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Existing nutrition knowledge measures tend to be lengthy or tailored for specific contexts, making them unsuitable for population-based surveys. Given the growing emphasis within country-specific dietary guidelines on reducing consumption of highly processed foods, consumers' ability to understand and apply principles related to level of food processing could serve as a proxy measure of general nutrition knowledge. To examine the content validity of the Food Processing Knowledge (FoodProK) score based on subject matter expert consultation with Registered dietitian nutritionists (RDNs). RDNs in Canada (n = 64) completed an online survey, including the FoodProK, in January 2020. Participants rated the "healthiness" of 12 food products from four categories (fruit, meat, dairy, and grains) on a scale from 1 to 10. FoodProK scores were assigned based on concordance of ratings within each food category, with rankings according to the NOVA classification system, with less processed foods representing higher healthiness. For each category, one-way repeated-measures analysis of variance models tested whether the three product ratings were significantly different from one another. Descriptive statistics compared ratings and FoodProK scores across categories. Open-ended feedback was solicited to assess face validity of the score. RDNs' FoodProK scores were strongly associated with level of food processing. Almost one in three RDNs received perfect FoodProK scores, and the mean score was 7.0 of 8.0 possible points. Within each category, the three foods received significantly different healthiness ratings, in the same order as the NOVA system (P < 0.001 for all contrasts). Open-ended responses showed that RDNs did not perceive meaningful differences between the processed meat products, suggesting the need to change one of the products in the meat category. Overall, 80% of RDNs reported level of processing as an important indicator of the healthiness of foods. Level of food processing represents a promising framework for assessing general nutrition knowledge in population-based surveys. [ABSTRACT FROM AUTHOR]

Recent federal proposals in Canada have called for changes in the delivery and funding of school lunches. Yet little evidence has documented the nutritional quality of meals eaten by school children, which is needed to inform school lunch reforms. To assess the dietary contributions of lunch foods to daily food and nutrient intakes on school days and compare dietary intakes across eating locations (school, home, and off campus). Cross-sectional analyses of school day data from the 2015 Canadian Community Health Survey—Nutrition. Children aged 6 to 17 years who completed a 24-hour dietary recall falling on a school day in 2015 (n=2,540). Mean percent of daily intakes of energy, food groups, and nutrients contributed by foods reported at lunch and energy-adjusted intakes of nutrients and food groups consumed during the lunch meal. Descriptive statistics were used to assess the percent of daily energy, nutrients, and food groups contributed by lunch foods. Multivariable linear regression models examined differences in dietary outcomes across eating locations for the full sample and stratified by age group, with separate models for children aged 6 to 13 and 14 to 17 years. On average, foods reported at lunch provided ∼26% of daily calories on school days. Relative to energy, lunch foods provided lower contributions of dark green and orange vegetables, whole fruit, fruit juice, whole grains, milk and alternatives, fluid milk; minimally nutritious foods including sugar-sweetened beverages; and several related nutrients including total sugars; vitamins A, D, B-6, and B-12; riboflavin; and calcium. Yet, lunch foods provided proportionally higher contributions of grain products, non–whole grains, meat and alternatives, and sodium. Children aged 14 to 17 years who ate lunch at school reported higher intakes of total vegetables and fruit, whole fruit, whole grains, fiber, vitamin C, and magnesium but reported fewer calories from sugar-sweetened beverages compared with their peers who ate lunch off campus. Relative to its contribution to energy, lunch on school days contributed to proportionally lower intakes of many healthful foods such as dark green and orange vegetables, whole fruit, whole grains, and fluid milk but also proportionally lower intakes of other high-fat and high-sugar foods including sugar-sweetened beverages. This study adds to the growing body of evidence on dietary concerns during school time for Canadian children and highlights particular nutritional challenges for adolescents consuming lunch off campus. [ABSTRACT FROM AUTHOR]

