PEN eNews 10(7) July 2020
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.
If you practice in a specialized area of dietetics, we need your expertise. Currently, we are looking for dietetic specialists to volunteer to review PEN client handouts on:
ostomy, arthritis, pancreatitis and vegetarianism.
Coconut Oil - What is the Latest?
Are there any health benefits in consuming coconut oil?
Evidence does not support recommendations to use coconut oil to support weight loss or improved satiety in adults.
Data from a systematic review of 16 clinical trials suggests that coconut oil in comparison to non-tropical oils (e.g. soybean, olive, safflower and canola oils) has no effect on body weight, waist circumference, percent body fat or glycemic markers.
Grade of Evidence B
Research on satiety after coconut oil and medium chain triglyceride oil compared to vegetable oils provide mixed results. The results from two studies showed both some significant and some nonsignificant effects on satiety and fullness. For three hours after consuming breakfasts containing various fats, participants reported no differences in three satiety measures (hunger, desire to eat and prospective food consumption, P>0.05) but reported greater feelings of fullness in the medium chain triglycerides (MCT) arm compared to the coconut arm (P=0.037). Compared to a vegetable oil- (olive and rapeseed) containing breakfast, participants reported lower satiety after the coconut oil-containing breakfast.
Grade of Evidence C
Results of systematic reviews suggest that weight loss may be slightly greater (average 0.5 and 0.7 kilograms weight differences lost over three or more weeks) when medium chain triglyceride oil is included instead of long chain triglyceride oils; however, the evidence is low quality and commercial bias was detected. Results from purified MCT oil cannot be extrapolated to coconut oil due to differences in fatty acid composition.
Grade of Evidence C
Coconut oil (Cocos nucifera) consists of 75-90% saturated fatty acids, about 50-75% of these are C8:0 to C14:0 fatty acids, of which lauric acid (C12:0) is the major fatty acid (45%). In contrast, MCT oil is comprised primarily of C8:0 and C:10 fatty acids, which are rapidly metabolized and not directly stored in adipose tissue. Coconut oil contains 14% C8:0 and C:10 fatty acids. Some studies have examined health effects of MCT oil; however, these cannot be extrapolated to coconut oil because of the marked differences in fatty acid composition and possible differences in biological responses.
See Additional Content: What effect do tropical oils (palm oil and coconut oil) have on blood lipids?
To see the entire practice question, including evidence statements and references, click here
Want to know what else is new and updated? Bookmark these pages:
New Knowledge Pathway Content
(Knowledge Pathways, Practice Questions, Summary of Recommendations and Evidence, Practice Guidance Toolkits, Backgrounds)
The Sweeteners Knowledge Pathway is Updated!
The Sweeteners Knowledge Pathway was just updated. Here are the new and updated practice questions:
- What is the evidence on the safety of sweeteners (e.g. nonnutritive, artificial, intense, low calorie, sugar substitutes)?
- What is the evidence on the safety of sugar alcohols?
- Are there any specific considerations with regard to the use of sweeteners (e.g. nonnutritive, artificial, sugar substitutes, intense, low calorie) in pregnancy/lactation?
Are there any specific considerations with regard to the use of sugar alcohols as sweeteners in pregnancy/lactation?
- Are there any specific considerations with regard to the use of sweeteners (e.g. nonnutritive, artificial, intense, low calorie, sugar substitutes) and sugar alcohols in children?
- What effect do sweeteners (e.g. nonnutritive, artificial, intense, low calorie, sugar substitutes) have on cardiometabolic health?
- What effect do sweeteners (e.g. nonnutritive, artificial, intense, low calorie, sugar substitutes) and sugar alcohols have on weight management?
Iron Deficiency and Gastrointestinal Disease – Is There a Connection?
This practice question was just updated: Should iron-deficient individuals be screened for gastrointestinal disease? Here are the recommendations:
- All individuals with iron-deficiency anemia (IDA) should be screened for celiac disease.
- Individuals with iron deficiency without anemia (IDWA) are at low risk of gastrointestinal (GI) malignancy. However, individuals who present with IDWA and are >50 years or have not been screened for GI malignancies should be investigated for gastrointestinal malignancies.
