Progress towards eliminating industrially produced trans-fatty acids in the Canadian marketplace, 2013-2017

Trans-fat labelling and potential presence of industrially produced trans-fat in the New Zealand packaged food supply: 2015-2019 & 2022

BACKGROUND AND AIM

The World Health Organization (WHO) recommends that countries reduce industrially produced TFA (iTFA) in the food supply. However, New Zealand (NZ) has no mandatory regulation to control amounts of iTFA in foods. The objectives of this study were to assess within the NZ packaged food supply in recent years (2015-19 and 2022): i) the availability of products displaying information on TFA content on nutrition information panels (NIPs), ii) the content of TFA declared, and iii) the presence/potential presence of iTFA (n = 85,892 products).

METHODS AND RESULTS

A database of packaged foods from major NZ supermarkets was used. TFA contents declared on NIPs were benchmarked against limits recommended by the WHO and the Canadian Trans Fat Task Force. Proportions of products listing specific ingredients (containing iTFA) or non-specific ingredients (potentially containing iTFA) were examined. Trends in proportions were assessed (Mantel-Haenszel tests). Among all products and years examined (n = 81,591), 84.0 % did not display information on TFA content. Across all products declaring TFA contents and years 15.4 % and 6.4 %, respectively, were above the WHO and Canadian TFA limits. Across all products and years, 0.8 % and 13.6 % listed ingredients that contained or potentially contained iTFA, respectively. Across 2015-2019, there was a trend of decrease in the proportions of products listing specific (0.9 %-0.7 %; P = 0.018) and non-specific ingredients (15.1 %-12.8 %; P < 0.001).

CONCLUSION

Information on the TFA content and ingredients containing iTFA in NZ packaged foods is lacking and ambiguous and government-led interventions to control and reduce TFA in the food supply are warranted.

Current Insights into Industrial Trans Fatty Acids Legal Frameworks and Health Challenges in the European Union and Spain

The presence of industrial trans-fatty acids (iTFAs) in processed foods poses significant public health concerns, necessitating comprehensive regulatory frameworks. In this study, the current legal landscape governing iTFA in the European Union and Spain is analyzed, with a particular focus on regulatory effectiveness and implementation challenges. The research methodology combines a systematic review of existing regulations, including EU Regulation No. 1169/2011 and Spanish Law 17/2011, with the analysis of the scientific literature on iTFA health impacts. The results reveal significant regulatory gaps, particularly in enforcement mechanisms and iTFA detection methods. Key challenges are also identified in the present study, including inconsistent compliance monitoring, varying analytical methods for iTFA detection, and contradictions between EU and Spanish regulatory frameworks. Additionally, in this work, the need for harmonized approaches to ultra-processed food regulation is emphasized. Further, the conclusion is that despite the current regulations providing a foundation for iTFA control, it is compulsory to enhance the monitoring systems, and clearer regulatory guidelines are necessary. These would contribute valuable insights for policymakers, food industry stakeholders, and public health professionals working towards effective iTFA regulation.

Food environment research in Canada: a rapid review of methodologies and measures deployed between 2010 and 2021

Numerous research methodologies have been used to examine food environments. Existing reviews synthesizing food environment measures have examined a limited number of domains or settings and none have specifically targeted Canada. This rapid review aimed to 1) map research methodologies and measures that have been used to assess food environments; 2) examine what food environment dimensions and equity related-factors have been assessed; and 3) identify research gaps and priorities to guide future research. A systematic search of primary articles evaluating the Canadian food environment in a real-world setting was conducted. Publications in English or French published in peer-reviewed journals between January 1 2010 and June 17 2021 and indexed in Web of Science, CAB Abstracts and Ovid MEDLINE were considered. The search strategy adapted an internationally-adopted food environment monitoring framework covering 7 domains (Food Marketing; Labelling; Prices; Provision; Composition; Retail; and Trade and Investment). The final sample included 220 articles. Overall, Trade and Investment (1%, n = 2), Labelling (7%, n = 15) and, to a lesser extent, Prices (14%, n = 30) were the least studied domains in Canada. Among Provision articles, healthcare (2%, n = 1) settings were underrepresented compared to school (67%, n = 28) and recreation and sport (24%, n = 10) settings, as was the food service industry (14%, n = 6) compared to grocery stores (86%, n = 36) in the Composition domain. The study identified a vast selection of measures employed in Canada overall and within single domains. Equity-related factors were only examined in half of articles (n = 108), mostly related to Retail (n = 81). A number of gaps remain that prevent a holistic and systems-level analysis of food environments in Canada. As Canada continues to implement policies to improve the quality of food environments in order to improve dietary patterns, targeted research to address identified gaps and harmonize methods across studies will help evaluate policy impact over time.

Accelerating the Classification of NOVA Food Processing Levels Using a Fine-Tuned Language Model: A Multi-Country Study

The consumption and availability of ultra-processed foods (UPFs), which are associated with an increased risk of noncommunicable diseases, have increased in most countries. While many countries have or are planning to incorporate UPF recommendations in their national dietary guidelines, the classification of food processing levels relies on expertise-based manual categorization, which is labor-intensive and time-consuming. Our study utilized transformer-based language models to automate the classification of food processing levels according to the NOVA classification system in the Canada, Argentina, and US national food databases. We showed that fine-tuned language models using the ingredient list text found on food labels as inputs achieved a high overall accuracy (F1 score of 0.979) in predicting the food processing levels of Canadian food products, outperforming traditional machine learning models using structured nutrient data and bag-of-words. Most of the food categories reached a prediction accuracy of 0.98 using a fined-tuned language model, especially for predicting processed foods and ultra-processed foods. Our automation strategy was also effective and generalizable for classifying food products in the Argentina and US databases, providing a cost-effective approach for policymakers to monitor and regulate the UPFs in the global food supply.

The estimated dietary and health impact of implementing the recently approved 'high in' front-of-package nutrition symbol in Canada: a food substitution scenario modeling study

Background

Front-of-pack labeling (FOPL) has been identified as a cost-effective policy to promote healthy food environments and to help consumers make healthier food choices. Consumer surveys report that after implementation of mandatory 'high in' FOPL symbols between 30 and 70% of consumers choose or were willing to choose products with fewer 'high in' symbols. Health Canada has recently published FOPL regulations that will require prepackaged food and beverages that meet or exceed thresholds for sodium, total sugars, or saturated fat to display a 'high in' FOPL nutrition symbol.

