PEN eNews 10(9) September 2020

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The Anemia: Folate and B12 Deficiency Knowledge Pathway is Updated!

The Hematology/Haematology - Anemia/Anaemia: Folate and B12 Deficiency Knowledge Pathway was just updated. Do you know the answer to these questions?

Are oral and intramuscular vitamin B12 supplements equally effective in increasing serum B12 levels in people with vitamin B12 deficiency?

Before folate therapy is initiated in suspected folate-deficiency anemia, what deficiency must be excluded?

For answers to these questions and for more information, see the links below:

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Stay Safe,
The PEN Team

This September has extra special meaning for my family because my firstborn will enter the ranks of the elementary school system as a tiny but mighty junior kindergarten student. As I navigate the typical challenges of sending a child to school (getting the necessary supplies, bus schedules, after-school care, etc.) alongside some new challenges associated with COVID-19 (i.e. convincing a 4-year-old to wear a mask all day and maintain physical distance), there’s one component of the school day that I find particularly intriguing as a dietitian: lunch.

Actually, scratch that. I should have said ‘nutrition break’. I was surprised to learn that our school observes a balanced school day whereby one longer lunch period has been divided into two smaller nutrition breaks. What’s more, instead of eating first and then going outside to play, students play first and then come inside to eat. I couldn’t help but wonder about the impact of these policies on dietary intake.

It turns out that a balanced school day may not be associated with a balanced lunchbox. More research is needed, but one observational study of home-packed lunches in 3rd and 4th grade students (n=321) reported significant increases in the number of servings of sugars-sweetened beverages and snack foods that were both packed in the lunchbox and consumed by the student in schools that observed the balanced school day compared to a traditional lunch period (1). The study was limited by its cross-sectional design and possibly by its unobtrusive measurement method, whereby only food that was physically removed from the lunch bag (i.e. visible) was recorded.

However, the concept of ‘reverse recess’ may have merit. Two cross-sectional studies from the U.S. described significantly increased vegetable and fruit consumption when students played first and then ate (2,3) and a third study described significantly increased fruit but not vegetable intake (4). These studies are limited by their design (which precludes causality) and may not be generalizable to the Canadian school system because they examined elementary school lunches provided in a cafeteria setting.

To learn more about how school nutrition policies can impact the nutritional intake and behaviours of students, check out our recently updated Practice Question and others in the School Health Knowledge Pathway.

Wishing all the students, educators and parents a safe and happy start to the school year!

Mary Anne Smith, RD, PhD
Director of Knowledge Translation