To see the country-specific recommendations, related evidence and references, click here
Use the PEN Search function to find information on gastrointestinal disease or hematology - anemia. There are 19 Gastrointestinal System Knowledge Pathways:
Gastrointestinal System - Bowel Obstruction
Gastrointestinal System - Cleansing
Gastrointestinal System – Collagenous Sprue
Gastrointestinal System - Diverticular Disease
Gastrointestinal System - Gallbladder Disease
Gastrointestinal System - Gastritis and Peptic Ulcer Disease
Gastrointestinal System - Gastroesophageal/Gastro-oesophageal Reflux Disease
Gastrointestinal System - Infant Colic
Gastrointestinal System - Inflammatory Bowel Disease
Gastrointestinal System - Irritable Bowel Syndrome
Gastrointestinal System - Irritable Bowel Syndrome: FODMAP
Gastrointestinal System - Microbiota
Gastrointestinal System - Ostomy
Gastrointestinal System – Pancreatitis
Gastrointestinal System - Pediatric/Paediatric
Gastrointestinal System - Pediatric/Paediatric Constipation
Gastrointestinal System - Pediatric/Paediatric Gastroesophageal Reflux Disease (GERD)
Gastrointestinal System - Postoperative Feeding
Gastrointestinal System - Probiotics
And six Hematology- Anemia Knowledge Pathways:
Hematology/Haematology - Anemia/Anaemia: Iron Deficiency
Hematology/Haematology - Anemia/Anaemia: Folate and B12 Deficiency
Hematology/Haematology - Anemia/Anaemia: Thalassemia/Thalassaemia
Hematology/Haematology - Anemia/Anaemia: Sickle Cell
Hematology/Haematology - Anemia/Anaemia: Pediatrics/Paediatrics
Open Access to COVID-19 Content Continues
Although the Open Access to the entire PEN System is now closed, we continue to make COVID-19 information, Trending Topics and PEN® eNews available to all with no PEN subscription or access credits required:
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The PEN Team
Farewell, Dear Friend & Colleague: Here’s to It
It is with deep sadness that we share that Beth Armour passed away unexpectedly but peacefully on June 28th, 2020. Beth lived a vibrant life filled of rich relationships and never missed an opportunity to make a friend, make someone laugh or have fun. She was the life of every party and never showed up without goodies (e.g. oatmeal chocolate chip cookies!) and jokes.
Over a career that spanned more than four decades, Beth worked as the Clinical Coordinator of McGill University’s Dietetic Internship Program, as the Manager of Clinical Nutrition for the McGill University Health Centre, as an entrepreneur dedicated to producing and distributing gluten-free oats and as the Content Manager for the PEN System. She also spent countless hours volunteering both within the dietetics profession and in her community. Throughout the years, Beth served on the Board of Directors for Dietitians of Canada and on dietetic practice committees too numerous to name, contributed to the Canadian Celiac Association and provided her special brand of kindness to nursing home residents in her Montreal community. Along with Barb Anderson, Beth was instrumental in establishing the Dietitians of Canada Morgan Award that recognizes the research achievements of dietetic students and interns as a tribute their friend and colleague Susan Morgan.
Beth established herself early on as a valued and visionary leader in dietetics as she tirelessly devoted herself to advocating for the profession and for dietetic students in particular. Beth loved working with students and was an extraordinary mentor of hundreds of students, engaging and supporting them as they learned about critical appraisal and applying evidence to practice. Noor Naqvi, a former student of Beth’s, wrote, “They say the mediocre mentor tells, the good mentor explains, the superior mentor demonstrates, but the greatest mentors inspire. Over the course of my dietetic internship across Montreal, I met a number of people who had been mentored by Beth. One told me how Beth had saved her from throwing away years of hard work and quitting internship and others spoke fondly of her. Working with her was one of the highlights of my academic career in dietetics. The experience was a lesson in professionalism and the power of positive reinforcement. I consider myself lucky to have been mentored by Beth. She was the greatest!” A former dietetic intern, Lesley French, remembers, “I came to know Beth in my Royal Victoria Hospital Internship in Montreal. Beth was our internship coordinator for our 1st and 2nd Stage of McGill MacDonald Campus Internship, 1982-1983. I remember that we had regular Friday afternoon meetings, which were picnic lunches on the hospital ground’s beautiful grassy lawn overlooking Montreal. There may or may not have been a bottle of wine involved! At the end of our two stages with her, she invited us to her apartment for a meal and the food was fantastic. She was always fair, respectful and fun as an internship coordinator. She was down to earth and kind. She was always rooting for her Ontario sports team (we were in Montreal, so rival teams). But she’d do it in such a fun way. She was certainly a dietitian to look up to, and aspire to have her caring and kindness for others as a part of our own practice.”
