Differences in the Quantity and Types of Foods and Beverages Consumed by Canadians between 2004 and 2015

Cost of a healthy diet: A population-representative comparison of three diet cost methods in Canada

INTRODUCTION

Different food price sources and dietary assessment tools may impact the estimation of diet costs and hamper our understanding of the relationship between diet costs and dietary intakes. We investigated the effect of three diet cost derivation methods, with increasing numbers of food prices and geographic specificity, holding consistent the dietary assessment, on the estimation of diet costs overall and by food group.

METHODS

We matched 24-hour dietary recall data from the 2015 Canadian Community Health Survey-Nutrition (CCHS-N) to food price data from three Canadian Consumer Price Index (CPI) food price lists; national short list, national long list, and provincial long list. We compared the daily ($/day) and energy-adjusted ($/2,000kcal) diet costs overall and by food groups for the overall population (4+), children (4-18), and adults (19+).

RESULTS

The proportion of dietary intakes (g) that were covered by CPI prices significantly increased from the national short list to the national long list but did not significantly differ from the national long list to the provincial long list. The national short list resulted in the highest daily and energy-adjusted diet costs overall. No difference in diet costs was noted between the national and provincial long lists. Diet costs for four food groups-additions, sweets, fruits, and vegetables, which were poorly covered by the national short list-significantly differed using the national and provincial long lists. All three diet cost methods were significantly correlated with energy intakes; however, a strong/very strong correlation was detected for children, and a weak/moderate correlation for adults.

CONCLUSION

The choice of food price data may introduce bias in the diet cost estimate, as well as limiting our understanding of how individuals allocate their diet costs. Refinement of diet cost estimation methodology and measures can strengthen future studies of how consumers allocate their purchases to their diets.

Temporal snacking patterns among Canadian children and adolescents

Snacking is nearly universal among children but there is growing concern around snacking patterns and energy contribution. This study aimed to characterize temporal snacking patterns among Canadian children and adolescents. A cross-sectional analysis drew on data from 5209 respondents aged 4-18 years from the 2015 Canadian Community Health Survey Nutrition, using one 24 h dietary recall. Descriptive statistics estimated proportions of morning, afternoon, and evening snackers, the mean caloric contribution of each snacking period to total daily energy intake, and the top food categories consumed as snacks (kcal per capita). Snacking was nearly universal and accounted for one of every four calories consumed. Morning snacks were more popular among children vs. adolescents and contributed significantly less energy than afternoon or evening snacking periods for both age groups (P < 0.001). The top food groups consumed as snacks were the same for children and adolescents, although the ranking order varied. Fruits were the leading food group in terms of per capita energy for children and second for adolescents. Aside from fruits and milks, all other top per capita energy contributors were generally more energy-dense, nutrient-poor foods such as cookies, biscuits and cereal bars, and other breads. Among children, morning snacks were higher in desirable nutrients compared with afternoon snacks. Not all snacking periods are equal in terms of energy and nutrients. A better understanding of how time of day may influence the quality of snack foods can inform meal-based guidance and help children achieve the recommended daily amounts of foods and nutrients.

Dietary polyphenol intake in the Canadian population: Findings from the 2015 Canadian Community Health Survey-Nutrition

OBJECTIVES

This study aimed to estimate usual polyphenol intake among Canadians using the nationally representative 2015 Canadian Community Health Survey-Nutrition and to explore the main dietary contributors to polyphenol intake and the sociodemographic and lifestyle factors that may impact polyphenol intake.

METHODS

Dietary information was collected from 19,409 respondents using 24-h dietary recalls. The polyphenol content of foods was estimated using the Phenol-Explorer Database (version 3.6). Daily intake values for total polyphenols (adjusted to energy intake), main classes, and subclasses were calculated for each respondent and dietary recall. Usual intake was estimated by age/sex groups and by sociodemographic and lifestyle characteristics independently for adults and children using the National Cancer Institute method. Given-day arithmetic mean polyphenol intakes and mean proportions of main classes contributing to sum total polyphenol intakes were explored. Population proportions were used to determine dietary contributors.

RESULTS

Usual total polyphenol intake was 1119.3 mg/1000 kcal/day (95% CI: 1090.5, 1148.1) for adults ≥ 19 years and 473.0 mg/1000 kcal/day (95% CI: 454.9, 491.0) for children 2‒18 years. Generally, total polyphenol intakes differed by age, sex, ethnicity, and household education status and were higher among coffee and tea consumers. Most polyphenols came from flavonoids (40.0%) and phenolic acids (49.8%), with children consuming more flavonoids and other polyphenols and adults more phenolic acids. The top food contributors to polyphenol intake were coffee (26.8%), tea (8.9%), fruit juice (4.2%), banana (4.1%), and apple (3.8%).

CONCLUSION

Usual intake of total polyphenols among Canadians differed primarily by age. Non-alcoholic beverages were top contributors to total polyphenol intake.

Meat reduction among post-secondary students: Exploration of motives, barriers, diets and preferences for meals with partial and full meat substitution

Before developing new meat reduction interventions to support increased sustainability, it is important to understand the motives, diets and preferences of consumers who have already made efforts to reduce meat consumption. While self-declaration has been typically used to identify meat reducers, food frequency data suggests some reducers still identify as omnivores, here termed transitional meat reducers. We compared these "transitional" meat reducers to self-declared meat reducers, unrestricted omnivores and vegetarians/vegans for differences in diet, motives for reducing meat, and perceived barriers to consuming more legumes (dried beans, peas or lentils) and plant-based meat alternative products (PBMAs). We also compared their intention to choose four specific entrees where legumes or PBMAs had partially or fully replaced meat. A convenience sample of Canadian university students completed an online survey (N = 438). 34% of participants were self-declared meat reducers, 16% transitional meat reducers, 33% unrestricted omnivores and 16% vegetarians/vegans. Frequency of eating red meat differed, with self-declared meat reducers eating red meat less often than either transitional meat reducers or unrestricted omnivores. Motives for meat reduction were similar in the two reducer groups. Transitional meat reducers reported significantly more frequent consumption of other protein foods and more barriers to legumes but not PBMA, than either unrestricted omnivores or self-declared meat reducers. Lastly, intention to consume all versions of entrees was very similar in both reducer groups, but with increased preference for full vs partial substitution among self-declared reducers. Transitional meat reducers may be a distinct group for meat reduction interventions compared to omnivores or self-declared reducers.

Development of the Canadian Food Intake Screener to assess alignment of adults' dietary intake with the 2019 Canada's Food Guide healthy food choices recommendations

NOVELTY

The Canadian Food Intake Screener was developed to rapidly assess alignment of adults' dietary intake over the past month with the Food Guide's healthy food choices recommendations. The screener was developed and evaluated through an iterative process that included three rounds of cognitive interviews in each of English and French, along with ongoing feedback from external advisors and face and content validity testing with a separate panel of content experts. The 16-question screener is intended for use with adults, aged 18-65 years, with marginal and higher health literacy in research and surveillance contexts in which comprehensive dietary assessment is not possible.

Barriers and facilitators to diet, physical activity and lifestyle behavior intervention adherence: a qualitative systematic review of the literature

BACKGROUND

Consuming a balanced diet and regular activity have health benefits. However, many adults have a difficult time adhering to diet and activity recommendations, especially in lifestyle interventions. Adherence to recommendations could be improved if common facilitators and barriers are accounted for in intervention design. The aim of this systematic review was to understand perceived barriers and facilitators to lifestyle (diet and/or activity) intervention guidelines.

METHODS

This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Studies included relied on qualitative methods to explore the barriers and facilitators healthy adults ([Formula: see text] 18 years) experienced in lifestyle interventions. Google Scholar, Cochrane Reviews, Medline, PubMed, and Web of Science were searched from January 2005 to October 2021. Main themes from each paper were thematically analyzed and reported as a barrier or facilitator to adherence at the individual, environment or intervention level using inductively derived themes. Study quality was assessed using the Critical Appraisal Skills Programme.

