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Area of expertise is the liver.

Helena Cortez Pinto is a Gastroenterologist specialised in Hepatology and a Professor at the Faculty of Medicine, University of Lisbon.

In the month where we have dedicated the Newsletter to the launch of the new Nutrition Science Study Programme, we would like to get to know the mentors of this innovative project and chase the past that explains why the Faculty of Medicine is once again supporting Nutritionists, this time with a new approach.

While balancing between the roots the past holds and the perspective fieldwork brings for the future, we went to meet Professor Helena Cortez Pinto, the Gastro expert who is a national and international adviser and whom also wishes to meet great Nutritionists in the upcoming years that will help her prevent diseases magnified by bad eating habits.

As coordinator, during the last phase of the Faculty's former Dietetics and Nutrition Study Programme, Helena Cortez Pinto inherited a study programme that was planned and created by Professor Ermelinda Camila, who is currently retired. When looking back, Helena Cortez Pinto doesn't regard those times as easy "because there was a dispute between Dietetics and Nutritionists" Students who graduated from the Faculty of Medicine at that time were professionally uncertain if they were Dietetics of Nutritionist and that worried them. "Only after several negotiations, during the Administration of Professor José Fernandes e Fernandes, and Minister Ana Jorge, who always acted in an exemplary manner during these negotiations, were we able to reach an equivalent statute for Nutritionists that allowed us to follow a professional path.

In the years following, the distinction between one professional group and the other would come to an end and professionals entitled Nutritionist would be those who completed a specific study programme in Nutrition. " The Order of Nutritionists was created and it was safeguarded that students who completed a Bachelor's Degree could apply."

It was the current Director Fausto J. Pinto, advised by Helena Cortez Pinto, who placed the last dice on the table to make the game perfect. The Faculty of Medicine, which already kept close ties with ESTeSL due to the mutual Master's Programme in Clinical Nutrition, now needed to create a new Bachelor's Degree that would give an answer to so many requests.

Helena Cortez Pinto brought the clinical experience and vision of what didn't work so well in the previous degree and knew a Nutritionist, someone exclusively dedicated to Nutrition, would be needed to guide this new Bachelor's Degree in the right direction. Lisbon only had a Bachelor's Degree at a private institute and a public option at the Polytechnic; the moment was right for a Bachelor's Degree in the public sector, meaning the Faculty of Medicine, and what Director Fausto J. Pinto predicted. “Professor Catarina Sousa Guerreiro came from ESTsEL and had done her PhD with us (the Faculty); she had the perfect profile to run for a position here and because I had a great impression, I suggested her to Professor Fausto. It was she who later outlined the programme and proposed it to the Higher Education Evaluation and Accreditation Agency to validate the Study Programme. And was accepted.

While Professor Helena Cortez Pinto would be responsible for mentoring the Study Programme, through the Bachelor's Committee and coordinating of some clinical courses in Nutrition Science. However, it would be redundant to speak only of her role as a Professor at the Lisbon Faculty of Medicine. As Director of the Gastroenterology University Clinic, she is responsible for the optional course in Gastro by the Subject Area of Digestive Pathology as well as training in Digestive Pathology, a course where 5th year medical students have hands-on experience and interaction with patients.

Also responsible for the Nutrition Lab located at the Egas Moniz facilities, she does research specifically on alcoholic and non-alcoholic fatty liver. She specifically focuses on clinical projects and welcomes interns from the Order of Nutritionists who apply the clinical methods. She says she does less "benchwork," but those she does are always in collaboration with the Faculty of Pharmacy.

Since 2015, she is a Political Advisor to all European Union matters within EASL – European Association for the Study of the Liver – whose objective is to develop activities, mainly in Brussels, influencing the political power in hopes of reducing the effects of diseases that affect the liver. Problems related to nutrition and alcohol is what helps this team create what we call policy statements, in other words a political declaration that warns European leaders of liver ailments. “For example, for the fatty liver we briefly introduce the problem and then create warning messages and establish national and European measures.”

She has also been President of the Portuguese Association of Liver Studies (Associação Portuguesa para o Estudo do Fígado - APEF). Helena Cortez Pinto knows that more than treating, change lies in prevention. Starting a Bachelor's Degree in Nutritional Science is a step in the prevention I was speaking of.

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Professor, what structural differences do you see in the Dietetics Degree you coordinated to the Degree that is now entitled Nutritional Science?

Helena C Pinto: The Bachelor's Degree now created is intended to be more wide-ranging. It isn't as focused on the clinical, even though it has clinical courses such as Anatomy and Physiology; however, it seeks to train Nutritionists, which is now the only designation for dietetics and nutritionists, that will work in areas such as the food industry, public health, catering going beyond the clinical, hospitals and health centres. Thus, students today are very different from those of the previous Degree. We could no longer have a Degree focused only on clinical

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Does that mean students today aren't the students they were in the past?

