The Athens OPTIMAL NUTRITIONAL CARE FOR ALL conference. Advancing Holistic Health Through Optimal Nutritional Care
ONCA Pre-conference Patient Session
Marek Lichota & Robert Greene
Marek Lichota and Robert Greene opened the ONCA Conference with a warm welcome to participants from 21 countries, gathered at a historic university in Athens. They introduced the event’s objectives, emphasizing the campaign’s commitment to strengthening the role of patients in nutritional care through a patient-centred approach and advocacy. Central to ONCA’s mission is the systematic integration of patient perspectives in all activities, including the annual conference, Malnutrition Awareness Week, and ongoing national initiatives. To ensure meaningful engagement, ONCA aims to establish clear pathways for patient involvement in decision-making, content creation, and awareness efforts. A sustainable framework will support long-term patient participation through coordinated structures, structured follow-ups, and capacity-building actions. A notable strategic development is the formation of the ONCA Patient Stakeholder Group, which will provide continuous, structured patient input across the campaign’s levels.
The session began with a keynote by Ms. Cristina Guerrero Paez, Director of BorstkankerVereging Nederland (BVN), who discussed how holistic nutritional care can be defined from a patient’s point of view.
Ms. Adela Maghear, Senior Policy Advisor, followed with a presentation on the importance of embedding patient voices into nutrition policy priorities.
Nicole Erickson, Health Literacy Coordinator, then examined how patients and dietitians can collaborate to improve access to nutritional care across Europe. A focused small-group discussion ensued, providing space for deeper dialogue.
Later, Mr. Robert Greene returned to the stage to elaborate on the formation of the ONCA Patient Stakeholder Group, reinforcing the campaign’s commitment to structured patient engagement. The session concluded with a reflective discussion highlighting the gap between policy-making and actual understanding of policy intentions. Participants emphasised the necessity for patients to be fully informed from the beginning about their needs and the care process, and they called for innovative ways to organise knowledge and refine care approaches.
Summary ONCA day 1:
Opening by the chairs:
Olle Ljungqvist
Chair of the European Nutrition for Health Alliance
The presenter welcomed the presidency, the audience, and those watching online. He spoke about the purpose of the event and presented key data from across Europe regarding nutrition. He explained where we currently stand and emphasised the critical role nutrition plays in the prevention and management of chronic diseases. He outlined how decisions are made at the European level, who the key collaborators are, and how various stakeholders work together. He also clarified the connection between EU4Nutrition and ONCA, highlighting their aligned missions and joint efforts. Finally, he announced that Malnutrition Awareness Week will take place from the 10th– 14th of November and will be marked in various countries across Europe.
Fani Preventi
President of the Hellenic Dietetic Association
She warmly welcomed the audience, highlighting the recent enactment of a law that officially empowers dietitians and strengthens their role within the healthcare system. She also referred to additional legislative measures underway, aimed at further advancing and supporting the profession. He shared a clear and hopeful vision: that in the future, nutrition will no longer be seen as a privilege for the few, but recognised as a fundamental right for everyone. She concluded by welcoming all participants to Greece and to this important conference.
Michael Chourdakis
President of the Hellenic Society of Medical/Clinical Nutrition and Metabolism-GrESPEN, Professor of Clinical Nutrition at Aristotle University of Thessaloniki
He began by greeting the audience in several languages, creating a warm and inclusive atmosphere. He spoke about how strong collaboration has been key in making many initiatives possible, such as actions, conferences, and training programs. He highlighted the legislative progress that Greece has made in the field of nutrition, noting that the most recent step has been the introduction of mandatory nutritional screening. This marks a significant development in preventive healthcare. He expressed his optimism, saying that through this exchange, Greece also hopes to learn from the valuable practices of others, so that together we can all improve and move forward. He concluded by sincerely thanking everyone for being present and for offering their time and knowledge to help spread expertise and elevate the field of nutrition.
Session 1: A holistic perspective on health: Integrated Nutritional Care
Maria Panousopoulou
PhD, HR & Administrative Manager at EOPYY, Vice President of Institute of Health and Technology Promotion
Making the economic case for reimbursement and dietetic care in Greece
Maria Panousopoulou welcomed the audience and thanked the organization for the proposal. She mentioned that her speech would be about ‘’Making the economic case for reimbursement of dietetic care in Greece’’. She spoke about EOPYY, about FSMPs being reimbursed by EOPYY. She also mentioned the situation before EOPYY. It was initially explained that in order to make informed decisions and develop effective health policies, reliable data is essential. However, it was noted that data provided solely by EOPYY, especially in its current form, is insufficient. As a result, it became necessary to establish an alternative system for data collection and analysis which was named EOPYY’s Registry for Reimbursed MD and FSMPs. Then the speaker analyzed the registry project: what is it, what is the procedure and focused on what helps. He mentioned where things are now, the policies implemented in 2019-2029, what they have set as next steps and what needs to be done.
Vasiliki Rafaela Vakouftsi
Greek Patients’ Association
A holistic approach on nutritional care and quality of life
Vasiliki Rafaela Vakouftsi welcomed everyone and thanked the organizers for the opportunity to speak on such an important topic: “A Holistic Approach on Nutritional Care and Quality of Life.” She mentioned that she would present the patients’ perspective and began by explaining why nutrition matters so much to patients. She discussed how malnutrition and restrictive diets affect various aspects of life, including mental health, social life, and physical strength. She highlighted the existing gaps in nutritional care and focused on what patients truly want, emphasizing their desire not to be passive recipients but active partners in their care. She spoke about Holistic Nutritional Care, the interdisciplinary care model, and the role of patient advocacy. She closed with some final thoughts, stressing that nutrition is a right and that we need a holistic model of care that supports both body and soul, so that above all, people can live well. She concluded by expressing her gratitude.
