PEN eNews 11(12) December 2021

Most Popular PEN Content In 2021

It's hard to believe another year has come and gone. Take a look below at the top 10 Search Terms, Summaries of Recommendation and Evidence, Practice Guidance Toolkits and Backgrounds of 2021! 

Top 10 Search Terms

Gout
Cholesterol
Diabetes
Pancreatitis
Iron
Fatty Liver
Diverticulitis
PCOS
IBS
Constipation

Top 10 Summary of Recommendation and Evidence 

Gastrointestinal System - Inflammatory Bowel Disease
Endocrine/Metabolic - Polycystic Ovary Syndrome
Gastrointestinal System - Gastroesophageal/Gastro-oesophageal Reflux Disease (GERD/GORD)
Cardiovascular Disease
Women's Health - Menopause
Gastrointestinal System - Irritable Bowel Syndrome
Hepatic Disorders
Food Skills
Weight/Obesity
Gastrointestinal System - Gallbladder Disease

Top 10 Toolkits 

Cardiovascular Disease
Gastrointestinal System - Irritable Bowel Syndrome
Weight/Obesity
Diabetes/Glucose Intolerance
Endocrine/Metabolic - Polycystic Ovary Syndrome
Gastrointestinal System - Inflammatory Bowel Disease
Pregnancy
Cancer
Vegetarianism
Cancer - Nutritional Implications of Treatment

Top 10 Backgrounds

Food, Nutrition and Health During the COVID-19 Pandemic Background
Nutrition Care Process and Terminology (NCPT) Background
Polycystic Ovary Syndrome Background
Weight Stigma Background
Nutritional Implications of Cancer Treatment Background – Diarrhea
Vegetarianism
Nutritional Implications of Cancer Treatment Background - Constipation, Nausea and Vomiting
Sustainable Diets and the Environment Background
Hepatic Disorders Background
Diabetes - Glycemic Index Background

Sunscreen and Vitamin D: What is the Latest?

A 2019 systematic review of 76 studies (four experiments with artificial light, three field trials with solar light and 69 observational studies) concluded that sunscreen use was not associated with serum vitamin D concentrations in real world settings, although they noted that the association with high SPF sunscreens (e.g. 30+) had not been studied in randomized field trials. The most reliable evidence came from studies examining sunscreen with SPF ~16. 

A 2019 consensus from an international panel of 13 experts concluded that regular sunscreen use did not impede cutaneous vitamin D synthesis and recommended that individuals with all skin types use high UVA-PF sunscreen daily. Most studies were performed in populations with lighter skin and this recommendation may differ for populations with darker skin. Individuals requiring strict photoprotection (e.g. due to genetic or acquired photosensitivity disorders) are susceptible to vitamin D deficiency and require screening and possible vitamin D supplementation. 

Artificial and solar light have different ratios of UVA, UVB and UVC wavelengths, which may contribute to the difference in findings between experimental trials using artificial light and real world observational data. Changes in serum vitamin D concentrations can also be affected by an individual’s initial serum vitamin D levels, the amount of skin exposed to light, skin colour, season and the use of vitamin D supplements. The terms UVA-PF and UVB-PF refer to protection against UVA and UVB rays specifically, while SPF is a general term denoting the protection factor against sunburn from solar rays.

To see the full practice question, including references, click here.

Want to know what else is new and updated? Bookmark these pages:
New Knowledge Pathway Content (Knowledge Pathways, Practice Questions, Summary of Recommendations and Evidence, Practice Guidance Toolkits, Backgrounds)

Add being a PEN Reviewer to your 2022 goals!

Did you know that all PEN Practice Questions are peer-reviewed by experts in the field, just like journal articles? Being a reviewer plays a vital role in contributing to and building the dynamic PEN^® System, which helps support dietitians in practice. We rely on more than 400 PEN Reviewers to keep our content up-to-date for everyday dietetic practice.

