for informing policy is limited. Collating and monitoring relevant data in real-time from multiple levels, sectors and sources is essential in preparing and responding to the ongoing COVID-19 pandemic. Objectives To identify key data sources related to food, nutrition, and health indicators in the context of the COVID-19 pandemic. Methods A COVID-19, food, nutrition and health framework was developed through multiple iterative rounds of online multidisciplinary discussions including the NNEdPro COVID- 19 taskforce and the Swiss Re Institute's Republic of Science, which comprised researchers and clinicians with expertise in data science, food, nutrition, and health. Results The proposed framework encompasses five socio-ecological levels which were further sub-divided by six categories of the food and nutrition ecosystem, including food production & supply, food environment & access, food choices & dietary patterns, nutritional status & comorbidities, health & disease outcomes, health & nutrition services. A limited number of exemplar variables for the assessment of global status of food, nutrition and health are identified under each category. Discussion/Conclusion This collaborative framework is the first step towards the development of a better understanding of the impact of COVID-19 on food, nutrition, and health systems. Limited data availability and disruption in routine data collection as well as other nutrition assessments during the pandemic are challenges that might limit the potential of the proposed framework. Next steps will include formal research and data gap analysis and the identification, as well as utilisation, of other indicators that could be used as proxies of the variables identified. (Table Presented).

NNEDPRO GLOBAL CENTRE RESPONSE TO THE UK GOVERNMENT OBESITY STRATEGY

Background Following considerable interest in the relationship between obesity and COVID-19, the UK Government have released a policy paper: 'Tackling obesity: empowering adults and children to live healthier lives'.1 This response may be focused on a limited and potentially historical view of overweight and obesity. We consider the complexity of the condition, its determinants, and co-existing conditions.2 Objectives We sought to gain consensus iteratively, using implementation framework thinking, to advocate for the appreciation of a wider, more complete understanding of the existing science behind obesity and the appropriate strategies needed to address it. Results We identified four strategic points and provided recommendations for more comprehensive coverage and greater impact: 1. Improving focus and messaging 2. Understanding drivers of food choice and nutritional status 3. Promoting healthy eating from early years 4. Addressing the complexity of obesity Discussion 1. Effective messaging should be inclusive, collaborative and non-judgemental, promoting co-participation in the development of messages used in public national campaigns.3 2. Higher rates of obesity are observed in socioeconomically deprived groups who rely on food assistance programmes, in which nutritional quality could be improved through involvement of nutrition professionals.4 In order to influence behaviour, basic food literacy and financial management skills could be developed, while subsidies for healthier alternatives may complement taxes on less healthy foods.5 3. Advocating for better education on food science and nutrition from early learning sectors will promote increased awareness early in life.6 This could be augmented by reinstatement of initiatives like the healthy start programme. 4. Human health is multidimensional, therefore focussing on a single-metric risks oversimplifying this complexity and undervaluing the importance of healthy behaviours, even those not directly associated with weight.7 Instead, we should consider positive lifestyle habits, rather than a narrow focus on weight or BMI alone for the individual, informed by existing and accepted scientific findings. Conclusion An integrated systems approach ought to be developed with a multipronged intervention strategy, targeting food production, supply and environments as well as marketing to improve availability of as well as accessibility to more nutrient-rich but less energy-dense foods. These combined with appropriate food education for consumers would enable more consistently healthy food choices.

DATA-DRIVEN ACTION FOR FOOD SYSTEMS TRANSFORMATION

Data that is accurate and accessible helps to drive innovation and progress, which was a key theme of discussion at the NNEdPro Sixth International Summit on Nutrition and Health. Data-driven policies and programmes have the potential to reorient food systems and end malnutrition by 2030, according to Andre Laperriere of Global Open Data for Agriculture and Nutrition (GODAN). The COVID-19 pandemic has exacerbated the existing food crisis, affecting production, processing, and distribution within the food system, and highlights the critical need for timely and reliable data to drive decision-making. The pandemic has affected food on the levels of production, transformation, and distribution, which presents an unprecedented opportunity for change. Using data, we can identify and learn from countries who have had the most success in reducing hunger (E.g., Armenia, Brazil, Ghana) and those which have achieved zero hunger while keeping adult overweight and obesity to a minimum (E.g., Republic of Korea, Japan). However, making practice and policy decisions involves a complicated process influenced by logic, current evidence, existing models and authorities, previous experiences, emotions, and cognitive biases, as discussed by Dr Jeffrey Bohn. Causal inference approaches could be one way to address some of these complications by merging nutrition data and scientific evidence to promote better decision-making in the context of nutrition-related communicable diseases targeted by the Nutrition Decade and the Sustainable Development Goals. Although challenges exist in all data science, there are particular challenges in applying mathematical precision in nutrition. Nutrition research considers dynamic processes that evolve and are often influenced by the process of studying them. Additionally, nutrition research occurs against the backdrop of traditional biomedical research where the randomised control trial (RCT) is considered the gold standard in proving causation. While pre-registration of data, protocol and analyses can address some of these primary challenges with research behaviour, to truly understand causation we must consider counterfactuals, which consider the context of the research (models, interventions, characteristics, and cognitive bias) for a more complete understanding. Causal inference tools can be applied to relevant, curated data to identify confounders and subsequent causal linkages. There is a necessity for the quality use of data to identify and strengthen high-impact policies and programmes for action on nutrition.

