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This study was undertaken to assess how low-carbohydrate-density diets below the acceptable macronutrient distribution range relate to food and micronutrient intake and sociodemographic and health-related characteristics. The multistage stratified cluster design in the 1990 Ontario Health Survey was used. There were 5,194 subjects, 12 to 18 years of age, in sampled households. Dietary data were collected via a food frequency questionnaire. Low-carbohydrate-density diets were consumed by 27.6% of males and 24.1% of females. Low-carbohydrate-density diets were related (P<.05) to reduced sufficiency of vegetables and fruit and higher consumption of meat and alternatives and added fats. The low-carbohydrate-density diet resulted in intakes lower in vitamin C and fiber and higher in cholesterol and total fat. The low-carbohydrate-density diet was directly associated with being Canadian-born (odds ratio [OR] = 1.78, 95% confidence interval [CI] =1.27 to 2.50), overweight status (OR = 1.27, 95% CI = 1.02 to 1.57), smoking (OR = 1.53, 95% CI = 1.23 to 1.90), alcohol use (OR = 1.46, 95% CI = 1.21 to 1.75), and poorer self-rated health (OR = 1.47, 95% CI =1.01 to 2.14). Use of the acceptable macronutrient distribution range identified adolescents with low-carbohydrate-density diets whose food choices and nutrient intake may impact negatively on short- and long-term health. J Am Diet Assoc. 2005;105:1783-1788.

Background Dietary exposure assessments are a critical issue in evaluating human nutrition studies; however, nutrition-specific criteria are not consistently included in existing bias assessment tools. Objectives Our objective was to develop a set of risk of bias (RoB) tools that integrated nutrition-specific criteria into validated generic assessment tools to address RoB issues, including those specific to dietary exposure assessment. Methods The Nutrition QUality Evaluation Strengthening Tools (NUQUEST) development and validation process included 8 steps. The first steps identified 1) a development strategy; 2) generic assessment tools with demonstrated validity; and 3) nutrition-specific appraisal issues. This was followed by 4) generation of nutrition-specific items and 5) development of guidance to aid users of NUQUEST. The final steps used established ratings of selected studies and feedback from independent raters to 6) assess reliability and validity; 7) assess formatting and usability; and 8) finalize NUQUEST. Results NUQUEST is based on the Scottish Intercollegiate Guidelines Network checklists for randomized controlled trials, cohort studies, and case-control studies. Using a purposive sample of 45 studies representing the 3 study designs, interrater reliability was high (Cohen's κ: 0.73; 95% CI: 0.52, 0.93) across all tools and at least moderate for individual tools (range: 0.57–1.00). The use of a worksheet improved usability and consistency of overall interrater agreement across all study designs (40% without worksheet, 80%–100% with worksheet). When compared to published ratings, NUQUEST ratings for evaluated studies demonstrated high concurrent validity (93% perfect or near-perfect agreement). Where there was disagreement, the nutrition-specific component was a contributing factor in discerning exposure methodological issues. Conclusions NUQUEST integrates nutrition-specific criteria with generic criteria from assessment tools with demonstrated reliability and validity. NUQUEST represents a consistent and transparent approach for evaluating RoB issues related to dietary exposure assessment commonly encountered in human nutrition studies. [ABSTRACT FROM AUTHOR]

Background The Omega-3 Index (OI) is a proposed marker of coronary artery disease (CAD) risk. Another index, the EPA/arachidonic acid (AA) ratio has also been proposed as a possible risk marker for CAD. Objective Our primary objective was to characterize the Canadian population subgroups that have an undesirable OI (<4%, associated with high CAD risk) and to identify the participants' characteristics most strongly associated with the OI. Our secondary objective was to identify the characteristics most strongly associated with the EPA/AA ratio. Design Data from 4025 adult participants of cycles 3 and 4 (2012–2015) of the cross-sectional Canadian Health Measures Survey were pooled. Adjusted mean proportions of erythrocyte membrane ω-3 (n–3) fatty acids, total ω-6 fatty acids, and ratios were analyzed by sociodemographic, health, and lifestyle characteristics using covariate-adjusted models. Results The mean OI was 4.5%. Almost 40% of Canadians had an undesirable (<4%) OI. ω-3 supplement use, fish intake, and race were the variables most strongly associated with OI scores. The prevalence of undesirable OI was significantly higher among participants consuming fish less than twice a week (43.8%; 95% CI: 39.0%, 48.6%) than among those consuming more fish (12.7%; 95% CI: 7.8%, 19.9%), among smokers (62.7%; 95% CI: 52.9%, 71.7%) than nonsmokers (33.4%; 95% CI: 29.4%, 37.7%), in whites (42.7%; 95% CI: 38.2%, 47.4%) than in Asians (23.0%; 95% CI: 15.4%, 33.0%), and in adults aged 20–39 y (49.6%; 95% CI: 42.3%, 56.9%) than in those aged 60–79 y (24.4%; 95% CI: 21.0%, 28.1%). ω-3 supplement intake and fish intake were the characteristics most strongly associated with EPA/AA. All P  ≤ 0.05. Conclusions An important proportion of Canadian adults has an undesirable (<4%) OI, with higher prevalence in some subgroups. Further assessment is required to determine the value and feasibility of an increase in the population's OI to the currently proposed target of ≥8% as a potential public health objective. [ABSTRACT FROM AUTHOR]

