Wondering About Sweeteners?

Wondering About Sweeteners?

There has been lots of chat about sweeteners lately. We have reviewed the recent evidence and, as a result, have updated six of our existing practice questions:

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 sweeteners (e.g. nonnutritive, artificial, intense, low calorie, sugar substitutes) and sugar alcohols in children?

Does the use of sweeteners (e.g. nonnutritive, artificial, intense, low calorie, sugar substitutes) increase the risk of developing type 2 diabetes in adults and children?

What effect do sweeteners (e.g. nonnutritive, artificial, intense, low calorie, sugar substitutes) have on the management of diabetes?

What effect do sweeteners (e.g. nonnutritive, artificial, intense, low calorie and sugar substitutes) have on weight management?

What effect do sweeteners (e.g. nonnutritive, artificial, intense, low calorie, sugar substitutes) have on cardiometabolic health?

The PEN Team will continue to monitor the evidence as more research is published related to sweeteners. The PEN System has additional evidence-informed nutrition resources to support your practice, such as:

• Sweeteners Background
• Sweeteners Summary of Recommendations and Evidence (includes the 12 Practice Questions in this Knowledge Pathway).

• Should My Clients Consume Less Aspartame? The Recent WHO/IARC Report on the Health Impacts of Aspartame
• New Non-Sugar Sweetener Guideline from the World Health Organization
• Does Erythritol Consumption Add to Cardiovascular Risk?

Knowledge Pathway Alert: Nutritional Genomics

The Nutritional Nutrigenomics KP has four new practice questions! Do you know the answers to these questions?

What is the evidence for incorporating genetic testing results into nutrition practice on health outcomes?

Does providing genetic-based nutritional advice motivate dietary behaviour change compared to providing general nutrition advice?

What is the evidence for the impact of genetic variation on the plasma lipid, lipoprotein and apolipoprotein response to omega-3 fatty acid intake?

What is the scientific validity of nutrigenetic interactions related to caffeine intake?

Also, check out the Nutritional Genomics Summary of Recommendations and Evidence, the Nutritional Genomics Background and the Related Tools and Resources.

Probiotics and UTIs - Do They Work?

Are probiotics effective in the prevention or treatment of urinary tract infections (UTIs) in women?

Recommendation

A probiotic agent containing a strain of Lactobacillus administered either orally or vaginally may not help prevent or treat UTIs in women with recurrent UTIs, although little high quality research has been conducted on this topic.

Results from a 2022 systematic review of nine studies (n=772) suggest that there is a lack of evidence showing a beneficial effect of probiotics containing a strain of Lactobacillus administered either orally or vaginally on the incidence of recurrent UTIs in women. Adverse events from oral probiotics were reported in some studies and included abdominal discomfort and gastrointestinal side-effects. Results may be limited by the small sample sizes, short study durations, different routes of administration and variations in how recurrent UTI was defined in the included studies.

A 2022 comparison of clinical practice guidelines examined the management of recurrent UTIs by major urological, gynecological, infectious disease and general practice organizations in Europe, the U.K. and North America. All guidelines stated that there was not enough evidence to recommend Lactobacillus or probiotics to prevent recurrent UTIs. 

Grade of Evidence C

A UTI is typically caused by a bacterial infection in the kidneys, bladder or urethra and is usually treated with antibiotics. Among middle-aged adults, UTIs are more common in women than in men. Probiotics are hypothesized to help prevent or treat bacterial UTIs by influencing the microflora population in the urogenital tract. 

See Additional Content:
Can the ingestion of cranberry products help to prevent or treat urinary tract infections (UTIs)?
Are there any safety concerns with the use of probiotics?

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

Looking for more content on probiotics? See the following Knowledge Pathways and use the PEN Search to find additional content:
Gastrointestinal System - Probiotics
Allergic Disease - Probiotics
Allergic Disease - Probiotics and Prebiotics (Infants).

You may have noticed that NAFLD and NASH have new names in PEN content. In addition, the related PEN glossary terms have been updated. These changes were made to align with current nomenclature and definitions.

The term metabolic dysfunction-associated steatotic liver disease (MASLD) is a replacement term for the condition nonalcoholic fatty liver disease (NAFLD) and the term metabolic dysfunction-associated steatohepatitis (MASH) as a replacement term for nonalcoholic steatohepatitis (NASH). MASLD provides a non-stigmatizing description of the condition that occurs in conjunction with a cardiometabolic risk factor, rather than a diagnosis of exclusion. This new nomenclature and definitions received wide support in an international consensus process that included content experts and patient advocates (1).

Check out the Hepatic Knowledge Pathway and look for the related updated glossary terms, which appear as hover overs for green double underlined words. For example: 

References

1. Rinella ME, Lazarus JV, Ratziu V, Francque SM, Sanyal AJ, Kanwal F, Romero D, Abdelmalek MF, Anstee QM, Arab JP, Arrese M, Bataller R, Beuers U, Boursier J, Bugianesi E, Byrne C, Castro Narro GE, Chowdhury A, Cortez-Pinto H, Cryer D, Cusi K, El-Kassas M, Klein S, Eskridge W, Fan J, Gawrieh S, Guy CD, Harrison SA, Kim SU, Koot B, Korenjak M, Kowdley K, Lacaille F, Loomba R, Mitchell-Thain R, Morgan TR, Powell E, Roden M, Romero-Gómez M, Silva M, Singh SP, Sookoian SC, Spearman CW, Tiniakos D, Valenti L, Vos MB, Wai-Sun Wong V, Xanthakos S, Yilmaz Y, Younossi Z, Hobbs A, Villota-Rivas M, Newsome PN; NAFLD Nomenclature consensus group. A multi-society Delphi consensus statement on new fatty liver disease nomenclature. J Hepatol. 2023 Jun 20:S0168-8278(23)00418-X. doi: 10.1016/j.jhep.2023.06.003. Epub ahead of print. PMID: 37364790. Abstract available from:  https://pubmed.ncbi.nlm.nih.gov/37364790/