RESULTS

Thirty-five papers were included. Of these, 46% were conducted in North America and the majority had more female participants (86% in mixed-sex studies, 26% females only). Similar themes emerged across all three levels as facilitators and barriers. At the individual level, attitudes, concern for health and physical changes. At the environmental level, social support, social accountability, changeable and unchangeable aspects of the community. Finally, delivery and design and content at the intervention level. An additional facilitator at the intervention level included fostering self-regulation through Behavior Change Taxonomies (BCT).

CONCLUSIONS

Lifestyle interventions that foster self-regulatory skills, opportunities for social engagement and personalization of goals may improve behaviour adherence. This can be achieved through inclusion of BCT, tapering off of intervention supports, identification of meaningful goals and anticipated barriers with participants.

Food and nutrient intakes and compliance with recommendations in school-aged children in Ireland: findings from the National Children’s Food Survey II (2017–2018) and changes since 2003–2004

The childhood years represent a period of increased nutrient requirements during which a balanced diet is important to ensure optimal growth and development. The aim of this study was to examine food and nutrient intakes and compliance with recommendations in school-aged children in Ireland and to examine changes over time. Analyses were based on two National Children’s Food Surveys; NCFS (2003–2004) (n 594) and NCFS II (2017–2018) (n 600) which estimated food and nutrient intakes in nationally representative samples of children (5–12 years) using weighed food records (NCFS: 7-d; NCFS II: 4-d). This study found that nutrient intakes among school-aged children in Ireland are generally in compliance with recommendations; however, this population group have higher intakes of saturated fat, free sugars and salt, and lower intakes of dietary fibre than recommended. Furthermore, significant proportions have inadequate intakes of vitamin D, Ca, Fe and folate. Some of the key dietary changes that have occurred since the NCFS (2003–2004) include decreased intakes of sugar-sweetened beverages, fruit juice, milk and potatoes, and increased intakes of wholemeal/brown bread, high-fibre ready-to-eat breakfast cereals, porridge, pasta and whole fruit. Future strategies to address the nutrient gaps identified among this population group could include the continued promotion of healthy food choices (including education around ‘healthy’ lifestyles and food marketing restrictions), improvements of the food supply through reformulation (fat, sugar, salt, dietary fibre), food fortification for micronutrients of concern (voluntary or mandatory) and/or nutritional supplement recommendations (for nutrients unlikely to be sufficient from food intake alone).

Comparing the perceptions and opinions of the 2007 and 2019 Canada's food guides among parents of young children

Background

The Canada's Food Guide (CFG) is recognized as the most prominent authoritative guideline for healthy eating in Canada. In 2019, Health Canada released the latest iteration of the CFG with substantial changes to its messaging and format from the previous 2007 CFG.

Objective

This study compared the awareness, use, knowledge, and opinions of the 2007 and 2019 CFGs among parents with children aged 18 months to 5 years who are participants in a family-based intervention trial, the Guelph Family Health Study.

Methods

The sample consisted of 327 parents (59% women) who responded to questions about the 2007 CFG and 177 parents (60% women) who responded to questions about the 2019 CFG. Parents' awareness and knowledge of the 2007 and 2019 CFGs were compared using Pearson's Chi-Square, while parents' opinions of the two CFGs were compared using Wilcoxon Rank-Sum tests. To describe and provide context about how parents used the 2007 and 2019 CFG descriptive analysis was used. To analyze the open-answer comments parents provided for the 2007 and 2019 CFGs thematic coding was used.

Results

Awareness of the 2007 and 2019 CFGs was high with 94.5 and 90.4% of parents reported having heard about the 2007 and 2019 CFGs, respectively. Knowledge of the plate proportion recommendations in the 2019 CFG was significantly higher than knowledge of the recommended number of servings in the 2007 CFG with 93.4% of parents identifying the Vegetable and Fruit Plate Proportions in the 2019 CFG. Parents identified that the 2019 CFG was a helpful and trustworthy resource, and that it was easier to follow and understand, and more representative of their culture and traditional foods than the 2007 CFG.

Conclusion

Our results suggest that parents' knowledge of the 2019 CFG recommendations was higher than for the 2007 CFG recommendations. Parents also had more positive opinions about the 2019 CFG as compared to the 2007 CFG. Future research is needed to explore whether these higher levels knowledge of the 2019 CFG recommendation translate to healthier eating patterns among Canadian families.

Benchmarking unhealthy food marketing to children and adolescents in Canada: a scoping review

INTRODUCTION

Unhealthy food and beverage marketing in various media and settings contributes to children's poor dietary intake. In 2019, the Canadian federal government recommended the introduction of new restrictions on food marketing to children. This scoping review aimed to provide an up-to-date assessment of the frequency of food marketing to children and youth in Canada as well as children's exposure to this marketing in various media and settings in order to determine where gaps exist in the research.

METHODS

For this scoping review, detailed search strategies were used to identify relevant peer-reviewed and grey literature published between October 2016 and November 2021. Two reviewers screened all results.

RESULTS

A total of 32 relevant and unique articles were identified; 28 were peer reviewed and 4 were from the grey literature. The majority of the studies (n = 26) examined the frequency of food marketing while 6 examined actual exposure to food marketing. Most research focussed on children from Ontario and Quebec and television and digital media. There was little research exploring food marketing to children by age, geographical location, sex/gender, race/ethnicity and/or socioeconomic status.

CONCLUSION

Our synthesis suggests that unhealthy food marketing to children and adolescents is extensive and that current self-regulatory policies are insufficient at reducing the presence of such marketing. Research assessing the frequency of food marketing and preschooler, child and adolescent exposure to this marketing is needed across a variety of media and settings to inform future government policies.

The relationship between diet quality and the severity of household food insecurity in Canada

OBJECTIVE

To examine the relationship between the dietary quality of Canadian children and adults and household food insecurity status.

DESIGN

Dietary intake was assessed with one 24-h recall. Households were classified as food secure or marginally, moderately or severely food insecure based on their responses to the Household Food Security Survey Module. We applied multivariable analyses of variance to determine whether % energy from ultra-processed foods, fruit and vegetable intake, Healthy Eating Index (HEI) scores, macronutrient composition and micronutrient intakes per 1000 kcal differed by food insecurity status after accounting for income, education and region. Analyses were run separately for children 1-8 years and 9-18 years and men and women 19-64 years of age.

SETTING

Ten provinces in Canada.

PARTICIPANTS

Respondents to the 2015 Canadian Community Health Survey-Nutrition, aged 1-64 years, with complete food insecurity data and non-zero energy intakes, N 15 909.

RESULTS

Among adults and children, % energy from ultra-processed foods was strongly related to severity of food insecurity, but no significant trend was observed for fruit and vegetable intake or HEI score. Carbohydrate, total sugar, fat and saturated fat intake/1000 kcal did not differ by food insecurity status, but there was a significant negative trend in protein/1000 kcal among older children, a positive trend in Na/1000 kcal among younger children and inverse associations between food insecurity severity and several micronutrients/1000 kcal among adults and older children.

CONCLUSIONS

With more severe household food insecurity, ultra-processed food consumption was higher, and diet quality was generally lower among both adults and children.

Feasibility and measurement error in using food supply data to estimate diet costs in Canada

OBJECTIVE

The cost of food is a key influence on diet. The majority of diet cost studies match intake data from population-based surveys to a single source of food supply prices. Our aim was to examine the methodological significance of using food supply data to price dietary intakes.

METHODS

Nationally representative 24-hour dietary recall data from the 2015 Canadian Community Health Survey-Nutrition (CCHS-N) was matched to the 2015 Canadian Consumer Price Index (CPI) food price list. Proportions and means of reported intakes covered by the 2015 CPI price list were used to compare reported intakes of food groups and food components of interest and concern overall, and by quartile of CPI coverage.