Adonis Georgiadis
Minister of Health, Greece
Greek ambitions in Health Innovation and the role of nutrition in care
In his address, Adonis Georgiadis the Minister outlined Greece’s vision for innovation in health, emphasizing the pivotal role of nutrition and prevention in enhancing healthcare services. He pointed out a significant paradox: despite being the birthplace of the renowned Mediterranean diet, Greece today sees poor dietary habits and low adherence to this model, reflected in high obesity rates. The country ranks among the highest in Europe for adult obesity and leads in childhood obesity, based on recent data. Mr. Georgiadis presented two major initiatives supported by the Recovery Fund: A program to prevent and tackle adult obesity in collaboration with the WHO. A program to address childhood obesity, in partnership with UNICEF. He also announced that 2025 will see the largest recruitment of dietitians and nutritionists in Greece’s history, strengthening public health and prevention services. He stressed the critical role of nutrition in promoting health and quality of life and referred to the newly established public body, the Hellenic Dietetic Association, aimed at protecting public health and regulating the profession to international standards.
Session 2: European Strategies for Advancing Nutritional Care Policies and Implementation
András Kulja
Member of the European Parliament’s SANT committee
The new EU mandate: opportunities for nutritional care equality
András Kulja, member of the European Parliament’s SANT committee, underlined the decisive role of nutrition in the management and prevention of chronic diseases, such as cardiovascular diseases (CVD) and diabetes. He highlighted the importance of nutrition in healing and in the broader context of EU public health initiatives. He called for increased EU-level responsibility and support for nutritional care strategies, stressing the importance of raising public awareness to improve quality of life.
Note:
Eleonora Meleti, member of the European Parliament – TBC, was unable to attend the session but assured organizers of her intention to contribute actively upon her return.
Konstantina Boumaki
Board Member of European Patients’ Forum (EPF)
European Initiatives to unite patients in need of nutrition care
Konstantina Boumaki, speaking on behalf of European Patients’ Forum-EPF, emphasized that patients must be actively involved in all aspects of nutritional care, not as passive recipients but as partners. She explained that while the importance of nutrition is widely recognized in theory, there is still a significant gap in its practical application within patient care models. She stressed the need for a systemic change to ensure that nutrition is not treated as an afterthought but as a core component of healthcare. Highlighting the mission of EPF, she called for more inclusive and transparent approaches that embed patient voices into research, clinical guidelines, and care strategies. Boumaki concluded by sharing tangible ways to bridge the current gap in patient-centered nutritional care, calling for institutional support, structured frameworks, and a culture that values lived experience alongside clinical evidence.
Grigoris Risvas
Vice President European Federation of the Associations of Dietitians (EFAD)
A joint approach to nutrition care in Europe
Grigoris Risvas, the representative of EFAD (European Federation of the Associations of Dietitians), took the floor to explain the organization’s mission and activities. He outlined the role of EFAD in developing policies and professional guidelines for dietitians across Europe, highlighting its commitment to supporting the ‘One Health’ approach, which emphasizes the interconnectedness of human, animal, and environmental health. EFAD collaborates with various stakeholders, including academic institutions, professional bodies, and international organizations. Particular emphasis was placed on the annual Awareness Week, an initiative aimed at promoting the role of dietitians and raising public awareness about nutrition-related issues. The representative also spoke about EFAD’s ongoing collaboration with ESPEN (European Society for Clinical Nutrition and Metabolism) and upcoming joint initiatives designed to further strengthen the impact of nutrition in healthcare. Cristina Cuerda, Secretary European Society for Clinical Nutrition and Metabolism (ESPEN), concluded the session with an overview of ESPEN’s mission and organizational framework. She briefly explained the structure of ESPEN, highlighting the roles of its Executive Committee, the ECPC (European Clinical Practice Committee), the Scientific Committee, and the Charges de Mission. She emphasized ESPEN’s long standing role in fostering collaboration and professional development in clinical nutrition through its extensive network. Cuerda also referred to ESPEN’s recent publication activities, underscoring the organization’s ongoing commitment to advancing the science and practice of clinical nutrition at both European and global levels.
Alison Bate
WHO Athens Office on Quality of Care and Patient Safety
Nutritional Care, Quality and Disease Prevention
Alison Bate, on behalf of the WΗΟ Athens Office on Quality of Care and Patient Safety, expressed her gratitude for participating in the conference. She began by introducing the World Health Organization (WHO) and outlining its strategic framework. The focus then shifted to the three pillars of quality of care and the demonstrated cost-effectiveness of quality interventions. She discussed the four categories of health services and how they relate to nutrition for Universal Health Coverage (UHC). The presentation continued with an exploration of the connection between clinical nutrition and quality of care. She highlighted several WHO tools, including eLENA and the Pocket Book for Primary Health Care. Finally, she presented the Health-IQ Project, emphasizing its main objectives and its contribution to improving nutrition and care quality across the region.
Radost Asenova
Board Member of World Organization of Family Doctors (WONCA) Europe
Primary care in the nutritional care patient pathway: a European policy perspective
Radost Asenova, on behalf of the World Organisation of Family Doctors (WONCA) Europe, began by expressing her gratitude to the organisers for the opportunity to participate and shared her delight that this important conference is taking place in Greece. She opened her presentation by introducing WONCA, outlining its structure, and describing the various working groups within the organisation. She then addressed the importance of nutrition in primary care, emphasising why nutrition matters, and illustrated her points using the WONCA tree diagram in connection with the role of the family physician. The presentation included key findings from the Nutrition Day in Primary Care pilot project, highlighting both the challenges and opportunities identified through the data. She then showcased the various initiatives undertaken by WONCA and underscored the organisation’s openness to collaboration for the greater public good. Moving forward, she explained the key elements of a nutritional care pathway, offering insights into what needs to be done both at a general level and through policy action to strengthen nutritional care in primary health care (PHC). The speaker also elaborated on the role of WONCA Europe and the region’s ongoing commitments. She emphasised the importance of developing a shared agenda to effectively move forward. She concluded her presentation with a compelling call to action, encouraging collective efforts to enhance nutritional care in primary care settings.
