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Individuals receiving hemodialysis are at increased risk of malnutrition; however, regular diagnosis of malnutrition using subjective global assessment (SGA) is time-consuming. This study aimed to determine whether the Canadian Nutrition Screening Tool (CNST) or the Geriatric Nutrition Risk Index (GNRI) screening tools could accurately identify hemodialysis patients at risk for malnutrition. A retrospective medical chart review was conducted for in-centre day shift hemodialysis patients (n = 95) to obtain the results of the SGA assessment and the CNST screener and to calculate the GNRI score. Sensitivity and specificity analyses showed only a fair agreement between the SGA and CNST (sensitivity = 20%; specificity 96%; κ = .210 (95% CI, -0.015 to .435), p  < .05) and between the SGA and GNRI (sensitivity = 35%; specificity = 88%; κ = .248 (95% CI, .017 to .479), p  < .05). There was no significant statistical difference between the accuracy of either tool in identifying patients at risk of malnutrition ( p  = .50). The CNST and GNRI do not accurately screen for risk of malnutrition in the hemodialysis population; therefore, further studies are needed to determine an effective malnutrition screening tool in this population.

Information on the use of validated malnutrition risk screening tools in pediatric facilities to guide malnutrition identification, diagnosis, and treatment is scarce. Therefore, a survey of pediatric healthcare facilities and practitioners to ascertain malnutrition risk screening practices in North America was conducted. A pediatric nutrition screening practices survey was developed and sent to members of the American Society for Parenteral and Enteral Nutrition, the Council for Pediatric Nutrition Professionals and the Academy of Nutrition and Dietetics Pediatric Nutrition Practice Group. Respondents represented 113 pediatric hospitals in the United States and six in Canada, of which 94 were inpatient and 59 were outpatient. Nutrition risk screening was completed in 90% inpatient settings, and 63% used a validated screening tool. Nurses performed most malnutrition risk screens in the inpatient setting. Nutrition risk screening was reported in 51% of outpatient settings, with a validated screening tool being used in 53%. Measured anthropometrics were used in 78% of inpatient settings, whereas 45% used verbally reported anthropometrics. Measured anthropometrics were used in 97% outpatient settings. Nutrition risk screening was completed in the electronic health record in 80% inpatient settings and 81% outpatient settings. Electronic health record positive screen generated an automatic referral in 80% of inpatient and 45% of outpatient settings. In this sample of pediatric healthcare organizations, the results demonstrate variation in pediatric malnutrition risk screening in North America. These inconsistencies justify the need to standardize pediatric malnutrition risk screening using validated pediatric tools and allocate resources to perform screening., (© 2024 American Society for Parenteral and Enteral Nutrition.)

Background: This study constitutes a secondary analysis of a prospective cohort aiming to evaluate the potential correlation between nutritional risk and status at admission with the occurrence of post-discharge complications and hospital readmissions in children receiving care at high resource Centres., Methods: Data was collected from 5 Canadian tertiary pediatric Centers between 2012 and 2016. Nutritional risk and status were evaluated at hospital admission with validated tools (STRONGkids and Subjective Global Nutrition Assessment [SGNA]) and anthropometric measurements. Thirty days after discharge, occurrence of post-discharge complications and hospital readmission were documented., Results: A total of 360 participants were included in the study (median age, 6.1 years; median length of stay, 5 days). Following discharge, 24.1% experienced complications and 19.5% were readmitted to the hospital. The odds of experiencing complications were nearly tripled for participants with a high nutritional risk compared to a low risk (OR = 2.85; 95% CI [1.08-7.54]; P = 0.035) and those whose caregivers reported having a poor compared to a good appetite (OR = 2.96; 95% CI [1.59-5.50]; P < 0.001). According to SGNA, patients identified as malnourished had significantly higher odds of complications (OR, 1.92; 95% CI, 1.15-3.20; P = 0.013) and hospital readmission (OR, 1.95; 95% CI, 1.12-3.39; P = 0.017) than to those well-nourished., Conclusions: This study showed that complications and readmission post-discharge are common, and these are more likely to occur in malnourished children compared to their well-nourished counterparts. Enhancing nutritional care during admission, at discharge and in the community may be an area for future outcome optimization., (© 2024. The Author(s).)

Purpose: To examine the social network factors associated with changes in nutrition risk scores, measured by SCREEN-8, over three years, in community-dwelling Canadians aged 45 years and older, using data from the Canadian Longitudinal Study on Aging (CLSA). Methods: Change in SCREEN-8 scores between the baseline and first follow-up waves of the CLSA was calculated by subtracting SCREEN-8 scores at follow-up from baseline scores. Multivariable linear regression was used to examine the factors associated with change in SCREEN-8 score. Results: The mean SCREEN-8 score at baseline was 38.7 (SD = 6.4), and the mean SCREEN-8 score at follow-up was 37.9 (SD = 6.6). The mean change in SCREEN-8 score was -0.90 (SD = 5.99). Higher levels of social participation (participation in community activities) were associated with increases in SCREEN-8 scores between baseline and follow-up, three years later. Conclusions: Dietitians should be aware that individuals with low levels of social participation may be at risk for having their nutritional status decrease over time and consideration should be given to screening them proactively for nutrition risk. Dietitians can develop and support programs aimed at combining food with social participation.