Objectives

The aims were to estimate the potential (1) dietary impact of substituting foods with similar foods that would display at least one less 'high in' symbol, and (2) the number of diet-related noncommunicable disease (NCD) deaths that could be averted or delayed due to estimated dietary changes.

Methods

Baseline and counterfactual intakes of sodium, total sugars, saturated fats, and energy were estimated among Canadian adults (n = 11,992) using both available days of 24 h-recall data from the 2015 Canadian Community Health Survey-Nutrition (CCHS). Similar foods to those reported in CCHS that would display at least one less 'high in' symbol (n = 239) were identified using a Canadian branded food composition database. Based on current FOPL consumer research, identified foods were substituted for 30, 50, and 70% of randomly selected CCHS-Nutrition adult participants and for all adult participants. Potential health impacts were estimated using the Preventable Risk Integrated ModEl.

Results

Mean dietary reductions of between 73 and 259 mg/day of sodium, 2.0 and 6.9 g/day of total sugars, 0.2 and 0.5 g/day of saturated fats, and 14 and 46 kcal/day of energy were estimated. Between 2,148 (95% UI 1,913-2,386) and 7,047 (95% UI 6,249-7,886) of deaths due to diet-related NCDs, primarily from cardiovascular diseases (70%), could potentially be averted or delayed if Canadians choose products with fewer 'high in' symbols.

Conclusion

Results suggest that FOPL could significantly reduce sodium and total sugar intakes among Canadian adults, the consequences of which could avert or delay an important number of diet-related NCD deaths. These findings provide relevant data to support the importance of the impending FOPL regulations.

Association of male fatty acid intake with fecundability among couples planning pregnancy

STUDY QUESTION

To what extent is male fatty acid intake associated with fecundability among couples planning pregnancy?

SUMMARY ANSWER

We observed weak positive associations of male dietary intakes of total and saturated fatty acids with fecundability; no other fatty acid subtypes were appreciably associated with fecundability.

WHAT IS KNOWN ALREADY

Male fatty acid intake has been associated with semen quality in previous studies. However, little is known about the extent to which male fatty acid intake is associated with fecundability among couples attempting spontaneous conception.

STUDY DESIGN, SIZE, DURATION

We conducted an internet-based preconception prospective cohort study of 697 couples who enrolled during 2015-2022. During 12 cycles of observation, 53 couples (7.6%) were lost to follow-up.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Participants were residents of the USA or Canada, aged 21-45 years, and not using fertility treatment at enrollment. At baseline, male participants completed a food frequency questionnaire from which we estimated intakes of total fat and fatty acid subtypes. We ascertained time to pregnancy using questionnaires completed every 8 weeks by female participants until conception or up to 12 months. We used proportional probabilities regression models to estimate fecundability ratios (FRs) and 95% CIs for the associations of fat intakes with fecundability, adjusting for male and female partner characteristics. We used the multivariate nutrient density method to account for energy intake, allowing for interpretation of results as fat intake replacing carbohydrate intake. We conducted several sensitivity analyses to assess the potential for confounding, selection bias, and reverse causation.

MAIN RESULTS AND THE ROLE OF CHANCE

Among 697 couples, we observed 465 pregnancies during 2970 menstrual cycles of follow-up. The cumulative incidence of pregnancy during 12 cycles of follow-up after accounting for censoring was 76%. Intakes of total and saturated fatty acids were weakly, positively associated with fecundability. Fully adjusted FRs for quartiles of total fat intake were 1.32 (95% CI 1.01-1.71), 1.16 (95% CI 0.88-1.51), and 1.43 (95% CI 1.09-1.88) for the second, third, and fourth vs the first quartile, respectively. Fully adjusted FRs for saturated fatty acid intake were 1.21 (95% CI 0.94-1.55), 1.16 (95% CI 0.89-1.51), and 1.23 (95% CI 0.94-1.62) for the second, third, and fourth vs the first quartile, respectively. Intakes of monounsaturated, polyunsaturated, trans-, omega-3, and omega-6 fatty acids were not strongly associated with fecundability. Results were similar after adjustment for the female partner's intakes of trans- and omega-3 fats.

LIMITATIONS, REASONS FOR CAUTION

Dietary intakes estimated from the food frequency questionnaire may be subject to non-differential misclassification, which is expected to bias results toward the null in the extreme categories when exposures are modeled as quartiles. There may be residual confounding by unmeasured dietary, lifestyle, or environmental factors. Sample size was limited, especially in subgroup analyses.

WIDER IMPLICATIONS OF THE FINDINGS

Our results do not support a strong causal effect of male fatty acid intakes on fecundability among couples attempting to conceive spontaneously. The weak positive associations we observed between male dietary fat intakes and fecundability may reflect a combination of causal associations, measurement error, chance, and residual confounding.

STUDY FUNDING/COMPETING INTEREST(S)

The study was funded by the National Institutes of Health, grant numbers R01HD086742 and R01HD105863. In the last 3 years, PRESTO has received in-kind donations from Swiss Precision Diagnostics (home pregnancy tests) and Kindara.com (fertility app). L.A.W. is a consultant for AbbVie, Inc. M.L.E. is an advisor to Sandstone, Ro, Underdog, Dadi, Hannah, Doveras, and VSeat. The other authors have no competing interests to report.

TRIAL REGISTRATION NUMBER

N/A.