SETTING

Canada.

PARTICIPANTS

20,487 Canadians ages one and older.

RESULTS

The CPI covered on average 76.3% of total dietary intake (g) without water. Staple food groups that were more commonly consumed had better CPI price coverage than those less commonly consumed. Yet some food groups (vegetables, additions, sweets) that were also commonly consumed by Canadians were not well covered by price data. Individuals in the poorest CPI coverage quartile reported consuming significantly greater fibre (g), gram weight (g), dietary fibre (g), and energy (kcal) as compared to those with the best coverage.

CONCLUSIONS

Differential CPI price coverage exists among food components and commonly consumed food groups; additionally dietary intake differs significantly in the population by CPI coverage. Methodological refinements are needed to better account for error when using prices from food supply data to estimate diet costs.

The Content, Quality, and Behavior Change Techniques in Nutrition-Themed Mobile Apps for Children in Canada: App Review and Evaluation Study

BACKGROUND

Children increasingly use mobile apps. Strategies to increase child engagement with apps include the use of gamification and images that incite fun and interaction, such as food. However, the foods and beverages that children are exposed to while using apps are unknown and may vary by app type.

OBJECTIVE

The aim of this study is to identify the app content (ie, types of foods and beverages) included in nutrition-themed apps intended for children, to assess the use of game-like features, and to examine app characteristics such as overall quality and behavior change techniques (BCTs).

METHODS

This analysis used a cross-sectional database of nutrition-themed apps intended for children (≤12 years), collected between May 2018 and June 2019 from the Apple App Store and Google Play Store (n=259). Apps were classified into four types: food games or nongames that included didactic nutrition guides, habit trackers, and other. Food and beverages were identified in apps and classified into 16 food categories, as recommended (8/16, 50%) and as not recommended (8/16, 50%) by dietary guidelines, and quantified by app type. Binomial logistic regression assessed whether game apps were associated with foods and beverages not recommended by guidelines. App quality, overall and by subscales, was determined using the Mobile App Rating Scale. The BCT Taxonomy was used to classify the different behavioral techniques that were identified in a subsample of apps (124/259, 47.9%).

RESULTS

A total of 259 apps displayed a median of 6 (IQR 3) foods and beverages. Moreover, 62.5% (162/259) of apps were classified as food games, 27.4% (71/259) as didactic nutrition guides, 6.6% (17/259) as habit trackers, and 3.5% (9/259) as other. Most apps (198/259, 76.4%) displayed at least one food or beverage that was not recommended by the dietary guidelines. Food game apps were almost 3 times more likely to display food and beverages not recommended by the guidelines compared with nongame apps (β=2.8; P<.001). The overall app quality was moderate, with a median Mobile App Rating Scale score of 3.6 (IQR 0.7). Functionality was the subscale with the highest score (median 4, IQR 0.3). Nutrition guides were more likely to be educational and contain informative content on healthy eating (score 3.7), compared with the other app types, although they also scored significantly lower in engagement (score 2.3). Most apps (105/124, 84.7%) displayed at least one BCT, with the most common BCT being information about health consequences.

CONCLUSIONS

Findings suggest nutrition-themed apps intended for children displayed food and beverage content not recommended by dietary guidelines, with gaming apps more likely to display not recommended foods than their nongame counterparts. Many apps have a moderate app quality, and the use of consequences (instead of rewards) was the most common BCT.

Consumption of Milk and alternatives decreased among Canadians from 2004 to 2015: evidence from the Canadian community health surveys

Background

Milk and milk products make important contributions to the diet of Canadians. The aim of this study was to examine trends in Milk & Alternatives consumption among Canadians (≥2 years) from 2004 to 2015.

Methods

We used nutrition data from 2 nationally representative cross-sectional surveys conducted in 2004 and 2015 [Canadian Community Health Survey (CCHS) 2004 Cycle 2.2 and CCHS-Nutrition 2015] to compare Milk & Alternatives consumption between 2004 and 2015. Data from 24-h dietary recalls were collected using the Automated Multiple-Pass Method (AMPM).

Result

From 2004 to 2015, the proportion of Canadians consuming Milk & Alternatives food group significantly decreased from 89.5 to 87.7% and the number of servings consumed per day dropped from 1.9 to 1.7. Despite their low energy contribution (12.3% of energy), Milk & Alternatives contributed 45.8% of calcium, 39.9% of vitamin D, and 36.0% of vitamin B12 to the diet of the Canadian population in 2015. Milk & Alternatives were among the top sources of vitamin A, phosphorus and riboflavin. Milk & Alternatives food group was a major contributor to saturated fat intake in both 2004 (31.2%) and 2015 (28.6%). In 2015, dietary intakes of calcium and vitamin D among Milk & Alternatives consumers were 137.8, and 59.4% higher, respectively, than those of non-consumers.

Conclusion

Daily intake of Milk & Alternatives has decreased in the Canadian population over time, which may adversely affect the nutritional profile of the diet.

Inadequate vitamin D status is associated with lower food plus supplemental intake of vitamin D in children of South Asian ethnicity living in the National Capital Region of Canada

Vitamin D status, measured in a Vitamin D Standardization Program certified laboratory, was assessed among children of South Asian and European ethnicity living in the national capital region of Canada to explore factors that may account for inadequate status. Demographic information, dietary and supplemental vitamin D over 30 d prior to measurement of serum 25-hydroxyvitamin D (25OHD), and anthropometry were measured (age 6.0-18.9 y; n = 58/group; February-March 2015). No group related differences in age, height and body mass index (BMI) Z-scores or in food vitamin D intakes were observed. Standardized serum 25OHD was lower in South Asian children (mean ± SD: 39.0 ± 16.8 nmol/L vs. European: 58.4 ± 15.8 nmol/L). A greater proportion of South Asian children had serum 25OHD <40 nmol/L (56.9 vs. 8.6%, P < 0.0001) and fewer took supplements (31 vs. 50%, P = 0.0389). In a multi-factorial model (r2 = 0.54), lower vitamin D status was associated with overweight/obese BMI and older age (14-18 y); no interaction with ethnicity was observed. Lower vitamin D status was associated with lower total vitamin D intake only in South Asian children. This study reinforces the importance of public health actions towards meeting vitamin D intake recommendations among those of high-risk deficiency. Novelty: A higher proportion of South Asian vs. European children had inadequate vitamin D status. Lower vitamin D status was associated with a BMI in the overweight/obese range. Lower vitamin D status was associated with lower total vitamin D intake in South Asian but not European children.

Nutrient intakes of Canadian adults: results from the Canadian Community Health Survey (CCHS)-2015 Public Use Microdata File

BACKGROUND

Accurate estimates of the usual intake of nutrients are important for monitoring nutritional adequacy and diet quality of populations. In Canada, comprehensive, nationally representative nutrient estimates have not been available since the Canadian Community Health Survey (CCHS)-Nutrition 2004 survey.

OBJECTIVE

The objective of this research was to assess nutrient intakes, distributions, and adequacy of the intakes of Canadian adults.

METHODS

Participants' first 24-h dietary recall, and the second-day recall from a subset of participants from the recently released CCHS 2015 Public Use Microdata File (PUMF) were used to estimate usual intakes of macronutrients, vitamins, and minerals in adults [≥19 y, excluding lactating females and those with invalid energy intake (EI)]. Usual intakes by DRI age-sex groups were estimated using the National Cancer Institute method, adjusted for age, sex, misreporting status, weekend/weekday, and sequence of recall analyzed (first/second) with outliers removed (final sample, n = 11,992). Usual intakes from food were assessed for prevalence of inadequacy in relation to DRI recommendations.

