The Armour Morgan Memorial Convocation Prize has It's First Recipient!

The Armour Morgan Memorial Convocation Prize has its First Recipient

Muscle Cramps - The Latest Evidence on Nutrients and Beverages that Exacerbate or Alleviate?

The Recommendation

Older Adults

Fair evidence from a systematic review suggests that magnesium supplements (336 to 520 mg elemental magnesium/day) taken for four weeks likely do not prevent or treat idiopathic leg cramps in older adults (mean age >65 years). However, fair evidence from an RCT published after the systematic review suggests that magnesium supplements (226 mg elemental magnesium/day) taken for two months may reduce the frequency or severity of nocturnal cramps in adults (mean age 57 years). More evidence is needed before a recommendation can be made.  

Pregnancy

Limited evidence suggests an unclear effect of magnesium supplements on pregnancy-related cramps.

Liver Cirrhosis

A conclusion about magnesium supplements for cramps in individuals with cirrhosis is not possible because evidence is extremely limited.

The Recommendation

Limited evidence suggests that electrolyte beverages (e.g. sports drinks) protect against and reduce pain associated with exercise-induced muscle cramps in healthy young adults. Limited evidence also suggests that pickle juice may shorten the duration of exercise-induced muscle cramps in healthy young adults and may reduce the severity of cramps in adults with cirrhosis.   

Key Practice Point #3: Vitamin D, Vitamin E, Vitamin K, Zinc, Amino Acids and L-carnitine

The Recommendation

Liver Cirrhosis

Limited evidence, mostly from prospective single-arm studies, suggests that taurine, L-carnitine, branched-chain amino acids (BCAAs), vitamin D and zinc show promise for reducing the frequency, severity and/or duration of muscle cramps in individuals with liver cirrhosis, but results may not be applicable to other populations. Evidence for vitamin E is contradictory. There is not enough high quality research to make a recommendation.

Hemodialysis

Limited evidence from one small RCT suggests that vitamin K2 may reduce the frequency, severity and duration of muscle cramps experienced during hemodialysis. Additional high quality research is needed before a recommendation can be made.

Key Practice Point #4: Alcohol

The Recommendation

Limited evidence from a small observational study suggests that drinking alcohol at least once a week is associated with nocturnal leg cramps in older adults (≥60 years) but it is unclear if avoiding alcohol reduces the risk of cramps.

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

Looking for more Summaries of Recommendations and Evidence (SRE)? The PEN System has 180 SREs on a variety of topics that are relevant to dietitians! Here is a sample of the latest updated ones:

• Integumentary System (Skin, Hair, Nail Health) Summary of Recommendations and Evidence
• Urology - Interstitial Cystitis Summary of Recommendations and Evidence
• Child and Youth Nutrition Summary of Recommendations and Evidence
• Allergic Disease Summary of Recommendations and Evidence
• Neuromuscular - Muscle Cramps Summary of Recommendations and Evidence
• Nutrition and Fertility Summary of Recommendation and Evidence
• Diet Composition - Alkaline Diet Summary of Recommendations and Evidence
• Gestational Diabetes Summary of Recommendations and Evidence

The Nutrigenomics Background has been updated. Check out this excerpt:

Nutritional genomics is the scientific field and application of the interaction between genetics, genomics and diet and nutrition in relation to disease treatment and prevention (1). It consists of two distinct areas, nutrigenetics and nutrigenomics. Nutrigenetics examines how genetic variation influences dietary response, while nutrigenomics examines how nutrients and bioactive food compounds influence gene expression (1). The advancement of nutritional genomics has the potential to enable personalized nutrition by delivering dietary intervention to those who are more likely to respond well, to reduce unnecessary adverse consequences, and to improve cost and health effectiveness (2). Dietitians are prime candidates for providing guidance to the public on the interplay of nutrition and genetics (3). Discussions around nutritional genomics, related technology, interpretation of genetic variation information, and the legal, ethical and social aspects of genetic information are relevant to dietitians as they are considered the front-line contact with the public regarding nutritional genomics.

Log in to see the remainder of the background, including 21 references and the following:

• Topic Overview
  • Nutritional Genomics in Practice
  • Assessing the Scientific Validity of a Nutrigenetic Test Using Scientific Literature
• Relevant Basic Information
• Regulatory Issues
• Resources for Professionals
• Additional Reading

And the answers to these questions:

• Is the referral of a client for nutrigenetic testing within the scope of practice for a dietitian?
• Should registered dietitians advise clients to use nutrigenetic testing?
• What ethical issues should be considered when providing services based on nutritional genomics?
• Are genetic tests that are accessible to the public regulated? Are direct-to-consumer advertisements of genetic tests regulated?
• Are there privacy laws that govern the genetic information that is obtained through nutrigenetic tests?

Looking for more backgrounds? These are a few of the latest new and updated ones:

• Food Safety Culture and Climate Background
• Metabolic and Bariatric Surgery Background
• Dysphagia Background

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.

Practice guidance toolkits make 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 on 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 can see only your country’s information or view 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: 

• Urology - Interstitial Cystitis Practice Guidance Toolkit
  
• Nephrology - Chronic Kidney Disease with and without Dialysis Practice Guidance Toolkit
  
• Neuromuscular - Muscle Cramps Practice Guidance Toolkit
  
• Diabetes/Glucose Intolerance Practice Guidance Toolkit