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Objective: To assess the prevalence of partially hydrogenated oils (PHO), hydrogenated oils (HO) and/or both in Canadian packaged foods in 2013 and 2017 and to determine the mean trans-fatty acid (TFA) content of products declaring such oils.Design: Repeated cross-sectional study of the Food Label Information Program.Setting: Food labels (n 32 875) were collected from top Canadian grocery retailers in 2013 and 2017. Proportions of products declaring PHO, HO and/or both in the Ingredients List were calculated by year and food category. The percentage contribution of TFA (g) to total fat (g) was calculated and compared against the voluntary TFA limits, defined as <2 % of total fat content for fats and oils, and <5 % for all other foods. Foods exceeding limits were identified. The mean TFA content (in g/serving and per 100 g) was calculated for products with these oils.Results: The use of PHO, HO and/or both significantly decreased in Canadian foods from 2013 to 2017 (0·8 to 0·2 %, 5 to 2·4 % and 5·7 to 2·6 %, respectively, for PHO, HO and/or both). The mean TFA content of products containing PHO increased (0·34 to 0·57 g TFA/serving); although it was not statistically significant, it is still concerning that TFA content increased. The TFA content significantly decreased in foods with HO (0·24 to 0·16 g TFA/serving, P < 0·05) during 2013-2017.Conclusions: Products with PHO continue to be present in the Canadian marketplace, despite voluntary efforts to eliminate them. Products with HO should also be monitored, as they can also contribute to TFA content in foods. [ABSTRACT FROM AUTHOR]

In 2010, as part of a national sodium reduction strategy, Canada published sodium reduction benchmark targets for packaged foods; however, no evaluation of this policy has occurred. The objective was to evaluate changes in the sodium content of packaged foods, identify categories reduced in sodium, and determine the proportion meeting Health Canada's sodium reduction benchmarks. This was a cross-sectional analysis of Canadian packaged foods in 2010 and 2013 ( n = 10 487 and n = 15 394, respectively). Sodium content was obtained from the Nutrition Facts table. Overall, 16.2% of food categories had significantly reduced sodium levels. The greatest shifts in the distribution of sodium within food categories occurred in imitation seafood (mean ± SD, mg/100 g; 602 ± 50 to 444 ± 81, 26.2%, p = 0.002), condiments (1309 ± 790 to 1048 ± 620, 19.9%, p = 0.005), breakfast cereals (375 ± 26 to 301 ± 242, 19.7%, p = 0.001), canned vegetables/legumes (269 ± 156 to 217 ± 180, 19.3%, p < 0.001), plain chips (462 ± 196 to 376 ± 198, 18.6% p = 0.004), hot cereals (453 ± 141 to 385 ± 155, 15.0%, p = 0.011), meat analogues (612 ± 226 to 524 ± 177, 14.4%, p = 0.003), canned condensed soup (291 ± 62 to 250 ± 57, 14.1%, p = 0.003), and sausages and wieners (912 ± 219 to 814 ± 195, 10.7%, p = 0.012). The proportion of foods meeting at least 1 of the 3 phases of the sodium reduction benchmark targets slightly increased (51.4% to 58.2%) and the proportion exceeding maximum benchmark levels decreased (25.2% to 20.8%). These data provide a critical evaluation of changes in sodium levels in the Canadian food supply. Although progress in reducing sodium in packaged foods is evident, the food industry needs to continue efforts in reducing the sodium in the foods they produce. [ABSTRACT FROM AUTHOR]