Session 3: Driving pan-European awareness of malnutrition: key approaches
Panos Papandreou
SymbIASIS Team
Revolutionising nutrition and health: a start-up approach
Panos Papandreou, on behalf of the SymbIASIS Team, discussed the topic of parenteral nutrition, highlighting the potential risks involved and the importance of proper management. He emphasized the vital role of a well-organized, multidisciplinary team in supporting patients, outlining the specific responsibilities of each member and the sequence of actions taken. He underscored the goals of their project and focused on the key components of CPOE (Computerized Physician Order Entry) and CDSS (Clinical Decision Support Systems), which enhance prescription accuracy and clinical decision-making. He then addressed the comprehensive management of parenteral nutrition—from prescription to production, illustrating its benefits and presenting examples of home parenteral nutrition. He stressed that it is very important to have parenteral nutrition at home, no matter how difficult it is. It is a significant change while acknowledging the difficulties that patients on PN face when it comes to traveling, he stressed that their team does everything possible to make travel accessible and safe for these individuals. During his presentation at the conference, the keynote speaker shared valuable lessons for entrepreneurs drawn from their journey. He emphasized the importance of focusing on a specific niche, highlighting that building strong scientific knowledge and expertise in that area lays the foundation for business opportunities to emerge organically. He also stressed the value of engaging with colleagues from diverse and distant backgrounds, as such exchanges foster innovation and lead to better outcomes for patients. Finally, he underlined the significance of connecting with patients and patient networks, as this interaction offers unique insights into the real needs of the community and enables the design of targeted services that truly address and alleviate those needs.
Katerina Nikitara
Head of EU Programmes for Hellenic Cancer Federation (ELLOK)
The role of patient advocates on nutrition in Europe
Katerina Nikitara began by explaining the Ecological Model, which consists of five interconnected levels: policy, community, institutional, interpersonal, and personal. This model illustrates how various layers of influence affect health behaviours and outcomes. She then connected this framework to the Quadruple Helix Model, which involves collaboration among industry, community, policymakers, and academia, emphasising that sustainable progress in health and nutrition requires the integration of all these sectors. She provided a detailed explanation of the role of patient advocates, stressing that their involvement helps address barriers present at every level of the ecological model and that they interact dynamically with all actors in the quadruple helix. She also highlighted who can become a patient advocate, underlining the value of lived experience and community engagement. Focusing on community-level involvement, she showcased several initiatives and actions where patient advocates have made a meaningful impact, ranging from awareness campaigns to grassroots health education efforts. She then moved on to the role of patient advocates in policymaking, structured around four main pillars: 1. Contributing to informed, evidence-based legislation, 2. Connecting policymakers with other stakeholders, 3. Mobilising public support and media to drive policy changes, 4. Building capacity within patient organisations to engage effectively at the political level. The presentation continued with a spotlight on key advocacy actions in Greece and included a preview of the upcoming Forum on Cancer Synergies, which aims to bring together various stakeholders to create integrated, patient-centred strategies. Finally, she explored the involvement of patient advocates in academia and in industry. She emphasised that codes of conduct that promote transparency, independence and ethical collaboration are important.
Michael Hiesmayr
Head of Department of Medical University of Vienna
How can nutritionDay data inform European policies?
Michael Hiesmayr, Head of Department of Medical University of Vienna, began by introducing the Nutrition Care Policy Pyramid, followed by an in-depth explanation of the patient trajectory throughout the healthcare process. The speaker then explored the background and evolution of nutritionDay, including its history, associated risks, and outcomes. He provided detailed insights into nutritionDay’s application across various care settings—primary care, intensive care units, hospital wards, nursing homes, and long-term care facilities. He presented the development of the nutritionDay concept from its inception in 2006 through to 2024, illustrating its growing relevance and impact. The presentation also featured a study exploring what patients actually know about their health and examined key factors associated with in-hospital mortality. In addition, the speaker presented data on human resources in European hospitals, alongside other findings derived from nutritionDay-based research. In closing, the speaker emphasized several key points: nutritionDay is your worldwide network, utilize a common language to address nutrition issues of patients across sectors of health care, reality check & health care evolution, supports benchmarking and education, and it provides up-to-date data for policymakers and stakeholders. The session concluded with the unveiling of the nutritionDay 2025 poster.
Stephane Schneider
Chair of LIFE
The LIFE Survey First Results: opportunities to improve IF policies
Stephane Schneider, Chair of LIFE, focused on Chronic Intestinal Failure (IF) and the evaluation of adherence to nutritional care standards across healthcare centers of varying sizes. He mentioned what this disease is, its types, its etiology, and what treatment is needed. Emphasis was placed on the critical role of multidisciplinary teams—including physicians, nurses, pharmacists, dietitians, and other specialists—in delivering high-quality care to IF patients. The analysis showed that nutritional care standards are largely followed across centers, with no significant size effect observed for most criteria. This widespread adherence is likely due to the use of well-established ESPEN guidelines and alignment with governmental approval standards. However, smaller centers were found to lack specific procedures for non-emergent referrals and ward-based management. Graphical data further indicated that these smaller facilities often show less consistency in key processes such as waiting list monitoring and providing clinical advice to referring units. In terms of patient outcomes—including inpatient mortality, quality of life, and complication rates—larger centers tended to demonstrate more robust monitoring and better response rates, underscoring the influence of organizational capacity and resources. The conclusions also noted a potential recruitment bias, which could have contributed to the overall high compliance reported. Collectively, these findings highlight the importance of structured, multidisciplinary systems and sufficient institutional support in ensuring optimal care for patients with chronic intestinal failure.
Video URL: https://www.youtube.com/watch?v=VREou62ivl8
Summary ONCA day 2
Rapid Interview Panel Session: Next Steps in Nutritional Policies by Greek Societies
Professor Tzortzis Nomikos, representing the Hellenic Atherosclerosis Society, outlined the society’s long-standing efforts to integrate nutrition into cardiovascular prevention strategies. With over 1,000 multidisciplinary members and strong representation from nutrition science, the society has organised numerous educational initiatives, funded research, and published clinical guidelines with a dedicated focus on diet. Future steps include the development of updated dietary guidelines for general and high-risk populations, promoting clinical nutrition training among healthcare professionals, supporting nutrition-focused research, and strengthening public awareness campaigns and policy collaborations to encourage sustainable, health-promoting food systems.