Background Sodium-reduced packaged food products are increasingly available to consumers; however, it is not clear whether they are suitable for inclusion in a potassium-reduced diet. For individuals with impaired renal potassium excretion caused by chronic kidney disease and for those taking certain medications that interfere with the rennin-angiotensin aldosterone axis, the need to limit dietary potassium is important in view of the risk for development of hyperkalemia and fatal cardiac arrhythmias. Objective The primary objective of this study was to determine the impact of the reduction of sodium in packaged meat and poultry products (MPPs) on the content of potassium and phosphorus from food additives. Design This was a cross-sectional study comparing chemically analyzed MPPs (n=38, n=19 original, n=19 sodium-reduced), selected from the top three grocery chains in Canada, based on market share sales. All MPPs with a package label containing a reduced sodium content claim together with their non-sodium-reduced packaged MPP counterparts were selected for analysis. The protein, sodium, phosphorus, and potassium contents of sodium-reduced MPPs and the non-sodium-reduced (original) MPP counterparts were chemically analyzed according to the Association of Analytical Communities official methods 992.15 and 984.27 and compared by using a paired t test. The frequency of phosphorus and potassium additives appearing on the product labels' ingredient lists were compared between groups by using McNemar’s test. Results Sodium-reduced MPPs (n=19) contained 44% more potassium (mg/100 g) than their non-sodium-reduced counterparts (n=19) (mean difference [95% CI): 184 [90-279]; P =0.001). The potassium content of sodium-reduced MPPs varied widely and ranged from 210 to 1,500 mg/100 g. Potassium-containing additives were found on the ingredient list in 63% of the sodium-reduced products and 26% of the non–sodium-reduced products ( P =0.02). Sodium-reduced MPPs contained 38% less sodium (mg/100 g) than their non–sodium-reduced counterparts (mean difference [95% CI]: 486 [334-638]; P <0.001). The amounts of phosphorus and protein, as well as the frequency of phosphorus additives appearing on the product label ingredient list, did not significantly differ between the two groups. Conclusions Potassium additives are frequently added to sodium-reduced MPPs in amounts that significantly contribute to the potassium load for patients with impaired renal handling of potassium caused by chronic kidney disease and certain medications. Patients requiring potassium restriction should be counseled to be cautious regarding the potassium content of sodium-reduced MPPs and encouraged to make food choices accordingly. [ABSTRACT FROM AUTHOR]

Background A previous comprehensive prehabilitation program, providing nutrition counseling with whey protein supplementation, exercise, and psychological care, initiated 4 weeks before colorectal surgery for cancer, improved functional capacity before surgery and accelerated functional recovery. Those receiving standard of care deteriorated. The specific role of nutritional prehabilitation alone on functional recovery is unknown. Objective This study was undertaken to estimate the impact of nutrition counseling with whey protein on preoperative functional walking capacity and recovery in patients undergoing colorectal resection for cancer. Design We conducted a double-blinded randomized controlled trial at a single university-affiliated tertiary center located in Montreal, Quebec, Canada. Colon cancer patients (n=48) awaiting elective surgery for nonmetastatic disease were randomized to receive either individualized nutrition counseling with whey protein supplementation to meet protein needs or individualized nutrition counseling with a nonnutritive placebo. Counseling and supplementation began 4 weeks before surgery and continued for 4 weeks after surgery. Main Outcome Measure The primary outcome was change in functional walking capacity as measured with the 6-minute walk test. The distance was recorded at baseline, the day of surgery, and 4 weeks after surgery. A change of 20 m was considered clinically meaningful. Results The whey group experienced a mean improvement in functional walking capacity before surgery of +20.8 m, with a standard deviation of 42.6 m, and the placebo group improved by +1.2 (65.5) m ( P =0.27). Four weeks after surgery, recovery rates were similar between groups ( P =0.81). Conclusion Clinically meaningful improvements in functional walking capacity were achieved before surgery with whey protein supplementation. These pilot results are encouraging and justify larger-scale trials to define the specific role of nutrition prehabilitation on functional recovery after surgery. [ABSTRACT FROM AUTHOR]

