PEN eNews 12(5) May 2022

What is the Latest? Chromium and Cardiovascular Prevention

Data from clinical trials is inconsistent regarding the effect of chromium supplements on improving cardiovascular disease (CVD) with no clinically significant effect on related risk factors (e.g. lipid profile). Additional research is required to make a recommendation on chromium supplementation and CVD risk reduction.

Country-specific Recommendations
Cardiovascular guidelines from Australia, Canada, Europe, the United Kingdom and the United States do not include specific recommendations in relation to chromium supplementation.

A 2021 systematic review and meta-analysis of RCTs showed chromium supplementation (42 to 1000 mg/day) in the elemental, picolinate or nicotinate forms for three weeks to two years (mean 12 weeks) may result in a nonclinically significant reduction in total cholesterol, but not on other lipid measures assessed (LDL-C, HDL-C, VLDL-C or triglycerides). Moreover, a total cholesterol-lowering effect of chromium supplementation may be synergistic when provided over shorter durations (<12 weeks), low dose (<200 mg/day), in younger adults (<54 years) and using the picolinate and elemental forms.
Grade of Evidence B

A 2020 narrative review suggested that following Dietary Recommended Intake levels of chromium may aid in reducing CVD risk; however, the evidence reported was inconsistent as it related to the serum lipid profile; findings were not associated with cardiovascular-related morbidity or mortality. Chromium picolinate supplementation was determined to be safe, specifically as it relates to kidney failure or DNA damage.  
Grade of Evidence C

Epidemiological data on chromium exposure and CVD risk suggests lower levels of chromium may be associated with greater CVD-related risk in men. However, findings are inconsistent and cannot be extrapolated to women. Sources of chromium exposure are unknown.
Grade of Evidence C

To see the full practice question, including the Evidence Statements, Remarks, Comments and References, click here.

Updated Knowledge Pathway Alert! Weight/Obesity - Assessment

The Weight/Obesity - Assessment Knowledge Pathway has been updated. Check out these new and updated practice questions:

• What personal and lifestyle factors should be assessed when agreeing on a treatment plan for an adult with obesity-related health risk? 

• How should a practitioner screen an adult for the risk of obesity (excess adiposity that negatively affects an individual’s health) and obesity-related health risks?

• Should adults with higher weights (BMI ≥30 kg/m2) or obesity (excess adiposity that negatively impacts health) who have not previously undergone bariatric surgery be screened or routinely monitored for vitamin and/or mineral deficiency?

Looking for Related Content? Check out these knowledge pathways:
Weight/Obesity
Weight/Obesity - Pediatric/Paediatric: Prevention 
Weight/Obesity - Pediatric/Paediatric
Weight/Obesity - Dietary Approaches
Weight/Obesity - Dietary Supplements

Soon to be Updated
Weight/Obesity - Bariatric Surgery

We Need Your Expertise: PEN^® Reviewers Needed 

We need reviewers within the next few months for:

• Cancer - Nutritional Implications of Treatment
• Gastrointestinal System - Bowel Cleansing
• Metabolic Syndrome
• Musculoskeletal/Connective Tissue Disorders - Fibromyalgia
• Nephrology - Acute Renal Failure; Chronic Kidney Disease
• Pediatric - Dyslipidemia

We want to share a fantastic opportunity to help shape PEN content to ensure it is relevant to Canadian dietitians in everyday food and nutrition practice.

The following PEN Knowledge Pathways will be updated this year:

• Toddler and Preschool Nutrition
• Child Growth
• Gerontology

When developing new or updating existing PEN content, we look for input on practice questions that make up a knowledge pathway. Specifically, this looks like:

• Providing input on the existing practice questions that reflect the everyday practice situations faced by dietitians in the specific topic area.
• Providing direction on any practice guidelines, national policy documents or reports that would be important for authors to include in their work.
• Recommending Canadian reviewers for content review once it's been written.

This is a 1:1 request. Meaning it's a one-time request that requires about one hour of your time (you are not committing to writing or reviewing content). 

With your permission, you will be acknowledged for your role as a contributor. You can also download a letter of contribution signed by PEN's Director of Knowledge Translation acknowledging your contributions to the PEN System once the content is published.

In April 2013, the PEN^® Team introduced the Practice Guidance Toolkits. These toolkits make the access to essential information on nutrition assessment, diagnosis, intervention, monitoring, associated tools and education materials based on nutrition-related conditions/diseases more 'up-front' and easier to retrieve. The toolkits present information in a format consistent with Nutrition Care Process Terminology (NCPT) with direct access to succinct information that dietitians use in their practice. The toolkits are a stand-alone tool used primarily for clinical knowledge pathways and also include the associated Summary of Recommendations and Evidence.  

To find them on the PEN home page, click on the Toolkits icon, which leads to all available toolkits. 

They can also be found on the Knowledge Pathways Table of Contents page. Click on any of the icons under the Practice Guidance Toolkit column. Alternatively, within a knowledge pathway, click on the “Toolkit “ tab on the right-hand side of the page. The Toolkit tab will only display as an option if the knowledge pathway has a toolkit.

Helpful Features in the Toolkits  

• Click on any of the items on the Table of Contents of the right-hand side of a toolkit to get quick, direct access to any section within the toolkit.  
• Flags! Where information is specific to a particular country, you have the option of seeing only your country’s information or viewing other’s information as well.  Simply click the box at the top of the page for the country information that you would like to view, and it will be displayed (or alternatively unclick the box to hide it).

Below is a list of toolkits that have recently been added or updated: 

• Pediatrics/Paediatrics - Child Growth and Growth Faltering Toolkit
• Gastrointestinal System - Gallbladder Disease Toolkit
• Gastrointestinal System - Pediatric/Paediatric Gastroesophageal/Gastro-oesophageal Reflux Disease (GERD/GORD) Toolkit
• Gastrointestinal System - Diverticular Disease Toolkit

Adapted from an April 2013 PEN eNews article.