PEN eNews 10(10) October 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.
The Pancreatitis Knowledge Pathway is Updated!
The Gastrointestinal System – Pancreatitis Knowledge Pathway was just updated. Do you know the answer to these questions?
- When should nutrition assessment occur for a child or adult admitted to hospital for acute pancreatitis?
- Should a child or adult admitted to hospital for acute pancreatitis be NPO?
- Should a low fat diet be followed by individuals with pancreatitis?
For answers to these questions and for more information, see the links below:
Looking for more information related to the gastrointestinal system? There are:
- 24 Knowledge Pathways
- 185 Practice Questions
- 91 Handouts
Enter the search term “gastrointestinal” in the PEN Search and check out the results!
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 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 90! 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:
Fructose - What is the Latest?
What are the effects of fructose ingestion on blood glucose levels and circulating triglycerides among individuals with and without diabetes?
Replacing some dietary carbohydrate (such as glucose, sucrose or refined starches) with food sources of fructose, particularly sources such as fruit, without increasing energy intakes (isocaloric substitution) for at least a week up to a few months:
- may benefit (decrease) A1C and fasting glucose levels among those with or without diabetes, but potentially more so among those with diabetes
- may decrease fasting blood glucose among those with diabetes
- probably has no effect on fasting insulin or insulin resistance and sensitivity in most groups
- has no effect on fasting triglycerides levels
- has no effect on post-prandial triglycerides levels, with the possible exception among a subgroup of individuals with overweight or obesity, where it increased.
When fructose is consumed in addition to baseline intakes (hypercaloric feeding condition), it:
- may increase fasting blood glucose and insulin, especially when the dietary source of fructose is sugar-sweetened beverages or fruit juice
- increases fasting and post-prandial triglycerides.
To see the full practice question, including the Evidence Summary, Remarks, Evidence Statements, Rationale 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)
Tools and Resources.
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:
If you are interested in continuing your access to the entire PEN System and you are not a current subscriber, please view the different subscription options available at: https://www.pennutrition.com/signup.aspx
. Revenue from PEN subscriptions is reinvested in the system to keep the content up-to-date and constantly growing while positioning you on the leading edge in your practice. The PEN System does not accept industry revenue or advertising.
We hope you'll be an active member of our PEN community and stay connected with us:
The PEN Team
Surprising Findings: Postbiotics - A Ghostly Topic
As I find life constantly surprising these days and feeling a little overwhelmed, I asked my PEN Team colleagues for an idea for my Surprising Findings article. The topic of postbiotics was suggested, which was truly surprising as I hadn’t heard of postbiotics in my editorial travels. As another name for postbiotics is ghost probiotics and with Halloween on the horizon, how could I resist?
After a PubMed search, I began reading with these questions in mind:
- What are postbiotics?
- How do they differ from prebiotics, probiotics and synbiotics?
- Are they safe?
- Are there any promising research studies?
- Should we add some content on this topic to the PEN® System?
This is what I found out:
What are postbiotics?
Żółkiewicz, et al. provide the following definition of postbiotics “Postbiotics include any substance released by or produced through the metabolic activity of the microorganism, which exerts a beneficial effect on the host, directly or indirectly” (1). However, there does not appear to be consensus for a definition at present (2). Postbiotics are also called modified, inactivated, non-viable, paraprobiotics or ghost probiotics (3).
How do they differ from prebiotics, probiotics and synbiotics?
Postbiotics do not contain live microorganisms (1). Thus, the name ghost probiotics.
Are they safe?
Postbiotics appear to be superior to probiotics in regard to safety (1). Postbiotics have fewer risks than their biotic cousins as they do not contain live microorganisms (1). Although probiotics are generally safe, caution may be needed with high risk populations, including critically ill individuals (4). Thus, the potential of postbiotics for some populations (1).
Are there any promising research studies?
It is early days for postbiotics. There are a limited number of studies available. A search in PubMed reveals 156 results compared to 29,733 for probiotics, 9405 for prebiotics and 1571 for synbiotics. There are very few clinical trials and only one systematic review at the time of writing.
Research has been in a number of areas including infant colic, adult atopic dermatitis, diarrhea (2) and common infectious diseases in children (5). More research is needed to explore the benefits and risks of postbiotics prior to recommending their use.