Canadian Free Sugar Intake and Modelling of a Reformulation Scenario

Recommendations suggest limiting the intake of free sugar to under 10% or 5% of calories in order to reduce the risk of negative health outcomes. This study aimed to examine Canadian free sugar intake and model how intakes change following the implementation of a systematic reformulation of foods and beverages to be 20% lower in free sugar. Additionally, this study aimed to examine how calorie intake might be impacted by this reformulation scenario. Canadians' free sugar and calorie intakes were determined using free sugar and calorie data from the Food Label Information Program (FLIP) 2017, a Canadian branded food composition database, and applied to foods reported as being consumed in Canadian Community Health Survey-Nutrition (CCHS-Nutrition) 2015. A "counterfactual" scenario was modelled to examine changes in intake following the reformulation of foods to be 20% lower in free sugar. The overall mean free sugar intake was 12.1% of calories and was reduced to align with the intake recommendations at 10% of calories in the "counterfactual" scenario (p < 0.05). Calorie intake was reduced by 3.2% (60 calories) in the "counterfactual" scenario (p < 0.05). Although the overall average intake was aligned with the recommendations, many age/sex groups exceeded the recommended intake, even in the "counterfactual" scenario. The results demonstrate a need to reduce the intake of free sugar in Canada to align with dietary recommendations, potentially through reformulation. The results can be used to inform future program and policy decisions related to achieving the recommended intake levels of free sugar in Canada.

How Many Diet-Related Non-Communicable Disease Deaths Could Be Averted or Delayed If Canadians Reduced Their Consumption of Calories Derived from Free Sugars Intake? A Macrosimulation Modeling Study

Free sugars are a major source of calories in diets and contribute to the burden of many non-communicable diseases (NCDs). The World Health Organization (WHO) recommends reducing free sugars intake to less than 10% of total energy. This study aimed to estimate the number of diet-related NCD deaths which could be averted or delayed if Canadian adults were to reduce their calorie intake due to a systematic 20% reduction in the free sugars content in foods and beverages in Canada. We used the Preventable Risk Integrated ModEl (PRIME) to estimate the potential health impact. An estimated 6770 (95% UI 6184-7333) deaths due to diet-related NCDs could be averted or delayed, mostly from cardiovascular diseases (66.3%). This estimation would represent 7.5% of diet-related NCD deaths observed in 2019 in Canada. A 20% reduction in the free sugars content in foods and beverages would lead to a 3.2% reduction in calorie intake, yet an important number of diet-related NCD deaths could be averted or delayed through this strategy. Our findings can inform future policy decisions to support Canadians' free sugars intake reduction, such as proposing target levels for the free sugars content in key food categories.

Differences in child and adolescent exposure to unhealthy food and beverage advertising on television in a self-regulatory environment

BACKGROUND

Food and beverage promotion is a contributor to children's dietary behaviours, and ultimately, downstream health consequences. Broadcast television remains an important source of such advertising. The objective of this study was to examine and compare children and adolescent's exposure to food advertising on television in Canada over an entire year in a self-regulatory environment.

METHODS

Television advertising data for 57 selected food and beverage categories were licensed from Numerator for 36 stations in Toronto, for 2019. The estimated average number of advertisements viewed by children aged 2-11 and adolescents aged 12-17 was determined overall, by food category, and by marketing technique. The healthfulness of advertisements was also assessed using Health Canada's Nutrient Profile Model.

RESULTS

Overall in 2019, children viewed 2234.4 food ads/person/yr while adolescents viewed 1631.7 ads, exposure for both groups stemmed primarily from stations with general appeal, and both age groups were exposed to a range of powerful marketing techniques. Exposure to advertising for restaurants, snacks, breakfast food and candy and chocolate was high among both age groups and the healthfulness of most advertised products was considered poor. Adolescents were exposed to 36.4% more food products classified as unhealthy, had higher exposure to all marketing techniques examined, and were exposed to substantially more child-related marketing techniques compared to children.

CONCLUSION

Children and adolescents were heavily exposed to food advertisements on television in 2019. Despite current self-regulatory policies, children's exposure to unhealthy food and beverages remains high. Differences in exposure to food advertisements by food category and healthfulness may suggest that adolescents are being disproportionately targeted by food companies as a result of self-regulatory marketing restrictions.

Advertising expenditures on child-targeted food and beverage products in two policy environments in Canada in 2016 and 2019

BACKGROUND

The food industry advertises unhealthy foods intended for children which in turn fosters poor diets. This study characterized advertising expenditures on child-targeted products in Canada and compared these expenditures between Quebec, where commercial advertising to children under 13 is restricted, and the rest of Canada, where food advertising to children is self-regulated.

METHODS

Advertising expenditures data for 2016 and 2019 for 57 select food categories and five media channels were licensed from Numerator. Products and brands targeted to children were identified based on their nature and the advertising techniques used to promote them. Advertising expenditures were classified as healthy/unhealthy using Health Canada's nutrient profile model. Expenditures per child capita aged 2-12 years were calculated and expenditures from 2016 were adjusted for inflation. Advertising expenditures were described by media, food category, year, and geographic region.

RESULTS

Overall, $57.2 million CAD was spent advertising child-targeted products in Canada in 2019. Television accounted for 77% of expenditures followed by digital media (18%), and the food categories with the highest expenditures were candy/chocolate (30%) and restaurants (16%). The totality of expenditures (99.9%-100%) in both Quebec and the rest of Canada in 2016 and 2019 were considered 'unhealthy'. Across all media channels (excluding digital), advertising expenditures were 9% lower in 2019 versus 2016. Advertising expenditures per capita were 32% lower in Quebec ($9.40/capita) compared to the rest of the country ($13.91/capita).

CONCLUSION

In Canada, millions are spent promoting child-targeted products considered inappropriate for advertising to children. While per capita advertising expenditures for these products are lower in Quebec compared to the rest of Canada, they remain high, suggesting that Quebec's commercial advertising restrictions directed to children are likely not sufficiently protecting them from unhealthy food advertising.

Child-appealing packaged food and beverage products in Canada-Prevalence, power, and nutritional quality

BACKGROUND

Children are frequently exposed to marketing on food packaging. This study evaluated the presence, type and power of child-appealing marketing and compared the nutritional quality of child-appealing vs. non-child-appealing Canadian packaged foods and examined the relationship between nutrient composition and marketing power.

METHODS

Child-relevant packaged foods (n = 5,850) were sampled from the Food Label Information Program 2017 database. The presence and power (# of techniques displayed) of child-appealing marketing were identified. Fisher's Exact test compared the proportion of products exceeding Health Canada's nutrient thresholds for advertising restrictions and Mann Whitney U tests compared nutrient composition between products with child- /non-child-appealing packaging. Pearson's correlation analyzed the relationship between nutrient composition and marketing power.

