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.
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 The authors do not cite the best or most recent evidence to support this claim.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
Sugary Drink Research
Using 2004 data from the Canadian Community Health Survey to analyze sugary drink consumption and using data purchased from Euromonitor International, researchers at the University of Waterloo projected the health and economic impact of sugary drinks in Canada, which includes over 63,000 projected deaths that will cost the health care system more than $50 billion over the next 25 years. The research was commissioned by Canadian Cancer Society, Canadian Diabetes Association (now Diabetes Canada), Childhood Obesity Foundation, Chronic Disease Prevention Alliance of Canada, and Heart & Stroke. Click here to view the media release and to gain access to the Health and Economic Impacts of Sugary Drinks in Canada research summary.
Heart & Stroke Report: Food Marketing to Children
The Heart & Stroke 2017 report on the Health of Canadians, The Kids Are Not Alright, presents results from national and international studies/reports on how industry is marketing unhealthy food and beverages directly to children and youth, and how this marketing affects their preferences and choices, their family relationships and their health. The report also includes results from the Heart & Stroke commissioned online poll of 2,400 Canadians from September to October 2016 on these related issues. Seventy percent of the surveyed Canadians stated that they think children are exposed to too much food and beverage marketing, 78% believe that the food industry markets unhealthy foods and drinks to children, and 71% stated that they think this marketing is unfairly influential. The report provides data that children's food choices are influenced by this marketing. Dietitians of Canada is a member of the Stop Marketing to Kids Coalition, founded by Heart & Stroke in 2014. The goal of the Coalition is to restrict all food and beverage marketing to children and youth 16 years and under. View a two-minute video by research Dr. Monique Potvin Kent and read more about the problem and solutions of food marketing to children at Stop M2K. See a similar post in the U.K. in December 2016 on New Rules Ban the Advertising of High Fat, Salt and Sugar Food and Drink Products in Children's Media.
Green Tea Extract Supplements
On February 3, 2017, the Canadian Broadcast Corporation (CBC) Marketplace program described some cases of serious harm associated with green tea extract supplements that included hepatotoxicity, liver transplants and even death. In their feature story they point out that labelling a product as 'natural' does not assure that it works or that it is safe.
Since 2011, the evidence synthesis on green tea extract within the PEN® System is that any potential weight loss effect of green tea extract supplements is small and of questionable clinical significance and supplements are associated with the risk of hepatotoxicity and other side-effects. The practice question on this topic is currently being reviewed. Studies identified thus far also did not report clinically meaningful differences in weight loss between green tea extract and placebo. Of importance, more papers were published highlighting the potential for rare but serious risks of hepatotoxicity and severe liver damage from supplementation and weight loss products containing green tea (single and multi-ingredient products). Specifically, three publications (see below) describing 18 cases of hepatotoxicity, which resulted in liver transplantation for six individuals were identified and are being reviewed for incorporation into the PEN analysis on this topic.
See Additional Content:
Are green tea supplements safe and effective for weight loss among overweight or obese adults?
Health Canada case report describing the 17-year-old profiled in the CBC Marketplace program.
Mazzanti G, Di Sotto A, Vitalone A. Hepatoxicity of green tea: an update. Arch Toxicol. 2015 Aug;89(8):1175-91. doi: 10.1007/s00204-015-15121-x. Epub 2015 May. Abstract available from: https://www.ncbi.nlm.nih.gov/pubmed/25975988
Zheng EX, Rossi S, Fontana RJ, Vuppalanchi R, Hoofnagle JH, Kham I, et el. Risk of liver injury associated with green tea extract in SLIMQUICK(®) weight loss products: results from the DILIN prospective study. Drug Saf. 2016 Aug;39(8):749-54. doi: 10.1007/s40264-016-0428-7. Abstract available from: https://www.ncbi.nlm.nih.gov/pubmed/27189593
Whitsett M, Marzio DH, Rossi S. SlimQuick™ - associated hepatoxicity resulting in fulminant liver failure and orthotopic liver transplantation. ACG Case Rep J. 2014 Jul;1(4):220-2. doi: 10.14309/crj.2014.59. eCollection 2014. Abstract available from: https://www.ncbi.nlm.nih.gov/pubmed/26157882
Introduction of Allergenic Food to Infants, Especially Peanuts: Interim Guidelines for Canadian Dietitians
This interim DC communication provides DC members with information on the scientific evidence regarding the introduction of peanuts to infants and how the current dietetic practice recommendations agree and differ from NIAID recommendations published in January 2017. In brief, the key differences between these new NIAID guidelines and current Canadian Nutrition for Healthy Term Infant (NHTI) recommendations are in the different definitions of “at risk” infants, the strength of wording for introducing peanut containing food early, and the recommendation to undergo physician supervised testing/feeding before introduction for a small subset of very high-risk infants . Refer to the full document for more information. See also the PEN Evidence Clip : Food Allergy Prevention in Infants.
Article Analysis: Calcium and Heart Health