Paul Farajian, on behalf of the Hellenic Medical Association for Obesity, emphasised the association’s mission to educate health professionals and the public on obesity as a chronic, multifactorial disease. He highlighted alarming rates of obesity in Greece, particularly in children and older adults, alongside poor diet quality and nutrient deficiencies. The association’s work includes professional training, collaboration with municipalities, and public education campaigns. Farajian stressed the need for a personalised, evidence-based, multidisciplinary approach to obesity management, recognising malnutrition even in patients with obesity, and called for better tools, regular screening, and cooperation between specialties.
Lampros Mpizas, on behalf of the Hellenic Regulatory Body of Nurses, emphasised that no national nutrition policy can succeed without the active involvement of nurses. He advocated for mandatory nutritional screening in clinical settings, continuous nurse training, and interdisciplinary collaboration. Hellenic Regulatory Body of Nurses supports public education initiatives, school-based nutrition programs, and evidence-based communication tools. It proposes a structured role for school nurses and aims to formalise nurses’ contributions to nutrition care across all levels of prevention, diagnosis, and rehabilitation, ensuring their expertise is embedded in national health strategies.
Charis Dimosthenopoulos spoke on behalf of the Hellenic Society of Internal Medicine, highlighting its strong partnerships with medical and nutrition associations to promote nutrition education and practice. The society regularly integrates nutritional topics into its conferences and collaborates on obesity and diabetes management through roundtables, working groups, and public health campaigns. He stressed the importance of internal medicine’s role in multidisciplinary care and policymaking, particularly in areas like therapeutic protocols and obesity regulation. The society also supports public awareness around the Mediterranean diet and lifestyle changes for chronic disease prevention.
Dorina Sialvera, on behalf of the Hellenic Dietetic Association (HDA), highlighted its strategic priorities in addressing malnutrition through systemic change. Central goals include the nationwide implementation of mandatory nutritional screening within 48 hours of hospital admission, supported by the development of clinical protocols, professional training, and a national malnutrition registry. HDA also plans a multimedia public awareness campaign and advocates for increased dietitian staffing, expanded reimbursement for nutritional support, and legislative reforms to integrate nutrition into standard healthcare practice. These actions aim to elevate the role of dietitians and embed nutrition more firmly within Greece’s national health policy.
Michael Chourdakis, President of the Hellenic Society of Medical/Clinical Nutrition and Metabolism (GrESPEN) and Professor of Clinical Nutrition at Aristotle University of Thessaloniki, highlighted their commitment to advancing clinical nutrition in Greece through strategic education and policy efforts. Their primary goal is to integrate nutrition screening into general family medicine by revising speciality curricula in collaboration with the relevant professional societies. In partnership with the Ministry of Education, GrESPEN promotes wider adoption of structured nutrition education, modeled on medical school’s successful programs, offering an elective course since 2006, a mandatory course since 2020, and a postgraduate program since 2018. However, expansion to other medical schools is hindered by staffing and budget limitations. Additionally, GrESPEN has reapplied for the MNI Award, aiming to secure both financial support and institutional recognition. Such awards enhance their credibility when advocating with ministries and stakeholders. By strengthening its brand and fostering international visibility, the Society seeks to embed nutrition more firmly within healthcare and medical education in Greece.
Interactive break-out workshops round #1
Nutritional Education in Medical Schools: Latest State of Play
Moderators: Cristina Cuerda & Michael Chourdakis
Cristina Cuerda, Professor of Medicine in Spain, opened the session by outlining the rationale and development of the Nutrition Education in Medical Schools (NEMS) project, co-led with Maurizio Muscaritoli. She began by highlighting the widespread gap in nutrition training within medical education, despite the high prevalence of nutrition-related disorders such as obesity, undernutrition, sarcopenia, and micronutrient deficiencies. Cuerda framed her presentation around three core questions: why nutrition education matters, who should be responsible for advancing it, and how it can be implemented. She stressed the importance of involving not only university faculty but also national governments, international health organisations like the WHO and European Commission, scientific societies, and student groups in pushing forward curriculum reform. Cuerda presented the 2020 ESPEN manifesto as a foundational milestone advocating for mandatory, evidence-based nutrition education during undergraduate medical training. She emphasised that students must receive a minimum, harmonised nutrition knowledge as a matter of clinical competence and public health necessity. Finally, she introduced the educational tools being developed by the project, which aim to support medical schools in integrating nutrition teaching in a flexible, interdisciplinary manner.
Maurizio Muscaritoli, Professor of Internal Medicine at Sapienza University of Rome, followed by presenting the concrete deliverables of the NEMS initiative. He described the slide kit developed by a volunteer task force composed of 20 professionals from multiple countries. This educational resource comprises 196 slides grouped across 21 topics and three domains: basic nutrition, public health nutrition, and clinical nutrition. Each topic includes clear learning objectives, simplified bullet points, and extensive speaker notes to support non-specialist educators. Muscaritoli emphasised that the resource was designed to be modular, adaptable, and accessible for integration into existing university curricula without requiring new standalone courses. The aim was not to create specialists in nutrition, but rather to ensure that every graduating doctor possesses foundational competence in recognising, assessing, and advising on nutrition-related issues. He also presented usage statistics showing global interest in the materials, with downloads from over 40 countries. In closing, he introduced the project’s expansion under the acronym NEUS (Nutrition Education in Undergraduate Schools), starting with the development of materials for pharmacy students under the NEPS subproject, and future plans for nursing and potentially advanced dietetic training.