RESULTS

13% (746/5850) of products displayed child-appealing marketing; the techniques used, and the power of the marketing varied ([Formula: see text] 2.2 techniques; range: 0-11). More products with child-appealing packaging than with non-child appealing packaging exceeded Health Canada's thresholds (98% vs. 94%; p < .001). Products with child-appealing packaging (vs. non-child-appealing) were higher in total sugars (median: 14.7 vs. 9 g/RA; p < .001) and free sugars (11.5 vs. 6.2 g/RA; p < .001), but lower in all other nutrients. There was weak overall correlation between marketing power and nutrient levels. Results varied by nutrient and food category.

CONCLUSIONS

Unhealthy products with powerful child-appealing marketing displayed on package are prevalent in the food supply. Implementing marketing restrictions that protect children should be a priority.

Advertising expenditures across media on food and beverage products heavily advertised on youth-appealing television stations in Canada

This research estimated and characterized advertising expenditures on food products heavily advertised on youth-appealing television stations in Canada in 2019 overall, by media, by food category, and compared expenditures in two policy environments (Quebec and the rest of Canada, excluding the territories) and on "healthier" versus "less healthy" products. Advertising expenditure estimates for 57 selected food categories promoted on television, radio, out-of-home media, print media, and popular websites were licensed from Numerator. Sixty-one products or brands were identified as heavily advertised on youth-appealing stations and classified as "healthier" or "less healthy" based on a nutrient profile model proposed by Health Canada. Total expenditures and expenditures per adolescent capita were calculated. Approximately, $110.9 million was spent advertising food products heavily advertised to adolescents in Canada in 2019, with television accounting for 77% of total expenditures and fast food restaurants accounting for 51%. Most expenditures (77%; $80.6 million) were devoted to advertising "less healthy" products. In Quebec, advertising expenditures on examined products were 23% lower per capita ($45.15/capita) compared to the rest of Canada ($58.44/capita). Advertising expenditures in Quebec were lower for energy drinks (-47%; -$0.80/capita) and candy and chocolate (-41%; -$1.00/capita) and higher for yogurt (+85%; +$1.22/capita) and portable snacks (+25%; +$0.15/capita). Quebec's restriction of commercial advertising directed to children under 13 may explain lower per capita advertising expenditures on some "less healthy" foods heavily advertised to adolescents in Quebec. Nevertheless, this spending remains high in Quebec and nationally. Continued monitoring of these expenditures is warranted.

Broadcast Television Is Not Dead: Exposure of Children to Unhealthy Food and Beverage Advertising on Television in Two Policy Environments (Ontario and Quebec). An Observational Study

BACKGROUND

Food marketing can influence children's dietary behaviors. In Canada, Quebec banned commercial advertising to children under the age of 13 y in 1980, whereas advertising to children is self-regulated by industry in the rest of the country.

OBJECTIVES

The objective of this study was to compare the extent and power of food and beverage advertising on television to children (age: 2-11 y) in two different policy environments (Ontario and Quebec).

METHODS

Advertising data for 57 selected food and beverage categories were licensed from Numerator for Toronto and Montreal (English and French markets) from January to December 2019. The 10 most popular stations for children (age: 2-11 y) and a subset of child-appealing stations were examined. Exposure to food advertisements (ads) was based on gross rating points. A content analysis of food ads was conducted, and the healthfulness of ads was assessed using Health Canada's proposed nutrient profile model. Descriptive statistics were tabulated for the frequency of and exposure to ads.

RESULTS

On average, children were exposed to 3.7 to 4.4 food and beverage ads per day, exposure to fast-food advertising was highest (670.7-550.6 ads per year), advertising techniques were used frequently, and the majority (>90%) of advertised products were classified as unhealthy. On the top 10 stations, French children in Montreal were most exposed to unhealthy food and beverage advertising (712.3 ads per year), although they were exposed to fewer child-appealing advertising techniques compared with those in other markets. On the child-appealing stations, French children in Montreal were least exposed to food and beverage advertising (43.6 ads per year per station) and child-appealing advertising techniques compared with the other groups.

CONCLUSIONS

The Consumer Protection Act appears to positively impact exposure to child-appealing stations; yet, it does not sufficiently protect all children in Quebec and requires strengthening. Federal-level regulations restricting unhealthy advertising are needed to protect children across Canada.

Estimating Canadian sodium intakes and the health impact of meeting national and WHO recommended sodium intake levels: A macrosimulation modelling study

BACKGROUND

Cardiovascular diseases (CVDs) are the second leading cause of total deaths in Canada. High blood pressure is the main metabolic risk factor for developing CVDs. It has been well established that excess consumption of sodium adversely affects blood pressure. Canadians' mean sodium intakes are well above recommended levels. Reducing dietary sodium intake through food reformulation has been identified as a cost-effective intervention, however, dietary sodium intake and the potential health impact of meeting recommended sodium intake levels due to food reformulation have not been determined in Canada.

OBJECTIVE

This study aimed to 1) obtain robust estimates of Canadians' usual sodium intakes, 2) model sodium intakes had foods been reformulated to align with Health Canada's sodium reduction targets, and 3) estimate the number of CVD deaths that could be averted or delayed if Canadian adults were to reduce their mean sodium intake to recommended levels under three scenarios: A) 2,300 mg/d-driven by a reduction of sodium levels in packaged foods to meet Health Canada targets (reformulation); B) 2,000 mg/d to meet the World Health Organization (WHO) recommendation; and C) 1,500 mg/d to meet the Adequate Intake recommendation.

METHODS

Foods in the University of Toronto's Food Label Information Program 2017, a Canadian branded food composition database, were linked to nationally representative food intake data from the 2015 Canadian Community Health Survey-Nutrition to estimate sodium intakes (and intakes had Health Canada's reformulation strategy been fully implemented). The Preventable Risk Integrated ModEl (PRIME) was used to estimate potential health impact.

RESULTS

Overall, mean sodium intake was 2758 mg/day, varying by age and sex group. Based on 'reformulation' scenario A, mean sodium intakes were reduced by 459 mg/day, to 2299 mg/day. Reducing Canadians' sodium intake to recommended levels under scenarios A, B and C could have averted or delayed 2,176 (95% UI 869-3,687), 3,252 (95% UI 1,380-5,321), and 5,296 (95% UI 2,190-8,311) deaths due to CVDs, respectively, mainly from ischaemic heart disease, stroke, and hypertensive disease. This represents 3.7%, 5.6%, and 9.1%, respectively, of the total number of CVDs deaths observed in Canada in 2019.

