PEN eNews 10(3) March 2020

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.

OPEN ACCESS: The PEN^® System and COVID-19

With the spread of COVID-19, the day-to-day practice of dietitians, dietetic students and interns around the world has changed fundamentally. Many dietitians are on the front lines while others are now working virtually. During the next few weeks, access to the PEN System should not be one of your stressors. We believe this so strongly that the team at PEN: Practice-based Evidence in Nutrition has decided to provide open access to the PEN System to dietitians and dietetic students worldwide. The hope is that by eliminating barriers to practice questions and client resources, your life becomes a little easier as you continue to provide care, support and evidence-based nutrition information to your patients and clients around the world.

During this period, open access to the PEN System will be available through a special login page: www.pennutrition.com/COVID19. Please review the Disclaimer.

For current subscribers who use personal access credits - your access credits will not be affected when accessing the PEN System from the special login page. However, if you wish to access the My Favourites feature and other personalized features of the PEN System, you will need to login to your personal individual account using your existing username and password. Your access credits will be used in this case.

Yours in Health,

The PEN Team

DISCLAIMER: PEN^®: Practice-Based Evidence in Nutrition is a system developed for dietitians, those in the process of becoming a dietitian and nutrition professionals. Dietitians are health care professionals with specialized knowledge in food and nutrition. The information found on the PEN website is not intended for the public nor should it replace the advice of a health care professional. Dietitians of Canada is the owner or authorized licensee of all trademarks and copyrighted material on the PEN website. Our organization is committed to protecting its intellectual property rights by enforcing them against unauthorized use. PLEASE NOTE: In using the temporary open access link, you represent that you are 18 years old or older and you agree to be bound by the terms and conditions laid out in the PEN License Agreement and the Privacy and Security Policy. PLEASE READ BOTH CAREFULLY BEFORE ACCESSING OR USING THE OPEN ACCESS PEN SYSTEM. We acknowledge that the license agreement, as written, does not describe the process for logging in using our open access link and that all fees in relation to access to the PEN System will be waived during this period. Dietitians of Canada reserves the right, in its sole discretion, to suspend or terminate operation of or access to the open access PEN System at any time without notice to you.

What’s New for PEN^® Client Handouts

PEN Handouts for Your Clients

There are hundreds of PEN-developed handouts in the PEN System; many of which have been culturally adapted and are available in a variety of languages.

New and Updated Handouts

Some of our latest new and updated handouts include:
The Mediterranean Diet: A Guide to Healthy Eating English French
Mediterranean Diet Sample Menus (1500 kcal) English French
Mediterranean Diet Sample Menus (2000 kcal) English French
Using the DASH Diet to Lower Blood Pressure English French
Healthy Eating Guidelines for Early Chronic Kidney Disease English
Quick Nutrition Check for Vitamin B12 English
Soy: Nutrition and Health English

Handout Collections

There are eight PEN Handout Collections:

Breastfeeding Friendly
Food Service
Food Sources and Nutrients (Canada)
Food Sources and Nutrients (U.K.)
Health Conditions
Healthy Living
Nutrition Over the Lifespan
Pediatrics

Read more about the Handout Collections in this PEN eNews article.

Probiotics and Rheumatoid Arthritis– What Does the Evidence Tell Us?

The Question

Do individuals with rheumatoid arthritis (RA) who supplement their diet with probiotics have improvement in their arthritic symptoms compared to individuals with RA not using probiotics?

The Evidence

A 2018 systematic review and meta-analysis of five RCTs (n=153) found that probiotic supplementation significantly reduced disease activity score compared to placebo in adults with RA, although their number of swollen and tender joints did not change. The doses, durations of treatment and probiotic strains varied widely between studies.

A 2017 systematic review and meta-analysis found no difference in disease activity score (DAS28), American College of Rheumatology 20% Improvement criteria (ACR20) or health assessment questionnaire (HAQ). However, biochemical markers (C-reactive protein, TNF-α, IL-1β, IL-10) were improved in the probiotic groups. Included studies may not have been powered to detect significance.

The Recommendation

Probiotic supplementation may reduce disease activity score and biochemical markers in adults with rheumatoid arthritis (RA), although the optimal dose, duration of treatment and probiotic strain are not known.

To see the entire practice question, including evidence statement and references, click here.

Arthritis

Diabetes and Sweeteners - Are You Up-to-Date?