RESULTS

Canadian macronutrient intakes were within the recommended acceptable macronutrient distribution ranges. EI was 2154 kcal/d for males (19+) and 1626 kcal/d for females (19+). A high prevalence of inadequate intakes was seen for vitamin A (>47%), vitamin D (>94%), vitamin C (>29% for nonsmokers and >59% for smokers), magnesium (>45%), and calcium (>44%), whereas <25% and <40% of adults (19+) had intakes above the adequate intake for fiber and potassium, respectively. Canadians continue to consume sodium in excess of recommendations (74.8% of males and 47.6% of females).

CONCLUSIONS

A significant number of Canadian adults may not be meeting recommendations for several essential nutrients, contributing to nutrient inadequacies. These results highlight the nutrients of concern by specific age-sex groups that may be important for public health interventions aimed at improving diet quality and nutrient adequacy for Canadian adults.

Generating community measures of food purchasing activities using store-level electronic grocery transaction records: an ecological study in Montreal, Canada

OBJECTIVE

Geographic measurement of diets is generally not available at areas smaller than a national or provincial (state) scale, as existing nutrition surveys cannot achieve sample sizes needed for an acceptable statistical precision for small geographic units such as city subdivisions.

DESIGN

Using geocoded Nielsen grocery transaction data collected from supermarket, supercentre and pharmacy chains combined with a gravity model that transforms store-level sales into area-level purchasing, we developed small-area public health indicators of food purchasing for neighbourhood districts. We generated the area-level indicators measuring per-resident purchasing quantity for soda, diet soda, flavoured (sugar-added) yogurt and plain yogurt purchasing. We then provided an illustrative public health application of these indicators as covariates for an ecological spatial regression model to estimate spatially correlated small-area risk of type 2 diabetes mellitus (T2D) obtained from the public health administrative data.

SETTING

Greater Montreal, Canada in 2012.

PARTICIPANTS

Neighbourhood districts (n 193).

RESULTS

The indicator of flavoured yogurt had a positive association with neighbourhood-level risk of T2D (1·08, 95 % credible interval (CI) 1·02, 1·14), while that of plain yogurt had a negative association (0·93, 95 % CI 0·89, 0·96). The indicator of soda had an inconclusive association, and that of diet soda was excluded due to collinearity with soda. The addition of the indicators also improved model fit of the T2D spatial regression (Watanabe-Akaike information criterion = 1765 with the indicators, 1772 without).

CONCLUSION

Store-level grocery sales data can be used to reveal micro-scale geographic disparities and trends of food selections that would be masked by traditional survey-based estimation.

Gender plays a role in adolescents' dietary behaviors as they transition to secondary school

Little research explores how changes in adolescents' peer, family and school environments may influence dietary behaviors during the shift from elementary school to secondary school and whether boys and girls experience these changes in similar ways. Drawing on Bronfenbrenner's socio-ecological model and Ridgeway's gendered framework, thematic analysis of twenty-seven semi-structured interviews with parent-adolescent dyads reveals that changes in adolescents' peer, family and school environments affect dietary behaviors following the transition in gendered ways. Within the peer context, food facilitates friendships among girls. Girls use food to forge intimate relationships with their peers whereas boys do not report relying on their peers to influence their dietary choices. In the family environment, gender-based body ideals (i.e., being strong and fit for boys versus being thin for girls) become more apparent and influential over adolescents' dietary behaviors. In some families, parents oppose gender-based body ideals (i.e., food restriction among girls) whereas in others, parents' expectations around food become supportive of gendered norms (i.e., encouraging food consumption among boys to gain muscle or acquiring food literacy skills among girls). Within the school context, socializing emerges as a key priority above eating at lunchtime, but boys and girls engage in this socialization differently. Girls use their lunch hour to socialize with peers through sedentary activities whereas boys socialize through team sports. In summary, gender plays a role in how changes in the peer, family and school environments influence boys' and girls' dietary behaviors as they transition into secondary school. Future public health interventions should consider using a targeted gender approach to encourage adolescents to make healthier food choices.

Food and Nutrient Intakes of Nova Scotian Children in Home and Childcare Environments

Purpose: To describe the energy (E), sodium, saturated fat, sugar, and fibre intakes of a sample of children attending regulated childcare (RCC) in Nova Scotia.Methods: Nutrient analyses from 79 food records were compiled and grouped by intakes in and outside of RCC, age, sex, location of the RCC (urban or rural), and nutrient intake data. Descriptive statistics and independent t tests were conducted.Results: Mean E and macronutrients were within recommended ranges and, for days attending RCC, 45%E was consumed in RCC. Saturated fat intake was 12%E on average. Mean sodium intake exceeded or approached the tolerable upper limit for 3-year olds (1726 mg/day) and 4-5-year olds (1770 mg/day), respectively. Total sugar was 27%E intake and significantly more sugar was consumed outside RCC and by boys compared to girls. Mean daily dietary fibre intake was below recommended levels (15 g/day).Conclusions: On average dietary intakes of children exceeded recommendations for sodium, saturated fat, and sugar with higher intakes outside RCC. The foods provided by RCC have a positive influence on children's intakes, but given the pervasiveness of sugar and sodium in the food environment and the challenges of feeding children, support is needed for both RCC and families to encourage healthy eating behaviours for positive growth and development.

Development and Pilot Testing of a Nutrition Attitudes and Knowledge Questionnaire to Measure Changes of Child Nutrition Knowledge related to the Canada's Food Guide

Foodbot Factory is a serious game developed to teach children about the 2019 Canada's Food Guide (CFG) healthy eating principles. Because no measurement tools existed to assess changes in children's knowledge of the CFG, the Nutrition Attitudes and Knowledge (NAK) questionnaire was developed for this purpose. The NAK is based on the 2019 CFG nutrition content and aligned with the Foodbot Factory modules (Drinks, Whole Grain foods, Vegetables and Fruit, Protein foods). Seven experts assessed face and content validity of the draft NAK questionnaire. Three sections were deemed valid, while the remaining two required minor revisions. The NAK was pilot tested for changes in nutrition attitudes and knowledge among children 9-10 years-old (n=23), who answered the NAK questionnaire before and after using Foodbot Factory. Significant increases were found in overall nutrition knowledge, and knowledge of Whole Grain foods, Vegetables and Fruit and Protein foods. Knowledge of Drinks and nutrition attitudes remained unchanged. The NAK showed a moderate reliability when tested among a group of children (n=23). While the NAK questionnaire is a promising tool for assessing changes nutrition knowledge related to the 2019 CFG guidelines in children, further research is required to test construct validity of this instrument. Novelty bullets: • The Nutrition Attitudes and Knowledge (NAK) questionnaire was developed by educators and dietitians. • The NAK underwent face and content validity assessments and was pilot tested among children. • The NAK questionnaire is a potential tool to detect changes in children's knowledge of the 2019 Canada's Food Guide.

Association between whole grain food intake in Canada and nutrient intake, food group intake and diet quality: Findings from the 2015 Canadian Community Health Survey

Whole grains have been associated with numerous beneficial health outcomes and are recommended in Canada's Food Guide; however, there is little research on whole grains specific to Canada. Therefore, the objective of this study was to characterize the association between Canadians' WG intake and nutrients, food groups and diet quality and to understand top sources of WG in the diets of Canadians. We used data from the Canadian Community Health Survey 2015: a cross-sectional survey that collected information on diet (using a 24-hour recall) and health from 20,487 Canadians 1 year and older. We classified study participants according to their WG intake: non-WG (n = 10,883) and three groups based on age-specific tertiles of WG intake, low-WG (n = 3,322), mid-WG (n = 3,180), and high-WG (n = 3,102). Results were analyzed using population-based survey methods and were adjusted for energy, age, gender, overweight/obesity, income, and supplement use. We found differences in nutrients and food groups by WG group: there was a significant linear trend across groups of increasing WG for increased fiber (children and adults), vitamin B6 (children), thiamin (adults), potassium (children and adults), zinc (adults), calcium (children and adults), iron (children and adults), magnesium (children and adults), fruit (adults), and legumes, nuts and seeds (adults); and decreased total fat (adults), saturated fat (adults), folate (children and adults), refined grains (adults and children), and meat and poultry (adults) intake. We found that there were no differences in total sugar or sodium intake across WG intake groups. The high WG intake group for both children and adults had higher diet quality, measured by the Nutrient Rich Food Index 9.3, compared to non-WG eaters. The top 2 food sources of WG across WG intake groups for children and adults were whole grain oat and high fiber breakfast cereal and whole grain and whole wheat bread. Other top sources of WG included rice, bread products, other breakfast cereals, salty snacks, cereal grains and flours, pasta, and sweet snacks. This research supports recommendations to increase WG foods intake as a means to improve diet quality of Canadians.

