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    • eNews - Nutrition for Transgender and Gender-diverse Individuals
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    Nutrition for Transgender and Gender-diverse Individuals

    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.


    New Knowledge Pathway Alert: Nutrition for Transgender and Gender-diverse Individuals



    The latest knowledge pathway (KP) added to the PEN System is the Nutrition for Transgender and Gender-diverse Individuals KP. We expect this KP to expand as more research becomes available. Here is the current content:

    • What are the considerations for nutrition assessment when working with transgender and gender-diverse (TGD) individuals?
    • What role, if any, do foods, herbals or dietary supplements facilitate in medical transition?
    • Nutrition for Transgender and Gender-diverse Individuals Background
    • Nutrition for Transgender and Gender-diverse Individuals Summary of Recommendations and Evidence

    • Nutrition for Transgender and Gender-diverse Individuals Related Tools & Resources

    Want to find out what else is new on the PEN website? You can check out the New and Upcoming Content page, which is updated regularly. 

    • Transgender Nutrition 

    Gout: Are You Up to Date?


    Do you know the answers to these questions?

    Do any specific foods or dietary patterns decrease the risk of developing gout or reduce the recurrence of gout attacks?

    Does a diet high in purines increase the risk of developing gout? Does a diet low in purines reduce the recurrence of gout attacks?

    Does alcohol intake increase the risk of developing gout? Does reducing alcohol intake decrease the recurrence of gout attacks?

    Does the consumption of sugar-sweetened beverages (SSBs) increase the risk of developing gout or the recurrence of gout attacks?

    Does the consumption of cherries reduce the recurrence of gout attacks?

    Does increasing dietary or supplemental vitamin C decrease the risk of developing gout or decrease the recurrence of gout attacks?

    What is the effect of weight loss on gout attacks in adults with higher weights (BMI >25)?


    To find out, click on each practice question above or for a condensed version, see the Gout Summary of Recommendations and Evidence.


    Looking for more information? See the Gout Practice Guidance Toolkit, which provides an overview of the Gout Knowledge Pathway that includes key nutrition issues; nutrition assessment, monitoring and evaluation; diagnosis; intervention; and professional and client resources.

    • Gout 

    Pediatric Intractable Epilepsy - Is a Ketogenic Diet an Effective Treatment?

    The Question

    What is the efficacy of following a ketogenic diet (classic, medium chain triglyceride, low glycemic index treatment or modified Atkins diet) in the treatment of pediatric intractable epilepsy?

    Recommendation

    All types of ketogenic diets (classic, medium chain triglyceride (MCT), low glycemic index treatment (LGIT) and modified Atkins diet (MAD)) have been shown to reduce seizure frequency and improve the likelihood of achieving seizure freedom in children with intractable epilepsy.  

    The classic ketogenic diet (KD) and MAD have been studied most rigorously. The classic KD may have a larger effect than the MAD, while the MAD may have fewer side-effects. The MCT and LGIT are less well studied but appear efficacious, with the MCT having shown similar efficacy to the classic KD. 

    In infants <2 years, the classic KD has been recommended. Adolescents may do better with the MAD or LGIT, which are easier to follow and have better adherence.

    Evidence Summary

    A 2022 systematic review and meta-analysis of eight RCTs (n=453) found that children and adolescents with intractable epilepsy who followed a KD were more likely to reduce their seizure frequency by >50% than those who did not follow a KD. Only the classic KD and the MAD were examined. 

    A 2020 Cochrane review of 13 RCTs/quasi-RCTs (n=932) found that KDs could be effective in reducing seizures and achieving seizure freedom in children with intractable epilepsy, although the evidence is low or very low quality. Specifically, the classic KD and MAD showed potential efficacy, with a larger effect associated with the classic KD (seizure freedom in up to 55% of individuals compared to 25% for MAD, and reduced seizure frequency in up to 85% of individuals compared to 60% for MAD). However, fewer side-effects were associated with the MAD. Only one study compared the classic KD to the MCT, which found no significant differences in seizure reduction between the two diets. The LGIT was not examined in any included studies.  

    A 2018 expert consensus statement noted that the classic KD was most appropriate in children <2 years, while the MAD or LGIT were more appropriate in adolescents due to increased adherence. Although no studies have compared the LGIT to other ketogenic diets, it has shown promise in children with intractable epilepsy, especially those with Angleman syndrome. The MCT appears equivalent in efficacy to the classic KD while allowing for higher carbohydrate and protein intakes and a larger variety of food choices. 