One in three hospitalized children have disease-related malnutrition (DRM) upon admission to hospital, and all children are at risk for further nutritional deterioration during hospital stay; however, systematic approaches to detect DRM in Canada are lacking. To standardise and improve hospital care, the multidisciplinary pediatric working group of the Canadian Malnutrition Taskforce aimed to develop a pediatric, inpatient nutritional care pathway based on available evidence, feasibility of resources, and expert consensus. The working group ( n  = 13) undertook a total of four meetings: an in-person meeting to draft the pathway based on existing literature and modelled after the Integrated Nutrition Pathway for Acute Care (INPAC) in adults, followed by three online surveys and three rounds of online Delphi consensus meetings to achieve agreement on the draft pathway. In the first Delphi survey, 32 questions were asked, whereas in the second and third rounds 27 and 8 questions were asked, respectively. Consensus was defined as any question/issue in which at least 80% agreed. The modified Delphi process allowed the development of an evidence-informed, consensus-based pathway for inpatients, the Pediatric Integrated Nutrition Pathway for Acute Care (P-INPAC). It includes screening <24 h of admission, assessment with use of Subjective Global Nutritional Assessment (SGNA) <48 h of admission, as well as prevention, and treatment of DRM divided into standard, advanced, and specialized nutrition care plans. Research is necessary to explore feasibility of implementation and evaluate the effectiveness by integrating P-INPAC into clinical practice., Competing Interests: Jessie M. Hulst has received speaker fees from Abbott Nutrition Canada and Nutricia Canada. Kim Brunet-Wood has received speaker fees from Abbott Nutrition Canada. Valerie Marchand has received speaker fees from Takeda. Nikhil Pai has received speaker fees from Abbott Nutrition Canada and Takeda.

Malnutrition is prevalent among surgical candidates and associated with adverse outcomes. Despite being potentially modifiable, malnutrition risk screening is not a standard preoperative practice. We conducted a cross-sectional survey to understand healthcare professionals' (HCPs) opinions and barriers regarding screening and treatment of malnutrition. HCPs working with adult surgical patients in Canada were invited to complete an online survey. Barriers to preoperative malnutrition screening were assessed using the Capability Opportunity Motivation-Behaviour model. Quantitative data were analyzed using descriptive statistics and qualitative data were analyzed using summative content analysis. Of the 225 HCPs surveyed ( n  = 111 dietitians, n  = 72 physicians, n  = 42 allied HCPs), 96%-100% agreed that preoperative malnutrition is a modifiable risk factor associated with worse surgical outcomes and is a treatment priority. Yet, 65% ( n  = 142/220; dietitians: 88% vs. physicians: 40%) reported screening for malnutrition, which mostly occured in the postoperative period ( n  = 117) by dietitians ( n  = 94). Just 42% (48/113) of non-dietitian respondents referred positively screened patients to a dietitian for further assessment and treatment. The most prevalent barriers for malnutrition screening were related to opportunity, including availability of resources (57%, n  = 121/212), time (40%, n  = 84/212) and support from others (38%, n  = 80/212). In conclusion, there is a gap between opinion and practice among surgical HCPs pertaining to malnutrition. Although HCPs agreed malnutrition is a surgical priority, the opportunity to screen for nutrition risk was a great barrier., Competing Interests: CG has received honoraria for giving educational talks sponsored by Abbott Nutrition, Nestle Nutrition and Fresenius Kabi, which were unrelated to this manuscript. DSM has received honoraria for giving educational talks sponsored by Merck and Walnut Foundation which were unrelated to this manuscript. OL is a co-founder of the ERAS® Society and co-author of several of the guidelines from the ERAS®Society. He also held a patent for a preoperative carbohydrate drink until 2013, and has received honoraria for speaking, travel and advise unrelated to the current work from Nutricia, and Encare AB. LG has received honoraria for giving educational talks sponsored by Abbott Nutrition, Baxter and Fresenius Kabi, which were unrelated to this manuscript.

Malnutrition affects up to one in three Canadian children admitted to hospital. Awareness among pediatric healthcare providers (HCPs) of the prevalence and impacts of hospitalized malnutrition is critical for optimal management. The purpose of this study was to determine perceptions of malnutrition among pediatric HCP across two major academic health sciences centres, and to determine how the use of a standardized pediatric nutritional screening tool at one institution affects responses. Between 2020 and 2022, 192 HCPs representing nursing, dietetics, medicine, and other allied health were surveyed across McMaster Children's Hospital and The Hospital for Sick Children. 38% of respondents from both centres perceived rates of malnutrition between approximately one in three patients. Perceptions of the need for nutritional screening, assessment, and management were similar between centres. All respondents identified the need for better communication of hospitalized malnutrition status to community providers at discharge, and resource limitations affecting nutritional management of pediatric inpatients. This study represents the largest and most diverse survey of inpatient pediatric HCPs to date. We demonstrate high rates of baseline knowledge of hospital malnutrition, ongoing resource challenges, and the need for a systematic approach to pediatric nutritional management., Competing Interests: Daina Kalnins is a member of the Canadian Malnutrition Task Force-Pediatric Working Group and a member of Healthcare Advisory Council, CF Canada. Jessie Hulst is a member of the Canadian Malnutrition Task Force-Pediatric Working Group and Co-chair in the Pediatric Working group. Jessie Hulst received honoraria from Abbott Canada and Nutricia. Jillian Owens is a member of the Canadian Malnutrition Task Force-Pediatric Working Group. Nikhil Pai is a member of the Canadian Malnutrition Task Force-Pediatric Working Group and the North American Society of Pediatric Gastroenterology, Hepatology & Nutrition- Section on Nutrition. Nikhil Pai received grants from Hamilton Health Sciences, Canadian Institutes of Health Research, Hamilton Academic Health Sciences Organization, Ministry of Colleges and Universities Ontario, McMaster University and Hamilton Health Sciences Foundation. Nikhil Pai has received consulting fees from Ministry of Heath Ontario, Abott Canada and Ferring. Nikhil Pai received honoraria from Takeda, Abbott Canada and American Society of Parenteral and Enteral Nutrition (Educational Events). Nikhil Pai received support for attending meetings and/or travel from American Society of Parenteral and Enteral Nutrition and McMaster KidsDigHealth (student support). Nikhil Pai has pending patent for Method of Diagnosing and Treatment Monitoring of Crohn's Disease and Ulcerative Colitis (CA3164043A1). Nikhil Pai received in-Kind FMT research Materials from Rebiotix Inc., a Ferring Company.

