Journal of Hygienic Engineering and Design

Review paper
UDC 613.2:37.017(497.7)

IMPROVING PUBLIC HEALTH THROUGH NUTRITION EDUCATION AND

RESEARCH: SUPPORT TO PROACTIVE PARTNERSHIP TO PRODUCE QUALITY
EDUCATION STANDARDS FOR NUTRITIONISTS
Vera Simovska1*, Vesna Antoska-Knights1
Faculty of Technology and Technical Sciences Veles, University St. Kliment Ohridski - Bitola,
Dimitar Vlahov bb., 1400, Veles, Macedonia

e-mail: vera.simovska@uklo.edu.mk

Abstract
Education and nutrition are important fundamental
conditions and resources for improving public health.
Unhealthy nutrition is one of the key risk factors for
developing main non-communicable diseases. Studies
have confirmed that the countrys population has unhealthy eating habits. Dietetics is not included in the
curricula of Macedonian Medical Faculties. In order to
improve population health, by improving the quality
of nutrition education and research, we determined
the following objectives: - Supporting proactive partnership in defining national standards for the formulation of Doctoral study program for the innovative
technology for food and nutrition; - Forming a set of
competencies upon completion of studies; - Application of information and communication technology
(ICT) and e-learning.
Analyzing the results of numerous scientific findings
that confirm the important role of food and nutrition in
health promotion and prevention of nutrition-related
diseases, we developed the Doctoral study programs
for the innovative technology for food and nutrition.
The model of designing, planning and implementation of curriculum is in accordance with Bologna Declaration (1999), Dublin description (2004), EC Tuning
project (2009), European standards for improvement of
academic and practical curricula (2010) and DIETS2 advanced competencies (2013). Proactive work with the
industry and private companies is related to practice
placement. Innovative application of ICT, e-learning
and creating a website are intended for collaboration
with other national and European nutrition networks.
This doctoral study program will allow: education of
our own nutritionists who will be able to meet the domestic and global issues relating to food and nutrition,
inclusion of the researchers and experts in the projects
and in the: healthcare teams, HEIs, food industry and
they will be qualified to be responsible for production
20

of healthy, quality, safe, environmentally friendly and

affordable food for domestic and export needs. Also,
these nutritional experts will contribute to changes
in public health policy and health education strategy
(2014-2020) in the area of Health Enhancing through
Nutrition Education.
Key words: Nutrition education, Research, Descriptors,
Competencies, Doctoral degree.

1. Introduction
In recent years, the importance of healthy nutrition for
the population health as well as the economic aspect
of producing healthy and nutrient rich food accessible
to all has been in focus worldwide.
Consequently, numerous nutrition and food technology education programs started being implemented in higher education institutions across the United
States and Europe. Higher education institutions in
the United States currently focus particularly on introducing Food Technology in the academic studies of
nutrition, in order to enforce nutrition professionals
in the innovative technologies, reformulation of food
and facilitation of the existing food technology. This is
done in accordance to the Academy of Nutrition and
Dietetics (formerly theAmerican Dietetic Association).
Moreover, two key summits took place in 2011, one
in Moscow, Russia focusing on healthy lifestyle entitled: First Global Ministerial Conference on Healthy
Lifestyles and Non-communicable Disease (NCDs)
Control and one in New York, USA, entitled: UN Highlevel Meeting on NCDs. In addition, Roma Declaration
on Nutrition and Framework for Action was adopted at
the Second International Conference on Nutrition in
2014 (FAO/WHO, 2014).

Journal of Hygienic Engineering and Design

Unhealthy nutrition is one of the key risk factors for

developing main non-communicable diseases in the
Republic of Macedonia. Studies have confirmed that
the countrys population has unhealthy eating habits.
Dietetics is not included in the curricula of Macedonian
Medical Faculties.

science and facilitate production and processing, so

existing issues can be addressed, and new ones will be
prevented from arising. In summary, it is foreseen that
the new nutrition professionals will assist in education,
health maintenance, prevention and treatment of diseases on individual and national level.

