Nutrient patterns, nutritional adequacy, and comparisons with nutrition recommendations among French-Canadian adults in Montreal

The Domestic Foodscapes of Young Low-Income Women in Montreal: Cooking Practices in the Context of an Increasingly Processed Food Supply

Over the course of the past century, the quantity of prepackaged, pre-prepared foods available in the North American context has increased dramatically. This study examines the shifts in food practices that are taking place through an exploration of the day-to-day cooking practices of a group of young, low-income women in Montreal and considers how these contribute to health problems such as obesity and nutritional deficiencies in addition to health inequalities within populations. The participatory study uses data from five focus groups with a total of 22 participants to contribute to our understanding of how social and physical food environments (the “foodscape”) shape daily food and cooking practices. Aspects of these environments that were discussed include household roles and responsibilities that require complex management, personal food choice and skill, as well as health, learning, and access to food.

The relationship between low income and household food expenditure patterns in Canada

Objectives:

To compare food expenditure patterns between low-income households and higher- income households in the Canadian population, and to examine the relationship between food expenditure patterns and the presence or absence of housing payments among low-income households.

Design:

Secondary data analysis of the 1996 Family Food Expenditure Survey conducted by Statistics Canada.

Setting:

Sociodemographic data and 1-week food expenditure data for 9793 households were analysed.

Subjects:

Data were collected from a nationally representative sample drawn through stratified multistage sampling. Low-income households were identified using Statistics Canada's Low Income Measures.

Results:

Total food expenditures, expenditures at stores and expenditures in restaurants were lower among low-income households compared with other households. Despite allocating a slightly greater proportion of their food dollars to milk products, low-income households purchased significantly fewer servings of these foods. They also purchased fewer servings of fruits and vegetables than did higher-income households. The effect of low income on milk product purchases persisted when the sample was stratified by education and expenditure patterns were examined in relation to income within strata. Among low-income households, the purchase of milk products and meat and alternatives was significantly lower for households that had to pay rents or mortgages than for those without housing payments.

Conclusions:

Our findings indicate that, among Canadian households, access to milk products and fruits and vegetables may be constrained in the context of low incomes. This study highlights the need for greater attention to the affordability of nutritious foods for low-income groups.

Canadian Aboriginal women have a higher prevalence of vitamin D deficiency than non-Aboriginal women despite similar dietary vitamin D intakes

Canadian Aboriginal women have high rates of bone fractures, which is possibly due to low dietary intake of minerals or vitamin D. This study was undertaken to estimate dietary intake of calcium and vitamin D by designing a culturally appropriate dietary survey instrument and to determine whether disparities exist between Aboriginal and white women. After validation of a FFQ, 183 urban-dwelling and 26 rural-dwelling Aboriginal women and 146 urban white women completed the validated FFQ and had serum 25-hydroxyvitamin D [25(OH)D] measured. Urban Aboriginal women had lower (P=0.0004) intakes of total dietary calcium than urban white women; there was no difference in rural Aboriginal women. Only a minority of all women met the adequate intake (AI) for calcium intake. Ethnicity did not affect total vitamin D intake; however, rural Aboriginal women consumed all of their dietary vitamin D from food sources, which was more (P<0.03) than both urban Aboriginal and white women. Rural and urban Aboriginal women had lower (P<0.0004) serum 25(OH)D than urban white women. We found that 32% of rural Aboriginal, 30.4% of urban Aboriginal, and 18.6% of urban white women were vitamin D deficient, with serum 25(OH)D concentrations<37.5 nmol/L. The high prevalence of vitamin D deficiency among Aboriginal women, combined with lower dietary intake of calcium, especially in older women, likely contributes to the higher incidence of fracture in this population.