Historically, the constructs of inclusion, diversity, equity, and access (IDEA) have not been sufficiently considered or included in population health nutrition research and practice. Consequently, current nutrition assessment benchmarks and knowledge translation tools may not accurately or adequately reflect diversity in the Canadian population or produce meaningful dietary guidance. The purpose of this current opinion paper is to introduce the population health nutrition research and practice framework and explore the current application of IDEA within this framework. Recommendations are offered to incorporate the constructs of IDEA along the continuum of future nutrition research and services to improve population nutritional health., Competing Interests: The authors declare there are no competing interests.

Purpose: The objective of this study was to survey registered dietitians (RDs) at acute care hospitals across Canada to determine whether valid screening and assessment methods (i.e. those with formal evaluation of the psychometric and/or clinimetric properties of the tool) are used to identify protein-energy malnutrition following stroke.Methods: One hundred and twenty-five Canadian healthcare institutions admitting high volumes (≥100/year) of acute stroke patients were identified. RDs at these sites who provided services to patients recovering from acute stroke were contacted and invited to participate in an online survey.Results: Ninety-five RDs completed the survey. Sixty dietitians (63%) indicated that patients were screened routinely at their institution, which was conducted primarily by dietitians (n = 64, 67.3%). Ten respondents (10.5%) stated they used a screening tool with previously-established validity, while 32 (33.7%) indicated they used a validated assessment tool. Among dietitians using validated tools, 40% and 64% indicated that they used modified versions of the original screening and assessment tools. The most frequently cited tools used for both screening and assessment purposes were Subjective Global Assessment and Mini Nutritional Assessment.Conclusions: The results of this national survey suggest that screening and assessment of nutritional status following acute stroke is conducted using tools that have not been validated previously.Implications for RehabilitationAlthough the use of valid screening and assessment tools is considered part of evidence-based practice, and recommendations for their adoption are included in several national stroke-specific clinical practice guidelines, the results from an online survey suggest that they are not used in clinical practice by RDs in Canada caring for patients following stroke.There are associated risks with the use of screening and assessment tools, which have not been formally validated. The true nutritional status of patients may not be initially identified correctly, and the response to subsequent nutritional interventions may not be assessed accurately or reliably.While the results of this survey were stroke-specific, we suggest that the results are likely generalizable to dietitians working in other patient areas. [ABSTRACT FROM AUTHOR]

Introduction: Malnutrition is a condition that negatively impacts the clinical outcomes of numerous diseases. The aim of this study was to assess the nutritional status of coronary artery disease (CAD) patients and to investigate its relationship with the main clinical aspects of CAD., Material and Methods: 50 CAD patients undergoing coronary angiography were enrolled in this study. The nutritional status assessment was based on Nutritional Risk Score 2002 (NRS 2002), body mass index (BMI), and bioelectrical impedance analysis (BIA) measurements., Results: The analysis showed a moderate inverse correlation between NRS 2002 and BIA phase angle measured at 50 kHz (R: -0.31; p = 0.03) and Z 200/5 parameter (R: 0.34; p = 0.02). The analysis of CAD clinical parameters showed a significant correlation between NRS 2002 and Canadian Cardiovascular Society (CCS) class (R: 0.37; p = 0.01). Left ventricle ejection fraction (LVEF) was correlated with BMI (R: 0.38; p = 0.02), however further BIA revealed hydration changes as LVEF was correlated to intracellular (ICF) and extracellular fluid (ECF) proportion: positively with ICF (R: 0.38; p = 0.02) and negatively with ECF (R: -0.39; p = 0.02)., Conclusions: NRS 2002 and BIA are valuable tools for nutritional status assessment in CAD patients. Malnutrition is related to the severity of CAD symptoms, particularly in women. Maintaining proper nutritional status can have a potentially important role in this group of patients.