DISSEMINATING EVIDENCE DURING THE COVID-19 PANDEMIC

Knowledge networks, such as the NNEdPro Nutrition and COVID-19 Taskforce, are central to the rapid creation and dissemination of evidence, as highlighted at the NNEdPro Sixth International Summit on Nutrition and Health. During the COVID-19 pandemic, the Taskforce rapidly collated evidence and widely shared clear and accessible resources globally, via NNEdPro Regional Networks. The impact of the Taskforce on disseminating evidence and encouraging collaboration was made evident, and thus demonstrates the importance of this approach for addressing regional and global nutrition challenges. Scientific journals, such as BMJ Nutrition, Prevention & Health, as discussed by Editor-in-Chief, Professor Kohlmeier, also play a significant role in the dissemination of evidence. Once published, research is open access, disseminated widely online, and is encouraged to be used to inform practice. During the COVID-19 pandemic, any article with research findings relevant to the Coronavirus outbreak, were also shared widely with policymakers to increase global uptake. Knowledge networks, and scientific journals such as BMJ Nutrition Prevention and Health, are critical to the generation and dissemination of evidence, which is key to its uptake and implementation in policy and practice.

PUTTING RESEARCH INTO PRACTICE: KNOWLEDGE TRANSLATION AND IMPLEMENTATION FOR ACTION ON NUTRITION

The transfer of research evidence into practice has been historically slow, and requires an integration of many elements, including quality evidence, supportive physical and intellectual environments, and facilitation, as discussed at the NNEdPro Sixth International Summit on Nutrition and Health. Examples of applying clinical research into practice focused on the use of group consultations (also known as group clinics or shared medical appointments) to support behaviour change, the role of dietary micronutrients during the COVID-19 pandemic and the potential of Precision Nutrition. An emerging area from early implementation evidence includes group consultations, also known as shared medical appointments, as discussed by Dr Fallows. Group consultations have been shown to improve clinical outcomes for some patient groups (e.g., HbA1c, lipids, BMI), as well as improve self-care and health education, and patient and clinician satisfaction. These groups have been piloted throughout the UK both face-to-face and virtually, with initial findings suggesting they are feasible and acceptable to patients and clinicians. Further work is needed to assess whether these could be cost-effective when scaled-up in National Health Service UK primary care. During the COVID- 19 pandemic, there has been increasing emphasis on the central role of nutrition in health, including the role of dietary micronutrients, as discussed by Dr Van Dael and Shane McAuliffe. Nutrition plays an important role in immunity, yet the nutritional status of the most vulnerable population groups is likely to deteriorate further due to the health and socio-economic impacts of the novel coronavirus. Thus, implementation of this evidence into health care practice is key. Precision Nutrition, defined as an 'approach that uses information on individual characteristics to develop targeted nutrition advice, products or services', offers an exciting opportunity to further individualise dietary advice for behaviour change, as discussed by Dr Kohlmeier and Dr Hernandez. Precision nutrition is underpinned by the recognition that individuals differ in many important ways due to identifiable molecular traits and can be utilised to determine personalised weight loss interventions based on genetic variants. Use of implementation science is in line with one of the six cross-cutting pillars of the Nutrition Decade: Aligned health systems for universal coverage of nutrition actions. Dr Bell, an Advanced Accredited Practising Dietitian in Australia, provided an overview of key implementation science models and frameworks. Implementation frameworks such as the Action Research Framework, the Knowledge to Action Cycle, and the Spread and Sustain Framework, are underpinned by knowledge creation, effective education, and culture change. Dr Bell then highlighted how theoretical frameworks have provided guidance for the implementation of real world, complex nutrition interventions, including the Systematised Interdisciplinary Program for Implementation and Evaluation (SIMPLE) in Australia, and the More-2-Eat program in Canada.