Should we add some content on this topic to the PEN® System?
Absolutely when more research is available! Stay tuned! In the meantime, the PEN System has lots of information on probiotics and prebiotics! Go to: https://www.pennutrition.com
and use the search function to check it out.
A safe and Happy Halloween to all!
Heather Alaverdy MA, RD
- Żółkiewicz J, Marzec A, Ruszczyński M, Feleszko W. Postbiotics-A Step Beyond Pre- and Probiotics. Nutrients. 2020 Jul 23;12(8):2189. doi: 10.3390/nu12082189. PMID: 32717965; PMCID: PMC7468815. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7468815/
- Wegh CAM, Geerlings SY, Knol J, Roeselers G, Belzer C. Postbiotics and Their Potential Applications in Early Life Nutrition and Beyond. Int J Mol Sci. 2019 Sep 20;20(19):4673. doi: 10.3390/ijms20194673. PMID: 31547172; PMCID: PMC6801921. Abstract available from: https://pubmed.ncbi.nlm.nih.gov/31547172/
- Postbiotics. Wikipedia. 2020 July 23. Available from: https://pubmed.ncbi.nlm.nih.gov/32024037/
- Dietitians of Canada. Are there any safety concerns with the use of probiotics? In: Practice-based Evidence in Nutrition [PEN]. 2010 Jun 26 [cited 2020 Oct 16]. Available from: https://www.pennutrition.com/KnowledgePathway.aspx?kpid=3085&pqcatid=148&pqid=3138 Access only by subscription. Click Sign Up on PEN login page.
- Malagón-Rojas JN, Mantziari A, Salminen S, Szajewska H. Postbiotics for Preventing and Treating Common Infectious Diseases in Children: A Systematic Review. Nutrients. 2020 Jan 31;12(2):389. doi: 10.3390/nu12020389. PMID: 32024037; PMCID: PMC7071176. Abstract available from: https://pubmed.ncbi.nlm.nih.gov/32024037/
How is PEN® “GRADE”ing the evidence for you?
Reposted from PEN eNews June 2016
PEN® has joined more than 100 organizations around in the world in using the GRADE system! To help dietitians understand the advantages of the GRADE system, how it will it impact what we see in PEN, and how as dietitians we can interpret and use this information in our practice, we presented The new face of PEN®: “GRADE”ing the evidence for you at the national Dietitians of Canada Annual Conference.
GRADE stands for Grading of Recommendations, Assessment, Development and Evaluation.
GRADE recommendations have two parts:
- Reviewing the evidence and indicating the quality of evidence, from high to very low.
- Our confidence in the actual results decreases with decreasing quality of evidence. For high quality evidence, we can be very confident in a result (called the effect estimate) or have little confidence in the effect estimate for very low quality evidence. We looked at examples of evidence tables to gain an appreciation of the factors considered in assessing the quality of evidence.
- Making a recommendation and indicating how strong a recommendation is. Developing a recommendation for a proposed course of action involves balancing benefits and harms, patients’ values and preferences, and the resources required to implement the intervention in question. We went through examples of strong and conditional recommendations, and the justification for these recommendations.
Reviewers play a key part in the PEN GRADE process. GRADE recommendations explicitly provide the key underlying information needed to act on a recommendation. Therefore reviewers’ feedback is necessary in several steps of the process from question identification to developing the recommendation. International review panel (IRP) members represent academic experts and practitioners with acknowledged expertise in topic areas. IRP members may be involved in:
- Reviewing the questions and identifying patient-important outcomes
- Reviewing the search strategy and literature retrieved
- Providing feedback on the evidence tables and recommendations.
One of the many benefits of moving to the PEN GRADE process includes helping readers understand how we arrived at a recommendation, thereby making recommendations more transparent. We are currently in a transition phase with GRADE implementation into the PEN system. Some questions that deal with diagnosis or prognosis, will use our existing PEN process. We will be focusing on using GRADE for intervention questions in PEN when we update and develop new content.
Dietitians, there are opportunities for you to be involved in the PEN GRADE process:
Contact us if you’d like to be involved in PEN GRADE.
By: Dawna Royall, MSc, RD
Senior Evidence Analystdawna.firstname.lastname@example.org
Jayne Thirsk RD, PhD, FDC
October 2020 Volume
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.