Background: Population-wide sodium reduction strategies aim to reduce the cardiovascular burden of excess dietary sodium. Lowering sodium in packaged foods, which contribute the most dietary sodium, is an important intervention to lower population intakes. Purpose: To determine sodium levels in Canadian packaged foods and evaluate the proportion of foods meeting sodium benchmark targets set by Health Canada. Methods: A cross-sectional analysis of 7,234 packaged foods available in Canada in 2010−2011. Sodium values were obtained from the Nutrition Facts table. Results: Overall, 51.4% of foods met one of the sodium benchmark levels: 11.5% met Phase 1, 11.1% met Phase 2, and 28.7% met 2016 goal (Phase 3) benchmarks. Food groups with the greatest proportion meeting goal benchmarks were dairy (52.0%) and breakfast cereals (42.2%). Overall, 48.6% of foods did not meet any benchmark level and 25% of all products exceeded maximum levels. Meats (61.2%) and canned vegetables and legumes (29.6%) had the most products exceeding maximum levels. The range of sodium within and between food categories was highly variable. Food categories highest in sodium (mg/serving) were dry, condensed, and ready-to-serve soups (834±256, 754±163, and 636±173, respectively); oriental noodles (783±433); broth (642±239); and frozen appetizers/sides (642±292). Conclusions: These data provide a critical baseline assessment for monitoring sodium levels in Canadian foods. Although some segments of the market are making progress toward sodium reduction, all sectors need encouragement to continue to reduce the amount of sodium added during food processing. [ABSTRACT FROM AUTHOR]

Background: An increasing number of dietitians use non‐diet approaches, referred to as non‐weight focused practice approaches (NWFAs), in clinical practice when working with higher weight adult clients. However, the factors that impact dietitians' ability to successfully implement these approaches in practice are unknown. Methods: Aiming to examine how implementing NWFAs in clinical practice differs based on the extent to which a dietitian uses NWFAs with their clients, we conducted a cross‐sectional online survey among Canadian registered dietitians who work with higher weight adults (May to July 2021), developed and validated following the Consolidated Framework for Implementation Research. Descriptive statistics were conducted to identify barriers and facilitators with respect to implementing NWFAs. The Kruskal–Wallis was used to test for differences in barriers and facilitators with respect to implementing NWFAs among five different practice approaches. The results showed that, among participants (n = 383; 82% white; 95% women) the most important barriers for implementation of NWFAs were clients' focus on weight as an outcome, when losing weight is a condition to access enhanced services, requiring changes to their practice philosophy, difficulty funding professional development and not having sufficient skills or knowledge to implement NWFAs in practice. Top‐rated facilitators included the use of clinical guidelines, scientific publications and educational materials, which were rated with higher agreement across all implementation stages (p < 0.001). Conclusions: The present study highlights important factors that may impact the effective implementation of NWFAs in dietetic practice for higher weight adult clients, which is essential to minimise barriers in practice. Highlights: The most common barriers to implementing non‐weight focused practice approaches (NWFAs) were external influences of other health professionals, and practitioner characteristics including lack of knowledge and confidence.Including clinical guidelines in undergraduate/practicum training and access to scientific publications and educational materials were the highest rated facilitators to implement NWFAs. [ABSTRACT FROM AUTHOR]

Serious games (i.e., digital games designed for educational purposes) can foster positive learning attitudes and are increasingly used as educational tools. Foodbot Factory is a serious game application (app) that helps children learn about healthy eating based on Canada's Food Guide principles and has demonstrated to increase nutrition knowledge among this group. This paper describes the process followed to expand Foodbot Factory's educational content and integrate immersive technologies and innovative features into the app. The revision process, which was guided by the Obesity-Related Behavioral Intervention Trials model, included the following phases: first, an interdisciplinary team of nutrition scientists, education experts, and computer scientists analyzed data from the original pilot study, recently published literature, and feedback from stakeholders to define areas to improve Foodbot Factory. The five original Foodbot Factory modules were evaluated by the team during weekly meetings, where the educational content, interactive features, and other elements that required updates (e.g., aesthetics and accessibility) were identified. Second, prototypes were created and refined until a final version of Foodbot Factory was approved. Nineteen children tested the updated Foodbot Factory and found it "easy to use" (89%) and "fun" (95%). The new version of Foodbot Factory contains 19 learning objectives, including 13 original and six new objectives. Interactive engagement features in the updated Foodbot Factory included augmented reality incorporated into two learning modules; new mini-games were created, including a memory game; an overhaul of the aesthetics; (e.g., new food images); and accessibility features were included to support users with cognitive and vision disabilities. [ABSTRACT FROM AUTHOR]