Background The Mediterranean-style dietary pattern has been associated with several cardiometabolic benefits, yet no study has assessed the potential benefits of this diet in adults with type 1 diabetes mellitus (T1DM). Objective The objective of the present study was to examine the association between cardiometabolic profile and alignment of the diet with 1) Canadian nutrient recommendations for T1DM in terms of fat, protein, carbohydrate, saturated fat, dietary fiber, and sodium and 2) a Mediterranean-style dietary pattern among adults with T1DM. Design/participants/setting This is a cross-sectional analysis including 118 adults with T1DM recruited between 2011 and 2013 in Montreal, Canada. Statistical analyses Body mass index (calculated as kg/m 2 ), waist circumference, truncal fat percentage (dual-energy x-ray absorptiometry), blood pressure, and lipid profile values were measured. Insulin sensitivity was estimated (estimated glucose disposal rate). A 3-day food record was completed and physical activity was measured with a motion sensor. Differences for the cardiometabolic profile between groups with a diet meeting the Canadian nutrient recommendations for T1DM (percentage of energy from fat, protein, carbohydrate, saturated fat, as well as grams of dietary fiber and milligrams of sodium) or not were examined with general linear models. A Mediterranean diet score was calculated (range=0 to 44) and Pearson correlations between this score and cardiometabolic variables were computed. Significance was set at P ≤0.05. Results Participants’ mean±standard deviation age was 44.3±12.3 years, glycated hemoglobin was 8.0%±1.1%, and Mediterranean diet score was 20.2±5.0. Having a diet that meets at least three nutritional recommendations was associated with a lower truncal fat percentage (28.0% vs 32.2%; P =0.01) only. In contrast, the Mediterranean diet score was inversely correlated with body mass index ( r =−0.30, P =0.002), waist circumference ( r =−0.31, P =0.002), truncal fat percentage ( r =−0.38, P <0.001), systolic ( r =−0.20, P =0.03) and diastolic blood pressure ( r =−0.23, P =0.01), and was directly correlated with estimated glucose disposal rate ( r =0.22, P =0.03), after adjustments for energy intake, sex, and age. The association with estimated glucose disposal rate was no longer significant ( P =0.055) after adjustment for physical activity level. Conclusions These results suggest that a higher Mediterranean diet score in the context of T1DM is associated with a favorable cardiometabolic profile. Further research is needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Background There is evidence that dietary quality declines as children age in North America, but few studies have explored whether food environment exposures in secondary schools as opposed to elementary schools are associated with changes in students’ school-day food choices. Methods This study examined differences in dietary practices (at or en route to and/or from school) between students in their last years of elementary school (grades 5 to 7) and first year of secondary school (grade 8) in Vancouver, Canada, controlling for sociodemographic characteristics and school-level socioeconomic status. Demographic characteristics and dietary data were collected through a cross-sectional survey (n=950 from 26 schools) and combined with school-level socioeconomic data derived from the 2006 Canadian Census. Results Multilevel logistic regression analyses indicated that secondary school students were significantly more likely to report daily consumption of fast foods (odds ratio=1.92; 95% CI 1.18 to 3.12) and minimally nutritious packaged snacks (eg, candy or chocolate bars) (odds ratio=1.60; 95% CI 1.05 to 2.45), and to report regular purchases from off-campus retailers (odds ratio=1.63; 95% CI 1.10 to 2.42). Gender, food insecurity, lower acculturation to Canada, and access to more weekly spending money were associated with nutritionally poor practices. Students attending schools drawing from lower-income neighborhoods were also significantly more likely to consume fast foods and packaged snacks daily. The majority of students sampled did not report consuming healthy foods, such as fruit and vegetables, daily at or en route to and/or from school. Intake of fruit, vegetables, and low-fat milk did not differ significantly between elementary and secondary school students. Conclusions Findings suggest that research and intervention strategies should address modifiable school-level exposures and policies to improve dietary practices for both elementary and secondary school–aged youth, while at the same time addressing sociocultural factors associated with eating behavior. [ABSTRACT FROM AUTHOR]