CONCLUSION

Results suggest that reducing sodium intake to recommended levels could prevent or postpone a substantial number of CVD deaths in Canada. Reduced sodium intakes could be achieved through reformulation of the Canadian food supply. However, it will require higher compliance from the food industry to achieve Health Canada's voluntary benchmark sodium reduction targets.

Food and beverage advertising expenditures in Canada in 2016 and 2019 across media

Background

Food and beverage advertising has been identified as a powerful determinant of dietary intake and weight. Available evidence suggests that the preponderance of food and beverage advertising expenditures are devoted to the promotion of unhealthy products. The purpose of this study is to estimate food advertising expenditures in Canada in 2019 overall, by media and by food category, determine how much was spent on promoting healthier versus less healthy products and assess whether changes in these expenditures occurred between 2016 and 2019.

Methods

Estimates of net advertising expenditures for 57 selected food categories promoted on television, radio, out-of-home media, print media and popular websites, were licensed from Numerator. The nutrient content of promoted products or brands were collected, and related expenditures were then categorized as “healthy” or “unhealthy” according to a Nutrient Profile Model (NPM) proposed by Health Canada. Expenditures were described using frequencies and relative frequencies and percent changes in expenditures between 2016 and 2019 were computed.

Results

An estimated $628.6 million was spent on examined food and beverage advertising in Canada in 2019, with television accounting for 67.7%, followed by digital media (11.8%). In 2019, most spending (55.7%) was devoted to restaurants, followed by dairy and alternatives (11%), and $492.9 million (87.2% of classified spending) was spent advertising products and brands classified as “unhealthy”. Fruit and vegetables and water accounted for only 2.1 and 0.8% of expenditures, respectively, in 2019. In 2019 compared to 2016, advertising expenditures decreased by 14.1% across all media (excluding digital media), with the largest decreases noted for print media (− 63.0%) and television (− 14.6%). Overall, expenditures increased the most in relative terms for fruit and vegetables (+ 19.5%) and miscellaneous products (+ 5%), while decreasing the most for water (− 55.6%) and beverages (− 47.5%).

Conclusions

Despite a slight drop in national food and beverage advertising spending between 2016 and 2019, examined expenditures remain high, and most products or brands being advertised are unhealthy. Expenditures across all media should continue to be monitored to assess Canada’s nutrition environment and track changes in food advertising over time.

Evaluating the potential implications of canadian front-of-pack labelling regulations in generic and branded food composition databases

Background

Canada proposed the implementation of mandatory front-of-pack (FOP) labelling regulations, whereby foods meeting or exceeding thresholds for nutrients-of-concern (i.e., total sugars, saturated fat, sodium) must display a ‘high-in’ FOP symbol (FOP). The objective of the study was to evaluate the potential implications of the proposed regulations using Canadian generic and branded food composition databases.

Methods

A generic food composition database of products consumed by Canadians, Canadian Nutrient File (CNF) 2015 (n = 3,677), and a branded food composition database of packaged foods and beverages, Food Label Information Program (FLIP) 2017 (n = 17,521), were used to evaluate the number and proportion of foods that would display a FOP symbol based on the details of the proposed FOP labelling regulations published in 2018.

Results

Overall, 35.5% (n = 1,306) of products in CNF 2015 and 63.9% (n = 11,193) of products in FLIP 2017 would display a FOP symbol for at least one nutrient-of-concern exceeding proposed thresholds. Soups, Combination Dishes, and Desserts categories in CNF 2015 and Combination dishes, Soups, and Meats categories in FLIP 2017 would have the highest proportion of products that would display a FOP symbol. Although displaying a FOP symbol for one nutrient was most common in both CNF 2015 (n = 992; 27.0%) and FLIP 2017 (n = 7,296, 41.6%), the number (i.e., 0–3) and type (i.e., saturated fat, sodium, total sugar) of nutrients displayed varied by food category.

Conclusion

While the generic database, containing both packaged and unpackaged foods, revealed a low prevalence of foods that would display a FOP symbol, the branded database showed that the proposed FOP labelling regulations would identify over 60% of packaged foods with excess contents of nutrients-of-concern. Considering the high prevalence of packaged foods in Canada that would meet or exceed the thresholds of nutrients-of-concern, the proposed FOP labelling regulations should be implemented in a timely manner to help consumers easily identify foods high in nutrients-of-concern and encourage manufacturer-driven product reformulations.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14269-4.

Trans-Fat Labeling in Packaged Foods Sold in Brazil Before and After Changes in Regulatory Criteria for Trans-Fat-Free Claims on Food Labels

Consumption of industrially produced trans-fat acids (TFA) is a public health concern. Therefore, it is important that information on TFA in packaged foods be clearly informed to consumers. This study aimed to assess the evolution of TFA information presented in packaged foods sold in Brazil in 2010 and 2013, before and after the introduction of stricter regulatory requirements for TFA-free claims on food labels. A repeated cross-sectional study was performed through food label censuses of all packaged foods available for sale in two stores from the same supermarket chain, totaling 2,327 foods products in 2010 and 3,176 in 2013. TFA-free claims and information indicating TFA in the ingredients list and nutrition facts label were analyzed by descriptive statistics and Pearson's chi-square test. There was a 14% decrease in the use of ingredients containing or potentially containing industrially produced TFA (i-TFA), according to analysis of the ingredients list. However, when analyzing foods by groups, it was found that this decrease was significant only for group A (bakery goods, bread, cereals, and related products; from 59 to 35%, p < 0.001). By contrast, food group F (gravies, sauces, ready-made seasonings, broths, soups, and ready-to-eat dishes) showed a 5% increase in i-TFA. The use of specific terms for i-TFA decreased between 2010 and 2013, but there was an increase in the use of alternative terms, such as vegetable fat and margarine, which do not allow consumers to reliably identify whether a food product is a possible source of i-TFA. There was an 18% decrease in the use of TFA-free claims in products containing or potentially containing i-TFA. However, almost one-third of foods sold in 2013 were false negatives, that is, foods reported to contain 0 g of TFA in the nutrition facts label or with TFA-free claims but displaying specific or alternative terms for i-TFA in the ingredients list. The results indicate that adoption of stricter requirements for TFA-free claims on food labels in Brazil helped reduce the prevalence of such claims but was not sufficient to decrease i-TFA in industrialized foods sold in supermarkets.