Dietary sodium reduction is commonly used in the treatment of hypertension, heart and liver failure, and chronic kidney disease. Sodium reduction is also an important public health problem since most of the Canadian population consumes sodium in excess of their daily requirements. Lack of awareness about the amount of sodium consumed and the sources of sodium in diet is common, and undoubtedly a major contributor to excess sodium consumption. There are few known tools available to screen and provide personalized information about sodium in the diet. Therefore, we developed a Web-based sodium intake screening tool called the Salt Calculator (), which is publicly available for individuals to assess the amount and sources of sodium in their diet. The Calculator contains 23 questions focusing on restaurant foods, packaged foods, and added salt. Questions were developed using sodium consumption data from the Canadian Community Health Survey cycle 2.2 and up-to-date information on sodium levels in packaged and restaurant food databases from the University of Toronto. The Calculator translates existing knowledge about dietary sodium into a tool that can be accessed by the public as well as integrated into clinical practice to address the high levels of sodium presently in the Canadian diet. [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]

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 2 required minor revisions. The NAK was pilot tested for changes in nutrition attitudes and knowledge among children aged 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: 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. [ABSTRACT FROM AUTHOR]

The current study describes the frequency of use of different forms of nutrition marketing in Canada and the nutrients and conditions that are the focus of nutrition marketing messages. Prepackaged foods with a Nutrition Facts table ( N = 10 487) were collected between March 2010 and April 2011 from outlets of the 3 largest grocery chains in Canada and 1 major western Canadian grocery retailer. The nutrition marketing information collected included nutrient content claims, disease risk reduction claims, and front-of-pack nutrition rating systems (FOPS). We found that nutrition marketing was present on 48.1% of Canadian food packages, with nutrient content claims being the most common information (45.5%), followed by FOPS on 18.9% of packages. Disease risk reduction claims were made least frequently (1.7%). The marketing messages used most often related to total fat and trans fat (15.6% and 15.5% of nutrient content claims, respectively). Limiting total and trans fats is a current public health priority, as recommended by Health Canada and the World Health Organization. However, other nutrients that are also recommended to be limited, including saturated fats, sodium, and added sugars, were not nearly as prominent on food labels. Thus, greater emphasis should be placed by the food industry on these other important nutrients. Repeated data collection in the coming years will allow us to track longitudinal changes in nutrition marketing messages over time as food marketing, public health, and consumer priorities evolve. [ABSTRACT FROM AUTHOR]

Dietary modifications are key health behaviour recommendations for the prevention and management of hypertension, a leading contributor of global disease burden. Despite this, few primary care physicians discuss nutrition with their patients. This study describes the barriers and facilitators to the provision of dietary advice for hypertension prevention and management among Canadian physicians. A validated 62-item cross-sectional survey was distributed online to 103 Canadian primary care physicians between 2017 and 2019. Eighty participants were included in the analyses. The majority of participants were based in Ontario (68.7%) and saw 10–24 patients per week (53.5%). Fewer than half (47.5%) of participants were knowledgeable about the recommended sodium level by Hypertension Canada (< 2000 mg/day) and 38.8% felt it was difficult to know which foods are high or low in sodium. Approximately one quarter felt the findings about sodium and hypertension and cardiovascular disease are controversial. Other significant barriers were: not enough time to talk to patients about diet (76.3%), belief that patients are not truthful about their diet (76.3%), patients would not follow their advice (46.8%), and that it was difficult to keep up with so many guidelines (50.0%). Many identified that electronic medical record tools (80.8%), access to dietitians (84.9%), or more nutrition education in medical training (65.8%) would help facilitate advice. Given the importance of diet and the central role of physicians in motivating dietary change among patients, approaches are required to address identified barriers and facilitators to providing dietary advice to reduce the burden of hypertension. [ABSTRACT FROM AUTHOR]