Beth was involved with the PEN System from the beginning serving as a volunteer member of the original advisory committee in the early 2000s. Officially, Beth was the PEN System’s Content Manager, internationally coordinating the development and update of PEN content between authors and reviewers. This position suited her well because she had the largest social and professional network of anyone we knew and she had an incredible talent for strategically connecting people. Unofficially, Beth was so much more for the PEN Team. She was a master of thoughtful and helpful feedback, an asker of tough questions that enhanced work products, an early adopter of the latest and greatest technologies, a brilliant systems thinker who could zero in on the smallest details without ever losing sight of the bigger picture and an embracer of diverse input. She had an unparalleled work ethic.
Beth Armour had a special way of connecting with people. For instance, while representing the PEN Team at a reception hosted by the Japanese Dietetic Association, Beth in her usual fashion, began circulating amongst the delegates. Wherever she was in the room, there were giggles, laughter and much flailing of hands as rudimentary sign language was attempted to aid the conversation. She spoke no Japanese and the Japanese delegates spoke little English, but nevertheless Beth “connected”. Her warmth and genuine interest in dietetics in Japan sowed the seeds of a new partnership.
In addition to being a committed team member, Beth was a dear friend. She placed a high value on friends and family and was always there for them even if it meant travelling across the country to support them. She always had our back – whether it was staying up all night to load PEN content for the original launch or reviewing a presentation the night before it was delivered. She was quick to volunteer to take on tasks to help manage the workload of others or to support their success. While she has been central to the success of the PEN System, she never sought centre-stage and instead delighted in supporting and celebrating the successes of her colleagues.
Beth exuded a zest for life; she had a willingness to try anything! She will be fondly remembered for her love of dressing up as Santa at holiday parties, for her ability to heckle speakers in a way that made everyone, including the speaker, laugh and for the way she effortlessly filled the awkward silences of large Zoom meetings. She’ll also be remembered for her kindness, her generosity, her wicked sense of humor and her love of Archie, her Tibetan terrier. We are so sad to say goodbye. Beth, you left us with so many fond memories and as you often toasted us: “ Here’s to it and from it and if you get to it to do it, do it as you may never get to it to do it again.”
The PEN Team & Friends
PEN® Summary of Recommendations and Evidence: Where Evidence and Practice Guidance Meet
Short on time, but need a quick and comprehensive overview of the evidence on a topic area? The Summary of Recommendations and Evidence (SRE) is your new favourite tool. The SRE organizes all of the questions in a knowledge pathway by topic. It is your one-stop shop to find the key practice points (including recommendations and graded evidence) for the topics covered in the knowledge pathway. The SRE replaces the Evidence Summary, which was a synthesis of just the evidence part of the key practice points, organized by evidence grade level. The SRE is a stand-alone tool and is mirrored in the Practice Guidance Toolkit, replacing the Key Findings and Recommendations section.
There are now more than 200 Knowledge Pathways in the PEN System, which means that we have many SREs to create! So far, we have created more than 80! The remainder of SREs will be in the former Evidence Summary format until content in those KPs are updated or new content is added.
Here are the latest new or updated Summaries of Recommendations and Evidence:
July 2020 Volume
A Publication of the PEN® System Global Partners,
a collaborative partnership between International Dietetic Associations.
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