Although breakfast is associated with more favourable nutrient intake profiles in children, limited data exist on the impact of breakfast on nutrient adequacy and the potential risk of excessive intakes. Accordingly, we assessed differences in nutrient intake and adequacy among breakfast non-consumers, consumers of breakfasts with ready-to-eat cereal (RTEC) and consumers of other types of breakfasts. We used cross-sectional data from 12 281 children and adolescents aged 4–18 years who took part in the nationally representative Canadian Community Health Survey, 2004. Mean nutrient intakes (obtained using a multiple-pass 24 h recall method) were compared among the breakfast groups using covariate-adjusted regression analysis. Usual nutrient intake distributions, generated using the National Cancer Institute method, were used to determine the prevalence of nutrient inadequacy or the potential risk of excessive intakes from food sources alone and from the combination of food plus supplements. Of these Canadian children, 10 % were breakfast non-consumers, 33 % were consumers of RTEC breakfasts and 57 % were consumers of other types of breakfasts. Non-consumption of breakfast increased with age (4–8 years: 2 %; 9–13 years: 9 %; 14–18 years: 18 %). Breakfast consumers had higher covariate-adjusted intakes of energy, many nutrients and fibre, and lower fat intakes. The prevalence of nutrient inadequacy for vitamin D, Ca, Fe and Mg (from food alone or from the combination of food plus supplements) was highest in breakfast non-consumers, intermediate in consumers of other types of breakfasts and lowest in consumers of RTEC breakfast. For vitamin A, P and Zn, breakfast non-consumers had a higher prevalence of nutrient inadequacy than both breakfast groups. The potential risk of excessive nutrient intakes was low in all groups. Efforts to encourage and maintain breakfast consumption in children and adolescents are warranted. [ABSTRACT FROM PUBLISHER]

Aim To document and compare current practice in nutrition assessment of Parkinson's disease by dietitians in Australia and Canada in order to identify priority areas for review and development of practice guidelines and direct future research. Methods An online survey was distributed to DAA (Dietitians Association of Australia) members and PEN (Practice-based Evidence in Nutrition) subscribers through their email newsletters. The survey captured current practice in the phases of the Nutrition Care Plan. The results of the assessment phase are presented here. Results Eighty-four dietitians responded. Differences in practice existed in the choice of nutrition screening and assessment tools, including appropriate body mass index ranges. Nutrition impact symptoms were commonly assessed, but information about Parkinson's disease medication interactions was not consistently assessed. Conclusions The variation in practice related to the use of screening and assessment methods may result in the identification of different goals for subsequent interventions. Even more practice variation was evident for those items more specific to Parkinson's disease and may be due to the lack of evidence to guide practice. Further research is required to support decisions for nutrition assessment of Parkinson's disease. [ABSTRACT FROM AUTHOR]

Automated, self-administered, Web-based 24-h dietary recall tools are increasingly available for nutrition research in different settings, particularly in epidemiological studies and national surveys because of their practicality and efficiency. However, the usability of different 24-h dietary recall tools must be assessed and compared for use in specific populations as it is a major driver of the response rate and retention of participants. The primary aim of this study was to compare the usability of two validated, self-administered, web-based 24-h dietary recall tools available for the Canadian population: the R24W and the 2018 Canadian version of the ASA24. The R24W was developed in French for primary use in the province of Québec, Canada while the ASA24 was developed in English for primary use in the USA and recently adapted and translated for use in French-speaking Canadian adults. Whether the R24W and the ASA24-Canada-2018 yield similar nutritional data was also tested. In this randomized crossover study, 48 women and 20 men (mean age of 35 ± 14 years; range: 19−79 years) recruited in the province of Quebec completed the R24W and the ASA24-Canada-2018 in French twice on each occasion. Participants also completed the System Usability Scale (SUS), a reliable and valid scale giving a global view of subjective assessments of usability. Mean SUS score as well as mean dietary intakes of energy, nutrients and food groups generated by each tool were compared using mixed model analyses for repeated measures. On a scale of 0 to 100, the mean SUS scores (±SD) for the R24W and the ASA24-Canada-2018 were 81 ± 2 and 58 ± 2, respectively (p < 0.0001). 84% of participants stated that they would prefer to use the R24W if they were invited to complete additional 24-h dietary recalls. No significant difference was found between the R24W and the ASA24-Canada-2018 for the intake of energy, proteins, lipids, saturated fatty acids, carbohydrates, fibers, sodium and vegetables and fruits. In sum, while the R24W and the ASA24-Canada-2018 generate comparable self-reported dietary intake data, the R24W showed a better usability than the ASA24-Canada-2018 in a sample of French-speaking adults from the province of Quebec.

Background Nutritional risk screening is typically done in clinical settings to identify individuals at risk of malnourishment. This article presents the first population-level assessment of nutritional risk based on a large national sample representative of Canadian householders aged 65 or older. Data sources and methods Data from the 2008/2009 Canadian Community Health Survey--Healthy Aging were used to estimate the prevalence of nutritional risk by selected characteristics. Factors associated with nutritional risk were examined with restricted and full logistic models. The distribution of responses on the SCREEN II-AB nutritional risk instrument is reported. Results Based on the results of the 2008/2009 survey, 34% of Canadians aged 65 or older were at nutritional risk. Women were more likely than men to be at risk. Among people with depression, 62% were at nutritional risk, compared with 33% of people without depression. Level of disability, poor oral health, and medication use were associated with nutritional risk, as were living alone, low social support, infrequent social participation, and not driving on a regular basis. Lower income and education were also associated with nutritional risk. Interpretation Nutritional risk is common among seniors living in private households in Canada. The characteristics of people most likely to be at nutritional risk provide evidence for targeted screening and assessment. [ABSTRACT FROM AUTHOR]