Have you heard that the Practiced Based Evidence in Nutrition^® (PEN) Team is trying a new process to develop content? Knowledge co-creation encourages collaboration between researchers, knowledge translators and people with real-world experience to address critical issues and barriers facing practice (1). Knowledge co-creation increases the likelihood of nutrition recommendations being relevant and useful in informing clinical and other practice decisions (2). By engaging experts with lived experience, we can collectively drive the social impact of dietetic practice forward. The PEN Team is looking to integrate lived experience on specific topics throughout our evidence-based process.

We are currently seeking experts with lived experience to co-create knowledge on cultural humility (cultural competence) in dietetic practice for the PEN System. We define experts with lived experience as change-makers willing to use their professional and lived experience to inform PEN content development (3), including those leading change to address the dietitian's role in providing culturally safe practice. Specifically, this includes co-creators identifying as members of equity-denied/equity-seeking/equity-deserving groups* with firsthand experience with the barriers and challenges that impact culturally safe dietetic practice. 

The cultural competence/humility in dietetic practice knowledge pathway aims to enhance dietitians' capabilities to deliver care that is culturally safe and patient-centred (4,5) while addressing health disparities and promoting health equity (6). As a co-creator, your role will be to use your knowledge and experience to advise the PEN Evidence Analyst on topic scope, practice question identification, literature search strategy development, support for responding to external reviewer feedback and identifying opportunities for knowledge dissemination. You will not be responsible for writing the content itself.

The PEN Team is looking to co-create knowledge meaningfully and equitably. If you are a current or former dietitian and identify as an expert with lived experience, complete this form to express your interest or contact us to learn more about this opportunity. We expect this project to be up to 25 hours of work over 3-6 months and will include 2-3 virtual meetings plus work completed online using digital collaboration tools (e.g. Google Docs). Remuneration will be provided. Additional writing opportunities may be available (e.g. developing a Background knowledge product). Expressions of interest are requested by December 15, 2023.

Criteria and process for selection of experts with lived experience
Expressions of interest will be reviewed by PEN Team members to assess whether the applicant meets relevant expertise/experience in the areas described above. In addition to subject matter expertise/experience, the selection of knowledge co-creators will also take into consideration the diversity and complementarities representative of equity priorities to support an appropriate scope for the knowledge pathway. Additional criteria related to research experience, understanding the value of engagement/co-creation and working collaboratively will be considered. Selected co-creators will be invited to contribute only in their individual capacity/lived experience and will not represent their institution. Co-creators will be acknowledged in published content in the PEN System. Due to an expected high volume of applications, only selected individuals will be informed.

Please share this posting widely!

* Equity-Denied/Equity-Seeking/Equity-Deserving: "These three terms are used to refer to communities and groups that experience significant collective barriers in participating in society. This could include attitudinal, historic, social and environmental barriers based on age, ethnicity, disability, economic status, Indigeneity, gender identity and gender expression, nationality, race, sexual orientation, etc. Equity-denied groups are those who identify barriers to equal access, opportunities and resources due to disadvantage and discrimination and actively seek social justice and reparation". (7)

1. Canadian Institute of Health Research. Integrated Knowledge Translation (iKT). Available from: https://cihr-irsc.gc.ca/e/45321.html#a3
2. Jull J, Giles A, Graham ID. Community-based participatory research and integrated knowledge translation: advancing the co-creation of knowledge. Implement Sci. 2017 Dec 19;12(1):150. doi: 10.1186/s13012-017-0696-3. PMID: 29258551; PMCID: PMC5735911. Abstract available from: https://pubmed.ncbi.nlm.nih.gov/29258551/
3. Sandhu, B. The value of lived experience in social change:  The Need for Leadership and Organisational Development in the Social Sector. 2017. Available from: https://thelivedexperience.org/wp-content/uploads/2017/07/The-Lived-Experience-Baljeet-Sandhu-VLE-summary-web-ok-2.pdf
4. Lekas HM, Pahl K, Fuller Lewis C. Rethinking Cultural Competence: Shifting to Cultural Humility. Health Serv Insights. 2020 Dec 20;13:1178632920970580. doi: 10.1177/1178632920970580. PMID: 33424230; PMCID: PMC7756036. Abstract available from: https://pubmed.ncbi.nlm.nih.gov/33424230/
5. Partnership for Dietetic Education and Practice. Integrated competencies for Dietetic Education and Practice (ICDEP) Version 3.0. 2020. Available from: https://www.pdep.ca/library/PDEP-Policies/Integrated-Competencies-For-Dietetic-Education-And.aspx
6. Kibakaya EC, Oyeku SO. Cultural Humility: A Critical Step in Achieving Health Equity. Pediatrics. 2022 Feb 1;149(2):e2021052883. doi: 10.1542/peds.2021-052883. PMID: 35098316; PMCID: PMC9645708. Abstract available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9645708/#:~:text=Demonstrating%20cultural%20humility%20frees%20health,shared%20health%20and%20developmental%20outcomes
7. University of British Columbia. Equity and Inclusion Glossary Terms. Available from: https://equity.ubc.ca/resources/equity-inclusion-glossary-of-terms/#:~:text=In%20Canada,%20and%20in%20the,or%20questioning,%20intersex,%20asexual).