Prediction of type 2 diabetes mellitus based on nutrition data

Numerous predictive models for the risk of type 2 diabetes mellitus (T2DM) exist, but a minority of them has implemented nutrition data so far, even though the significant effect of nutrition on the pathogenesis, prevention and management of T2DM has been established. Thus, in the present study, we aimed to build a predictive model for the risk of T2DM that incorporates nutrition data and calculates its predictive performance. We analysed cross-sectional data from 1591 individuals from the population-based Cooperative Health Research in the Region of Augsburg (KORA) FF4 study (2013–14) and used a bootstrap enhanced elastic net penalised multivariate regression method in order to build our predictive model and select among 193 food intake variables. After selecting the significant predictor variables, we built a logistic regression model with these variables as predictors and T2DM status as the outcome. The values of area under the receiver operating characteristic (ROC) curve, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of our predictive model were calculated. Eleven out of the 193 food intake variables were selected for inclusion in our model, which yielded a value of area under the ROC curve of 0⋅79 and a maximum PPV, NPV and accuracy of 0⋅37, 0⋅98 and 0⋅91, respectively. The present results suggest that nutrition data should be implemented in predictive models to predict the risk of T2DM, since they improve their performance and they are easy to assess.

Seeing the food swamp for the weeds: Moving beyond food retail mix in evaluating young people's food environments

Nutritional health of children and youth is an increasing cause for concern in Canada. Through food and beverage messaging in multiple environments, young people develop eating behaviours with ramifications throughout their life course. Unhealthy food retailers near schools, recreation facilities, and childcare centres-key activity settings for healthy eating promotion-present repeated, compounding exposures to commercial geomarketing. Geomarketing impacts nutritional health by promoting highly processed, calorie-dense, and nutrient-poor foods and beverages across urban landscapes. While food retail mix (as a ratio of healthy to unhealthy food retailers) can be used to assess food environments at multiple scales, such measures may misrepresent young people's unique experience of these geographic phenomena. Moving beyond uniform conceptualization of food environments, new research methods and tools are needed for children and youth. We investigated young people's food environments in the major Canadian cities of Calgary and Edmonton. Using government-initiated nutrition guidelines, we categorized 55.8% of all food retailers in Calgary, and 59.9% in Edmonton as 'unhealthy'. A Bernoulli trial at the 0.05 alpha level indicated few differences in prevalence proximal to activity settings versus elsewhere in both cities, demonstrating the limited applicability of food retail mix for characterizing young people's food environments. To model unhealthy food retailers geomarketing to children and youth, we considered their proximity to multiple activity settings, using overlapping radial buffers at the 250 m, 500 m, 1000 m, and 1500 m scales. Examining young people's food environments relative to the spaces where they learn and play, we determined that as many as 895 out of 2663 unhealthy food retailers fell within 1500 m of 21+ activity settings. By conceptualizing, measuring, and problematizing these "super-proximal" unhealthy food retailers, urban planners and public health researchers can use these techniques to pinpoint unhealthy food retailers, or "weeds in the food swamp," as a critical site for healthy eating promotion in municipalities.

Effect of dairy intake with or without energy restriction on body composition of adults: overview of systematic reviews and meta-analyses of randomized controlled trials

CONTEXT

Some studies suggest that consumption of dairy products can aid in weight loss, while others suggest a negative effect or no effect.

OBJECTIVE

An overview of systematic reviews and meta-analyses was conducted to examine the effect of dairy product consumption on changes in body composition.

DATA SOURCES

PRISMA guidelines were followed to ensure transparent reporting of evidence. The MEDLINE, Embase, Cochrane Central Database of Systematic Reviews, and Web of Science databases were searched from inception to April 2018.

STUDY SELECTION

Six systematic reviews and 47 associated meta-analyses (which included the results of 58 different randomized controlled trials) published in English or Spanish and reporting data on dairy intake and changes in weight, fat mass, lean mass, or waist circumference were included.

DATA EXTRACTION

Two authors independently extracted the data and assessed the risk of bias using the AMSTAR2 tool.

RESULTS

Dairy consumption interventions without dietary energy restriction had no significant effects on weight, fat mass, lean mass, or waist circumference. Interventions in energy-restricted settings had significant effects on fat mass and body weight.

CONCLUSIONS

Increasing total dairy intake without energy restriction in adults does not affect body composition. In the context of an energy-restricted diet, however, increased dairy intake results in lower fat mass and body weight but has no conclusive effects on waist circumference or lean mass.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number CRD42018094672.

Dietary Riboflavin Intake and Riboflavin Status in Young Adult Women Living in Metro Vancouver, Canada

BACKGROUND

Nutrition surveys suggest that <10% of Canadian adults have inadequate riboflavin intakes. However, biochemical riboflavin deficiency [erythrocyte glutathione reductase activity coefficient (EGRac) ≥1.40] has been reported in 41% of young adult women living in Metro Vancouver. Canadian Chinese ethnicity comprise >25% of Vancouver's population and are postulated to have poorer riboflavin status than those of European ethnicity because they could be less likely to consume dairy products and fortified wheat.

OBJECTIVES

The objectives of this study were to determine dietary riboflavin intake and food sources, and to assess the association between riboflavin intake and status in young women of European (n = 107) and Chinese (n = 91) ethnicities living in Metro Vancouver, Canada.

METHODS

This was a cross-sectional study conducted in women (aged 19-45 y). Women were healthy, not pregnant or breastfeeding, of European or Chinese ethnicities, and not taking riboflavin-containing supplements for the past 4 mo. Dietary riboflavin intake was assessed using the past-year Diet History Questionnaire II, and riboflavin status (EGRac) was measured in fasting venous blood samples.

RESULTS

Only 7% of participants had dietary riboflavin intakes below the Estimated Average Requirement (0.9 mg/d), but 40% of women had biochemical riboflavin deficiency (EGRac ≥1.40). Although more Canadian women of European ethnicity than Chinese ethnicity had biochemical riboflavin deficiency (46% and 34%; P < 0.001), median dietary riboflavin intake did not differ (1.73 and 1.82 mg/d; P = 0.587). Dairy products and vegetables contributed the most to riboflavin intake. Energy-adjusted dietary riboflavin intake was inversely associated with EGRac (B = -0.04, 95% CI: -0.07, -0.01). However, after further adjustment the relation was not significant.

CONCLUSIONS

Overall, women of reproductive age living in Metro Vancouver, Canada, had a low prevalence of inadequate dietary riboflavin intake despite the high prevalence of apparent biochemical riboflavin deficiency.

Are closed campus policies associated with adolescent eating behaviours?

INTRODUCTION

The effectiveness of school nutrition regulations may be undermined by food environments surrounding schools. Given challenges in regulating external retail, some have recommended policies that ensure students are unable to leave school property during the day (closed campus policies; CCP). We aimed to examine whether CCP are associated with student eating behaviours.

