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Patients with diagnosed diabetes receive recommendations by their healthcare providers about lifestyle modification, particularly on diet. The aim of this study was to determine the prevalence of type 2 diagnosed diabetes, undetected (undiagnosed) type 2 diabetes, and prediabetes of Canadian adults, and to evaluate whether individuals with diagnosed diabetes have different dietary intakes compared with the other groups. We used nationally representative data from Canadian Health Measures Survey Cycles 1 and 2 (n = 6807, representing estimated population of 23 022 890). We evaluated prevalence of diagnosed diabetes, undetected diabetes, and prediabetes and their distribution across sociodemographic and lifestyle factors. The intake from different food/food groups was compared between those with diagnosed diabetes and the rest of the population. Among Canadians 20–79 years of age, 12.4% had prediabetes, and 7.5% had diabetes. Among all diabetes cases, 37.3% were undiagnosed. All 3 diabetic categories were more prevalent among older age groups (60–79 years) compared with younger age (20–39 years) groups. Diagnosed diabetes and prediabetes were more prevalent among less educated individuals compared with the higher educated ones. Diagnosed diabetes was more common among individuals with lower-middle income level compared with the highest income level. Diagnosed diabetes individuals had lower intake from juice and ice cream and higher intake from potatoes and diet soft drinks compared with other groups. More than 600 000 adults were unaware of their diabetes status; the aware ones had lower intakes of sugar-containing foods. In evaluating the association between dietary intake and risk of chronic diseases in populations, diagnosed diabetes cases should be evaluated separately. [ABSTRACT FROM AUTHOR]

Excess sugar consumption in children has led to the removal of chocolate milk from some schools. Lower-sugar formulations, if accepted, would provide the benefits of milk consumption. In a cross-over trial, milk consumption was measured in 8 schools over 6 weeks in 2 phases: phase 1 provided standard 1% chocolate milk and plain 2% milk choices for the first 3 weeks, and phase 2 provided reduced-sugar 1% chocolate milk and plain 2% milk for the next 3 weeks. Milk selection and milk wasted were measured by sex and grade (1-8). Children chose chocolate milk more often than white milk in both phases (phase 1, 8.93% ± 0.75% vs. 0.87% ± 0.11% (p < 0.001), and phase 2, 5.76% ± 0.29% vs. 0.78% ± 0.14% (p < 0.001), respectively). Fewer children chose reduced-sugar chocolate milk in phase 2 (p < 0.001). A greater percentage of younger students (grades 1-4) than older students (grades 5-8) purchased milk in both phases (phase 1, 11.10% ± 0.81% vs. 8.36% ± 0.74%, p = 0.020, and phase 2, 8.47% ± 0.43% vs. 4.62% ± 0.40%, p < 0.001, respectively); older children drank more milk at lunch. Schoolchildren preferred chocolate milk over plain milk even when a reduced-sugar formula was offered; however, switching to reduced-sugar chocolate milk led to a decrease in the number of students choosing milk. Longer-duration studies are required to determine if students would purchase reduced-sugar chocolate milk at the same rate as they would purchase regular chocolate milk. [ABSTRACT FROM AUTHOR]

Initial risk assessment to estimate 10-year risk of cardiovascular disease (CVD) is completed by Framingham Risk Score (FRS). In 2012 2 modifications were added to FRS by the Canadian Cardiovascular Society: FRS is doubled in subjects aged 30-59 years who have CVD present in a first-degree relative before 55 years of age for men and 65 years of age for women; and cardiovascular age is calculated for each individual. Our aim was to implement these modifications and evaluate differences compared with traditional FRS. Further, we evaluated the association between dietary intake and 10-year risk. The Canadian Health Measures Survey data cycle 1 was used among participants aged 30-74 years ( n = 2730). Descriptive and logistic regression analyses were conducted using STATA SE 11. Using modified FRS for predicting 10-year risk of CVD significantly increased the estimated risk compared with the traditional approach, 8.66% ± 0.35% versus 6.06% ± 0.18%, respectively. Greater impact was observed with the 'cardiovascular age' modification in men versus women. The distribution of Canadians in low- (<10%) and high-risk (≥20%) categories of CVD show a significant difference between modified and traditional FRS: 67.4% versus 79.6% (low risk) and 13.7% versus 4.5% (high risk), respectively. The odds of having risk ≥10% was significantly greater in low-educated, abdominally obese individuals or those with lower consumption of breakfast cereal and fruit and vegetable and greater potato and potato products consumption. In conclusion, the traditional FRS method significantly underestimates CVD risk in Canadians; thus, applying modified FRS is beneficial for screening. Additionally, fibre consumption from fruit and vegetable or breakfast cereals might be beneficial in reducing CVD risks. [ABSTRACT FROM AUTHOR]

