PEN eNews 11(10) October 2021
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 PEN® Team is delighted to announce that we welcomed Fagligt selskab af Kliniske Diætister (FaKD), the clinical dietetic association in Denmark, to the PEN Community this month!
FaKD united with the Association of Food and Nutrition in Denmark in 2018, allowing them to work collaboratively. Before that, they were independent associations. There are around 1300 dietitians in Denmark; FaKD has around 750 members, 100 of whom are students. The majority of dietitians in Denmark have a clinical role (around 900); other roles include those in education and research. Access to dietitians in Denmark is funded by the health system for hospitals and in the community. In other settings, clients pay for access to dietetic treatment. Since 1996, it has been a requirement that all clinical dietitians in Denmark have authorization to do so. Dietetics in Denmark is expanding, particularly in the community setting.
To showcase how the PEN System can support dietitians in Denmark, a representative from the PEN Team will be attending their conference on October 29th. Velkommen Demark, we hope you enjoy the PEN System as much as we do!
Low Carbohydrate Diets and Type 2 Diabetes - What is the Latest?
Does following a low carbohydrate diet (less than 130 g of carbohydrate per day or less than 45% of total energy intake) improve A1C, weight and blood lipids outcomes in adults with type 2 diabetes, compared with higher carbohydrate dietary patterns?
For those with type 2 diabetes, there is evidence that following a lower carbohydrate (CHO) diet (<130 g/day, <25% energy from CHO) may result in weight loss and reduced A1C levels compared to higher CHO diets.
Limited evidence suggests that although the low CHO diet offers benefits for glycemic control, particularly in studies <12 months and in older participants, other dietary strategies may be more efficacious (e.g. Mediterranean diet).
Clinical Practice Guidelines
National medical nutrition therapy guidelines in combination with national dietary guidelines for type 2 diabetes (T2DM) recommend a consistent pattern of carbohydrate for individuals on insulin and healthy food choices and portion control for those not taking insulin. Furthermore, there is acknowledgment that there is no ideal recommended macronutrient distribution and suggest that this should be individualized. Some national guidelines also recommend choosing lower GI (glycemic index) carbohydrates, limiting sugar-sweetened beverages (SSBs) and added sugars.
There is currently no consensus on what constitutes a low carbohydrate diet and the minimum safe level of carbohydrate. The Institute of Medicine’s Dietary Reference Intakes for CHO suggest a minimum of 130 g/day of carbohydrate be included in the diet based on the amount of glucose required by the brain.
See Additional Content: Should a ketogenic diet (<50 g/day carbohydrate) be recommended for adults with type 2 diabetes?
To see the full practice question, including references, click here.
Looking for more content on diabetes? The PEN® System has lots of content on diabetes including:
- 13 Knowledge Pathways
- 178 Practice Questions
- 230 Client Handouts.
Enter “diabetes” in the PEN search and see all the results!
Interested in low carbohydrate or ketogenic diet content? Check out the Following Knowledge Pathways:
Diet Composition - Low Carbohydrate
Diet Composition - Ketogenic Diet.
We Need Your Expertise: PEN® Reviewers Needed
We need reviewers within the next few months for:
Allergic Disease - High Risk Infant
Cancer - Nutritional Implications
Gerontology - Hydration
Infant Nutrition - Complementary Feeding
Musculoskeletal/Connective Tissue Disorders - Fibromyalgia
Nephrology - Kidney Stones; Acute Renal Failure; Chronic Kidney Disease
Did you know that PEN practice questions are peer-reviewed by experts in the field, just like journal articles? There are currently more than 400 PEN Reviewers. We would love for you to join this group and share your expertise and energy. For more information, contact http://www.pennutrition.com/BecomeAuthor.aspx
So, what do you need to be a PEN Reviewer? Take a look at this short presentation
. We provide guidance and training on how to become a PEN Reviewer and can work with your interest and availability to complete the review.
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
Surprising Findings: Are we at a tipping point for mainstream sustainable food?
Do you ever find that once your attention is tuned in to something, you can't help but see it everywhere? That's how I've been feeling on the topic of food sustainability. Let me share how I most recently experienced this.
There is a 'For Sale' sign on every other house in my Toronto neighbourhood. Neighbours tell me that the COVID-19 pandemic has pushed the decision to sell their homes, as we continually see the pandemic's impact on so many different dimensions of our lives. You might be asking yourself what this has to do with food and nutrition. I see the connection with recent reports on farmland and sustainability. The Ontario Federation of Agriculture (OFA) launched its Homegrown campaign earlier this year. The group shares an alarming statistic that since the last census, 175 acres of farmland are being lost every day due to urban development in Ontario (1). I looked that up to get a sense of what 175 acres actually looks like. For those missing travel, this works out to losing New York City’s Central Park about once every five days!