METHODS

We used student and school-administrator survey data from the 60 610 Grades 9 to 12 students and 134 Canadian secondary schools that participated in Year 7 (2018/19) of the COMPASS study. Multiple ordinal regression models tested school CCP as a predictor of weekday dietary behaviours (0-5 days), controlling for student-level (grade, sex, spending money, ethnicity) and school-level (urbanicity, province, area median household income, vending machines) covariates.

RESULTS

CCP were reported by 16 schools. Students who attended CCP schools reported eating lunch purchased from fast food outlets or other restaurants and drinking sugar-sweetened beverages (SSBs; soft drinks and sports drinks; sweetened coffee or tea drinks) on fewer weekdays, but consumed snacks from school vending machines on more weekdays, relative to students at open campus schools. No significant differences were observed in student reports of eating home-packed or school cafeteria lunches or snacks purchased off-campus.

CONCLUSION

CCP may help improve adolescent diets by reducing SSB and lunchtime fast food consumption on weekdays; however, students already purchasing food may shift from off-campus to within-school options, highlighting the importance of ensuring healthy school food environments and encouraging students to bring home-prepared lunches. Future studies using experimental longitudinal designs are needed to determine the effect of CCP on various health behaviours and outcomes.

Barriers and facilitators of household provision of dairy and plant-based dairy alternatives in families with preschool-age children

OBJECTIVE

This study aimed to explore barriers and facilitators of the provision of dairy and plant-based dairy alternatives (PBDA) by parents of preschool-age children, a previously unexplored area of research.

DESIGN

Five focus groups of parents were conducted and audio-recorded. Verbatim transcripts were analysed using thematic analysis.

SETTING

University of Guelph, in Guelph, ON, Canada in 2019.

PARTICIPANTS

Thirty-two (n 19 mothers, 13 fathers) parents of preschool-age children. Most (59 %) were university or college educated.

RESULTS

Facilitators common to both dairy and PBDA provision included perceived nutritional benefits, such as dairy's Ca, protein and fat content, and PBDA's protein content, and the perception that PBDA adds variety to the diet. Facilitators unique to dairy v. PBDA provision included the taste of, familiarity with, and greater variety and accessibility of dairy products, specifically child-friendly products. A facilitator unique to PBDA v. dairy provision was ethical concerns regarding dairy farming practices. Barriers common to both dairy and PBDA provision included perceived cost, concerns regarding the environmental impact of production, and high sugar content. Barriers specific to dairy included use of antibiotics and hormones in dairy production. A barrier specific to PBDA was the use of pesticides.

CONCLUSION

Behaviour change messages targeting parents of preschoolers can emphasise the nutrition non-equivalence of dairy and some PBDA and can educate parents on sources of affordable, unsweetened dairy and PBDA.

An examination of contributions of animal- and plant-based dietary patterns on the nutrient quality of diets of adult Canadians

Dietary guidance and Canada's 2019 Food Guide encourage increased consumption of plant-based foods as a source of dietary protein. However, there is an absence of recent data on protein and nutrient intakes and quality of Canadian dietary patterns that might occur with increased plant protein intakes. This study compared food sources and nutrient intakes of Canadian adults within groups of increasing plant protein-containing diets. The CCHS 2015 Public-Use Microdata File of single 24-hour dietary recalls of males and females ≥19 years (n = 6498) or ≥70 years (n = 1482) were examined. Respondents were allocated into 4 groups defined by their protein intake percentage coming from plant-based foods (i.e., group 1: 0-24.9%, group 2: 25-49.9%, group 3: 50-74.9%, group 4: 75-100%). Protein intake in adults averaged 63.3% animal and 36.7% plant protein. Where plant protein contributed >50% protein, higher intakes of carbohydrate, dietary fibre, folate, dietary folate equivalents, iron and magnesium (p < 0.001) but lower intakes of total and saturated fat, protein, vitamin D, vitamin B12, riboflavin and niacin (p < 0.0001) were reported. In contrast, group 1 had higher total and saturated fat, protein, vitamin B12, thiamin, niacin, and zinc, but lower carbohydrate, dietary fibre, and magnesium. Balancing plant- with animal-based protein foods leads to healthier dietary patterns with more favourable nutritional properties when compared with diets based on either high animal or high plant protein content. Novelty: Combinations of animal- and plant-based proteins improve nutrient quality of Canadian diets. The source of protein influences diet quality.

Seafood Consumption and Its Contribution to Nutrients Intake among Canadians in 2004 and 2015

Fish and seafood are excellent sources of nutrients such as omega-3 fatty acids, Vitamin D, and selenium. The aims of this study were to examine the pattern of seafood consumption among Canadians and determine their contribution to intakes of energy and nutrients. Day-1 24-h dietary recalls data collected from a national survey, the Canadian Community Health Survey—Nutrition in 2004 and 2015, were used to estimate food and nutrient intakes among Canadians. Seafood was classified according to the Bureau of Nutritional Sciences food list. Descriptive statistics were used to calculate the consumption rate and the average consumption amount of seafood by different age groups and sociodemographic characteristics. Population ratios were used to assess the contribution of seafood to the total intake of energy and nutrients. The overall consumption rate of seafood was around 17%, and the rate was similar between males and females, and slightly higher in 2015 (17.71%) compared to 2004 (16.38%). The average portion size is approximately 100 g, which translates into a ≈36 kg annual intake among the consumers and ≈6.2 kg per capita consumption. Adults (especially 30 years and above), Asians, individuals who were married, and with post-secondary education were more likely to consume seafood. Salmon, tuna, shrimp, cod, and crab were the most frequently consumed seafood in Canada, the consumption rate of which all increased from 2004 to 2015. Seafood provided up to 75% of n-3 PUFAs, 18% of Vitamin D, 19% Vitamin B12, 6% of niacin, and 4% of Vitamin B6 from all food sources. Seafood consumers had a healthier diet, as seafood consumption was related to a higher intake of key nutrients and a lower intake of total sugar and saturated fatty acids. Therefore, fish consumption should be promoted among Canadians.

Why Per Capita Apple Consumption Is Falling: Insights from the Literature and Case Evidence from South Tyrol

Per capita apple consumption is falling in many European countries while overall fruit intake is growing or is stable, and consumption of other fruits is increasing. The reasons for the consumption decline of the world’s third most produced fruit are unclear. Based on an extensive literature review and a logit regression of data from a postal survey of 153 apple consumers in South Tyrol, Italy, the purpose of this study is to explain this trend. We show that (i) the increasing average age of consumers, (ii) economic factors such as consumer incomes and apple prices in combination with other demographic characteristics at least for some population segments, (iii) the dissatisfaction of some consumers with available mainstream apple varieties, and (iv) the below-average nutrient content of apples as compared to other fruits for health-conscious consumers are among the main causes. For the European apple growing industry, the decline in local per capita apple consumption may not be an economic problem if the industry decides to focus on emerging markets in the future. However, innovating fruit quality and better satisfying apple consumer preferences in high-income markets may prove to be more challenging.

The Effectiveness of the Foodbot Factory Mobile Serious Game on Increasing Nutrition Knowledge in Children

The interactive and engaging nature of serious games (i.e., video games designed for educational purposes) enables deeper learning and facilitates behavior change; however, most do not specifically support the dissemination of national dietary guidelines, and there are limited data on their impact on child nutrition knowledge. The Foodbot Factory serious game mobile application was developed to support school children in learning about Canada's Food Guide; however, its impacts on nutrition knowledge have not been evaluated. The objective of this study was to determine if Foodbot Factory effectively improves children's knowledge of Canada's Food Guide, compared to a control group (control app). This study was a single-blinded, parallel, randomized controlled pilot study conducted among children ages 8-10 years attending Ontario Tech University day camps. Compared to the control group (n = 34), children who used Foodbot Factory (n = 39) had significant increases in overall nutrition knowledge (10.3 ± 2.9 to 13.5 ± 3.8 versus 10.2 ± 3.1 to 10.4 ± 3.2, p < 0.001), and in Vegetables and Fruits (p < 0.001), Protein Foods (p < 0.001), and Whole Grain Foods (p = 0.040) sub-scores. No significant difference in knowledge was observed in the Drinks sub-score. Foodbot Factory has the potential to be an effective educational tool to support children in learning about nutrition.