Diet quality of Montreal-area adults needs improvement: estimates from a self-administered food frequency questionnaire furnishing a dietary indicator score

OBJECTIVE/DESIGN

Time and budget constraints limit nutrition evaluation in Canadian health surveys. To encourage regular population diet monitoring in Canada, we developed and assessed the relative validity of a population-based food frequency questionnaire (FFQ) to assess usual diet in Quebecers. A 73-item, self-administered semiquantitative FFQ was designed in French and English from the Block National Cancer Institute Health Habits and History Questionnaire to capture usual food consumption among Quebec adults. The US Department of Agriculture Healthy Eating Index (HEI) (maximum score=100) was adapted to Canadian age- and sex-specific dietary recommendations, validated, and programmed to score the FFQ for diet quality.

SUBJECTS

The FFQ was pretested, pilot tested, and administered by mail to a random sample of 248 adults aged 18 to 82 years in the Montreal area (57% women) who were recruited by random digit dialing (64% response rate). A subgroup (n=94) furnished four nonconsecutive 1-day food records for validation of the FFQ.

RESULTS

Mean FFQ energy intakes were 2,216 kcal (median 2,110 kcal) for men and 1,785 kcal (median 1,680 kcal) for women. Proportional median macronutrient consumption was similar in both sexes at 17% protein, 34% to 35% fats, and 48% to 49% carbohydrates, but differed by age group in women. Adequacy of micronutrient intakes relative to Dietary Reference Intakes varied by age, sex, and nutrient. Whereas most mean or median intakes were at or exceeded recommendations, calcium intakes were low overall and levels of several other nutrients were very low at the 10th percentile. Mean Canadian HEI (range 46 to 99) was higher in women (74.9) than men (70.3, P<.001). Women's scores showed they met recommendations for intakes of vegetables and fruit, cholesterol, and sodium better than men (P ranged from <.01 to <.0001), while men fared better at meeting recommended fat intake levels (P<.05).

CONCLUSIONS

The Canadian HEI adequately discriminates overall diet quality based on dietary data estimated from our FFQ. Examination of subscores within and between quartiles may best reveal which food groups require attention to improve diet quality, providing valuable information for teaching and planning. Future studies should test diet quality indicators in populations recruited to reflect greater dietary diversity and reporting ability and include members of disadvantaged groups to provide a broader set of behaviors that could shed light on factors influencing diet quality.

An examination of at-home food preparation activity among low-income, food-insecure women

A secondary analysis of data from a study of nutritional vulnerability among 153 women in families seeking charitable food assistance was undertaken to estimate the extent and nutritional significance of at-home food preparation activity for these women. At-home food preparation was estimated from women's reported food intakes from three 24-hour recalls. The relationships between food preparation and energy and nutrient intake, food intake, and 30-day household food security status were characterized. Almost all participants (97%) consumed foods prepared from scratch at least once during the three days of observation; 57% did so each day. Both the frequency and complexity of at-home food preparation were positively related to women's energy and nutrient intakes and their consumption of fruits and vegetables, grain products, and meat and alternates. The intakes by women in households with food insecurity with hunger reflected less complex food preparation but no less preparation from scratch than women in households where hunger was not evident, raising questions about the extent to which food skills can protect very poor families from food insecurity and hunger. Our findings indicate the need for nutrition professionals to become effective advocates for policy reforms to lessen economic constraints on poor households.

Ten-year trends of dietary intake in a middle-aged French population: relationship with educational level

OBJECTIVE

To compare dietary intakes at a 10 y interval of a population aged 35-64 living in France. Trends in nutrient intake and food consumption were examined with a special emphasis on the relationships between educational level and dietary behaviour.

DESIGN

Two independent surveys conducted in 1985-1987 (S1) and 1995-1997 (S2) in the framework of the WHO MONICA project. Dietary intake was assessed with a 3-day record method and a food frequency questionnaire. The samples analysed included 416 men and 446 women for S1, 393 men and 409 women for S2.

RESULTS

A significant improvement of the quality of fat intake was observed between S1 and S2, independently of educational level, with an increase of the age adjusted P/S ratio from 0.42 to 0.50 in men (P=10(-4)) and from 0.41 to 0.50 in women (P=10(-4)), whereas the daily cholesterol intake dropped from 552.0 to 466.9 mg and from 447.2 to 384.6 mg in men and women, respectively (P=10(-4)). These variations were associated with a decrease in the consumption of high-fat foods and an increase in that of low-fat products (poultry, low-fat dairy foods, fish) in all educational classes. By contrast, the consumption of fruit and vegetables, which was highly associated with educational level, varied little over time.