Why not consider reviewing PEN content in 2022? Here are some answers to frequently asked questions about being a PEN reviewer:

How does reviewing for the PEN System help dietitians in practice?

Reviewing PEN content contributes to a growing evidence-based platform to translate knowledge for dietitians in practice. Your review provides essential feedback to the author regarding the relevance, currency and acceptability of the content in the PEN System. Your feedback ensures dietitians can continue to use the PEN System to support decision-making in everyday practice.

How does the PEN System recognize my contribution as a reviewer?

With your permission, you will be acknowledged for your role as a reviewer once the content is published. Furthermore, you can download a letter of contribution signed by PEN's Director of Knowledge Translation acknowledging your contributions to the PEN System once the content has been published. This can be used to support your professional portfolio, including continuing education objectives and activities. Dietitians Australia, Dietitians of Canada, and the British Dietetic Association also recognize the voluntary efforts of those who contribute to PEN.  

Who can review PEN Content?

The PEN System looks for individuals with expertise (academic and/or applied) on a wide range of topic related to nutrition practice. This may include:

• Researchers who are actively researching a topic area
• Practitioners with work experience in specific nutrition practice areas, settings and client populations 
• Masters or doctorate students who are researching a topic area
• Dietetic learners (students)/interns/stagiaire working in the practice area (with supervisory support).

How can I get involved in reviewing PEN Content?

There are two primary ways you can get involved in contributing to the PEN system:

• Provide input on scoping a PEN Knowledge Pathway: When developing new or updating existing PEN content, we look for input on the practice questions that make up a knowledge pathway. This means you’ll have an opportunity to review current questions for dietetic practice relevance while identifying any missing practice questions that should be considered.
• Review PEN Content: As a PEN Content Reviewer, your primary task is to determine the acceptability of PEN content based on the quality of evidence, accuracy of synthesis and relevance for practice. Reviewing PEN content asks for your input on everyday practice situations dietitians face. PEN Content review requests can be for Backgrounds, Practice Questions or Tools/Resources.  

If you are interested in learning more, please reach out to us at coordinator@pennutrition.com for more information! Current review opportunities are updated regularly on the PEN website and featured in PEN eNews.

See you in 2022!

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‘Vegetables are good for you’ is hardly a surprising conclusion for a dietitian. In fact, for many of us, it’s our MO. But I still did a double take at research suggesting that vegetable consumption was not just associated with happiness but could actually cause it (1). 

In my experience, vegetables rarely lead to joy for my two young children, but in a recently published pre-proof, De Leon et al. reported a significant increase in Subjective Happiness Scale scores in adults who were provided vegetables in accordance with U.S. dietary guidance (both in vegetable type and amount) for eight weeks compared to those who were not (1). 

Some things to note about the study: 

• The study design was a parallel-group, non-blinded, randomized controlled trial.
• This study reported on a secondary outcome of a larger study (2), which aimed to determine the effect of exposure to vegetables on the “relative reinforcing value of vegetables”.
• The sample size was small, and the participants (n=75) were adults (mean age 43±15 years) with low daily vegetable consumption (≤1 serving/day) and BMIs ≥ 25 kg/m², which limits the generalizability of the results to other populations.
• Participants in the intervention group selected their vegetables weekly from a list of 31 vegetables according to their energy needs and within specific vegetable categories (e.g. dark green, red and orange or starchy). Participants were not provided recipes or training to prepare the vegetables and were instructed to consume all the vegetables provided, all by themselves.
• The researchers controlled for vegetable consumption via weekly questionnaires and skin carotenoid scans.
• The Subjective Happiness Scale (SHS) scores in the vegetable group increased by an average of 0.3 points (on a 7-point scale, a 4% increase in ‘happiness’) after eight weeks, whereas SHS scores in the control group decreased by an average of 0.2 points (nonsignificant P-value). Overall, the effect size was small (d=0.26) and of debatable clinical significance.