How do sweeteners fit as part of diabetes management? See these new and updated practice questions to find out:

Bookmark these pages to check what is new and updated:

New Knowledge Pathway Content  (Knowledge Pathways, Practice Questions, Summary of Recommendations and Evidence, Practice Guidance Toolkits, Backgrounds)
Tools and Resources.

Passing the Torch

On March 31, 2020, I will also be passing a torch. I will be retiring from Dietitians of Canada and the position of Senior Director, Knowledge Translation (PEN^® System). Since the inception of the PEN System in 2003 and its launch in 2005, I’ve been fortunate to be engaged in work that I feel passionate about, supported by talented and dedicated colleagues. It’s been a privilege to lead the extraordinary PEN Team and see it expand to include valued international partners at the British Dietetic Association and Dietitians Association of Australia, and through our global networks to see PEN adopted internationally. Our vision, of the PEN System being used by educators around the world to ensure that our dietetic practice is grounded in evidence and that dietitians/nutritionists are leaders in evidence-based practice, is also being realized.

To the scores of dietitians that supported PEN at the launch when we had only 11 knowledge pathways, thank you for believing in us. To the scores of dietitians who have volunteered as peer reviewers or authors, thank you for sharing your expertise – and please continue to do so! Our little PEN team can’t keep the over 200 knowledge pathways updated alone and will need your ongoing support to ensure our professional database continues to put the best evidence into the hands of dietitians wherever they practice.

I leave knowing that the dedicated international PEN team will be led by an accomplished, creative, thoughtful leader – Dr Mary Anne Smith RD PhD. Mary Anne has been an Evidence Analyst contributing to the PEN System for almost five years. She is skilled at critical thinking, trained in GRADE and her PhD thesis examined effective ways of translating and communicating information into practice. She brings a superb foundation in nutrition and dietetic practice and experience as a researcher and educator. She is a prize-winning public speaker with strong business acumen and her national and international policy expertise will be of huge value to the PEN System. A recent quote by her illustrates her commitment to the PEN System:
“ I am convinced of the power of PEN^® to improve dietetic practice worldwide – to fill the gap between research and practice – and look forward to being part of its bright future.”

Thank you for the remarkable opportunity to lead such an initiative. I will treasure the many special friendships ignited by our common passion for evidence-based dietetic practice. May the PEN System continue to grow Citius, Altius, Fortius (Faster, Higher Stronger) (1) in the years ahead.

With gratitude and in service,
Jayne Thirsk RD PhD FDC

¹https://www.olympic.org/the-olympic-motto

PEN Partners

Tips to Spot Misinformation

With the COVID-19 outbreak, people around the world are being bombarded with nutrition advice, especially related to the immune system. It’s hard to know what is evidence-based.

Dietitians of Canada teamed up with PEN: Practice-Based Evidence in Nutrition^® to update and re-post some tips to help you help others spot misinformation.

Tips to spot misinformation

Is the person or product promising a quick fix, like a miracle cure? If it sounds too good to be true, then it likely is. Check out these dietetic association public websites for reliable nutrition and food safety information:
- British Dietetic Association Food & Health
- Dietitians of Australia Smart Eating for You
- Dietitians of Canada Unlockfood.ca
Are they trying to sell products such as supplements instead of educating people on how to make healthier food choices? Refer to posted consumer information from the Federal Trade Commission (FDC) about Coronavirus Scams.
Do they provide information based on personal stories rather than on facts? Nutrition advice should be based on the best available scientific research. Dietitians are university trained, regulated health professionals who use tools such as the PEN^® System, available internationally, to make sure they are basing their advice on the best evidence-based information available.
Is their claim based on a single study or a few research studies? Were the studies with cells in test tubes or Petri dishes, in animals or in humans? Were the participants randomized to treatments or were conclusions made based on observations about what some people consumed versus other people? Is the population you are working with similar to the humans that were studied (age, gender etc.)? The stronger the study design and the more studies available that draw the same conclusions, the stronger the evidence that something is reliable. Visit InformedHealth.org for an update on the various types of scientific studies (including experiments, observational studies and surveys) used and why they are chosen.
What are the person’s qualifications? Who is providing the nutrition advice? Dig deeper and ask for credentials. Are they associated with a university? Are they a licensed registered practitioner? Health professionals’ titles are protected by law.

Help prevent the spread of misinformation. View advice for dietitians and/or the public from the following dietetic associations:

British Dietetic Association
Dietitians of Australia (member login required)
Dietitians of Canada

PEN Features

PEN eNews

March 2020 Volume 10 (3)

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