CONCLUSIONS

Our results indicate slight improvement in fat quality, independently of educational level, while fruit and vegetable intake, which appeared more dependent on educational level, was only poorly modified over the 10 y interval.

Effect of withdrawal of calcium and vitamin D supplements on bone mass in elderly men and women

BACKGROUND

Supplementation with calcium and vitamin D reduces bone loss and prevents fractures in elderly people, but it is not known whether any lasting benefit remains if the supplements are discontinued.

OBJECTIVE

The objective was to determine whether gains in bone mineral density (BMD) induced by calcium and vitamin D supplementation persist after supplement withdrawal.

DESIGN

Two-hundred ninety-five healthy, elderly men and women (aged >/=68 y) who had completed a 3-y randomized, placebo-controlled trial of calcium and vitamin D supplementation were followed for an additional 2 y during which no study supplements were given. BMD was measured by dual-energy X-ray absorptiometry, and biochemical variables related to calcium metabolism and bone turnover were measured.

RESULTS

In the 128 men, supplement-induced increases in spinal and femoral neck BMD were lost within 2 y of supplement discontinuation, but small benefits in total-body BMD remained. In the 167 women, there were no lasting benefits in total-body BMD or at any bone site. Consistent with the observations on BMD, the bone turnover rates in both men and women (as measured by serum osteocalcin concentrations) returned to their original higher concentrations within the same 2-y period.

CONCLUSION

Discontinued calcium and vitamin D supplementation has limited cumulative effect on bone mass in men and women aged >/=68 y.

Nutrient intakes and adequacy among an older population on the eastern shore of Maryland: the Salisbury Eye Evaluation

OBJECTIVE

To describe the reported usual dietary intakes of the participants in the Salisbury Eye Evaluation (SEE) project and to estimate the prevalence of inadequate nutrient intakes using the probability approach.

SUBJECTS/SETTING

A representative sample of elderly residents (aged 65 to 85 years) of Salisbury, Md.

DESIGN

Cross-sectional survey, using a food frequency questionnaire to obtain nutrient intakes. We estimated energy and protein; percent of energy intake from carbohydrates, fat, and protein; as well as usual intakes of cholesterol, vitamin A, carotenoids, vitamin C, thiamin, riboflavin, vitamin B-6, vitamin E, niacin, iron, calcium, zinc, and folate. Estimates of prevalence of inadequate nutrient intakes were calculated using the probability approach among the 2,655 participants with complete nutrient intake information.

STATISTICAL ANALYSES PERFORMED

The chi 2 test for independence and analysis of variance. A P < .05 was considered significant in a 2-sided test.

RESULT

On average, white participants of both genders reported higher mean energy and nutrient intakes than did black participants. Zinc had the highest estimated prevalences of inadequacy across all gender and race categories, followed by calcium, vitamin E, and vitamin B-6. Vitamin C, with estimated prevalences of inadequacy lower than 13%, and folate, with prevalences lower than 17%, had the lowest estimated prevalences of inadequacy across all gender, race, and age categories.

CONCLUSIONS

In this population, there are race differences in estimated prevalences of inadequate nutrient intake. According to the current nutrient requirements for adults aged 51 years and older, many elderly persons have inadequate dietary intakes of key nutrients.

Women's dietary intakes in the context of household food insecurity

A study of food insecurity and nutritional adequacy was conducted with a sample of 153 women in families receiving emergency food assistance in Toronto, Canada. Contemporaneous data on dietary intake and household food security over the past 30 d were available for 145 of the women. Analyses of these data revealed that women who reported hunger in their households during the past 30 d also reported systematically lower intakes of energy and a number of nutrients. The effect of household-level hunger on intake persisted even when other economic, socio-cultural, and behavioral influences on reported dietary intake were considered. Estimated prevalences of inadequacy in excess of 15% were noted for Vitamin A, folate, iron, and magnesium in this sample, suggesting that the low levels of intake associated with severe household food insecurity are in a range that could put women at risk of nutrient deficiencies.