Abstract: Low intakes of calcium and vitamin D increase the risk for osteoporosis, bone fracture, and other health problems. This study aimed to examine the calcium and vitamin D intakes of Canadian-born Chinese (CBC) and Asian-born Chinese (ABC) in Edmonton, Canada, and to identify usual food sources of these nutrients. We hypothesized that CBC would have higher intakes of calcium and vitamin D than ABC and that the food sources of these nutrients would differ by region of birth (Canada vs Asia). Two in-person multipass 24-hour dietary recalls were administered for 1 weekday and weekend day for 81 healthy ethnically Chinese aged 18 to 58 years. The risks for calcium and vitamin D inadequacy were calculated as were the contributions of specific foods to calcium and vitamin D intakes. Calcium intake was 781 ± 337 mg/d for CBC and 809 ± 369 mg/d for ABC (P = .737). Vitamin D intake was 3.8 ± 3.4 μg/d for CBC and 5.0 ± 3.9 μg/d for ABC (P = .158). Respective risks for calcium and vitamin D inadequacy were 36% and 98% for men and 78% and 100% for women. Dairy contributed most to the calcium (43%) and vitamin D (52%) intake of participants. For ABC, soybean products contributed to 8.1% of calcium, whereas fatty fish contributed to 16.7% of vitamin D. For CBC, red meats contributed to 11.1% of vitamin D. Dietary intakes of calcium and vitamin D need to be increased in Chinese Canadians through the promotion of dairy and culturally relevant sources of these nutrients. [Copyright &y& Elsevier]

Abstract: Little data exist on vitamin D deficiency related with intake, especially for the Canadian population. The purpose of this study was to develop and evaluate a food frequency questionnaire (FFQ) with 37 items for rapid assessment of vitamin D intake in healthy young adults of diverse ancestry. We recruited 107 subjects in Southern Ontario during the late winter of 2007 who completed an FFQ twice (FFQ-1 and FFQ-2, repeated for reproducibility assessment) and a 7-day food diary (for validation). Serum 25-hydroxyvitamin D (25(OH)D), the major biomarker of vitamin D nutritional status, and skin melanin were determined. The FFQ results were highly correlated with 7-day diary results and with serum 25(OH)D concentrations (r = 0.529, P < .001; r = 0.481, P < .001, respectively). Modifications to the FFQ, by redefining the large serving size and excluding the fortified orange juice category, improved the validity of the FFQ (r = 0.602, P < .001; r = 0.520, P < .001, respectively). The FFQ results were highly correlated (r = 0.663, P < .001), but the mean intakes were different (P < .05). Using results from a modified version of FFQ-1, we examined dietary intakes in 3 predominant groups: East Asian (n = 27), European (n = 31), and South Asian (n = 32). The European group had higher total vitamin D intake (P < .05) and the highest serum 25(OH)D concentrations (P < .05), with a trend for dairy products being responsible for this (P < .10). Because Canadians are reliant on dietary intakes of vitamin D in the wintertime, especially those with higher skin melanin, our FFQ can monitor and provide information on intake and food group consumption. [Copyright &y& Elsevier]

Background: Zinc is an essential trace mineral that serves as a cofactor for the delta-5 and delta-6 desaturases (D5D, D6D) that are critical for long-chain polyunsaturated fatty acid (LC-PUFA) synthesis. While plasma zinc levels are generally reported to be associated with D5D and D6D indices in humans, it remains unclear if dietary zinc intake can be similarly associated with desaturase indices. Therefore, the present investigation examined if zinc intake determined by food frequency questionnaire (FFQ) is associated with desaturase indices in young Canadian adults. Additionally, we explored whether desaturase indices were modified by an interaction between dietary zinc intake and a common variant in the FADS1 gene., Methods: Dietary zinc intake (FFQ), plasma fatty acids (gas chromatography) and the FADS1 rs174547 polymorphism were analyzed in young men and women (n = 803) from the cross-sectional Toronto Nutrigenomics and Health Study. Product-to-precursor fatty acid ratios were used to determine desaturase enzyme indices (D5D = 20:4n-6/20:3n-6; D6D = 18:3n-6/18:2n-6). Individuals were grouped according to dietary zinc intake, as well as by their rs174547 genotype (TT vs. TC+CC). Data were analyzed by 1-way and 2-way ANCOVA., Results: Plasma fatty acids and D5D/D6D indices did not differ between individuals grouped according to dietary zinc intake. Further, the recently proposed biomarker of zinc intake, 20:3n-6/18:2n-6, was not associated with dietary zinc intake. Although the FADS1 rs174547 SNP was significantly associated with D5D and D6D indices in both men and women (p < 0.0001), we did not find evidence of a dietary zinc intake - FADS1 SNP interaction on D5D or D6D indices., Conclusion: Dietary zinc intake, as determined using FFQs, does not predict differences in desaturase indices, irrespective of FADS1 genotype., (Copyright © 2022. Published by Elsevier Ltd.)

Keenoa™ is a novel Canadian diet application (app) currently used by Canadian dietitians to collect diet-related data from clients. The goal of this study was to evaluate Keenoa™ based on user feedback and compare it to a conventional pen and paper method. One hundred and two participants were recruited and randomly assigned to record their diets using this application for 3 nonconsecutive days. Following this, participants were invited to complete an online "exit" survey. Seventy-two subjects responded, with 50 completing an open-ended question asking for general feedback about the app. Data were reviewed and 3 main themes emerged: strengths, challenges, and future recommendations. Strengths associated with the app consisted of picture recognition software, the additional commentary feature, and the overall pleasant data collection process. Challenges that were identified included inconsistencies with the barcode scanning features, the limited food database, time to enter food details, and software issues. Future recommendations included using a larger food database, pairing dietary intake with physical activity monitoring, and having accessible nutritional data. Despite these limitations, participants preferred using mobile apps to record diet compared with traditional written food diaries.

