PEN eNews 13(3) March 2023 - Nephrology - All Kinds of Updates!

Knowledge Pathway Alert: Bone Health and Osteoporosis

The Bone Health and Osteoporosis Knowledge Pathway has been updated. Check out these new and updated practice questions:

Should individuals with osteoporosis be screened for chronic gastrointestinal diseases (e.g. Crohn’s disease, ulcerative colitis, irritable bowel syndrome, celiac disease)?

What are the effects of lower carbohydrate/higher protein diets (LCDs) on bone health among adults?

Does the consumption of coffee or tea affect bone health or risk of osteoporosis?

Is the consumption of alcohol detrimental to bone health and osteoporosis?

Does the consumption of soft drinks impact bone health?

Which dietary patterns are recommended to preserve bone health and prevent osteoporosis?

What is the role of pre-, pro- or synbiotics in the maintenance of bone health and prevention or treatment of osteoporosis?

What is the role of silicon in bone health and preventing osteoporosis?

What are the recommendations for calcium and vitamin D intake for the prevention and treatment of osteoporosis?

What type of vitamin D supplement is the most effective and in what dose for osteoporosis prevention?

Besides calcium and vitamin D, are dietary supplements or nutraceuticals recommended for the prevention and/or treatment of osteoporosis?

Looking for a quick overview of this knowledge pathway?

What is the Latest on Dysphagia?

Among individuals with dysphagia, is the use of thickened liquids versus thin liquids associated with better clinical outcomes (lower risks of aspiration, pneumonia, death), hydration and quality of life?

Recommendation

Dementia and/or Parkinson's Disease

In individuals with dementia and/or Parkinson’s disease who have swallowing disorders/dysphagia, the effects of thickened liquids are uncertain. This is based on limited evidence, which suggests that thickened liquids compared to regular fluids (given in chin-down head posture) may have an immediate effect on decreasing the risk of aspiration; however, greater adverse effects (e.g. dehydration, urinary tract infection, fever and possibly pneumonia) and increased dissatisfaction with thickened fluids have been reported over three months.

Post-Stroke

In individuals with post-stroke dysphagia, limited evidence suggests no difference in the risk of pneumonia when individuals consume thin liquids, using safe swallowing strategies (such as proper positioning of the body, head or neck; oral care; intake of thin water between meals) compared with those consuming thickened liquids only. There is insufficient evidence to draw conclusions on whether the long-term use of thickened liquid is related to a higher incidence of dehydration or poorer quality of life (QoL) in this population.

Maxillary Carcinoma

In individuals with maxillary carcinoma who underwent total maxillectomy, limited evidence suggests that xanthan gum-based thickened liquid, compared to regular liquids, can improve hydration status and dysphagia-related QoL.  

Additional research is required to establish a stronger quality of evidence for the risks and benefits of the use of thickened liquids for different patient populations with dysphagia.

Country-specific Guidelines

A 2022 guideline from the Danish Centre for Clinical Guidelines for oropharyngeal dysphagia provides a weak recommendation against the use of textured modified liquids based on no difference between thickened and thin fluids on the risk of pneumonia or death and reduced QoL. 

The 2018 ESPEN guidelines on clinical nutrition in neurology suggests that texture-modified diets and thickened liquids may reduce aspiration in individuals with stroke and dysphagia and may lead to reduced energy and fluid intake. The guidelines acknowledge a lack of evidence on positive and adverse effects of texture-modified diets in stroke patients with dysphagia. 

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

Nephrology - All Kinds of Updates!

Four Nephrology Knowledge Pathways were recently updated:

Nephrology - Chronic Kidney Disease with Dialysis

Nephrology - Chronic Kidney Disease without Dialysis

Nephrology - Acute Kidney Injury

Nephrology - Kidney Stones

Here is a sample of the new and updated practice questions. Do you know the answers? Click on each link to find out!

What fluid and electrolyte (phosphorus, sodium, potassium) restrictions are required in adults receiving hemodialysis therapy?

What interventions are beneficial for preventing bone disease in adults with chronic kidney disease receiving and not receiving dialysis?

What are the most reliable tools to assess nutritional status in adults with chronic kidney disease (CKD) not receiving dialysis?

What are the energy and protein requirements and body weight recommendations for adults with stable chronic kidney disease (CKD) not receiving dialysis?

What interventions are beneficial for preventing bone disease in adults with chronic kidney disease receiving and not receiving dialysis?

What are the energy and nutrient recommendations for adults hospitalized with acute kidney injury (AKI) receiving continuous kidney replacement therapy (CKRT)?

What are the recommendations for provision of nutrition support (oral, enteral, parenteral) to noncritical adults hospitalized with acute kidney injury (AKI)?

What dietary recommendations can decrease the risk of calcium oxalate kidney stones in individuals with a prior history of calcium oxalate kidney stones?

Are you looking for a new way to apply your nutrition practice knowledge?

Become a PEN System Reviewer - it’s good for the PEN System and good for you, too!

As a reviewer you will:

• Contribute to advancing evidence-based nutrition practice by helping nutrition practitioners access timely, current and authoritative guidance on food and nutrition practice

• Become aware of the most up-to-date research and evidence-informed recommendations before the content is published on the PEN System. 

• Support your professional portfolio by demonstrating your knowledge of the field or critical appraisal skills. 

Opportunities are available to review PEN Backgrounds, Practice Questions and Canadian Client Handouts. 

Learn more about becoming a PEN reviewer by visiting our FAQ and reading our current opportunities to get involved. Reach out with additional questions to coordinator@dietitians.ca.

How Do I … Sort Through the PEN^® System to Find Tools and Resources?

Here’s how to sort to find the tools and resources in the PEN System:

Go to any Knowledge Pathway of interest (example: Irritable Bowel Disease) and click on Related Tools and Resources on the right-hand side of the screen.  

You can click on one or all three of the orange boxes (audience, country, language) to sort through the results and find the tools and resources you need:

Available options you can sort by:

• Audience: consumer or professional
• Country: Australia, Canada, Europe, Japan, Ireland, New Zealand, South Africa, United Kingdom, United States 
• Language: English, French, Chinese, Gujarati, Hindi, Indigenous Australian languages, Japanese, NA Aboriginal native languages, NZ Maori, Pacific Island languages, Punjabi, South Asian, Spanish, Tamil, Urdu, Vietnamese, Welsh  

You can also access all PEN-created consumer handouts through the PEN Handout Collection on the PEN home page:

After clicking on the handout collection icon you will be directed to a variety of collections. Each contains PEN-developed client handouts in English with most translated into French, and some are also available in other translations and cultural adaptations.

Here's an example of handouts available for Reactive Hypoglycemia under the 'Health Condition' collection: 

En - English   Fr - French   Sp - Spanish   Pun - Punjabi   Ch - Chinese Vi - Vietnamese

As always, we welcome your feedback.

PEN^® Resource Manager:
Jane Bellman MEd, RD
jane.bellman@dietitians.ca

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