Trans Fatty Acid Biomarkers and Incident Type 2 Diabetes: Pooled Analysis of 12 Prospective Cohort Studies in the Fatty Acids and Outcomes Research Consortium (FORCE)

OBJECTIVE

Trans fatty acids (TFAs) have harmful biologic effects that could increase the risk of type 2 diabetes (T2D), but evidence remains uncertain. We aimed to investigate the prospective associations of TFA biomarkers and T2D by conducting an individual participant-level pooled analysis.

RESEARCH DESIGN AND METHODS

We included data from an international consortium of 12 prospective cohorts and nested case-control studies from six nations. TFA biomarkers were measured in blood collected between 1990 and 2008 from 25,126 participants aged ≥18 years without prevalent diabetes. Each cohort conducted de novo harmonized analyses using a prespecified protocol, and findings were pooled using inverse-variance weighted meta-analysis. Heterogeneity was explored by prespecified between-study and within-study characteristics.

RESULTS

During a mean follow-up of 13.5 years, 2,843 cases of incident T2D were identified. In multivariable-adjusted pooled analyses, no significant associations with T2D were identified for trans/trans-18:2, relative risk (RR) 1.09 (95% CI 0.94-1.25); cis/trans-18:2, 0.89 (0.73-1.07); and trans/cis-18:2, 0.87 (0.73-1.03). Trans-16:1n-9, total trans-18:1, and total trans-18:2 were inversely associated with T2D (RR 0.81 [95% CI 0.67-0.99], 0.86 [0.75-0.99], and 0.84 [0.74-0.96], respectively). Findings were not significantly different according to prespecified sources of potential heterogeneity (each P ≥ 0.1).

CONCLUSIONS

Circulating individual trans-18:2 TFA biomarkers were not associated with risk of T2D, while trans-16:1n-9, total trans-18:1, and total trans-18:2 were inversely associated. Findings may reflect the influence of mixed TFA sources (industrial vs. natural ruminant), a general decline in TFA exposure due to policy changes during this period, or the relatively limited range of TFA levels.

The relationship between voluntary product (re) formulation commitments and changes in the nutritional quality of products offered by the top packaged food and beverage companies in Canada from 2013 to 2017

Background

Food companies shape Canada’s food supply through voluntary actions and commitments concerning product (re)formulation; however, the extent that these initiatives translate into actual improvements in nutritional quality is unclear. This study examined changes in the nutritional quality of products offered by the top 22 packaged food and beverage companies in Canada from 2013 to 2017, in relation to the strength of their product (re) formulation actions and commitments.

Methods

The Food Company Reformulation (FCR) scoring tool was used to quantify the strength of companies’ reported recent actions and commitments to reduce energy and nutrients of concern in their products, with higher scores signifying stronger voluntary actions/commitments. Nutritional information for products was sourced from the University of Toronto FLIP 2013 (n = 6490) and 2017 (n = 8277) databases (n = 4074 matched products). Changes in product healthfulness were assessed using the Health Star Rating (HSR) system (with higher HSRs denoting healthier products) and calories, sodium, saturated fat, trans fat, and total and free sugar levels per 100 g/mL. Generalized estimating equations examined changes in nutritional quality in relation to FCR scores.

Results

Overall, mean HSRs increased significantly for 5 companies’ product portfolios and were reduced in 1 company’s product portfolio. There were significant reductions in calories, sodium, saturated fat in 2 companies’ portfolios and increases in 4, 3, and 8 companies’ portfolios, respectively. Trans fats increased significantly in 2 companies’ portfolios. Total and free sugars decreased significantly in 4 and 5 companies’ portfolios, respectively, and increased in 1 company’s portfolio. There was little change in the healthfulness of matched products. Higher FCR scores were not associated with greater increases in HSRs, or reductions in calories or nutrient amounts. FCR scores were negatively associated with HSRs and positively associated with total and free sugars. No relationship was observed between FCR scores and calories, sodium, saturated fat or trans fat.

Conclusions

Reporting stronger voluntary product (re) formulation actions and commitments was not associated with greater improvements in the healthfulness of products offered by Canada’s leading packaged food and beverage companies from 2013 to 2017, suggesting a need for stronger industry initiatives or mandatory government interventions to improve the healthfulness of the food supply.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12683-2.

Consumption of Ultra-Processed Foods Is Associated with Free Sugars Intake in the Canadian Population

Excess sugar consumption can lead to noncommunicable diseases (NCDs) such as type 2 diabetes. Increasingly, ultra-processed foods (UPF) are suspected to be great contributors to free sugars intake in the population's diet. Thus, the aim of this study was to investigate the association between UPF consumption and free sugars intake in the Canadian population. We used data from one 24 h-recall of the nationally representative 2015 Canadian Community Health Survey-Nutrition (CCHS). Food items were classified according to the NOVA system, and to estimate free sugars intake, we used the University of Toronto's Food Label Information Program (FLIP) 2017 database. Results: Almost half of the population's energy intake (45.7%) came from UPF. On average, 221.5 kcal/day came from free sugars, and most of these calories (71.5%) came from UPF. Public health policies aiming to decrease consumption of UPF should be a priority considering their important contribution to sugar intake in the population.

Development of the Food Label Information Program: A Comprehensive Canadian Branded Food Composition Database

Objectives

Traditional methods for creating food composition databases struggle to cope with the large number of products and the rapid pace of turnover in the food supply. This paper introduces Food Label Information Program (FLIP), a big data approach to the evaluation of the Canadian food supply and presents the latest methods used in the development of this database.

Methods

The Food Label Information Program (FLIP) is a database of Canadian food and beverage package labels by brand name. The latest iteration of the FLIP, FLIP 2020, was developed using website “scraping” to collect food labeling information (e.g., nutritional composition, price, product images, ingredients, brand, etc.) on all foods and beverages available on seven major Canadian e-grocery retailer websites between May 2020 and February 2021.