Analyzing the results of numerous scientific findings

that confirm the important role of food and nutrition
in health promotion and prevention of nutrition-related diseases, we developed the academic study programs for food science and nutrition. The Republic of
Macedonia experienced a turning point for the nutrition profession in 2009 when the Macedonian Steering Committee for the Advancement of Healthcare
was launched at the Ministry of Health. After numerous discussions about the deficit of professional staff
in the country, the experts of the Steering Committee
emphasized the need for an academic study for the
innovative technologies, food science, nutrition and
dietetics. For the first time tangible results were seen
and laws and regulations have been produced. The
most substantial product of the work of the Committee is the so-called Green Book which integrated all
necessary national healthcare reforms [1].

The process of designing and implementing the National Framework for Higher Education Qualifications
in the Republic of Macedonia is in consonance with
the overarching Framework for Qualifications of the
European Higher Education Area [2] and the Official
Gazette of the Republic of Macedonia, 2010 [3].

At the same time, the University St. Kliment Ohridski

in Bitola started developing a new academic curriculum in the field of nutrition. In 2010, the University
introduced the Bachelors Degree program which
currently enrolls more than 350 undergraduate students. The Program for Nutritionists at the Faculty of
Technology and Technical Sciences Veles is offered in
three different towns across the country: Veles, Bitola
and Kicevo.

2. Academic curriculum in the field of nutrition

2.1 The curriculum
A career in Nutrition within the State University St. Kliment Ohridski of Bitola is established within two main
areas of work: one is Nutrition and Dietetics and the
other Food Technology and Biotechnology. With the installment of the program in 2010, a new vocational profile of multidisciplinary academic staff was introduced,
entitled Engineers of Technology - Nutritionists. The
new title was recognized and acknowledged by the European Federation of the Associations of D
ietitians.
The need to introduce a Bachelors and Masters degree
(1st and 2nd Bologna cycle qualifications) of multidisciplinary studies in nutrition in the Republic of Macedonia is a result of numerous scientific findings that
confirm the lack of knowledge on national level for the
important role of food, innovative food technologies,
and proper nutrition. In addition, one of the main goals
for creating the program was the need to have proper
staff in the country that will work in the domain of food

The first two Bologna cycles have been associated with

the following European Credit Transfer System (ECTS)
credit ranges:
Bachelors degree, or 1st cycle qualifications that
typically include 240 ECTS credits equivalent to level
6 of European Qualifications Framework (EQF).
Masters degree, 2nd cycle qualifications that typically include 60 and 120 ECTS credits equivalent to level
7 of EQF.
The academic curricula and structures of the practice
placements of both Bachelors and Masters programs
are based on the framework for ECTS calibration [2,
and 4] and the following statements of the European
Federation of the Associations of Dietitians (EFAD): the
European Dietetic Benchmark Statement (EDBS) [5],
and the European Dietetic Competencies and their
Performance Indicators (PIs) [6].
The Masters Degree Program is based on the model
of the European Commission/EACEA: Thematic Network for Dietetics (DIETS2) (2010-2013) [7]. The Work
Package 2 (WP2) of DIETS2 developed advanced level
benchmark competence statements for European dietitians entitled European Dietetic Advanced Competences (EDAC) [7]. The model of design, planning and
implementation of the curricula in the 1st and 2nd cycle
qualifications is based on the methodology proposed
in the Dublin description of program design (2004) and
the EU Educational Structures project Tuning (2009).
In 2011, Public Health HEPA Macedonia National organization for the promotion of health became an associative member of the European Thematic Network
for Dietetics and a team member of the DIETS2/WP2
Second and third cycle competences for dietitians.
The membership and recognition acquired has contributed to a great degree in the development of the
profession of nutrition and dietetics within the Republic of Macedonia [8].
2.2 The theoretical part of the study program
Study program is divided into the four sub-groups:
2.2.1 Basic Sciences: biology, physics, chemistry, nutritional biochemistry (cell and molecular basis of disease
21