Psychosocial stress and diet quality individually mediate associations between socioeconomic position (SEP) and health; however, it is not known whether they jointly mediate these associations. This is an important question because stress-related unhealthy eating is often invoked as an explanation for diet-related health inequities, particularly among women, seemingly with no empirical justification. This study examined whether psychosocial stress and diet quality jointly mediated associations between SEP and self-rated health in women and men. Multiple mediating pathways were modeled using data from the cross-sectional International Food Policy Study. Data were collected from 5,645 adults (aged 18 years or older) in Canada during 2018 and 2019. Participants reported SEP using indicators of materialist (educational attainment and perceived income adequacy) and psychosocial pathways (subjective social status), along with psychosocial stress, dietary intake (to assess overall diet quality via Healthy Eating Index-2015 scores), and self-rated health. Structural equation modeling modeled pathways linking SEP (ie, educational attainment, perceived income adequacy, and subjective social status) with self-rated health mediated by psychosocial stress and diet quality, stratified by gender. There was no evidence that psychosocial stress and diet quality jointly mediated associations between SEP and self-rated health in women or men. Diet quality mediated associations between educational attainment and self-rated health in women and men, with some evidence that it mediated associations between subjective social status and self-rated health in men (P = 0.051). Psychosocial stress mediated associations between perceived income adequacy and self-rated health in women and men, and between subjective social status and self-rated health in women. Although often invoked as an explanation for diet-related health inequities, stress-related poor diet quality did not mediate associations between SEP and self-rated health in women or men. Psychosocial stress and diet quality individually mediated some of these associations, with some differences by gender. [ABSTRACT FROM AUTHOR]

Front-of-package (FOP) nutrition labeling systems differ in how they rate food and beverage products. There is a need to examine the implications of these differences, including their focus on nutrients of public health concern. Our aim was to examine the impacts of 4 common FOP labels on consumers' purchases of products that received conflicting ratings across FOP systems. In an experimental marketplace, participants were randomized to complete a series of purchases under 1 of 5 FOP conditions: no label, "high in" nutrient labels, multiple traffic light, Health Star Rating, or a 5-color nutrition grade. A final sample of 3,584 Canadians (13 years and older) were recruited from shopping centers in March to May 2018. Probability of purchasing was assessed for 5 product categories (100% fruit juice, plain milk, chocolate milk, cheese snacks, and diet beverages), which received conflicting ratings across the FOP conditions. Separate generalized linear mixed models estimated the influence of FOP condition on 5 binary outcomes (1 = purchased, 0 = not purchased) corresponding to the product categories. Few differences were observed among the full sample. Among participants who noticed the labels (n = 1,993), those in the Health Star Rating condition were 4.5 percentage points (95% CI –7.0 to –1.9) more likely to purchase 100% fruit juice (compared to multiple traffic light) and 3.3 (95% CI 0.4 to 6.2) and 3.0 percentage points (95% CI 0.1 to 6.1) more likely to purchase cheese snacks (compared to no label and "high in"). "High in" labels produced fewer purchases of chocolate milk than no label. Despite some similarities, existing FOP systems differ in the extent to which they promote or dissuade purchases of common product categories. Although the Health Star Rating might encourage purchases of products with certain positive nutritional attributes, "high in" and multiple traffic light systems might more effectively discourage purchases of products contributing nutrients of public health concern. [ABSTRACT FROM AUTHOR]

Abstract: Background: Patients with thalassemia have low circulating levels of many nutrients, but the contribution of dietary intake has not been assessed. Objective: Our objective was to assess dietary intake in a large contemporary sample of subjects with thalassemia. Design: A prospective, longitudinal cohort study using a validated food frequency questionnaire was conducted. Participants/setting: Two hundred and twenty-one subjects (19.7±11.3 years, 106 were female) were categorized into the following age groups: young children (3 to 7.9 years), older children/adolescents (8 to 18.9 years), and adults (19 years or older); 78.8% had β-thalassemia and 90% were chronically transfused. This study took place at 10 hematology outpatient clinics in the United States and Canada. Main outcome measures: We conducted a comparison of intake with US Dietary Reference Intakes and correlated dietary intake of vitamin D with serum 25-OH vitamin D and dietary iron with total body iron stores. Statistical analyses performed: Intake was defined as inadequate if it was less than the estimated average requirement. χ2, Fisher''s exact, and Student''s t test were used to compare intake between age categories and logistic regression analysis to test the relationship between intake and outcomes, controlling for age, sex, and race. Results: More than 30% of subjects consumed inadequate levels of vitamin A, D, E, K, folate, calcium, and magnesium. The only nutrients for which >90% of subjects consumed adequate amounts were riboflavin, vitamin B-12, and selenium. Dietary inadequacy increased with increasing age group (P<0.01) for vitamins A, C, E, B-6, folate, thiamin, calcium, magnesium, and zinc. More than half of the sample took additional supplements of calcium and vitamin D, although circulating levels of 25-OH vitamin D remained insufficient in 61% of subjects. Dietary iron intake was not related to total body iron stores. Conclusions: Subjects with thalassemia have reduced intake of many key nutrients. These preliminary findings of dietary inadequacy are concerning and support the need for nutritional monitoring to determine which subjects are at greatest risk for nutritional deficiency. Future research should focus on the effect of dietary quality and nutritional status on health outcomes in thalassemia. [Copyright &y& Elsevier]