Results

The University of Toronto's Food Label Information Program (FLIP) 2020 was developed in three phases: Phase 1, database development and enhancements; Phase 2, data capture and management of food products and nutrition information; Phase 3, data processing and food categorizing. A total of 74,445 products available on websites of seven retailers and 2 location-specific duplicate retailers were collected for FLIP 2020. Of 57,006 food and beverage products available on seven retailers, nutritional composition data were available for about 60% of the products and ingredients were available for about 45%. Data for energy, protein, carbohydrate, fat, sugar, sodium and saturated fat were present for 54–65% of the products, while fiber information was available for 37%. Food products were classified under multiple categorization systems, including Health Canada's Table of Reference Amounts, Health Canada's sodium categories for guiding benchmark sodium levels, sugar-focused categories and categories specific to various global nutrient profiling models.

Conclusions

FLIP is a powerful tool for evaluating and monitoring the Canadian food supply environment. The comprehensive sampling and granularity of collection provides power for revealing analyses of the relationship between nutritional quality and marketing of branded foods, timely observation of product reformulation and other changes to the Canadian food supply.

2021 Dietary Guidance to Improve Cardiovascular Health: A Scientific Statement From the American Heart Association

Poor diet quality is strongly associated with elevated risk of cardiovascular disease morbidity and mortality. This scientific statement emphasizes the importance of dietary patterns beyond individual foods or nutrients, underscores the critical role of nutrition early in life, presents elements of heart-healthy dietary patterns, and highlights structural challenges that impede adherence to heart-healthy dietary patterns. Evidence-based dietary pattern guidance to promote cardiometabolic health includes the following: (1) adjust energy intake and expenditure to achieve and maintain a healthy body weight; (2) eat plenty and a variety of fruits and vegetables; (3) choose whole grain foods and products; (4) choose healthy sources of protein (mostly plants; regular intake of fish and seafood; low-fat or fat-free dairy products; and if meat or poultry is desired, choose lean cuts and unprocessed forms); (5) use liquid plant oils rather than tropical oils and partially hydrogenated fats; (6) choose minimally processed foods instead of ultra-processed foods; (7) minimize the intake of beverages and foods with added sugars; (8) choose and prepare foods with little or no salt; (9) if you do not drink alcohol, do not start; if you choose to drink alcohol, limit intake; and (10) adhere to this guidance regardless of where food is prepared or consumed. Challenges that impede adherence to heart-healthy dietary patterns include targeted marketing of unhealthy foods, neighborhood segregation, food and nutrition insecurity, and structural racism. Creating an environment that facilitates, rather than impedes, adherence to heart-healthy dietary patterns among all individuals is a public health imperative.

The Level of Processing, Nutritional Composition and Prices of Canadian Packaged Foods and Beverages with and without Gluten-Free Claims

Little is known about the healthfulness and cost of gluten-free (GF) foods, relative to non-GF alternatives, in Canada. This study compared the extent of processing, nutritional composition and prices of Canadian products with and without GF claims. Data were sourced from the University of Toronto Food Label Information Program (FLIP) 2013 (n = 15,285) and 2017 (n = 17,337) databases. Logistic regression models examined the association of NOVA processing category with GF claims. Calorie/nutrient contents per 100 g (or mL) were compared between GF and non-GF products. Generalized linear models compared adjusted mean prices per 100 g (or mL) of products with and without GF claims. The prevalence of GF claims increased from 7.1% in 2013 to 15.0% in 2017. GF claims appeared on 17.0% of ultra-processed foods, which were more likely to bear GF claims products than less-processed categories. Median calories and sodium were significantly higher in GF products; no significant differences were observed for saturated fat or sugars. Compared to non-GF products, adjusted mean prices of GF products were higher for 10 food categories, lower for six categories and not significantly different for six categories. Overall, GF claims are becoming increasingly prevalent in Canada; however, they are often less healthful and more expensive than non-GF alternatives, disadvantaging consumers following GF diets.

Comparing how Canadian packaged food products align with the 2007 and 2019 versions of Canada's Food Guide

In 2019, Canada's Food Guide (CFG) was updated from the 2007 version. This study developed a food-based nutrient profile model (NPM) to evaluate the alignment of packaged food and beverage products with CFG 2019 and compared it with CFG 2007. Packaged products from the University of Toronto's Food Label Information Program 2017 database were evaluated in terms of their alignment with CFG 2007 (using the Health Canada Surveillance Tool (HCST)) and CFG 2019 (using our newly developed CFG 2019 NPM). Agreement in alignment (e.g., products "in line" according to CFG 2019 NPM and in Tiers 1 or 2 according to the HCST) was calculated and differences in alignment and reasons for differences were quantified and described. Overall agreement in product alignment between CFG 2007 and 2019 was 81.9%, with fewer products aligned with CFG 2019: 16.4% vs. 31.8%, (χ² = 189.12, p < 0.001). Differences in alignment varied across food categories (0.0-73.8%), explained by differences in CFG 2019, reflected in the CFG 2019 NPM (e.g., emphasis on avoiding processed foods, encouraging whole grains and low-fat dairy). This study presents a first step in assessing packaged foods' alignment with CFG 2019; future work is needed to evaluate broader dietary adherence to the updated recommendations. Novelty: A food-based nutrient profile model was developed based on the 2019 CFG and tested on packaged foods by comparing it with the nutrient-based HCST, based on CFG 2007. Most (82%) packaged products were "not in line" with either CFG version.

Nonesterified Fatty Acids and Depression in Cancer Patients and Caregivers

BACKGROUND

Nonesterified fatty acids (NEFAs) are known to have inflammatory effects. The inflammatory hypothesis of depression suggests that omega-3 (ω-3) and omega-6 (ω-6) fatty acids might be negatively and positively correlated with depression, respectively.

OBJECTIVE

An exploratory study was conducted to determine the association between dietary free fatty acids and depressive symptoms in cancer patients and caregivers.

METHODS

Associations between depression and the NEFA pool were investigated in 56 cancer patients and 23 caregivers using a combination of nonparametric tests and regularized regression. Plasma NEFAs were measured using thin layer and gas chromatography with flame ionization detection. Depression was characterized both as a continuous severity score using the GRID-Hamilton Depression Rating Scale (GRID Ham-D), and as a categorical diagnosis of major depression by structured clinical interview.