Michael Chourdakis, Professor of Clinical Nutrition at Aristotle University of Thessaloniki and President of the Hellenic Society of Medical/Clinical Nutrition and Metabolism (GrESPEN), contributed a regional and practical perspective to the discussion. He reflected on Greece’s academic context, noting the variation in training across different types of dietetic and nutrition programs. While acknowledging that dietitians often receive more nutrition training than other professionals, he pointed out a common deficit in advanced clinical nutrition knowledge, particularly for those working in hospital settings. He also shared his experience integrating nutrition into the core curriculum at his own medical faculty, emphasising that long-term success requires institutional support and persistent advocacy. He described a stepwise approach: starting with voluntary elective modules, piloting success, and using international credibility, such as ESPEN endorsement, to persuade deans and academic councils. He stressed the importance of having a dedicated champion within each faculty willing to invest time and effort into driving change from within.
EU Session: Opportunities for Member State Actions on Nutritional Care
Moderators: Alessandro Laviano, Adela Maghear & Nicole Erickson
Nicole Erickson, a Research Scientist and Dietitian at Ludwig-Maximilians Universität München, presented Germany’s experience in addressing gaps in national nutrition policy. She described how the German team responded to an EU health policy initiative by creating a national Health Policy Platform, which served as a base for building a broader European coalition. This coalition included patients and other key stakeholders and developed a series of online seminars during the COVID-19 pandemic, allowing for widespread reach across Europe. Erickson emphasized that building momentum at the national level required persistence and coordination, but when Germany began to act, measurable results followed. Among the country’s initiatives was the launch of Malnutrition Awareness Week. Until recently, Germany had lagged behind other nations in participating in this campaign. Over the past three years, however, the country began to take part, with a characteristically structured and organized approach. A dedicated website was created, offering downloadable materials for both health care professionals and the public. The campaign included printable flyers, posters, and free resources aimed at increasing awareness. The final day of the awareness week was designated as Public Policy Day, during which German politicians were invited to engage in dialogue with stakeholders. The initiative proved successful, supported by a coalition of ten national partners representing over 34.000 individuals. Planning for the next Malnutrition Awareness Week involves meetings held every six weeks, where partners contribute ideas and coordinate efforts. Erickson highlighted the value of working with ONCA, describing it as both a stabilizing force and a catalyst that facilitates networking and action.
Alessandro Laviano, Associate Professor of Internal Medicine at Sapienza University of Rome, addressed the increasing complexity of hospital care in Europe due to aging populations and the growing prevalence of chronic conditions. He noted that healthcare systems have become more effective in controlling disease, but less so in supporting long-term patient well-being. Many patients, particularly older adults, now live with persistent functional limitations. He pointed out that in Europe, 20% of individuals living with dementia receive no assistance with daily activities, and up to 80% of the care they do receive comes from informal sources, primarily family. This reflects a broader failure to provide structured support for vulnerable populations. Laviano questioned whether mortality should remain the central outcome measure in evaluating nutritional care. He argued that other indicators, such as reductions in non-elective hospital readmissions or improvements in patients’ quality of life, may be more relevant in today’s health care context. He encouraged the integration of European and national data, greater public education, and long-term pilot studies to evaluate the effectiveness of nutritional interventions in slowing disease progression and reducing hospitalizations. The focus, he suggested, should not be solely on extending lifespan but on improving healthspan and preserving functional ability.
Adela Maghear, Pharmacist and Senior Health Policy Advisor based in Brussels, offered a critical perspective on the gap between policy creation and implementation. She explained that while many EU health strategies include references to nutrition, the issue is rarely prioritised, and few policies are enforced at the national level. The real challenge, she noted, is not the absence of policy but the failure to act on it. She introduced the concept of the “policy activation gap” and outlined three essential steps to bridge this divide: aligning national goals with EU policies, utilising available funding and programs such as Horizon Europe and structural funds, and tracking progress through measurable data. Maghear stressed the importance of stakeholder collaboration, urging governments, civil society, health care professionals, researchers, and patients to work together. National ONCA communities, she suggested, could appoint dedicated nutrition focal points, conduct alignment scans to assess their country’s standing relative to EU policies, and organize national roundtables with health authorities to discuss nutrition-related priorities. Her presentation concluded with a strong call to action, asserting that the true potential of policy lies in its implementation. EU policy, she argued, should be seen not just as a regulatory framework, but as an opportunity to improve population health, secure funding, and drive systemic change. The session as a whole underscored the need for sustained collaboration, strategic planning, and persistent advocacy to translate European nutrition policy into real, impactful health care practices at the national level.
Health Economics: Identifying the True Policy Drivers
Moderators: Anibal Marinho & Henrik Højgaard
This session tackled a tough but important topic: how to make malnutrition, often overlooked, a political and policy priority. With ageing populations, chronic diseases, and rising healthcare costs across Europe, the group discussed why investing in nutritional care saves lives, improves quality of life, and reduces health system costs. Denmark and Portugal shared case studies from their own national experiences on how to turn data into action and political decisions.
One of the central themes of the discussion was the role of health economics in shaping policy. It was acknowledged that clinical evidence alone rarely drives political change. Policymakers tend to respond more effectively to economic arguments that clearly demonstrate how inadequate nutrition care can lead to increased hospital stays, higher readmission rates, and inflated healthcare costs. The most compelling policy proposals, it was argued, are those supported by a combination of robust data, tangible economic benefits, emotionally resonant patient stories, broad public support, and well-documented success narratives.
Denmark’s approach exemplified how data-driven advocacy can effect systemic change. In 2022, the country introduced new national guidelines encompassing nutritional care from hospitals to community settings, including general practitioners. A dedicated health economics report quantified the cost burden of disease-related malnutrition, projecting a significant surge by 2035 if current practices remained unchanged. To guide strategic planning, three potential scenarios were modelled: maintaining the status quo, implementing the new guidelines alone, and combining guideline implementation with systematic screening and home care services. The analysis revealed that the third scenario could result in savings exceeding €6 billion over the next decade. Denmark’s strategy involved leveraging a national healthcare cost database to monitor patient outcomes and calculate financial impacts. Strategic alliances with patient advocacy groups and media channels helped amplify public pressure, and findings were presented directly to parliament and health leaders. While comprehensive data was indispensable, it was stressed that policymakers favour clear, impactful figures and human narratives over exhaustive technical documentation.
