Trending Topics pieces (Article Analyses, Evidence Clips and Other Topics) are published in timely response to recent media and journal articles, position statements, clinical guidelines, etc. Since they are based on the most recent evidence/publications, they may not be consistent with PEN evidence in other PEN content areas. As soon as possible, when this occurs, the PEN content will be reviewed and updated as needed.
Obesity Prevention and Management
The Canadian Task Force on Preventive Health Care (CTFPHC) recently released a free e-learning course called, Obesity Prevention and Management, to help clinicians understand the guideline recommendations, the evidence underlying the recommendations, strategies for implementing the recommendations, and the differences between the CTFPHC guidelines and guidelines developed by other groups. The CTFPHC guidelines, Obesity in Adults and Obesity in Children, published in 2015, were developed by primary care and prevention experts across Canada and are based on systematic analysis of scientific evidence.
Trans Fats on Their Way Out Again!
Health Canada has published a Notice of Proposal (Information Document) signalling its intent to implement the prohibition on the use of partially hydrogenated oils (PHOs) in all foods by adding PHOs to Part 1 of the List of Contaminants and Other Adulterating Substances in Foods. This prohibition is proposed to take effect in the summer of 2018, which would allow industry stakeholders time to phase-out the use of PHOs. Interested stakeholders are invited to share and provide comments on the proposal by June 21, 2017 and can view further information on the proposals as well as a summary of comments received during the previous public consultation at Notice of Proposal (Prohibiting the Use of PHOs in Foods).
Article Analysis: Dementia, Stroke and Sugary and Artificially Sweetened Drinks
Benefits of Reducing Saturated Fat Intake Criticized
A recent editorial by Malhotra, et al. made headlines claiming that reducing saturated fat intake has no effect on coronary heart disease. The authors do not cite the best or most recent evidence to support this claim. Importantly, they fail to acknowledge the results of a recent Cochrane review, which found moderate quality evidence that reducing saturated fat intake decreased cardiovascular (CV) events (including CV deaths, CV morbidity or unexplained CV interventions) in populations at low, moderate and high risk (1). When talking about reducing saturated fat intake, it is important to consider the replacement calories. Recent evidence identifies that the greater reductions in CV events occurred when saturated fat was replaced with polyunsaturated fat, but not with carbohydrate (1). The editorial does emphasize the benefits of a whole dietary approach, such as the Mediterranean diet, instead of focusing on specific nutrients. There is merit to this approach. The Mediterranean diet pattern is low in saturated fat and includes rich sources of unsaturated fat such as oils, nuts, seeds and oily fish, in addition to plenty of legumes, vegetables, fruit and whole grains. See additional commentary from David Katz published in Linkedin: Sat-Fat Bait & Switch.
Seems we were not alone in our concerns about the opinion piece that garnered media attention last week. Further expert reaction from the U.K. to the editorial on saturated fat and heart disease is available from Science Media Centre.
See Additional Content: Is a reduced saturated fat diet recommended for primary or secondary cardiovascular disease (CVD) prevention?
Hooper L, Martin N, Adbelhamid A, Dave Smith G. Reduction in saturated fat intake for cardiovascular disease. Cochrane Database Syst Rev. 2015 Jun 10;(6):CD011737. doi.10.1002/14651858.CD011737. Abstract available from: http://www.ncbi.nlm.nih.gov/pubmed/26068959
Article Analysis: Intensive Lifestyle Counselling and Improving Glycemic Control
A Resource for Health Care Professionals on the Practice of Sharing Human Milk
Perinatal Services BC has published a resource that provides health care professionals with information and the tools to facilitate a discussion and make decisions regarding the informal sharing of unpasteurized donor human milk (UDHM). Informal sharing involves the sharing of UDHM between friends, family members or online social networks, or the purchase of UDHM outside of the regulated milk banks. The practice of sharing UDHM is increasing and the resource, Informal (Peer-to-Peer) Milk Sharing:The Use of Unpasteurized Donor Human Milk, provides practice information on the risks and benefits of supplemental options (mother’s own milk, pasteurized donor human milk from regulated milk banks, commercial infant formula), how to minimize the risks of informal milk sharing, ethical and legal considerations, and other decision support tools.
The World Health Organization recommends exclusive breastfeeding for the first six months of life to achieve optimal development, growth and health (1). There are many benefits of breastfeeding; however, the BC resource may overstate the benefits as the cited health outcomes research are based on observational studies that are limited by the inadequate control of confounding factors. For information on the health outcomes for breastfed infants see the Infant Nutrition - Breastfeeding Knowledge Pathway. Also not mentioned in the BC resource - Appendix 5: Family Information Handout, is the high cost of pasteurized donor human milk. For additional information on this topic see PEN Evidence Clip: The Dangers of Sharing Unpasteurized Milk.
1. World Health Organization and UNICEF. Global strategy for infant and young child. 2003. Available from: http://www.who.int/nutrition/publications/infantfeeding/9241562218/en/
Can an intentional nudge influence decision-making towards choosing a healthier dietary option? A recent study, The Efficacy of Nudge Theory Strategies in Influencing Adult Dietary Behaviour: A Systematic Review and Meta-analysis in BioMed Central (BMC) Public Health, says it can. Nudge theory, or 'nudge' proposed by Thaler and Sunstein (2008) in their book, Nudge: Improving Decisions About Health, Wealth and Happiness, is based on providing indirect suggestions that guide voluntary shifts in behaviour towards choosing the healthier option. The BMC review assessed nudge effectiveness as a strategy in influencing adults (a generic population of men and women; 18-65 years) to change their dietary choices from unhealthy (foods high in fat, salt or sugar) for healthier ones (more nutrient dense, i.e. the consumption or purchase of more vegetables, fruit and whole grains; and lower in calories, salt, sugar, cholesterol or fat). The researchers systematically searched and quantitatively assessed (meta-analysis) 42 studies (31 RCT; two cohort; and nine cross-sectional) aimed at influencing behaviour related to food consumption. The interventions involved knowledge-based changes (e.g. menu labelling), availability of food (e.g. convenience or adjusting portion size), changes to the social environment or emotional priming. Most of the studies took place in a lab setting (48%) or in a cafeteria (17%) and were conducted predominantly in the U.S. The studies were analyzed based on their percent change in frequency of a choice or in the consumption/purchases made (outcome categories were calories, grams or purchases; either quantity purchased or monetary amount). The researchers found that, on average, nudge interventions lead to a 15.3% (95%CI, 7.6 to 23%) increase in healthier consumption/nutritional choices, as measured by the frequency of healthy choices or by overall intake of healthier food. While the generalizability of the findings is limited by the wide variety of interventions included and nudge-related research in more geographically and varied populations is needed, this paper provides some of the basics and justification for implementing nudging strategies into practice.
Are Your Clients Asking About "Leaky Gut Syndrome"?
There is little human evidence to support the theory that a "leaky gut" is the direct cause of any significant, widespread health problem. Read more at: "Leaky Gut Syndrome", Debunking the Myth of "Leaky Gut Syndrome" and Intestinal Permeability Defects: Is it Time to Treat?
Until more evidence is available on intestinal permeability, dietitians can educate their clients on nutritiously balanced diets based on nutrition assessment and evidence. Clients should be encouraged to be wary of any alternative program/diet that promises “magical results”.
Reposted from January 2016.
Evidence Clip: The Dangers of Sharing Unpasteurized Human Milk