RESULTS

Initial hypotheses regarding the relation between depression and omega-3 or omega-6 fatty acids were not well supported. However, elaidic acid, a trans-unsaturated fatty acid found in hydrogenated vegetable oils, was found to be negatively correlated with continuous depression scores in cancer patients. No significant associations were found in caregivers.

CONCLUSIONS

An unexpected negative association between elaidic acid and depression was identified, supporting recent literature on the role of G protein-coupled receptors in depression. Further research is needed to confirm this result and to evaluate the potential role of G protein agonists as therapeutic agents for depression in cancer patients.

The Development and Application of a Tool for Quantifying the Strength of Voluntary Actions and Commitments of Major Canadian Food Companies to Improve the Nutritional Quality of Their Products

BACKGROUND

Canada's food supply is high in nutrients of public health concern, contributing to poor diet quality and increased noncommunicable disease risk. Food companies shape the healthfulness of the food supply, yet little is known about companies' voluntary actions and commitments concerning product (re)formulation.

OBJECTIVE

This study aimed to develop and apply a tool for quantifying the strength of voluntary actions and commitments of major food companies in Canada to improve the healthfulness of their products.

METHODS

Twenty-two top packaged food and beverage companies were selected based on Canadian market share. Recent actions and/or commitments to reduce energy/portion sizes, sodium, saturated fat, trans fat, and sugars were identified from company websites and public documents, verified by company representatives (where possible), and scored based on breadth of application across the product portfolio, magnitude(s) of reduction, measurability, nutritional significance, national/global applicability, and transparency using the Food Company Reformulation scoring tool. Companies offering beverages only (n = 4) were not assessed for sodium, saturated fat, or trans fat (re)formulation.

RESULTS

Seventeen of 22 companies reported reductions and/or commitments concerning sodium (72.2%, n = 13/18), trans fat (61.1%, n = 11/18), sugars (59.1%, n = 13/22), saturated fat (55.6%, n = 10/18), and/or energy/portion sizes (50.0%, n = 11/22). Scores ranged from 0/155 to 122/155 for food companies (median = 49/155) and 0/65 to 42/65 for beverage companies (median = 17/65). Companies generally performed best for sodium reduction (median = 21/32; range = 0-32) and poorest for energy/portion-size reductions (median = 2/30; range = 0-24). Multinational companies had significantly higher total scores than domestic companies (P = 0.004). Higher total scores were associated with greater market shares in the beverage manufacturing sector (P = 0.04), but not packaged food (P = 0.50).

CONCLUSIONS

Many of Canada's leading food companies report limited or no action to reduce nutrients of concern in their products, suggesting a need for government intervention and strengthened accountability mechanisms to encourage alignment of reformulation efforts with government and expert recommendations.

Methodology for the Determination of Fruit, Vegetable, Nut and Legume Points for Food Supplies without Quantitative Ingredient Declarations and Its Application to a Large Canadian Packaged Food and Beverage Database

Nutrient profiling (NP) models are useful tools for objectively and transparently quantifying the nutritional quality of packaged foods and beverages. Many NP models incorporate ingredients beneficial for health (e.g., fruits, vegetables, nuts, legumes (FVNL)) in addition to less healthful nutrients or components, assigning points based on the proportion of the product that contains FVNL ingredients. However, with food labelling in most countries lacking mandatory quantitative ingredient declarations (QUIDs), there is potential for the estimation of FVNL points to be ambiguous and inconsistent. The purpose of this article was to describe the development and application of methodology for estimating FVNL points for products without QUIDs, based on the position of FVNL components within the ingredients list. Using this method, FVNL points were calculated for packaged foods and beverages in the University of Toronto Food Label Information Program 2017 database (n = 17,337). Distributions of FVNL points were examined overall and by food category. This study provides evidence of the feasibility of this method in distinguishing between products with differing amounts of FVNL ingredients. This method will be valuable for researchers and policymakers in ensuring consistent, objective and reproducible estimations of FVNL points—and consequently, assessments of product healthfulness—for food supplies without QUIDs.

A comparison of the nutritional quality of products offered by the top packaged food and beverage companies in Canada

BACKGROUND

Canada's food supply is abundant in less healthy products, increasing Canadians' risk of obesity and non-communicable diseases. Food companies strongly influence the food supply; however, no studies have examined differences in the healthfulness of products offered by various companies in Canada. This study aimed to compare the nutritional quality of products offered by the top packaged food and beverage companies in Canada.

METHODS

Twenty-two top packaged food and beverage manufacturing companies were selected, representing > 50% of the Canadian market share in 2018. Nutritional information for products (n = 8277) was sourced from the University of Toronto Food Label Information Program 2017 database. Descriptive analyses examined the nutritional quality of products based on: 1) the Health Star Rating (HSR) system; 2) calories, sodium, saturated fat and total sugars per 100 g (or mL) and per reference amounts (RAs) defined by Health Canada; and 3) "high in" thresholds for sodium, saturated fat and total sugars proposed by Health Canada for pending front-of-package labelling regulations. Kruskal-Wallis tests compared HSRs of products between companies.

RESULTS

Mean HSRs of companies' total product offerings ranged from 1.9 to 3.6 (out of 5.0). Differences in HSRs of products between companies were significant overall and for 19 of 22 food categories (P < 0.05), particularly for fats/oils and beverages. Calories, sodium, saturated fat and total sugars contents varied widely between companies for several food categories, and depending on whether they were examined per 100 g (or mL) or RA. Additionally, 66.4% of all products exceeded ≥1 of Health Canada's "high in" thresholds for sodium (31.7%), saturated fat (28.3%) and/or sugars (28.4%). The proportion of products offered by a company that exceeded at least one of these thresholds ranged from 38.5 to 97.5%.

CONCLUSIONS

The nutritional quality of products offered by leading packaged food and beverage manufacturers in Canada differs significantly overall and by food category, with many products considered less healthy according to multiple nutrient profiling methods. Variation within food categories illustrates the need and potential for companies to improve the healthfulness of their products. Identifying companies that offer less healthy products compared with others in Canada may help prompt reformulation.