Sarah Armes

Background: Nutrition care at the community level can support the prevention and management of nutrition-related chronic diseases. However, the lack of nutrition professionals, healthcare professionals’ limited understanding of their role in nutrition care and/or limited training in nutrition may affect nutrition care in India. This study explored the perspective of Indian medical doctors as well as nutritionists/dietitians on the demand, availability and impact of nutrition interventions and their attitudes and training towards nutrition care. Methods: A self-administered cross-sectional online survey was conducted with medical doctors, nutritionists and dietitians in February, 2021. The questions covered five domains: (1) participants’ characteristics, (2) perceived availability and demand for nutrition services, (3) perceived impact of nutrition services on dietary choices, hospitalisations and deaths, (4) perception of medical doctors’ role in nutrition care and (5) education and training in nutrition. Results: A total of 74 participants completed the survey with most being from West Bengal. Almost 60% of participants perceived a moderate demand for nutrition services (n=44) with many reporting unsatisfactory services (n=34; 45.9%). Nutritionists/dietitians ranked the impact of nutrition interventions (ie, food taxes/subsidies (median; IQR 3–0/3–2), food distribution (median; IQR 3–0.75/4–1.5) and food labels (median; IQR 3–2/4–1.25) on promoting healthier dietary choices higher than medical doctors. Similar findings were observed regarding the prevention of hospitalisations and deaths. Significant differences existed in the perceived role of medical doctors in encouraging patients/clients to eat healthy foods (median; IQR 4–2.75/4–0.5) and to seek support from other health professionals (median; IQR 5–1/4–2). About 30% of medical doctors did not receive any nutrition content as part of their training (n=12). Conclusion: Nutrition education and counselling services in primary healthcare are perceived as promising actions to support healthier dietary choices and to contribute to the management of malnutrition and chronic disease in India. Medical doctors and nutritionists/dietitians were generally aligned regarding the role of medical doctors in nutrition care, with more nutrition training warranted to further support their roles.

Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent chronic condition often accompanied by multiple comorbidities requiring complex pharmacological management. This review aims to examine the prevalence of polypharmacy in patients with MASLD, alongside an exploration of reported associations with side effects and observed relationships with patient-reported outcomes. Methods: We conducted a systematic review using MEDLINE, CINAHL, Embase, Cochrane CENTRAL and Scopus databases, supplemented by a grey literature search, from inception to August 2024. Inclusion criteria were randomised controlled trials, cohort studies or case-control studies that evaluated the prevalence of polypharmacy and its consequences in adults with MASLD. Three reviewers independently performed study selection and data extraction. The quality of included studies was assessed using the Newcastle-Ottawa Scale. The primary outcome was the prevalence of polypharmacy, with secondary outcomes including side effects and quality of life (QoL). A meta-analysis with a random-effect model was performed. Results: Six studies were included, of which three (totalling 2194 participants) were used in a meta-analysis. Polypharmacy prevalence ranged from 25% to 89%, with a pooled prevalence of 81% (95% CI 59 to 93), I²=99.5%. Adverse outcomes associated with polypharmacy included increased risk of hepatic encephalopathy-related hospitalisations, reduced QoL across physical and mental health domains, and augmented liver disease progression, particularly in individuals with advanced MASLD. Commonly used medications, such as anticholinergics and insulin, were linked to significant symptom burdens and metabolic dysregulation. Risk of bias assessments revealed that 50% of included studies had high risk due to limitations in study design, such as cross-sectional design and inconsistent definitions of polypharmacy, which reduced the certainty of evidence. Conclusions: Polypharmacy is highly prevalent in MASLD and associated with poorer clinical outcomes and reduced QoL. Interventions such as deprescribing programmes and enhanced medication management strategies are needed to mitigate risks and optimise patient care.

Background: In the context of global shifts in food systems, this paper explores the unique dietary practices of the Santal tribe, an indigenous group in eastern India, to understand the health, nutrition, and sustainability aspects of their traditional food systems. This study evaluates the nutritional content of the Santal diet in comparison to the EAT-Lancet Commission’s 2019 dietary guidelines for healthy and sustainable diets. Methods: The University of East Anglia, in collaboration with the NNEdPro Global Institute for Food, Nutrition and Health in Cambridge, PRADAN; colleagues in India and local Santal youth, conducted nutritional analyses of traditional Santal recipes. Two menu templates, Kanhu Thali and Jhano Thali, were selected for comparative analysis based on their representation of diverse dietary practices within the Santal community. Nutritional data, including energy as well as the distribution of macronutrients and micronutrients, were compiled and compared with the EAT-Lancet guidelines. Results: The Santal menu templates (nutritionally complete meals) demonstrated alignment with EAT-Lancet recommendations in aspects such as whole grains, starchy vegetables, vegetables, plant-based protein sources, unsaturated fats, and limited added sugars. However, notable deviations included the absence of animal-based protein sources and dairy. The Santal diet showed high protein intake, largely from plant-based sources, and emphasised the importance of whole grains. Seasonal variations in nutritional content were observed between the two templates. Conclusions: While the Santal diet aligns with some aspects of global dietary guidelines, there are notable deviations that underscore the complexity of aligning traditional diets with universal recommendations. The findings emphasise the need for culturally sensitive dietary recommendations that respect traditional diets while promoting sustainability. Research needs to support tailored global guidelines enshrining core principles of nutritional adequacy which are inter-culturally operable in order to accommodate cultural diversity, local practices, and seasonal variations, crucial for fostering sustainable and healthy eating habits in diverse sociodemographic contexts.

Background The COVID-19 pandemic may have contributed to poorer self-management (ie, diet, physical activity and sleep) of diabetes mellitus (DM), which might predispose individuals to more severe COVID-19 outcomes. Objective The first objective was to capture perceived changes in diet, physical activity and sleeping during the COVID-19 pandemic in adults with type 1 (T1DM) and type 2 diabetes mellitus (T2DM) in the UK. A second objective was to explore differences between individuals with DM compared with ‘no’ or ‘other’ health conditions. Methods Participants aged >18 years were selected by convenience. Individuals subscribed to the Diabetes.co.uk community were sent a web-based survey including questions about demographics and health, followed by 5-point Likert-type scale questions relating to lifestyle-related behaviours during the COVID-19 pandemic. Individuals were grouped by diagnosis of DM, ‘other’ or ‘no’ health condition and responses were compared. Results 4764 individuals responded, with 2434 (51.3%) being female and 1550 (32.6%) aged 55–64 years. T2DM (2974; 62.7%), hypertension (2147; 45.2%) and T1DM (1299; 27.4%) were most frequently reported. Compared with T1DM, ‘no’ or ‘other’ health conditions, respondents with T2DM reported making a less conscious effort to get outside and exercise daily (pConclusions Our study highlighted important differences in lifestyle by individuals with T1DM, T2DM, other and no health conditions in relation to the COVID-19 pandemic. Establishing surveillance systems and conducting repeated assessments are required to analyse how the situation shifted over time and whether adverse collateral effects of the pandemic were sustained in those with chronic health conditions.