Limitations aside, the results are very interesting! But the lingering question in my mind is: how? What’s the possible mechanism of action for vegetables causing happiness? In their discussion section, the authors suggest several possibilities: 

• Proposed biological mechanisms of action included antioxidant and anti-inflammatory effects of vitamins and phytochemicals, the role of some vitamins in neurotransmitter production and modulation and the role of B-vitamins in mitochondrial functioning. 
• Proposed behavioural mechanisms of action included the impact of replacing energy-dense, nutrient-poor foods (associated with depression and depressive symptoms) with low energy foods and the possibility that consuming foods perceived as ‘healthy’ might prime individuals to expect to feel good. 

Personally, I also question whether participants’ pride in increasing their vegetable consumption (a well known socially desirable activity) may have boosted their happiness. Or, as my colleague pointed out, maybe they were simply happy that they received eight weeks of free food! 

Interested in learning more about the impact of food and nutrition on psychological well-being? Check out the Mental Health Knowledge Pathway.

Written by:
Mary Anne Smith PhD RD
Director of Knowledge Translation

Reviewed by:
Dawna Royall MSc RD
PEN^® Senior Evidence Analyst

References

1. De Leon A, Jahns L, Roemmich JN, Duke SE, Casperson, SL. Consumption of dietary guidelines for Americans types and amounts of vegetables increases mean Subjective Happiness Scale scores: A randomized controlled trial. J Acad Nutr Diet. 2021 Nov 15;S2212-2672(21)01486-6. doi: 10.1016/j.jand.2021.11.09. Abstract available from: https://pubmed.ncbi.nlm.nih.gov/34793989/
2. Casperson SL, Jahns L, Temple JL, Appleton KM, Duke SE, Roemmich JN. Consumption of a variety of vegetables to meet dietary guidelines for Americans' recommendations does not induce sensitization of vegetable reinforcement among adults with overweight and obesity: A randomized controlled trial. J Nutr. 2021 Jun 1;151(6):1665-1672. doi: 10.1093/jn/nxab049. Abstract available from: https://pubmed.ncbi.nlm.nih.gov/33758940/

Dietitians Of Canada is Pleased to Bestow The 2021 PEN Achiever Award Canada on Dr. Rachel Prowse

Dietitians of Canada is pleased to bestow the 2021 PEN Achiever Award Canada on Dr. Rachel Prowse. This award recognizes members who demonstrate leadership in evidence-based practice through significant or ongoing contributions to the PEN: Practice-based Evidence in Nutrition^® System.

Dr. Prowse’s role to support public health units in implementing evidence-based public health nutrition interventions was the impetus for developing new PEN content for the Sustainable Food Systems Knowledge Pathway. Rachel connected with Dietitians of Canada and the PEN Team to discuss opportunities for collaboration to increase public health dietitians’ access to evidence on emerging topics. As a PhD dietitian with experience in a broad range of public health nutrition topics, Rachel provided expertise in authoring and reviewing PEN content for the Sustainable Food Systems Knowledge Pathway and reviewed other PEN content, including pediatric weight/obesity content. 

Dr. Prowse commented on her award: 

“Jayne Thirsk, Dawna Royall, and Mary Anne Smith were integral in facilitating a relationship with me as the Applied Public Health Science Specialist in Healthy Eating and Food Environments at Public Health Ontario. I am grateful for this relationship as it allowed us to generate valuable evidence summaries that met the needs of the public health field in Ontario. Our collaboration reduced duplication of effort, enhanced credibility, increased the speed with which work was completed, and produced outcomes that were mutually beneficial (Public Health Ontario received a detailed evidence summary, PEN received practice question evidence reviews). This opportunity has increased my passion to generate practice-relevant evidence reviews for dietitians as I have seen firsthand how these products make a difference to dietitians on the ground. I want to thank Ontario Dietitians in Public Health for offering practice-based questions that could be answered with the PEN System.”

Congratulations to Rachel on receiving this well-deserved award!