Ultra-processed food (UPF) consumption is increasing globally at an unprecedented rate. We investigated UPF consumption among Canadian adults and associated sociodemographic and health-related factors. This study was a secondary analysis of the Foodbook study (2014–2015), which collected self-reported data on foods consumed by Canadians during a 7-day period. UPF diversity was assessed by summing the different types of UPFs consumed in the previous week to produce a diversity score. Descriptive statistics summarized UPF diversity among subgroups in Canada. Regression models identified significant associations between UPF diversity, body mass index (BMI), and sociodemographic variables. This study included 6062 participants, aged 18 years and older, representing 24.7 million Canadian adults. Almost all Canadian adults (99.0%) consumed UPFs at least once weekly. The most common UPFs consumed were chocolate, chips/pretzels, cold breakfast cereal, and fast foods. UPF diversity was greatest among men, young respondents, those with high income, and those with obesity. When controlling for potential confounders, UPF diversity for men and women was significantly associated with younger age and higher BMI; it was also associated with region for women. This study suggests UPF consumption in Canada varies across sociodemographic subgroups, but ultimately is pervasive. Further research examining potential health risks associated with UPF consumption is encouraged to inform Canadian interventions. Novelty: Almost all Canadians consume at least one type of ultra-processed food weekly. Nearly half or more Canadians consume chocolate, chips/pretzels, cold breakfast cereal, or fast food at least once weekly. Gender, age, and BMI are consistently associated with ultra-processed food diversity. [ABSTRACT FROM AUTHOR]

The governments of the United States and Canada have jointly undertaken the development of the Dietary Reference Intakes (DRIs) since themid-1990s. The Federal DRI committees from each country work collaboratively to identify DRI needs, prioritize nutrient reviews, advance work to resolve methodological issues that is necessary for new reviews, and sponsor DRI-related committees through the National Academies of Sciences, Engineering and Medicine. In recent years, the Joint Canada-US DRI Working Group, consisting of members from both Federal DRI committees, developed an open and transparent nomination process for prioritizing nutrients for DRI review, by which sodium, the omega-3 (n–3) fatty acids, vitamin E, and magnesium were identified. In addition, discussions during the nutrient nomination process prompted the Federal DRI committees to address previously identified issues related to the use of chronic disease endpoints when setting DRIs. The development of guiding principles for setting DRIs based on chronic disease risk reduction will be applied for the first time during the DRI review of sodium and potassium. In summary, the US and Canadian governments have worked collaboratively to adapt our approach to prioritizing nutrients for DRI review and to broaden the scope of the DRIs to better incorporate the concept of chronic disease risk reduction in order to improve public health. [ABSTRACT FROM AUTHOR]

Introduction: There is evidence that 25-hydroxyvitamin D levels are lower in overweight and obese youth. This study examined the relationship between weight status and 25-hydroxyvitamin D, while controlling for confounders, in Canadian youth. Methods: Plasma 25-hydroxyvitamin D from subjects aged 6 to 17 years from the Canadian Health Measures Survey cycles 1 (2007 to 2009) and 2 (2009 to 2011) was used. Sex-specific multiple linear regression and logistic regressions examined the relationship of overweight and obesity (body mass index = 85th percentile) with 25-hydroxyvitamin D levels and the odds of 25-hydroxyvitamin D <40 nmol/L and <50 nmol/L. Results: The prevalence of risk of vitamin D deficiency (25-hydroxyvitamin D < 30 nmol/L) was 6% (95% confidence interval [CI] 3.26% to 10.12%). Vitamin D inadequacy, estimated by levels <40 nmol/L, was 15% (95% CI 10.34% to 20.39%; 19% [95% CI 13.1 to 25.6] for teenagers). Seventy per cent (95% CI 63.59 to 75.17) had levels >50 nmol/L, consistent with achieving the Recommended Dietary Allowance. In adjusted analyses, overweight/obesity (1/3 of subjects) was independently associated with lower 25-hydroxyvitamin D for both sexes after adjustment for age, race, income, season, vitamin D supplementation and daily milk consumption. For 25-hydroxyvitamin D <40 nmol/L, the overweight/obese odds ratio for males was 2.63 (95% CI 1.34 to 5.18). For 25-hydroxyvitamin D <50 nmol/L, overweight/obese odds ratios were 2.19 (95% CI 1.46 to 3.28) for males and 1.39 (95% CI 1.05 to 1.84) for females. Conclusions: This study confirms the inverse association between adiposity and serum concentrations of 25-hydroxyvitamin D in Canadian youth and the independent association of overweight/obesity to 25-hydroxyvitamin D level and vitamin D status after adjustment for other factors. [ABSTRACT FROM AUTHOR]