Consumers' Implicit and Explicit Recall, Understanding and Perceptions of Products with Nutrition-Related Messages: An Online Survey

This study aimed to assess consumers' implicit and explicit recall, understanding and perceptions of products with a nutrition claim and a symbol depicting 'health,' and to determine whether these perceptions differed among Nutrition Facts table (NFt) users vs. nonusers. In an online survey, participants (n = 1997) were randomized to one of eight conditions in a 2 × 2 × 2 factorial design, consisting of a label with a claim (present/absent) a heart-shaped symbol depicting 'health' (present/absent) for a healthier or less healthy soup. Participants were shown a label for 10 s and asked whether they recalled seeing a claim. If participants answered yes, they were then asked to describe their response using open-ended questions. Participants also rated the product's perceived nutritional quality and purchase intentions using seven-point Likert scales. In the claim condition, most participants (75%) were able to recall the presence of a claim, while 12% incorrectly mentioned the presence of a claim when there was none. Claims likely attracted consumers' attention and increased perceived nutritional quality, although with limited influence among NFt users (23%). The symbol depicting 'health' did not enhance perceived nutritional quality or purchase intentions. Although most participants (77%) made their decisions implicitly using the front of labels, those who used the NFt had a better understanding of the nutritional quality of products.

Diet Quality and Health Service Utilization for Depression: A Prospective Investigation of Adults in Alberta's Tomorrow Project

Depression is a leading cause of disability and economic burden worldwide. Primary prevention strategies are urgently needed. We examined the association of diet quality with depression in a large provincial cohort of adults. A past year food frequency questionnaire was completed by Alberta’s Tomorrow Project (ATP) participants enrolled between 2000–2008 (n = 25,016; average age 50.4 years) and used to calculate Healthy Eating Index-Canada (HEI-C) 2015 scores. The number of physician visits for depression 2000–2015 was obtained via linkage with administrative health records. Negative binomial regression models assessed the relationship between HEI-C 2015 scores and physician visits for depression, adjusting for confounders. Every 10-unit increase in HEI-C 2015 scores was associated with 4.7% fewer physician visits for depression (rate ratio (RR): 0.95; 95% Confidence Interval (CI): 0.92–0.98). This relationship persisted when participants with physician visits for mental illness prior to cohort enrollment were excluded. Higher quality diets were associated with a lower number of physician visits for depression. Results highlight diet may be an important prevention strategy for reducing the burden of health service utilization for depression.

Frequency of fruit juice consumption and association with nutrient intakes among Canadians

Background:

In Canada, studies on consumption of 100% fruit juice and nutrient intakes are limited.

Aim:

This study aimed to evaluate nutrient intakes and adequacy of intake by frequency of fruit juice consumption.

Methods:

Individuals ≥1 year (n = 34,351) participating in the Canadian Community Health Survey, 2004 with a 24-hour dietary recall and reported usual frequency of fruit juice consumption (assumed to be 100% juice) were categorized by frequency of consumption as <0.5, ≥0.5 to <1.5, or ≥1.5 times/day.

Results:

More frequent consumption of fruit juice (≥0.5 times/day) was associated with higher intakes of total fruits and vegetables, whole fruits, energy, total sugars, vitamin C and potassium. More frequent consumption of fruit juice was associated with improved intake adequacy of vitamin C for adults.

Conclusions:

Fruit juice consumption contributes to increased intakes of vitamin C and potassium as well as energy and total sugars, thus presenting a trade-off for consumers to balance.

Co-consumption of Vegetables and Fruit, Whole Grains, and Fiber Reduces the Cancer Risk of Red and Processed Meat in a Large Prospective Cohort of Adults from Alberta's Tomorrow Project

We examined whether co-consumption of red and processed meat with key foods items and food constituents recommended for cancer prevention (vegetables and fruit, whole grains, and fiber) mitigates cancer incidence. In a prospective cohort of 26,218 adults aged 35–69 years at baseline, dietary intake was collected through 124-item past-year food frequency questionnaire. Incidence of all-cause and 15 cancers previously linked to red and processed meat intake was obtained through data linkage with a cancer registry (average follow-up 13.5 years). Competing risk Cox Proportional Hazard models estimated cancer risk and Accelerated Failure Time models estimated time-to-cancer occurrence for different combinations of intake levels while considering mortality from vital statistics and established confounders. Co-consumption of low vegetables and fruit intake with high processed meat was associated with higher incidence of all-cause and 15 cancers (men: HR = 1.85, 1.91; women: HR = 1.44, 1.49) and accelerated time-to-cancer occurrence (men: 6.5 and 7.1 years and women: 5.6 and 6.3 years, respectively), compared to high vegetables and fruit with low processed meat intake. Less pronounced and less consistent associations were observed for whole grains and fiber and for red meat. The findings provide initial evidence toward refining existing cancer prevention recommendations to optimize the intake and combination of foods in the general adult population.

Translating "protein foods" from the new Canada's Food Guide to consumers: knowledge gaps and recommendations

The revised version of Canada's Food Guide, released in January 2019, issued new guidance by combining meat and alternatives with milk and alternatives into a single group called "protein foods" and emphasized selecting plant-based foods from this category more often. Though the changes represent a simple depiction of a healthy plate, the new Food Guide has opened knowledge gaps about protein foods and exposed new concerns about the interpretation and implementation of the Food Guide among vulnerable groups, particularly children and the elderly. To address key knowledge and research gaps, nutrition leaders need to reach a consensus on key messages to best inform the development of tools and resources to support practitioners in translating messages to consumers, including foodservice standards. Among consumers, families with young children are a primary target for these resources as they develop their life-long habits to ensure they have the knowledge and skills to select, prepare, and consume nutrient-rich protein foods. The new Food Guide provides an opportunity to address the existing knowledge gaps, develop tools and resources to support health professionals, and design interventions that will help Canadian families choose, prepare, and eat nutrient-rich protein foods. Novelty An updated Canadian regulatory framework is needed for protein labelling and content/health claims. There are knowledge gaps about protein foods consumption and food literacy needed to optimize nutritional health. Mandatory nutrition policies are needed to safeguard the provision of high-quality protein foods across institutions that serve children and older adults.

Optimizing Child Nutrition Education With the Foodbot Factory Mobile Health App: Formative Evaluation and Analysis

BACKGROUND

Early nutrition interventions to improve food knowledge and skills are critical in enhancing the diet quality of children and reducing the lifelong risk of chronic disease. Despite the rise of mobile health (mHealth) apps and their known effectiveness for improving health behaviors, few evidence-based apps exist to help engage children in learning about nutrition and healthy eating.

OBJECTIVE

This study aimed to describe the iterative development and user testing of Foodbot Factory, a novel nutrition education gamified app for children to use at home or in the classroom and to present data from user testing experiments conducted to evaluate the app.

METHODS

An interdisciplinary team of experts in nutrition, education (pedagogy), and game design led to the creation of Foodbot Factory. First, a literature review and an environmental scan of the app marketplace were conducted, and stakeholders were consulted to define the key objectives and content of Foodbot Factory. Dietitian and teacher stakeholders identified priority age groups and learning objectives. Using a quasi-experimental mixed method design guided by the Iterative Convergent Design for Mobile Health Usability Testing approach, five app user testing sessions were conducted among students (ages 9-12 years). During gameplay, engagement and usability were assessed via direct observations with a semistructured form. After gameplay, qualitative interviews and questionnaires were used to assess user satisfaction, engagement, usability, and knowledge gained.