Studies in the United States report inclusion of flavoured milk in the diets of children and youth improves nutrient intakes. No research has investigated the contribution of flavoured milk to overall milk intake or the milk preferences of Canadian children. The objective of the study was to measure milk consumption (plain milk and flavoured milk) by children in an elementary school environment and investigate factors contributing to milk choice. A mixed-method research design was applied across 6 schools for 12 weeks. Milk waste was measured in grades 1-8 for 12 weeks. Weeks 1-4 (phase 1) and 9-12 (phase 3) provided both plain milk and flavoured milk as chocolate milk while weeks 5-8 (phase 2) provided plain milk only. Beverage Frequency Questionnaires were used in each phase (in grades 5-8 only) to assess usual beverage consumption. Statistical nutrient modelling was conducted to determine the effects of removing chocolate milk during phase 2 as a milk choice. Later, focus groups were conducted with students in grades 5-8 to determine what influences them to choose/not choose to drink milk. Total milk intake decreased by 12.3% when chocolate milk was removed from the schools (26.6% ± 5.2% to 14.31% ± 1.6%, p < 0.001). Milk choice was influenced by environmental factors as well as taste, cost, convenience, and variety. Total milk intake was associated with location ( p = 0.035) and cost ( p < 0.001), with rural students and/or those students receiving free milk drinking the greatest amount of milk. Nutrient modelling revealed chocolate milk is more cost-efficient and convenient at providing nutrients than alternative food/drink combinations. [ABSTRACT FROM AUTHOR]

The Dietary Reference Intakes (DRIs) are a set of recommendations for healthy persons. For the most part, recommendations are determined experimentally under controlled conditions of light activity. During increased physical activity, it is expected that micronutrient requirements would increase relative to the inactive state. Micronutrients of interest to athletes are those associated with oxygen handling and delivery, such as iron, and vitamin D, a newly emerging function of which is to maintain muscle strength. The DRI report on electrolytes (including water) is the most recent set of recommendations. In addition to recommendations for intakes to meet needs, many micronutrients have an upper level that indicates caution in consuming a large amount. We illustrate the process of setting DRI values for the micronutrients (including electrolytes and water), and provide a summary of instances where physical activity needs were considered when DRI values were derived. Understanding the origin of DRI values for micronutrients will assist in understanding how to use the values in assessment and planning. [ABSTRACT FROM AUTHOR]

Adequate calcium intake and supply of vitamin D during childhood play important roles in ensuring adequate bone mass gain to achieve optimal peak bone mass. The Healthy Immigrant Children study employed a mixed-method cross-sectional study design to characterize the health and nutritional status of 300 immigrant and refugee children aged 3–13 years who had been in Canada for less than 5 years. This paper presents bone mineral content and vitamin D status data along with qualitative data that deepen the understanding of newcomer bone health status. A significantly higher percentage of refugee children (72.3%) had insufficient (<50 nmol/L) or deficient (<30 nmol/L) serum vitamin D compared with immigrants (53.2%). Vitamin D deficiency was most common among ethnic minority girls. Newcomer children with higher intakes of vitamin D, younger newcomer children, and those from western Europe or the United States had higher serum vitamin D levels. Immigrants had significantly higher mean total body bone mineral content compared with refugees. Total body fat, serum vitamin D, calcium intake, height, height by calcium intake, total body fat by calcium intake, and total body fat by height predicted total body bone mineral content levels. Vitamin D deficiency among newcomer children may be related to lack of knowledge regarding children's vitamin D requirements in the Canadian environment, dietary habits established in country of origin, low income that limits healthy dietary choices, and lifestyle habits that limit exposure to sunlight. Results suggest a need to screen newcomer children and pregnant women for vitamin D deficiency and support early intervention. [ABSTRACT FROM AUTHOR]

The following series of papers comprise a symposium on Dietary Reference Intakes (DRIs), which are the new dietary recommendations for North Americans, that was presented at the 2004 Annual Meeting of the Canadian Society for Exercise Physiology. The process of developing the DRIs has been an enormous undertaking resulting, thus far, in 12 book-length reports spanning from 1997 to 2004. It was therefore timely to review the recommendations, describe the considerations for physical activity that went into setting the recommendations, and, where possible, indicate how the DRIs may be applied to athletes. [ABSTRACT FROM AUTHOR]

This prospective study investigated associations between cord blood vitamin D, risk factors for low vitamin D, and pregnancy and neonatal outcomes. The study included 65 maternal-fetal dyads delivering between December and February in Saskatoon, Saskatchewan. Eighty-five percent of mothers reported taking daily prenatal vitamin D but 70% of their newborns had insufficient or deficient cord blood vitamin D, suggesting that usual prenatal supplementation may be inadequate to achieve sufficient cord blood vitamin D in most newborns. [ABSTRACT FROM AUTHOR]