Vitamin D is essential for facilitating calcium absorption and preventing increases in parathyroid hormone (PTH), which can augment bone resorption. Our objectives were to examine serum levels of 25-hydroxyvitamin D [25(OH)D] and PTH, and factors related to longitudinal change in a population-based cohort. This is the first longitudinal population-based study looking at PTH and 25(OH)D levels. We analyzed 3896 blood samples from 1896 women and 829 men in the Canadian Multicentre Osteoporosis Study over a 10-year period starting in 1995 to 1997. We fit hierarchical models with all available data and adjusted for season. Over 10 years, vitamin D supplement intake increased by 317 (95% confidence interval [CI] 277 to 359) IU/day in women and by 193 (135 to 252) IU/day in men. Serum 25(OH)D (without adjustment) increased by 9.3 (7.3 to 11.4) nmol/L in women and by 3.5 (0.6 to 6.4) nmol/L in men but increased by 4.7 (2.4 to 7.0) nmol/L in women and by 2.7 (−0.6 to 6.2) nmol/L in men after adjustment for vitamin D supplements. The percentage of participants with 25(OH)D levels <50 nmol/L was 29.7% (26.2 to 33.2) at baseline and 19.8% (18.0 to 21.6) at year 10 follow-up. PTH decreased over 10 years by 7.9 (5.4 to 11.3) pg/mL in women and by 4.6 (0.2 to 9.0) pg/mL in men. Higher 25(OH)D levels were associated with summer, younger age, lower body mass index (BMI), regular physical activity, sun exposure, and higher total calcium intake. Lower PTH levels were associated with younger age and higher 25(OH)D levels in both women and men and with lower BMI and participation in regular physical activity in women only. We have observed concurrent increasing 25(OH)D levels and decreasing PTH levels over 10 years. Secular increases in supplemental vitamin D intake influenced both changes in serum 25(OH)D and PTH levels. © 2012 American Society for Bone and Mineral Research. [ABSTRACT FROM AUTHOR]

Background: Vitamin D is recognized in bone health and the prevention of rickets and osteomalacia., Objective: This study aimed to assess vitamin D status of people in Canada and to identify factors associated with vitamin D inadequacy and deficiency., Methods: Serum 25-hydroxyvitamin D (25(OH)D) from the Canadian Health Measures Survey (cycles 3-6, n = 21,770, 3-79 y) were evaluated for geometric means and proportions <40 (inadequate) and <30 (risk of deficiency) nmol/L. Factors associated with inadequacy or deficiency were tested using logistic regression., Results: Mean serum 25(OH)D was 57.9 (95% CI: 55.4, 60.5) nmol/L; the prevalence of inadequacy was 19.0% (95% CI: 15.7, 22.3) and risk of deficiency was 8.4% (95% CI: 6.5, 10.3). Prominent dietary factors associated with inadequacy in adults included: not consuming fish compared with ≥1/wk (adjusted OR adj : 1.60; 95% CI: 1.21, 2.11), none compared with ≥1/d for cow's milk (OR adj : 1.41; 95% CI: 1.02, 1.94) or margarine (OR adj : 1.42; 95% CI: 1.08, 1.88); or nonuser compared with user of vitamin D supplements (OR adj : 5.21; 95% CI: 3.88, 7.01). Notable demographic factors included: younger adults compared with 71 to 79 y (19-30 y OR adj : 2.33; 95% CI: 1.66, 3.29); BMI ≥30 compared with <25 kg/m 2 (OR adj : 2.30; 95% CI: 1.79, 2.95); lower household income quartile 1 compared with 4 (OR adj : 1.46; 95% CI: 1.00, 2.15); and self-reported Black (OR adj : 8.06; 95% CI: 4.71, 13.81), East/Southeast Asian (OR adj : 3.83; 95% CI: 2.14, 6.85), Middle Eastern (OR adj : 4.57; 95% CI: 3.02, 6.92), and South Asian (OR adj : 4.63; 95% CI: 2.62, 8.19) race compared with White. Similar factors were observed in children and for deficiency., Conclusions: Most people in Canada have adequate vitamin D status; nonetheless, racialized groups have an elevated prevalence of inadequacy. Further research is required to evaluate if current strategies to improve vitamin D status, including increasing vitamin D in fortified foods and supplements, and dietary guidance to include a source of vitamin D every day help to reduce health inequality in Canada., (Crown Copyright © 2023. Published by Elsevier Inc. All rights reserved.)