RESULTS

The environmental scan data revealed that few evidence-based nutrition education apps existed for children. A literature search identified key nutrients of concern for Canadian children and techniques that could be incorporated into the app to engage users in learning. Foodbot Factory included characters (2 scientists and Foodbots) who initiate fun and engaging dialogue and challenges (minigames), with storylines incorporating healthy eating messages that align with the established learning objectives. A total of five modules were developed: drinks, vegetables and fruit, grain foods, animal protein foods, and plant protein foods. Seven behavior change techniques and three unique gamified components were integrated into the app. Data from each user testing session were used to inform and optimize the next app iteration. The final user testing session demonstrated that participants agreed that they wanted to play Foodbot Factory again (12/17, 71%), that the app is easy to use (12/17, 71%) and fun (14/17, 88%), and that the app goals were clearly presented (15/17, 94%).

CONCLUSIONS

Foodbot Factory is an engaging and educational mHealth intervention for the Canadian public that is grounded in evidence and developed by an interdisciplinary team of experts. The use of an iterative development approach is a demonstrated method to improve engagement, satisfaction, and usability with each iteration. Children find Foodbot Factory to be fun and easy to use, and can engage children in learning about nutrition.

Promoting healthy beverage consumption habits among elementary school children: results of the Healthy Kids Community Challenge 'Water Does Wonders' interventions in London, Ontario

INTERVENTION

This study examines the impact of London's Healthy Kids Community Challenge (HKCC) 'Water Does Wonders' interventions, which combined water infrastructure and education programs.

RESEARCH QUESTION

How effective were the HKCC interventions at increasing water and decreasing sugar-sweetened beverage (SSB) consumption among grade 4-8 children in London, Ontario?

METHODS

Non-randomized controlled trial. Children's knowledge and beverage intake were measured before and after the interventions were implemented during the 2016-2017 school year. Children at intervention schools (n = 521) received education programs (Growing Chefs or UTRCA [Upper Thames River Conservation Authority]) and water bottle filling stations. Children at control schools (n = 410) received filling stations only. Multivariable linear mixed-model ANCOVAs were used to compare water and SSB consumption and knowledge across intervention groups, accounting for school-level clustering.

RESULTS

Children who received an education intervention and filling station compared with only a filling station consumed more water (β = 2.18 (95% CI - 1.87, 6.22) for Growing Chefs and β = 2.90 (95% CI - 0.23, 6.03) for UTRCA) and fewer SSBs (β = - 1.17 (95% CI - 3.83, 1.49) for Growing Chefs and β = - 2.56 (95% CI - 5.12, 0.001) for UTRCA) post-intervention, and had higher nutrition knowledge (β = 1.57 (95% CI - 1.68, 4.83) for Growing Chefs and β = 2.02 (95% CI - 0.35, 4.39) for UTRCA). These findings were not statistically significant.

CONCLUSIONS

An intervention intended to promote healthy beverage consumption yielded effects in the expected direction; however, they were small and not statistically significant. This is likely because the educational interventions were not fully aligned with the goals of the 'Water Does Wonders' program, preventing them from evoking meaningful changes in dietary behaviours.

Calcium Intake in Children with Eczema and/or Food Allergy: A Prospective Cohort Study

Eczema and food allergy may impact diet. Using data from a cohort of Manitoba children born in 1995, we examined calcium intake, defined as the frequency and quality of calcium products consumed (with the exception of cheese), amongst Manitoba adolescents (12-14 years) with eczema or food allergy in childhood (7-8 years) or adolescence. At both ages, children were assessed by a physician for eczema and food allergy. Adolescents completed food frequency questionnaires. Calcium intake was defined as 1+ vs. <1 weekly. Linear and logistic regression was used as appropriate, with adjustments for confounders. Overall, 468 adolescents were included, of whom 62 (13.3%) had eczema only in childhood, 25 (5.3%) had food allergy only, and 26 (5.6%) had eczema and food allergy. Compared to children without eczema, those with eczema only had poorer calcium intake in adolescence (β -0.44; 95%CI -0.96; 0.00). Girls, but not boys, with eczema in childhood had poorer calcium intake in adolescence than girls without eczema (β -0.84; 95%CI -1.60; -0.08). These patterns persisted even if children experienced transient vs. persistent eczema to adolescence. Similar but non-significant trends were found for food allergy. Childhood eczema is associated with significantly lower calcium intake and consumption in adolescence. These differences persist to adolescence, even if a child "outgrows" their allergic condition.

Consumption and Sources of Saturated Fatty Acids According to the 2019 Canada Food Guide: Data from the 2015 Canadian Community Health Survey

The 2019 revised version of Canada’s Food Guide (CFG) recommends limiting the consumption of processed foods that are high in saturated fatty acids (SFA). Yet, the contributions of each CFG group to the total SFA intake of Canadians are not specifically known. The objectives of this study were to quantify the total SFA intake of Canadians, determine the sources of SFA consumed by Canadian adults, and identify potential differences in these sources. A nation representative sample from the Canadian Community Health Survey (CCHS – Nutrition 2015) was used for these analyses. Dietary intakes were measured using a single 24-h recall. Food sources of SFA were classified according to the revised 2019 CFG categories. We have also examined the contribution of foods not included in these three categories to total SFA intake. Among Canadian adults, total SFA contributed to 10.4 ± 0.1% (SE) of total energy intake (E). The “Protein foods” (47.7 ± 0.5% with 23.2 ± 0.4% from milk and alternatives and 24.5 ± 0.4% from meats and alternatives) and “All other foods” (44.2 ± 0.5%) categories were the main sources of total SFA intake. Few differences in SFA sources were identified between sexes, age groups, education levels, and body mass index (BMI) categories. These data show that the mean SFA consumption is greater than the 10% E cut-off previously proposed in Canada. Future studies should examine which food substitution is most likely to contribute to a greater reduction in SFA intake at the population level.

Consumption of Milk and Alternatives and Their Contribution to Nutrient Intakes among Canadian Adults: Evidence from the 2015 Canadian Community Health Survey-Nutrition

As a staple food and dense source of nutrients, milk and alternatives play an important role in nutrient adequacy. The aims of this study were to quantify the consumption of milk and alternatives within Canadian self-selected diets and determine their contribution to intakes of nutrients and energy. First, 24-h dietary recalls from the 2015 Canadian Community Health Survey—Nutrition were used to assess 1-d food and nutrient intakes among Canadian adults ≥19 y (n = 13,616). Foods were classified as milk and alternatives according to the 2007 Canada’s Food Guide. Descriptive statistics were used to calculate daily servings of milk and alternatives by different age groups and demographic characteristics. Population ratios were used to discern their contribution to total intakes of nutrients and energy. Mean daily servings (±SE) were highest for milk (0.60 ± 0.02) and cheese (0.42 ± 0.01), intermediate for frozen dairy (0.16 ± 0.01) and yoghurt (0.14 ± 0.01), and lowest for soy and other dairy (<0.03). Intakes were lowest among Canadians 51 + y (1.3 ± 0.03), females (1.25 ± 0.03), non-Caucasians (1.06 ± 0.05), those with less than a secondary education (1.19 ± 0.05), and British Columbians (1.17 ± 0.05). Milk and alternatives contributed >20% to total intakes of calcium (52.62 ± 0.46%), vitamin D (38.53 ± 0.78%), saturated fat (28.84 ± 0.51%), vitamin B12 (27.73 ± 0.57%), vitamin A (26.16 ± 0.58%), phosphorus (24.76 ± 0.35%), and riboflavin (24.43 ± 0.37%), of which milk was the top source. Milk and alternatives contribute substantially to nutrient intakes and thus warrant further attention in terms of mitigating nutrient inadequacy among the Canadian population.