Canadians using supplements containing vitamin D are more likely to have 25-hydroxyvitamin D (25(OH)D) levels consistent with the Recommended Dietary Allowance, particularly with the low UVB exposure during the winter. This study aimed to determine these users' characteristics and to examine the relationship between dosage and 25(OH)D using the 2007-2009 Canadian Health Measures Survey ( n = 5604, 6-79 years of age). Logistic regression models examined the odds of supplement use within the preceding 30 days. Thirty-one percent used vitamin D supplements; 58.5% were female. In adjusted analyses, females' odds of supplement use were lower for those 12-19 years old (odds ratio (OR), 0.63; 95% CI, 0.41-0.96) and higher for those 60-79 years old (OR, 4.19; 95% CI, 2.69-6.64) and 40-59 years old (OR, 1.56; 95% CI, 1.10-2.20) compared with those 20-39 years old; their odds of supplement use were also higher for those of higher income (OR, 2.29; 95% CI, 1.26-4.16) and middle income (OR, 1.59; 95% CI, 1.03-2.46), those reporting ≥1 chronic disease (OR, 1.48; 95% CI, 1.06-2.06), and those consuming milk ≥1 time·day−1 (OR, 1.35; 95% CI, 1.14-1.60). For males, increased use was associated with age 60-79 years (OR, 2.41; 95% CI, 1.54-3.77) and 6-11 years (OR, 1.77; 95% CI, 1.19-2.64) and higher income (OR, 2.12; 95% CI, 1.49-3.00) and middle income (OR, 1.55; 95% CI, 1.04-2.31). Use did not vary significantly by race, education, season, body mass index, health, or physical activity. A total of 35.7% of Canadians >50 years old took ≥400 IU of vitamin D; 25(OH)D increased with increasing supplement dosage ( r = 0.33) in winter, but differences between 1-399 IU and 400-999 IU were not significant. Usage and nonusage patterns are important to consider as ways of improving vitamin D intake are pursued. [ABSTRACT FROM AUTHOR]

The article discusses a 2015 Canadian Community Health Survey on the prevalence of vitamin-mineral supplement use for improving micronutrient intake and preventing deficiencies. It states that prevalence was 38% and 53% among Canadian men and women, respectively, and that sociodemographic and lifestyle variables were linked to supplement use, especially among adults. Also noted are independent positive predictors of supplement use like female gender, older age, and higher education level.

The objective of this study was to determine trends in calcium intake from foods of Canadian adults from 1970-1972 to 2004. We compiled the calcium intake of adults (aged >=19 years) from foods from Nutrition Canada (1970-1972; n = 7036); 9 provincial nutrition surveys (1990-1999; n = 16 915); and the 2004 Canadian Community Health Survey 2.2 (n = 20 197). Where possible, we used published confidence intervals to test for significant differences in calcium intake. In 2004, the mean calcium intake of Canadians was below Dietary Reference Intake recommendations for most adults, with the greatest difference in older adults (>=51 years), in part because the recommended calcium intake for this group is higher (1200 mg) than that for younger adults (1000 mg). The calcium intake of males in every age category was greater than that of females. Calcium intake increased from 1970 to 2004, yet, despite the introduction of calcium-fortified beverages to the market in the late 1990s, increases in calcium intake between 1970 and 2004 were modest. Calcium intakes in provinces were mostly similar in the 1990s and in 2004, except for women in Newfoundland and Labrador, who consumed less, especially in the 1990s, and for young men in 2004 in Prince Edward Island, who consumed more. When supplemental calcium intake was added, mean intakes remained below recommended levels, except for males 19-30 years, but the prevalence of adequacy increased in all age groups, notably for women over 50 years. The calcium intake of Canadian adults remains in need of improvement, despite fortification and supplement use. [ABSTRACT FROM AUTHOR]

Provincial nutrition surveys of adults were conducted between 1990 and 1999 in Canada. Eight reports have been issued, and one is forthcoming. The purpose of this study was to estimate the national dietary intake of adult Canadians, using the publicly available data. Group mean-nutrient-intake data from 16 915 adults, aged 18 to 84 years, from published provincial reports were collated by age and sex for each of 9 provinces (Manitoba data were unavailable). Using Canadian census data appropriate to the year of collection, intake data were weighted to provide 1 national intake value for each nutrient, by 8 age and sex categories. In general, the energy and nutrient intake of adults decreased with age. For every age group, with the exception of vitamin C, intake of nutrients by men was greater than that by women. On the basis of a comparison of recently recommended intakes (Dietary Reference Intakes), the nutrients that are of concern because of inadequate intake include dietary fibre, calcium, magnesium, and folate. The data demonstrate the impact of folate fortification on folate intake; the mean intake became twice that of prefortification levels. This study used group mean-intake data; therefore, we cannot make definitive conclusions about the prevalence of inadequacy for the nutrients. Because of limitations with some provincial response rates, our data should not be construed as representative of the Canadian population. However, because these surveys were completed between the 19701972 Nutrition Canada Survey and the 2004 Canadian Community Health Survey, these population-weighted data might be a useful point of comparison for monitoring trends in nutrient intake from food. [ABSTRACT FROM AUTHOR]