Background: Disease-associated malnutrition (DAM) is common in hospitalized children. This survey aimed to assess current in-hospital practices for clinical care of pediatric DAM in Canada. Methods: An electronic survey was sent to all 15 tertiary pediatric hospitals in Canada and addressed all pillars of malnutrition care: screening, assessment, treatment, monitoring and follow-up. Results: Responses of 120 health care professionals were used from all 15 hospitals; 57.5% were medical doctors (MDs), 26.7% registered dietitians (RDs) and 15.8% nurses (RNs). An overarching protocol for prevention, detection and intervention of pediatric malnutrition was present or "a work in progress", according to 9.6% of respondents. Routine nutritional screening on admission was sometimes or always performed, according to 58.8%, although the modality differed among hospitals and profession. For children with poor nutritional status, lack of nutritional follow-up after discharge was reported by 48.5%. Conclusions: The presence of a standardized protocol for the clinical assessment and management of DAM is uncommon in pediatric tertiary care hospitals in Canada. Routine nutritional screening upon admission has not been widely adopted. Moreover, ongoing nutritional care of malnourished children after discharge seems cumbersome. These findings call for the adoption and implementation of a uniform clinical care pathway for malnutrition among pediatric hospitals.

Background: Malnutrition in medical and surgical inpatients is an on-going problem. More-2-Eat (M2E) Phase 1 demonstrated that improved detection and treatment of hospital malnutrition could be embedded into routine practice using an intensive researcher-facilitated implementation process. Yet, spreading and sustaining new practices in diverse hospital cultures with minimal researcher support is unknown., Aims: To demonstrate that a scalable model of implementation can increase three key nutrition practices (admission screening; Subjective Global Assessment (SGA); and medication pass (MedPass) of oral nutritional supplement) in diverse acute care hospitals to detect and treat malnutrition in medical and surgical patients., Methods: Ten hospitals participated in this pretest post-test time series implementation study from across Canada, including 21 medical or surgical units (Phase 1 original units (n = 4), Phase 1 hospital new units (n = 9), Phase 2 new hospitals and units (n = 8)). The scalable implementation model included: training champions on implementation strategies and providing them with education resources for teams; creating a self-directed audit and feedback process; and providing mentorship. Standardized audits of all patients on the study unit on an audit day were completed bi-monthly to track nutrition care activities since admission. Bivariate comparisons were performed by time period (initial, mid-term and final audits). Run-charts depicted the trajectory of change and qualitatively compared to Phase 1., Results: 5158 patient charts were audited over the course of 18-months. Admission nutrition screening rates increased from 50% to 84% (p < 0.0001). New Phase 1 units more readily implemented screening than Phase 2 sites, and the original Phase 1 units generally sustained screening practices from Phase 1. SGA was a sustained practice at Phase 1 hospitals including in new Phase 1 units. The new Phase 2 units improved completion of SGA but did not reach the levels of Phase 1 units (original or new). MedPass almost doubled over the time periods (7%-13% of all patients p < 0.007). Other care practices significantly increased (e.g. volunteer mealtime assistance)., Conclusion: Nutrition-care activities significantly increased in diverse hospital units with this scalable model. This heralds the transition from implementation research to sustained changes in routine practice. Screening, SGA, and MedPass can all be implemented, improve nutrition care for all patients, spread within an organization, and for the most part, sustained (and in the case of original Phase 1 units, for over 3 years) with champion leadership., Competing Interests: Conflict of interest The authors declare that funding was provided by Abbott Laboratories Canada, as required matching funding by the primary funder, The Canadian Frailty Network. Funds were used to develop the INPAC registry and feedback reports used by sites., (Copyright © 2020 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background : High sodium intake is a leading modifiable risk factor for cardiovascular diseases. This study estimated full compliance to Canada's voluntary sodium reduction guidance (SRG) targets on social inequities and population sodium intake. Methods : We conducted a modeling study using n = 19,645, 24 h dietary recalls (Canadians ≥ 2 years) from the 2015 Canadian Community Health Survey-Nutrition (2015 CCHS-N). Multivariable linear regressions were used to estimate mean sodium intake in measured (in the 2015 CCHS-N) and modelled (achieving SRG targets) scenarios across education, income and food security. The percentage of Canadians with sodium intakes above chronic disease risk reduction (CDRR) thresholds was estimated using the US National Cancer Institute (NCI) method. Results : In children aged 2-8, achieving SRG targets reduced mean sodium intake differences between food secure and insecure households from 271 mg/day (95%CI: 75,468) to 83 mg/day (95%CI: -45,212); a finding consistent across education and income. Mean sodium intake inequities between low and high education households were eliminated for females aged 9-18 (96 mg/day, 95%CI: -149,341) and adults aged 19 and older (males: 148 mg/day, 95%CI: -30,327; female: -45 mg/day, 95%CI: -141,51). Despite these declines (after achieving the SRG targets) the majority of Canadians' are above the CDRR thresholds. Conclusion : Achieving SRG targets would eliminate social inequities in sodium intake and reduce population sodium intake overall; however, additional interventions are required to reach recommended sodium levels.