Background Healthy eating blogs are knowledge translation tools used by nutrition and dietetics practitioners for helping people improve their health behaviors and food choices. Objective Our aim was to explore women’s perceptions of the usefulness and ease of use of healthy eating blog (HEB) characteristics that might increase potential users’ intention to use them as tools to improve their dietary habits. Design We conducted qualitative research using semi-structured individual interviews. Participants Thirty-three women (mean age of 44 years; range=27 to 61 years) living in the Quebec City, Canada, metropolitan area were studied. Intervention Four existing HEBs, written by French-Canadian registered dietitians (RDs) whose main objective was the promotion of a healthy diet, were explored by women during individual interviews. A standardized open-ended interview questionnaire based on the Technology Acceptance Model was used to identify women's perceptions about characteristics of type of blog content delivery, RD blogger's delivery of information, blog layout, and blog design. Main outcome measures Women's perceptions toward the contribution of HEB characteristics to the usefulness and ease of use of those tools to improve their dietary habits were measured. Analyses performed Interviews were audiorecorded, transcribed verbatim, coded, and analyzed through an inductive content analysis using NVivo software. Results The most useful characteristics of type of blog content delivery identified by women were recipes, hyperlinks, and references. Among characteristics of RD blogger's delivery of information, most women reported that interaction between blog readers and the RD blogger created a sense of proximity and of connection that was helpful for improving their dietary behaviors. Women's perceptions toward various characteristics of blog layout and design were also discussed. Conclusions Incorporating specific characteristics when designing HEBs should be considered by RDs and future research to promote the use of those tools to support dietary behavior change efforts of internet users. [ABSTRACT FROM AUTHOR]

Introduction Indigenous people continue to experience health disparities relative to non-Indigenous populations. Interventions to improve nutrition during pregnancy in these groups may improve health outcomes for mothers and their infants. The effectiveness of existing nutrition intervention programs has not been reviewed previously. Objective The objective was to identify interventions targeting improving nutrition-related outcomes for pregnant Indigenous women residing in Organisation for Economic Co-operation and Development countries, and to identify positive factors contributing to successful programs. Methods Thirteen electronic databases were searched up until October 2015. Key words identified studies intervening to improve nutrition-related outcomes for pregnant Indigenous women. Two reviewers assessed articles for inclusion and study quality and extracted data. Only studies published in English were included. Data were summarized narratively. Results Abstracts and titles were screened (n=2,566) and 315 full texts were reviewed for eligibility. This review included 27 articles from 20 intervention programs from Australia, Canada, and the United States. The most prevalent measurable outcomes were birth weight (n=9) and breastfeeding initiation/duration (n=11). Programs with statistically significant results for these outcomes employed the following nutrition activities: individual counseling/education (n=8); delivery by senior Indigenous woman (n=2), peer counselor (n=3), or other Indigenous health worker (n=4); community-wide interventions (n=2); media campaigns (n=2); delivery by non-Indigenous health professional (n=3); and home visits (n=3). Conclusions Heterogeneity of included studies made it challenging to make firm recommendations regarding program success. Authors of included studies recommended community consultation be included when designing studies and working with communities at all stages of the research process. Individualized counseling/education can contribute to successful program outcomes, as can the use of Indigenous workers to deliver program content. Limitations of some studies included a lack of details on interventions and the use of nonrandom control groups. Future studies should include detailed descriptions of intervention components and include appropriate evaluation protocols. [ABSTRACT FROM AUTHOR]