Helena B Pinto: I think in the past they would be keener on the clinical aspect. The idea was that, when they finished their Degree, they would go on to work at a Hospital, plan diets for patients and advise from that point of view. Over ten years have gone by and the concept has changed and it has become more widespread, more diverse, including the Food Industry and Public Health. I think those who choose this profession today may not even think of seeing patients and want to focus on a more global perspective.

Large food companies such as Nestlé, or the Macdonald’s group request nutritional advice; they at least want to evaluate how they can cause less harm and they need experts. Nutrition is in constant change: over 40 years ago olive oil was bad for our health and oils were beneficial. Today, if you notice these concepts have changed, what we believe to be bad today might in a few years have yet another perspective. The Catering Industry also needs a lot of counselling. And even in terms of public health, there has been a greater concern. I realize that when I was in High School I didn't have all of these healthy eating habits, nobody really paid attention to what we ate in school. That isn't today's reality. But do you know why we are so concerned today? Because people's health became so much worse. Food today is more artificial and based on a lot of processed products, people barely cook natural products at home and there's also more access to processed products and sweetened beverages; in light of that, we must counteract this. Hence, the greater scope of these new professionals.

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But won't I be old enough to choose what I want to eat?

Helena C Pinto: Yes, I've heard that discussion. That everyone is free to choose what to eat, what to drink, but I don't think it's an individual decision: the way people are bombarded with "bad nutritional influences" and, therefore, there must be a contradiction and some bombarding of good influences. In terms of public health, there is a big role for nutritionists.

Last month, an article came out, also signed by the Health Secretary of State Dr. Fernando Araújo, where he states an increase in tax over sweetened beverages led to a significant reduction in its consumption. We consume 5,000 tons less sugar, it's an extraordinary thing. Of course we haven't been able to demonstrate if it has an effect on health in Portugal. However, it reduced consumption because companies reduced the amount of sugar. Now, a campaign wouldn't have half that effect. The same applies to alcohol, only when increasing costs do we see a reduction in its consumption, its's never just about bringing awareness. Nutrition, as you can see, is way more socio-political than just clinical.

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As the person responsible for the Health Sciences classes and Coordinator of the Clinical Nutrition Master's Programme, do you see this new Bachelor's Degree as a complement to what you already teach, or a parallel path?

Helena B Pinto: I see this Bachelor's Degree as a parallel path, but where the Master's Programme may become a complement, possibly having to be restructured to work as a specialisation study programme. And that way we can provide more job opportunities; we may even make the Master's more clinical because the Bachelor's went in another direction. The clinical aspect is still very important and has two roads, one of them is therapeutical intervention, in patients with the disease, and on the other hand a preventive point of view. An example is understanding to what point a specific diet can be associated with the development of colon polyps or diverticulitis.

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I wanted precisely to come to this point. Did you see the number of patients grow due to an increase in pathologies related to irritable bowel syndrome? And is that connected to their eating habits?

Helena B Pinto: The most obvious pathology to answer that is the fatty liver, meaning, fat in the liver. Thirty years ago, we didn't even notice these diseases and now approximately 31% of the Portuguese population has fatty liver. In children that percentage is 10% and that is believed to be related to the prevalence of obesity. But to answer your questions, I don't have scientific data that tells me that there is more bowel disease today because of eating habits. But did you know that irritable bowel syndrome has a great deal to do with psychological factors and stress?

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For a Gastroenterologist, is it easy to accept that there is something emotional, not tangible, that controls our intestines in a physically notorious way?

Helena B Pinto: In what concerns irritable bowel syndrome, it is well demonstrated. In inflammatory bowel disease, that hasn't been proven; however it has been shown that it can worsen with stress. We just don't know which mechanisms make the brain give the intestine those orders. Take a look at an example we have all gone through: that stomach ache before an exam or something important, it's driven by something emotional.

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In a cross-sectional sense and as a closing statement, can we affirm that if we train good Nutritionists they will become allies to avoid so many gastric patients?

Helena B Pinto: I think so because we are improving prevention. In the past, everything was turned to the role of a doctor. Today, maybe even architects should have training because our cities need infrastructures that give people more quality of life and thus prevent diseases. One of the causes of fatty liver is lack of physical activity people think they can solve that problem by going to the gym, those who actually go, but it isn't, how we commute, the traffic and the infrastructures to commuting is what complicates our quality of life. Who walks to work? Almost no one because access is bad for the most part. Another thing we are already doing and that intends on, in the long term, having less patients is the work being done with the Municipalities of our country. We are currently creating protocols with Sintra - "Sintra Grows Healthy" - and with Lisbon. Children are our focus because they gain eating habits very early on and those habits will stay with them throughout their life and believe me, sometimes, those habits are terrible and very hard to change. What we are emphasising that, if we invest heavily in changing children's eating habits, then we can achieve great results. And we will keep working toward that.

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Joana Sousa

Equipa Editorial