It's no surprise then that we're seeing so much more conversation around making our food systems sustainable. The pandemic has undoubtedly helped shine a light on the vulnerability of our food system. For example, the inextricable link between the current food system, climate change, food security and social justice is well established (2), all of which are global nutrition priorities (3). Yet, I know the issue of transforming food systems and prioritizing food sustainability is hardly new. I recall my own personal turning point upon first reading Fast Food Nation (4) twenty years ago, and even before my time in the late 1970s when early signs emerged that Canada’s food system was under strain (5).
This isn’t leaving me entirely discouraged - in fact - I’m feeling rather optimistic. I am optimistic about the possible tipping point in our food system, nationally and globally, as these conversations become more mainstream. I’m also seeing a connection beyond the impact of the pandemic on real estate listings. Most recently, the UN suggested a silver lining of COVID is the commitment to secure the right to food worldwide (6) and protect farmers who put food on our tables, including acknowledgement of farmer working conditions (7). In September 2021, the UN Food Systems Summit discussed the resilience of our food system as key to reaching the 2030 Sustainable Development Goals (8). And looking ahead to 2022, the theme of Nutrition Month 2022 and the upcoming Dietitians of Canada's National Conference is sustainable food systems.
"The time for a healthier, more just and more sustainable food system is now" (9). Do you think we’ve tipped? I am keen to read the new PEN content that focuses on dietary patterns and environmental impacts and health outcomes as I continue to follow the topic with great curiosity in my role both personally and professionally. It's also encouraging to know that there are so many opportunities to have dietitians at the sustainable food table and as part of the conversation (10). Who knows, I might even strike up a conversation with a new neighbour or two.
See Additional Content:
Sustainable Diets and the Environment Background
What dietary patterns are associated with environmental benefits (e.g. reduced impacts on greenhouse gases, land and water)?
What are the health outcomes of following a sustainable diet?
- Ontario Federation of Agriculture. Home Grown. Available from: https://homegrown.ofa.on.ca/
- Mbow C. Rosenzweig L, Barioni T, Benton M, Herrero, M, Krishnapillai E, et al. 2019: Food Security. In: Climate Change and Land: an IPCC special report on climate change, desertification, land degradation, sustainable land management, food security, and greenhouse gas fluxes in terrestrial ecosystems [P.R. Shukla, J. Skea, E. Calvo Buendia, V. Masson-Delmotte, H.-O. Pörtner, D.C. et al. (eds.)]. In press.
- United Nations. Decade of Action on Nutrition 2016-2025. Available from: https://www.un.org/nutrition/
- Schlosser E. Fast Food Nation: The Dark Side of the all-American Meal. Houghton Mifflin; 2001.
- The Report of the People’s Food Commission. The Land of Milk & Honey.1980. Available from: https://foodshare.net/custom/uploads/2015/11/Land_of_Milk_and_Money.pdf
- United Nations. UN News. Food systems transformation a ‘silver lining’ in COVID crisis: UN deputy chief. 2021. Available from: https://news.un.org/en/story/2021/07/1096632
- United Nations. UN News. Farmers the ‘lifeblood of our food systems’, deputy UN chief highlights, ahead of key summit. 2021. Available from: https://news.un.org/en/story/2021/07/1096362
United Nations. Department of Economic and Social Affairs. The 17 goals. Available from: https://sdgs.un.org/goals
- Food Secure Canada. Growing resilience and equity: a food policy action plan in the context of COVID-19. 2020. Available from: https://foodsecurecanada.org/sites/foodsecurecanada.org/files/fsc_-_growing_resilience_equity_10_june_2020.pdf
- Carlsson L, Callaghan E, Broman G. How can dietitians leverage change for sustainable food systems in Canada? CanJDiet Pract Res. 2019;80(4):164-171. Abstract available from: https://pubmed.ncbi.nlm.nih.gov/30907124/
Elizabeth Manafò MHSc RD
PEN® Content Manager
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 April 2021, as well as the International Working Groups.
If you would like to be a PEN author or reviewer, please click here to send us your contact information.
Jennifer Grant Moore
Holly-Anne Scott Velasco
Kwan Yu Huber
Júlia Muñoz Martínez (United States)
October 2021 Volume
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