Journal of Hygienic Engineering and Design

and metabolic complications), anatomy, nutritional

anthropometry, physiology, histology, genetics, immunology, biostatistics and mathematics, computers, and
methods of scientific research.
2.2.2 Food Science, Food Technology and Science of Nutrition and Dietetics:
a) Food Science and certain aspects of Food Technology:
nutritional values of common foods, the innovative
technologies for food, reformulation of food production, food processing and biotechnology.
b) Science of Nutrition and Dietetics: nutrition care model and process, methodology of nutritional assessments, examination of dietary intake, nutritional
testing, modification of diet in people with different
dietary habits, cultural and socio-economic conditions, hygiene of nutrition for healthy and sick
people, medical terminology and classification of
diseases, medical nutrition therapy (MNT), common
types of diet therapy and diagnostic procedures,
modeling and optimizing in nutrition, techniques of
food preparation, sensory evaluation, microbiology,
food safety and hygiene of food, practice based on
data and evaluation of practice.
2.2.3 Administration of Food Services: management,
planning and production of food legislations (NASSP),
economics, marketing, food equipment, packaging
and distribution.
2.2.4 Public Health Nutrition: nutrition and physical
activity, health promotion, nutritional epidemiology,
planning, coordination and evaluation of public health
strategies and policies, sociology, ethics, communications and cultural aspects of nutrition.
Further, to improve population health, by improving the
quality of nutrition education and research at advanced
level, in 2014 we determined the following objectives:
Supporting proactive partnership in defining national standards for the formulation of Doctoral study
program for the innovative technologies for food
and nutrition;
Forming a set of competencies upon completion of
studies;
Application of information and communication
technology (ICT) and e-learning.
Proactive work with the industry and private companies is related to practice placement. Innovative application of ICT, e-learning and creating a website are
intended for collaboration with other national and European nutrition networks.
In addition, the Master and Doctoral programs are especially focused on the scientific and research aspects
of the profession and the students will be able to develop various types of research, methodology and critical thought on the matter.
22

Doctoral study program will allow education of our

own nutritionists who will be able to meet the domestic and global issues relating to food and nutrition, inclusion of the researchers and experts in the projects
and in the healthcare teams, university and research
institutions, food industry and they will be qualified
to be responsible for production of healthy, quality,
safe, environmentally friendly and affordable food for
domestic and export needs. Also, these nutritional experts will contribute to changes in public health policy
and health education strategy (2014 - 2020) in the area
of Health Enhancing through Nutrition Education.
2.3 Implementation and results
With more than 350 students enrolled, the Bachelors
academic study program has shown to be successful
and increasingly popular with rising interest among the
youth. The study program lasts 8 semesters or 4 years,
each semester totaling 60 ECTS credits. The lessons are
conveyed by an academic staff with multidisciplinary
vocational profiles ranging in the areas from nutrition
medicine and dietetics, food technology and biotechnology, to natural and computer sciences. Both the academic staff and the students of nutrition have taken
part in various activities including the Tempus collaborative research project of the European Commission
entitled: Foodlinks, focused on the link between the
academia and the food industry. Another domestic
project financed by the University Research Centre
St. Kliment Ohridski that joined academic staff and
students was Monitoring of Eating Habits and Physical Activity Behavior among the Macedonian Population. It was implemented countrywide in 2011/2012.
Some of the many project outcomes were six scientific
articles published in the international journals [9]. The
students were actively involved in the initial process of
conducting the survey for the research. Also, with 60
postgraduate students enrolled, the Master study has
shown rising interest among graduated nutritionists.

3. Conclusions
- The first national cross-sectional study in the Republic of Macedonia with title: Monitoring of Eating Habits
and Physical Activity Behavior among the Macedonian
Population conducted by the Faculty staff (2011/2012)
with the aim to analyse and evaluate data on socioeconomic differences in educational levels and income
on the consumption of the main healthrelated foods
and physical activity levels of the population (1064
years) is essential for planning and evaluation of the
NCDs prevention programme. Also, the research study
provides results for health-policy decision-making and
can be used for evaluating specific health promotion
and NCDs prevention programmes.