Dietary patterns research is being pursued to provide a comprehensive way to characterize dietary exposures and explore diet-disease relationships. This paper outlines the need for further research into dietary pattern methodologies, and introduces papers presented at the Canadian Society for Clinical Nutrition-Canadian Society for Nutritional Sciences (now called Canadian Nutrition Society) Conference, held in Québec City in 2009. Themes that emerged include inconsistency of evidence linking diet patterns to risk of certain diseases, methodological issues around data collection and analysis, and the limitations of dietary pattern research for nutrition policy and recommendations. [ABSTRACT FROM AUTHOR]

Individuals who take medications may benefit from using vitamin and/or mineral supplements (VMS) yet excess supplementation can lead to overuse (daily intake exceeding the tolerable upper intake level (UL)). This study assessed VMS use of medically complex, community-living, older adults. A chart review of 229 patients ≥50 years with new medication assessments between 2014 and 2017 indicated that 76.9% of patients used ≥1 VMS daily. The UL for one or more nutrients was exceeded by 39.8% of supplement users. [ABSTRACT FROM AUTHOR]

Vitamin-mineral supplementation may offer older adults health and cognition-related benefits but overuse may contribute to polypharmacy. We examined the prevalence of supplement usage in long-term care facility (LTC) residents (≥65 years of age). As cognition may be affected by nutrition, we also examined use in those with diagnosis of dementia and those with no dementia diagnosis. The prevalence of supplement usage and overall 'pill count' from pharmaceutical use was assessed in 189 LTC residents and a subsample of 56 older adults with dementia diagnosis, respectively. Participants were residing in an LTC facility of a mid-size metropolitan area during 2009. The average use of supplements was 1.0 per day for all residents, with 35% taking vitamin D supplements, 20% multivitamins, and 26% calcium. Supplement use was similar ( p ≥ 0.05) for those with dementia diagnosis (53%, average 2.0 per day) and for those without such diagnosis (45%, average 2.2 per day). Usage ranged between 1-6 supplements per day. In both of these groups, ∼73% of users were taking vitamin D. The number of prescribed medications ranged from 4 to 24 (average 10.2) in a subsample of residents whose supplement intake was 0 to 6 (average 2). These findings suggest an overall low rate of supplement use, with no significant differences ( p ≥ 0.05) in use between residents with and without dementia diagnosis. However, some residents were at risk for supplement overuse. [ABSTRACT FROM AUTHOR]

A randomized double-blind placebo controlled study design was used to assess the effects of flaxseed lignan complex supplementation during exercise training on a metabolic syndrome composite score and osteoporosis risk in older adults. A total of 100 subjects (>=50 years) were randomized to receive flaxseed lignan (543 mg·day-1 in a 4050 mg complex) or placebo while completing a 6 month walking program (30-60 min·day-1, 5-6 days·week-1). Fasting serum glucose, triacylglycerol (TAG), high-density lipoprotein (HDL) cholesterol, low-density lipoprotein cholesterol, total cholesterol, interleukin-6, and tumor necrosis factor-α were measured every 2 months, while body composition, bone mineral density, and resting blood pressure were assessed at baseline and at 6 months. A composite Z score of 6 risk factors for metabolic syndrome (fasting glucose, HDL cholesterol, TAG, abdominal adiposity, blood pressure, and inflammatory cytokines) was calculated at baseline and at 6 months. Men taking placebo increased metabolic syndrome composite Z score (p < 0.05), but there were no changes in the other groups. A significant group × sex × time interaction was noted for TAG (p = 0.017) and diastolic blood pressure (p = 0.046), with men taking flaxseed lignan decreasing diastolic blood pressure relative to men taking placebo, and men taking placebo increasing TAG relative to men taking flax lignan. There were no differences between groups for change in bone measures, body composition, lipoproteins, or cytokines. Males taking the flaxseed lignan complex reduced metabolic syndrome score relative to men taking placebo, but a similar trend was not seen in females. Flaxseed lignan had no effect on bone mineral density or content, body composition, lipoproteins, glucose, or inflammation. [ABSTRACT FROM AUTHOR]