Nutritional factors and colon carcinoma: a case-control study involving French Canadians in Montréal, Quebec, Canada

BACKGROUND

In a population-based case-control study of colon carcinoma and nutrition involving the francophone community in Greater Montreal, a total of 402 cases (200 males and 202 females) and 668 controls (239 males and 429 females) were interviewed.

METHODS

Cases from 1989-1993 were identified through the admission offices of 5 major francophone teaching hospitals in Montreal and were ages 35-79 years. Controls matched by age, place of residence, and language were selected by a modified random digit dialing method. Information on dietary intake was collected with a quantitative food frequency questionnaire.

RESULTS

No associations were evident between colon carcinoma and total energy, protein, or carbohydrate consumption, whereas a suggestive inverse association was found with total fat intake, with an odds ratio (OR) of 0.78 (P = 0.0637), and with saturated fat intake as well (OR = 0.71, P = 0.0893). A strongly significant inverse association was found with dietary fiber (OR = 0.50, P = 0.0018). The strongest inverse association concerning fiber was found with fiber from vegetable sources (OR = 0.57, P = 0.0096), and a suggestive (although nonsignificant) inverse association (OR = 0.74, P = 0.0687) was found with fiber from fruits. Calcium was inversely associated with risk (OR = 0.69, P = 0.0411), as was dietary intake of vitamin A (OR = 0.67, P = 0.0162), retinol, (OR = 0.069, P = 0.0409), vitamin E (OR = 0.53, P = 0.0028), and alphatocopherol (OR = 0.63, P = 0.0256). Although there was no association demonstrated between dietary beta-carotene intake and risk, a suggestive (although nonsignificant) inverse association with intake of other types of carotene was observed (OR = 0.76, P = 0.0740). No association was found between intake of other nutrients investigated in this study and risk of colon carcinoma.

CONCLUSIONS

There is strong evidence from epidemiologic studies that high intake of fat and meat are risk factors for colorectal carcinoma in humans, whereas high intake of vegetable and fruit are inversely associated with risk of colon carcinoma. The findings from this study are in agreement with this observation.

Nutrient patterns and nutritional adequacy among French-Canadian children in Montreal

OBJECTIVES AND METHODS

A representative sample of French Canadian Montrealers was surveyed to compile data on food habits, nutrient intakes and sociodemographic characteristics, using interviewer-administered questionnaires and 7-day food records (7D-FR).

RESULTS

Complete 7D-FR and sociodemographic data were obtained from 614 adults aged 19 and over (40.1% males), and 182 children aged 5 to 18 (44.8% males). Average heights and weights of children were at the 50th percentile for both sexes and all age groups. Nutrient intakes surpassed most of the age- and sex-specific 1990 Canadian Recommended Nutrient Intakes (RNIs). Energy intakes were 83% to 98% of the RNIs, with 16-18 year old adolescent girls having systematically lower energy consumption. Calcium was most frequently found below the 66% age-sex specific RNI cut-off. On average, protein comprised 16% of energy, fat 36-37%, and carbohydrates 48-49%, for males and females, respectively. Simple sugars comprised 16-19% of energy among boys, and 16-20% among girls, fluctuating with age. Only a small proportion of respondents (15.4%) had low relative total fat and saturated fat intakes (ranging from 30-34%, and 10-12% of energy, respectively); no differences in mean nutrient levels were found between low, medium or higher fat consumers. Among those with inadequate intakes, 26% lived in one lower middle income sector of Montreal; however, no clear pattern emerged linking dietary adequacy and socioeconomic factors.

CONCLUSIONS

While Montreal youngsters consume generally adequate diets, sufficient quantities of calcium-furnishing foods must be eaten, particularly by adolescent girls. Surveillance of children's food and nutrient intakes will contribute to the reduction of chronic disease by providing data for effective health care planning.