We assessed the reliability and validity of a Salty Food Frequency Questionnaire for Sodium (FFQ-Na) and a Discretionary Salt Questionnaire (DSQ) developed for the French-Canadian population. The reliability was evaluated according to temporal stability over a 7-15 day interval ( n = 36). Validity was evaluated by testing the tools against a 24-h urine sodium excretion (24 h Uri-Na) and a 3-day food record, and this at individual and group levels ( n = 164). The intra-class coefficients (ICC) values for the test-retest of the DSQ, the FFQ-Na and the two questionnaires combined were 0.73, 0.97 and 0.98 respectively. Correlations of the FFQ-Na with the 24 h Uri-Na and the 3-day food record were 0.3 ( p < 0.001) and 0.35 ( p < 0.001) respectively. The DSQ showed no significant correlation with the reference measures. The correlation between the two methods combined were 0.29 ( p < 0.001) with the 24 h Uri-Na and 0.31 ( p < 0.001) with the 3-day food record. The results of Bland-Altman indicated that for the combined questionnaires, there was a bias of measurement (underestimation of intake), but it was constant for every level of intake according to the reference measures. Finally, the cross-classification indicated an acceptable proportion of agreement, but a rate between 20% and 30% of classification in the opposite quartile. In conclusion, the developed tools are reliable and showed some facets of validity.

Background: Although mostly food-based, the majority of dietary guidelines also recommend limiting the consumption of foods high in SFAs. Yet, the association between the consumption of SFAs from different food sources and overall diet quality remains uncertain., Objectives: The objective of this study was to examine the associations between SFAs from various food sources and the 2015 Healthy Eating Index (HEI-2015) as a proxy of overall diet quality., Methods: The study sample included 11,106 respondents between 19 and 70 y of age from the 2015 Canadian Community Health Survey. Dietary intakes as well as the HEI-2015 were calculated using data from a single 24-h recall. An HEI-2015 from which the SFA subscores were subtracted was also calculated. Low nutritive value foods were defined using Health Canada's 4-Tier system. Associations were investigated using multivariable linear regressions with restricted cubic splines., Results: Major sources of SFAs in this population were low nutritive value foods [4.4% of total energy intake (%E)], dairy (2.7%E), and meat products (1.9%E). The associations between SFA consumption (total and from different food sources) and the HEI-2015 were generally inverse and nonlinear (P for the nonlinearity test <0.03 for all). Total SFA intake showed no association with the SFA-subtracted HEI-2015 (P = 0.29). SFAs from dairy tended to be associated with an increase in the SFA-subtracted HEI-2015 (P < 0.001). Removing the SFA subscore from the HEI-2015 did not materially modify its association with SFAs from meat. SFAs from low nutritive value foods remained significantly and inversely associated with the SFA-subtracted HEI-2015 (P < 0.001)., Conclusions: These cross-sectional data in Canadian adults suggest that intake of SFAs from low nutritive value foods, but not total SFA intake, is captured by an index of healthy eating that does not account for SFA intake., (© The Author(s) 2020. Published by Oxford University Press on behalf of the American Society for Nutrition.)

Purpose: Validated methods to assess diet of non-European infants are sparse. We assessed the validity and reliability of a semi-quantitative food-frequency questionnaire (FFQ) for South Asian infants in Canada. Methods: We developed an 80-item FFQ to assess infant nutrient intake in the South Asian Birth Cohort study (START). Caregivers completed the FFQ twice along with two 24-hour diet recalls. We measured infant plasma ferritin to cross-validate reported iron intake. We evaluated validity using Spearman's rho ( ρ ), and reliability using the intraclass correlation coefficient. Results: Seventy-six caregivers provided 2 FFQs and 2 24-hour diet recalls. Energy-adjusted, de-attenuated correlations between the FFQs and 24-hour diet recalls ranged from -0.29 (monounsaturated fat) through 1.00 (cholesterol). The FFQ overestimated energy intake by 128%. Iron intake by 24-hour diet recalls correlated with plasma ferritin ( r  = 0.41; P  = 0.01; n = 37), but iron intake by FFQ did not. The average reproducibility coefficient of the FFQ ranged from 0.24 (macronutrients) to 0.65 (minerals). Conclusions: Among South Asian infants living in Canada, at least 2 days of diet recall completed with the primary caregiver yields more valid and reproducible estimates of nutrient intakes than a semi-quantitative FFQ, and it highlights that careful selection of FFQ portion sizes is important for assessing dietary intake with an FFQ.

