Knowledge Co-Creation In Evidence-Based Nutrition Practice and the PEN® System
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 on Calcium or Dairy Products on Anthropometric Measurements or Body Composition?
The QuestionDoes calcium supplementation or increased intakes of dairy products affect anthropometric measures or body composition in adults?
Key Practice Point #1: Calcium Supplementation and Weight Loss
A 2016 systematic review and meta-analysis of 33 RCTs from longitudinal and cohort studies concluded that although the body of literature as a whole has not shown a clear association between calcium supplementation and weight loss, there does appear to be a link in individuals with a BMI <25 kg/m2 and in men, premenopausal women and women >60 years. The most common dose studied was 1000-1600 mg/day for at least eight weeks.
Grade of Evidence B
Key Practice Point #2: Dairy Consumption, Body Composition and Body Weight
Although dairy consumption has not been associated with body weight, waist circumference (WC) or weight gain in every population, the effect of dairy consumption on body composition is dependent on dietary context. Dairy consumption leads to weight loss, decreased body fat and decreased waist circumference when it is included in the context of an energy-restricted diet. However, adding dairy foods to ad libitum intake may increase body weight and have no effect on body fat or WC. Lean mass is not affected by dairy intake, regardless of energy intake.
Results imply that considering energy balance remains important and that substituting some calories for dairy may aid weight loss during energy restriction, at least in the short term. However, adding dairy to ad libitum intakes (either to neutral energy balance or to a positive energy balance) does not appear to result in weight loss.
A 2018 systematic review and meta-analysis of 37 RCTs (n=184,802) found that dairy intake decreased body weight, body fat and WC when paired with an energy-restricted diet. However, body weight increased with dairy consumption when energy was not restricted, and body fat and WC were not affected. Lean mass was not significantly affected by dairy consumption regardless of energy restriction.
Grade of Evidence B
A 2019 systematic review and dose-response meta-analysis of 12 (n=195,764) prospective observational studies concluded that there was no evidence of an association between dairy consumption and elevated BMI (>25 kg/m2), elevated WC (definition not provided) or weight gain (increase in either BMI or WC during the study period).
Grade of Evidence C
Appropriate treatment blinding is extremely challenging with dairy product interventions as it is difficult to blind subjects to the fact that they are drinking milk or eating yogurt and cheese.
Key Practice Point #3: Whey Protein, Body Weight and Fat Mass
Consuming 20 to 75 grams of whey protein daily for a short-term period (two weeks to 15 months) can contribute to decreased body weight and fat mass when compared to an equivalent protein diet in adults with BMI >25 kg/m2. The effect of whey protein supplementation on waist circumference (WC) is not clear.
A 2018 systematic review and meta-analysis of nine RCTs (n=455) found that consuming 20 to 75 grams of whey protein supplements daily for two to 15 months decreased body weight, fat mass and lean mass but had no significant effect on WC in adults with BMI >25 kg/m2 compared to placebo or control. However, when only studies that used DEXA to measure body composition were included, WC was significantly decreased with whey protein consumption.
Grade of Evidence B
To see the full practice question, including the Evidence Statements, Remarks, Comments and References, click here.
Using knowledge co-creation in evidence-based nutrition practice
Did you know the PEN® Team is trying a new way to bring the latest evidence into your practice? Knowledge co-creation encourages collaboration between researchers and people with real-world experience to address critical issues and barriers facing practice (1). By engaging experts with experience, we can collectively drive the social impact of dietetic practice forward. Knowledge co-creation increases the likelihood that nutrition recommendations will be relevant and useful in informing clinical and other practice decisions (2). The PEN Team is looking to integrate lived experience on specific topics throughout our evidence-based process, including:
- Transgender Nutrition
- Indigenous and Aboriginal Nutrition
- Cultural Competence in Dietetic Practice.
We're currently seeking experts with lived experience on the topic of transgender nutrition to co-create knowledge across the stages of content development. We define experts with lived experience as changemakers who are willing to use their lived experience to inform PEN content development (3). As a knowledge co-creator, you will not be responsible for writing the content. Your experience will inform topic assessment, practice question and search strategy development, content review and support for knowledge dissemination.
The PEN Team is looking to co-create knowledge in a meaningful and equitable way. If you are a current or former dietitian and identify as an expert with lived experience, complete this form to express your interest or contact us to learn more about this paid opportunity. We expect this project to be up to 25 hours of work over three to six months. Expressions of interest are requested by July 8, 2022.
- Canadian Institute of Health Research. Integrated Knowledge Translation (iKT). 2015. Available from: https://cihr-irsc.gc.ca/e/45321.html#a3
- Jull J, Giles A, Graham ID. Community-based participatory research and integrated knowledge translation: advancing the co-creation of knowledge. Implement Sci. 2017 Dec 19;12(1):150. doi: 10.1186/s13012-017-0696-3. PMID: 29258551; PMCID: PMC5735911. Abstract available from: https://pubmed.ncbi.nlm.nih.gov/29258551/
- Sandhu, B. The value of lived experience in social change: The Need for Leadership and Organisational Development in the Social Sector. 2017. Available from: https://thelivedexperience.org/wp-content/uploads/2017/07/The-Lived-Experience-Baljeet-Sandhu-VLE-summary-web-ok-2.pdf
Do you love the PEN Handouts? Reviewers are Needed!
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 handouts will be updated this year:
- Nutrition for Infants and Babies.
This would entail:
- From your professional knowledge/clinical expertise lens, provide feedback on the information/content provided in the handout.
- Based on interactions with your clients and questions they may have about the related diet in your practice, is there any information missing within the handout that we should consider adding?
- General feedback - flow of information, clarity, what doesn't work well.
This is a 1:1 request. Meaning it's a one-time request that requires about one hour of your time.
PEN® Reviewers Needed!
We need reviewers within the next few months for:
- Diabetes/Glucose Intolerance
- Metabolic Syndrome
- 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® International Guideline Collections
Many knowledge pathways include a tool called the International Guideline Collection. These collections gather all of the clinical practice guidelines on a specific topic from our global partners and around the world.
There are over 20 International Guideline Collections. Here are the latest ones that are new or have been updated:
Looking for the entire list of International Guidelines Collections, look no further than here
June 2022 Volume
A Publication of the PEN® System Global Partners,
a collaborative partnership between International Dietetic Associations.
Learn more about PEN.
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