PEN eNews 12(5) May 2022

PEN® eNews is a monthly e-newsletter shared with the global PEN Community and created to help dietitians position themselves as leaders in evidence-based nutrition practice. In addition, users of the PEN System will find articles on the new evidence, resources and features available and how to maximize one's use of PEN.

What is the Latest? Chromium and Cardiovascular Prevention

The Question

Does chromium supplementation play a role in the prevention of cardiovascular disease?

The Recommendation

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.

The Evidence

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.

Cardiovascular Disease

Updated Knowledge Pathway Alert! Weight/Obesity - Assessment

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

A Note to Our Readers
The Global PEN Team recognizes the limitations of BMI as a measure of health risk and body composition. Although BMI has been used as a proxy measure for higher weights/obesity in this knowledge pathway for precision of reporting, it is not a direct or diagnostic measure of obesity and should be interpreted with caution.

Soon to be Updated
Weight/Obesity - Bariatric Surgery

Weight Management

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

Did you know that PEN practice questions are peer-reviewed by experts in the field, just like journal articles? There are currently more than 400 PEN Reviewers. We would love for you to join this group and share your expertise and energy. For more information, contact http://www.pennutrition.com/BecomeAuthor.aspx.

So, what do you need to be a PEN Reviewer? Take a look at this short presentation. We provide guidance and training on how to become a PEN Reviewer and can work with your interest and availability to complete the review.

PEN Applied

Are you a dietitian practicing in toddler and preschool nutrition, child growth or gerontology?

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.

Are you interested? That’s great! Reach out to the PEN Content Manager by June 30th, 2022.

Practice Guidance Toolkits - There for you!

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:

Adapted from an April 2013 PEN eNews article.

PEN eNews

May 2022 Volume 12 (5)

A Publication of the PEN® System Global Partners,
a collaborative partnership between International Dietetic Associations.
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