Portugal’s case offered a contrasting example of initiating change from a baseline of limited infrastructure and awareness. In 2016, the country lacked fundamental data and policy frameworks around clinical nutrition. Over eight years, Portugal undertook a multi-phase transformation. Stakeholder coalitions were established, and public commitments were secured from both health ministers and parliamentarians. National screening days and awareness weeks were launched to build public consciousness. Gradually, electronic nutrition screening was rolled out in hospitals and primary care settings. One of the landmark achievements was negotiating outpatient reimbursement for enteral and oral nutrition products, scheduled to begin in 2025 and to increase from 37% to 90% over a three-year period. Portugal’s success hinged on the strategic use of political windows, such as elections and major health events, to push proposals forward. A pragmatic approach was adopted, advocating for partial rather than full reimbursement to enhance political feasibility. Ultimately, the lesson from Portugal was that while numbers are crucial, framing nutrition in terms of dignity, quality of life, and fairness can be equally persuasive. Emotional appeals and visible public support often carry as much weight as economic modeling.
Across both case studies, shared challenges and effective strategies emerged. A common caution was that excessive data can be counterproductive; decision-makers may become overwhelmed, highlighting the importance of presenting only key, actionable metrics. It was also noted that policy change is inherently slow and often the result of persistent, incremental victories. Moreover, national contexts vary, and strategies must be adapted to local realities. Building alliances with patients, particularly those managing chronic diseases, and collaborating with other medical specialties such as cardiology, oncology, and palliative care were recommended as crucial tactics for advancing the nutrition agenda.
In conclusion, the session reinforced a fundamental message: to integrate better nutrition care into healthcare systems, advocates must communicate in the language of politicians, clear data, compelling stories, and pragmatic proposals. The experiences of Denmark and Portugal demonstrated that while change may take years, it is achievable through collaboration, persistence, and strategic advocacy. The call to action now lies with other countries to adapt these lessons to their own circumstances and to continue striving for equitable, effective nutrition care for all patients.
Interactive break-out workshops round #2
Accelerating Malnutrition Awareness Week’s Impact
Moderators: Konstantina Togka & Silvia Tarantino
Joost Wesseling, ONCA Executive Director, opened the session by emphasising the growing impact of Malnutrition Awareness Week (MAW) across Europe, marked by increasing national participation and a wide range of localised activities. He introduced a new layer to the initiative—a European-level campaign designed to complement country-specific efforts through top-down and bottom-up collaboration. This “ONCA Impact” approach is aimed at fostering stronger health policy outcomes through unified action by patient advocates, healthcare professionals, industry leaders, and NGOs. He explained the importance of leveraging Brussels-based networks and EU-level collaborations, such as those with the European Nutrition for Health Alliance, ESPEN, EFAD, and others, to raise visibility and political attention around nutrition care. He stressed that although the EU itself is not a healthcare provider, collective influence from national actors could shape better European nutrition policies. He concluded by urging countries to continue exchanging best practices, as facilitated in regular pre-week planning workshops hosted by ESPEN and ONCA, and to ensure that campaigns are adapted to national contexts for maximum success.
Liana Poulia, Assistant Professor in Clinical Dietetics at Agricultural University of Athens, LLL Director and General Secretary of the Hellenic Society of Medical/Clinical Nutrition and Metabolism (GrESPEN), presented Greece’s strategic contributions to the 2024 campaign. She highlighted the development of a renal patient-specific recipe book in partnership with a prominent Greek chef and the Hellenic Society of Nephrology. She also discussed a series of professional training courses organised in November, covering malnutrition screening, enteral nutrition, and oncology nutrition. These initiatives were aligned with Greece’s newly enacted legislation mandating universal malnutrition screening in all hospitals. She outlined plans to develop a free application to assist healthcare professionals in calculating nutritional risk and complying with the new law.
Dorina Sialvera, representing the Hellenic Dietetic Association (HDA), elaborated on Greece’s awareness campaigns. She highlighted HDA’s participation in “Race for the Cure,” where body composition analyses and nutrition counselling were provided to the public, focusing on cancer-related malnutrition. She also discussed a comprehensive webinar on clinical malnutrition and the relaunch of a previously underutilised awareness video, which gained significant traction on social media. Additional efforts included a widely circulated public-facing article on malnutrition and the creation of an infographic aimed at clinical practice. Upcoming plans included a seminar on kidney disease nutrition and sessions on malnutrition at the upcoming national nutrition congress.
Sarah Dries, from the Flemish Institute of Healthy Living in Belgium, described the Belgian Alliance’s 2024 contributions. A major achievement was the development of a multilingual toolbox for professionals and institutions, enabling broad use during MAW. The toolbox was deployed across hospitals, care homes, and universities, with additional backing from Belgium’s Ministry of Health. She also discussed their national-level outreach, including letters to politicians and a social media campaign, though she noted limited mainstream media uptake. She acknowledged the challenges in engaging the public, as malnutrition remains a less sensational and familiar topic, and noted that further planning for 2025 would follow stakeholder meetings.
Diana Cardenas, on behalf of the French “Collective de lutte contre la malnutrition,” delivered an in-depth overview of France’s extensive MAW activities. She explained that France had integrated MAW into national health policy through alignment with the National Nutrition and Health Program (PNNS). With substantial funding (€377,000), the initiative included 7,600 activities nationwide across hospitals, nursing homes, and communities. Key highlights included physical activity workshops, culinary contests, media appearances (including Le Monde), and engagement with regional health agencies. She emphasised the development of patient-focused educational tools, including a nutritional booklet for oncology patients. Plans for 2025 involve expanding outreach into mental health settings, promoting enriched meals in nursing homes, and deepening public communication through patient testimonies and regional labelling programs.