Journal of Hygienic Engineering and Design

- In line with the strategic development plan of the

St. Kliment Ohridski University, the next step for
the program would be further improvement and development of the role of nutritionists with Bachelors
and Masters degrees (1st and 2nd Bologna cycle qualifications of multidisciplinary nutrition studies) in the
healthcare strategy and in the prevention of NCDs
[10], but also in the domain of food production, food
technology and biotechnology.
- With the improved number of nutritionists in the
country, an opportunity arises for development of a
National association for nutritionists in the Republic of
Macedonia.

4. References

[8] Technological-Technical Faculty in Veles. (2012). Masters degree in nutrition (in Macedonian). University St.
Kliment Ohridski, Bitola, Technological-Technical Faculty in Veles.
<URL:http://www.ttfv.uklo.edu.mk/index.php/studiski-programi /2013-11-03-11-07-30/ 2013-11-03-11-08-53.
Accessed 22 September 2012.
[9] Simovska-Jarevska V., Martinovski S., Damjanovski D.,
Pavlova V., Nikolovska-Nedelkova D., Manceski Gj. (2013).
Monitoring of eating habits and physical activity levels as a
basis for a new noncommunicable disease prevention programme in the Republic of Macedonia. Proceedings of the
Latvian Academy of Sciences, Section B. Natural, Exact,
and Applied Sciences, 67, (4-5), pp. 357-362.
[10] Simovska V., Vidin M. (2012). Public health and lifestyle
interventions to reduce cardiovascular risk in Macedonia:
recommendations and evaluation. Circulation, Journal
of the American Heart Association, 125, pp. e812-e813.

[1] Simovska V., Vaknin S., Trenceski G., Grpcevski N. (2010).

Good Governance. In: Osmani B., (Ed.), Green Book,
Steering Committee for the Advancement of Healthcare System, Ministry of Health, Republic of Macedonia.
pp. 3-50.
< U R L : ht t p s : / / w w w. re s e a rc h g ate. n e t / p u b l i c a tion/256089380_Editors_Simovska_Vera_et_all._
G o o d _ G ove rn a n ce _ Fi r s t _ C h a p te r. _ I n _ G re e n _
Book_2010_%28unpublished%29. Accessed 5 September 2010.
[2] Bologna Working Group on Qualifications Frameworks.
(2005). A framework for Qualification of the European
Higher Education Area. Ministry of Science, Technology
and Innovation, Copenhagen, Denmark.
<URL:http://www.ond.vlaanderen.be/hogeronderwijs/
bologna/documents/050218_QF_EHEA.pdf. Accessed
5 September 2010.
[3] Republic of Macedonia Government (2010). Regulation
on National framework for Qualification of the Higher Education Qualifications (in Macedonian). Official Gazette
of the Republic of Macedonia. (154), pp. 16-18.
[4] The official Bologna Process website 2007-2010. Towards
the European Higher Education Area - Bologna Process.
<URL:http://www.ond.vlaanderen.be/hogeronderwijs/
bologna/about. Accessed 5 July 2010.
[5] The European Federation of the Associations of Dietitians. (2005). European Academic and Practitioner Standards for Dietetics (EDBS), Brussels, Belgium.
http://www.efad.org/everyone/2375/5/0/32. Accessed
June 2005.
[6] The European Federation of the Associations of Dietitians. (2009). European Dietetic Competences and their
Performance Indicators (PIs); first cycle, Brussels, Belgium.
<URL: http://www.efad.org/everyone/1468/5/0/32. Accessed March 2009.
[7] European Commission/EACEA. (2012). European Dietetic Advanced Competences (EDAC). Thematic Network for
Dietetics DIETS2, Brussels, Belgium.
<URL: http://www.aedn.es/resources/cbc3c2d86c8e83
bEDAC_May_2012.pdf. Accessed October 2012.

23