    Grade of Evidence C

    Remarks

    The classic KD is defined as a diet with high lipid to non-lipid ratio. The MCT is defined as a diet with 60% of calories coming from MCT oil; alternatively, if this is not tolerated due to gastrointestinal side-effects, a lower dose of MCT oil (30-50% calories) may be used. 

    The MAD is a high fat, low carbohydrate diet focusing on fat and carbohydrate targets rather than ratios. The LGIT allows 45-60 grams of carbohydrate daily but requires that all carbohydrates have a glycemic index <50.

    If a child requires a special dietary formulation, ketogenic liquid formula can be provided. Liquid diet formulations can be used in infants or in children with feeding tubes and have the benefit of increased compliance compared to whole food KDs.

     

    See Additional Content: Nervous System – Pediatric/Paediatric Epilepsy: Ketogenic Diet Background.


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

    • Pediatric Health, 
    • Ketogenic Diet 

    Blood Donation and Iron Deficiency - Do Diet and Supplementation Help?


    Did you know that it takes approximately 24 weeks to replete the amount of iron lost after one 10-minute blood donation if diet is not augmented by supplements? Iron deficiency occurs in 25-35% of blood donors, with risk factors including female sex, younger age, frequent donation and recent donation. To read more on this topic, see the practice question: What dietary or supplementation strategies can help prevent or treat iron deficiency among regular blood donors?


    Check out these additional updated practice questions:

    What is the impact of calcium or dairy product intake on non-heme iron absorption and is there an effect on iron status among healthy adults?

    What is the impact of tea and coffee consumption on non-heme iron absorption and is there an effect on iron status among healthy adults?

    What foods/nutrients facilitate iron absorption and improve iron status?

    What foods and nutrients decrease iron absorption and inhibit iron status?

    What dietary strategies can support the treatment of iron deficiency in non-pregnant adults, and when is supplementation warranted?

    What type of iron supplement is recommended for the treatment of iron deficiency in non-pregnant adults?

    What dietary or supplementation strategies can help prevent or treat iron deficiency among regular blood donors?


    For more information on anemia and/or iron, search the PEN website or click on these Knowledge Pathways:

    Hematology/Haematology - Anemia/Anaemia: Folate and B12 Deficiency

    Hematology/Haematology - Anemia/Anaemia: Thalassemia/Thalassaemia

    Hematology/Haematology - Anemia/Anaemia: Sickle Cell Disease

    Hematology/Haematology - Anemia/Anaemia: Pediatric/Paediatric

    Hemochromatosis/Haemochromatosis


    • Nutrition Supplement, 
    • Deficiency, 
    • Vitamins & Minerals 

    thank you to our PEN® volunteers

    Our global PEN® partnership has benefited from volunteer efforts around the world.  Please take a moment to read and acknowledge your colleagues who have served as authors, or peer reviewers for PEN content since December 2015, as well as the International Working Groups. 

     

    Australia

    Chloe Angel
    Jemma O’Hanlon
    Kirsty Leray

    South Africa

    Kerry Pilditch 

    United Kingdom  

    Agnieszka Szmurlo
    David Gray
    Elaine Anderson
    Elaine Lane
    Holly Jeffreys
    Maria Cazzulani
    Megan Schoen
    Ramona Lehadus
    Sue Acreman

    Canada

    Anna Millman
    Arundhati Joshi
    Denise K. Daley
    Denise Ridley
    Edmond Chan
    Emma Barr
    Jacqueline Stickel
    Jasna Robinson-Wright
    Justine Keathley
    Kim Arrey
    Kristyn Hall
    Marie-Claude Vohl
    Melissa McDowell
    Mun Cho
    Nola Thompson
    Ruth Harvie
    Sally Willis-Stewart
    Shée Lillejord
    Stephanie Krug
    Tanis Fenton
    Trishtee Boojharut

     


     

     

    Want to see your name amongst dietetics thought leaders from around the world? Become a PEN® author or reviewer! Please click here to send us your contact information.

     

    • PEN Skills, 
    • PEN Applied, 
    • PEN Partners 
    PEN eNews
    PEN: The Global Resource for Nutrition Practice  
    October 2023  Volume 13 (10)


    A Publication of the PEN® System Global Partners,
    a collaborative partnership between International Dietetic Associations.
    Learn more about PEN.
    Copyright Dietitians of Canada . All Rights Reserved.
    Articles in this issue
  • New Knowledge Pathway Alert: Nutrition for Transgender and Gender-diverse Individuals
  • Gout: Are You Up to Date?
  • Pediatric Intractable Epilepsy - Is a Ketogenic Diet an Effective Treatment?
  • Blood Donation and Iron Deficiency – Do Diet and Supplementation Help?
  • Thank you to our PEN Volunteers
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