Silvia Tarantino, representing ESPEN, detailed the European coordination of MAW. She described the multi-day structure of the campaign, with dedicated activities including webinars, Q&A sessions, Nutrition Day, and patient-centered discussions. Upcoming webinars will focus on nutrition in older adults, surgical protocols, and interdisciplinary nutrition care. Tarantino also highlighted new tools such as app-based Q&A and clinical case studies. She underscored the success of social media outreach using shared hashtags, translated fact sheets, and short interview videos that amplify the visibility of local campaigns. A major pillar of ESPEN’s work is Nutrition Day—a one-day audit conducted in healthcare institutions globally to benchmark and improve nutrition care. She outlined how Nutrition Day data informs institutional improvements, national benchmarking, and peer-reviewed publications.
Konstantina Togka, ONCA Campaign Coordinator, concluded by presenting a planning guide for countries to structure their MAW efforts. She emphasised setting SMART goals, defining target audiences, building core teams, selecting a few impactful activities, and maximising visibility through strategic promotion. Togka urged participants to share their planned dates and social media details by August 2025 and to attend a September workshop for final coordination. The reflection phase, scheduled for February 2026, will serve as a forum for sharing lessons learned and refining strategies for future impact.
Leveraging One Health to Drive Nutritional Care Policies for Patients
Moderators: Flora Tiniakos & Mary Yannakoulia
Flora Tiniakos, Nutrition Strategy Consultant, opened the session by introducing the concept of One Health – an integrated approach aiming to optimise health across humans, animals, plants, and their ecosystems. She emphasised the interconnectedness of these systems, stressing the need for a multidisciplinary effort not only to improve planetary and human health but also to support sustainable development and address global challenges such as climate change. Tiniakos highlighted the significant impact of food systems on issues such as zoonotic diseases, climate change, and natural resource depletion. She noted that food production is responsible for approximately one-quarter to one-third of global greenhouse gas emissions, uses up to 50% of habitable land, and consumes around 70% of global freshwater. Focusing on emissions and land use, she pointed out that animal-based products have a considerably higher carbon footprint than plant-based foods. In contrast, transportation contributes relatively little to total emissions compared to dietary choices. Supporting data showed that nearly half of the world’s habitable land is dedicated to agriculture, with 80% of that used for animal grazing or animal feed production. Despite occupying the majority of agricultural land, this sector delivers only 17% of global calories and 38% of global protein. In comparison, crops grown directly for human consumption – accounting for just 16% of land – provide the majority of calories and protein, exposing the inefficiency of the current food system.
Mary Yannakoulia, Professor of Nutrition and Dietary Behaviour at Harokopio University, continued by exploring the dual impact of food systems on environmental and human health, emphasising the need for transformation. She introduced the concept of the Planetary Health Diet as a practical model for embedding One Health principles into nutritional care policies. Yannakoulia described the planetary health plate, where half the plate consists of fruits and vegetables, and the other half includes whole grains, plant oils, plant-based proteins such as legumes and nuts, as well as animal-sourced proteins including fish, poultry, eggs, red meat in limited amounts, and dairy products, as well as starchy vegetables. Yannakoulia drew connections between this model and traditional, long-standing dietary practices such as vegetarian and flexitarian diets. She particularly emphasised that the Mediterranean Diet closely mirrors the Planetary Health Diet, highlighting its reliance on plant-based foods, cereals, fruits, vegetables, and olive oil as the primary fat source. The Mediterranean model also includes moderate consumption of dairy and fish, limited red meat, and occasional wine. Visual tools, such as the planetary plate and the Mediterranean diet pyramid, were presented as useful means of communicating these dietary principles. The discussion turned to strategies for integrating these dietary patterns into clinical practice, public policy, and food systems. For health professionals, proposed actions included conducting dietary assessments, offering professional nutrition counselling, supporting education and training in sustainable nutrition, revising procurement practices in healthcare settings to prioritise sustainably grown food, and engaging in advocacy for planetary health. Policy makers were encouraged to adopt flexible, context-sensitive solutions, recognising that there is no single approach suitable for all settings. Specific recommendations included targeting vulnerable groups, renewing and redesigning agricultural and food policies, ensuring leadership and long-term commitment, establishing innovative governance frameworks, enabling cost-effective financing mechanisms, creating social protection policies, promoting public education campaigns, incorporating nutrition education into schools, involving all certified health professionals in these initiatives, and equipping food producers with knowledge and tools to support sustainable practices. For food service professionals, Yannakoulia advocated for cultural shifts in menu design, placing greater emphasis on food quality and nutritional value, reducing food waste, and embracing biodiversity in meals. She emphasised the importance of letting plant-based foods take centre stage, bringing biodiversity to the table, and serving the farmer’s story.
Tiniakos concluded the session by addressing barriers to serving plant-based foods in hospital settings. She noted common perceptions that plant-based meals are less tasty, lack sufficient protein, are not nutritionally complete, and may be unfamiliar or even allergenic. These misconceptions, she explained, often lead to resistance from both patients and institutions. However, she shared a successful case of implementation, where over a two-year period, 1.2 million plant-based meals were served in hospital settings. The initiative not only satisfied patients’ nutritional needs but also supported climate goals and reduced institutional costs.
LIFE: The Leading Intestinal Failure Equality Initiative
Moderators: Stephane Schneider & Marek Lichota
This session was part of an ongoing conversation within the LIFE initiative, a growing group focused on raising awareness about intestinal failure (IF), improving patient care, and advocating for fair policies across Europe. What made this gathering stand out was its emphasis on working closely with patients, healthcare professionals, industry partners, and policy advocates alike. The goal is simple but urgent: ensure that everyone with IF, no matter where they live, gets the care and support they need.
At the heart of the LIFE initiative lies a multidisciplinary steering committee composed of physicians, nurses, patient advocates, and industry representatives. This committee is responsible for guiding the initiative’s strategic direction, ensuring inclusivity, and spearheading political engagement. Patient involvement is not merely symbolic but foundational, with co-chairs actively representing patient perspectives in the initiative’s planning and execution.
The session highlighted the central role of stakeholder engagement in advancing the initiative’s objectives. Key industry partners—including Baxter, Ironwood, Hanmi, and Fresenius Kabi—provide essential financial backing while also participating in educational and advocacy efforts. Despite logistical challenges and language barriers, the initiative is actively expanding its network of healthcare professionals, patient groups, and policy influencers across the continent.
Several key projects and outcomes were presented, showcasing tangible progress. One such initiative was a survey assessing the quality of care across IF centres of varying sizes. The findings were promising, revealing a noteworthy level of consistency in patient care practices throughout Europe. Another major development was the ongoing creation of a policy toolkit designed to support national-level recognition of IF as a rare disease and to guide the implementation of improved care infrastructures.
Notably, advocacy efforts in Italy have led to progress in classifying IF as a rare disease, with broader campaigns targeting EU-wide recognition. The LIFE initiative has also deepened its collaboration with ERNICA—the European Reference Network for rare congenital and hereditary gastrointestinal diseases—helping to bridge pediatric and adult care and encouraging comprehensive patient support.
Intestinal Failure Day (IFD), celebrated annually on February 1st as “1F Day,” has emerged as a cornerstone of the initiative’s awareness campaign. This event features coordinated activities including public engagement campaigns, patient storytelling, social media outreach, and distribution of advocacy toolkits. It serves both as a celebration of progress and a call to action for further policy change.
However, the session did not shy away from addressing ongoing challenges. A recurring theme was the underdiagnosis of IF and the resulting inequities in access to care. Variability in national healthcare systems and limited awareness among clinicians were cited as significant obstacles. Participants debated the relative merits of targeting public awareness versus focusing advocacy efforts on healthcare professionals and policymakers. The discussions underscored a key insight: while public engagement is valuable, systemic change often hinges on influencing those with decision-making power.
The lack of consistent access to multidisciplinary teams, particularly specialists such as dietitians, psychologists, and pharmacists, was another concern raised by both survey results and participant feedback. Addressing this gap will be essential to ensuring comprehensive care for IF patients across all treatment centres.
Looking ahead to the period from 2025 to 2027, the LIFE initiative has outlined a forward-looking strategy. Central to these plans is the expansion of the IF Ambassador Network, which aims to strengthen local representation and coordination of community-level and policy activities. The initiative also plans to launch a quarterly LIFE newsletter to maintain momentum, share success stories, and keep stakeholders informed.
Efforts will be made to expand the collection of patient stories to capture a diverse range of experiences, shedding light on disparities and informing advocacy work. The development of targeted educational materials—including improved fact sheets for policymakers, healthcare providers, and the general public—will support more effective and differentiated communication strategies. Additionally, a formal evaluation of IF Day campaigns will be undertaken, with the goal of documenting best practices and refining future efforts.
In conclusion, the LIFE initiative remains steadfast in its commitment to raising awareness of intestinal failure as a rare and life-threatening condition that demands specialised, multidisciplinary care. Through a combination of structured advocacy, inclusive partnerships, and evidence-based educational tools, the initiative seeks to close gaps in care, empower patient communities, and influence health policy at both national and European levels. The work ahead will be grounded in strengthened networks, richer patient engagement, and continued innovation—culminating in future observances of IF Day and beyond.
Round-Up and Closing
Pavel Tesinsky, representing the organising committee of the upcoming ESPEN Congress, opened the closing session by presenting a short preview of the 47th ESPEN Congress to be held in Prague in September 2025. He shared that the upcoming event, themed “Revolution, Evolution in Nutrition,” has already received a record number of abstract submissions. He emphasised that beyond its rich scientific program, the congress will serve as a hub for building connections among professionals passionate about clinical nutrition and metabolism. He also offered logistical details, highlighting the accessibility of Prague and the congress venue, and encouraging late-breaking abstract submissions and regular registration ahead of the July deadline.
Robert Johnstone, a former board member of the European Patients Forum and long-time advocate for patient-centred care, provided a compelling testimonial on the importance of involving informed patients in shaping nutritional education and policy. Drawing from his personal experience living with rheumatoid arthritis, Johnston shared how conventional medical advice early in his life dismissed the connection between nutrition and health outcomes. He argued that patients with chronic illnesses develop a unique, experiential understanding of their bodies and the effects of diet. Johnstone called on the ESPEN community to more actively engage patients as co-creators of knowledge and advocates for change, emphasising that policymakers often respond more readily to patients than professionals. He urged greater inclusion of patient voices in educational material development and political advocacy to drive faster and more effective systemic change.
One Health, One Nutrition: A Holistic Path to Optimal Nutritional Care
Antonis Zampelas
Professor of Human Nutrition (AUA)
Antonis Zampelas, Professor of Human Nutrition at the Agricultural University of Athens and President of the Hellenic Food Authority (EFET), delivered a comprehensive and interdisciplinary presentation on the One Health – One Nutrition paradigm. He framed his talk around the interconnection between climate, agriculture, food systems, and human health, presenting compelling evidence that climate change—through heatwaves, floods, crop failures, and ecosystem disruption—poses a growing threat to nutritional status and global food security. He reviewed the cascading impacts of food production on environmental degradation and human health, underscoring the dual role of food systems both as drivers and victims of climate change. He introduced the concept of sustainable diets, particularly the Mediterranean Diet, as a culturally adaptable and environmentally responsible dietary model. He presented data showing that adherence to such diets can significantly reduce greenhouse gas emissions, land and water use, and cardiovascular risk. He also discussed policy-level challenges such as the replacement of trans fats with other harmful substances like palmitic acid, and the socioeconomic barriers to accessing safe and nutritious food. Zampelas concluded by urging health professionals to promote not only scientifically grounded dietary guidelines but also to explore strategies to improve adherence, which remains the greatest obstacle to realizing the health and environmental benefits of such diets.
Update on the Optimal Nutritional Care for All campaign.
The aim is to translate nutritional care and science into policy. By exerting influence within organisations and at a policy level, they try to draw attention to the importance of optimal nutrition. But also, collaboration across different associations and fields is important to create influence on a European level.
ONCA is visible in Europe, and various working groups have been formed, 20 countries have now joined.
Meanwhile, 16 Malnutrition Awareness weeks have been organised ιν 2024, there are many ideas and inspiration that can be consulted via the ONCA website: Optimal Nutritional Care for All (european-nutrition.org).