Background: Accurate dietary assessment is needed in studies that include analysis of nutritional intake. Image-based dietary assessment apps have gained in popularity for assessing diet, which may ease researcher and participant burden compared to traditional pen-to-paper methods. However, few studies report the validity of these apps for use in research. Keenoa is a smartphone image-based dietary assessment app that recognizes and identifies food items using artificial intelligence and permits real-time editing of food journals., Objective: This study aimed to assess the relative validity of an image-based dietary assessment app - Keenoa - against a 3-day food diary (3DFD) and to test its usability in a sample of healthy Canadian adults., Methods: We recruited 102 participants to complete two 3-day food records. For 2 weeks, on 2 non-consecutive days and 1 weekend day, in random order, participants completed a traditional pen-to-paper 3DFD and the Keenoa app. At the end of the study, participants completed the System Usability Scale. The nutrient analyses of the 3DFD and Keenoa data before (Keenoa-participant) and after they were reviewed by dietitians (Keenoa-dietitian) were analyzed using analysis of variance. Multiple tests, including the Pearson coefficient, cross-classification, kappa score, % difference, paired t test, and Bland-Altman test, were performed to analyze the validity of Keenoa (Keenoa-dietitian)., Results: The study was completed by 72 subjects. Most variables were significantly different between Keenoa-participant and Keenoa-dietitian (P<.05) except for energy, protein, carbohydrates, fiber, vitamin B1, vitamin B12, vitamin C, vitamin D, and potassium. Significant differences in total energy, protein, carbohydrates, % fat, saturated fatty acids, iron, and potassium were found between the 3DFD and Keenoa-dietitian data (P<.05). The Pearson correlation coefficients between the Keenoa-dietitian and 3DFD ranged from .04 to .51. Differences between the mean intakes assessed by the 3DFD and Keenoa-dietitian were within 10% except for vitamin D (misclassification rate=33.8%). The majority of nutrients were within an acceptable range of agreement in the Bland-Altman analysis; no agreements were seen for total energy, protein, carbohydrates, fat (%), saturated fatty acids, iron, potassium, and sodium (P<.05). According to the System Usability Scale, 34.2% of the participants preferred using Keenoa, while 9.6% preferred the 3DFD., Conclusions: The Keenoa app provides acceptable relative validity for some nutrients compared to the 3DFD. However, the average intake of some nutrients, including energy, protein, carbohydrates, % fat, saturated fatty acids, and iron, differed from the average obtained using the 3DFD. These findings highlight the importance of verifying data entries of participants before proceeding with nutrient analysis. Overall, Keenoa showed better validity at the group level than the individual level, suggesting it can be used when focusing on the dietary intake of the general population. Further research is recommended with larger sample sizes and objective dietary assessment approaches., (©Yuwei Ji, Hugues Plourde, Valerie Bouzo, Robert D Kilgour, Tamara R Cohen. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 09.09.2020.)

Background & Aims: The Global Leadership Initiative on Malnutrition (GLIM) proposed a new framework for diagnosing malnutrition based on combinations of phenotypic and etiologic criteria. The aim of this study was to compare GLIM criteria to Subjective Global Assessment (SGA) judged to be the most validated standardized assessment of malnutrition., Methods: This is a retrospective analysis of variables extracted from a prospective cohort study assessing malnutrition at admission, in 18 Canadian hospitals. Based on the available parameters, GLIM was compared to SGA using the following combinations of one phenotypic and one etiologic criteria: A. weight loss and low intake; B. weight loss and high C-reactive protein (CRP); C. low body mass index (BMI) and low intake; D. low BMI, high CRP. Data were not available for fat-free mass. Since all patients had acute or chronic active disease as per GLIM etiologic criterion, CRP was used as a more specific measure to define inflammation. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were calculated. Data are expressed as mean and Clopper-Pearson exact 95% confidence interval (CI)., Results: From 1022 patients in the original dataset, 784 had all considered parameters with a prevalence of malnutrition (SGA B or C) of 45.15% (CI 41.60, 48.70), where severe malnutrition (SGA C) was 11.73% (CI 9.57, 14.20). Using the available GLIM parameters with the above combinations of two-criteria, the prevalence of malnutrition was 33.29% (CI 30.00, 36.71) and severe malnutrition was 19.77% (CI 17.00, 22.70). For all criteria combinations of GLIM together versus SGA, sensitivity was 61.30% (CI 56.0, 66.4), specificity was 89.77% (CI 86.5, 92.5) and PPV was 83.14% (CI 78.0, 87.5) while NPV was 73.80 (CI 69.8, 77.5). Sensitivity was improved when only SGA C for severe malnutrition was used as the criterion (82.61%; CI 73.3, 89.7) but PPV was greatly reduced (29.12%; CI 23.7, 35.0). Similarly, when using GLIM criteria for severe malnutrition only, sensitivity improved (76.09%; CI 66.1, 84.4). Any two criteria combinations of GLIM had much poorer sensitivity with the highest being weight loss + high CRP (46.33%) with a specificity of 93.02% (PPV: 84.54%; NPV: 67.80%), while the combination of low BMI + low intake had the highest specificity (98.84%) but with a sensitivity of 15.54% (PPV 91.67%; NPV: 58.70%)., Conclusions: Based on the CMTF dataset and using SGA as the most validated tool for diagnosing malnutrition, the two criteria combinations used for GLIM in the present study had fair criterion validity for the diagnosis of malnutrition, regardless of severity status. The best combinations were weight loss and high CRP or weight loss and low intake, both having high specificity at diagnosing malnutrition but unacceptably low sensitivity, and thus were considered poor. There may be potential for the full framework to be used to diagnose malnutrition, but individual combinations of two criteria when used exclusively will miss malnourished patients, as defined by SGA., Competing Interests: Conflicts of interest No conflict of interest to declare., (Copyright © 2019 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Operating in temperature extremes frequently leads to a discrepancy in energy balance. Investigating the effects of operating in extreme cold temperatures on metabolic requirements has not been well described in Canadian Armed Forces (CAF) personnel. The objective was to accurately assess energy deficits using the "gold standard" methodology for measuring energy intake (EI) and energy expenditure (EE). Nutritional intake of a convenience sample of 10 CAF Class A Reservists, completing a basic military qualification (land) course under winter weather conditions, was assessed using the daily measured food intake/food waste collections. EE was measured by the doubly-labelled water method. Average EI was 2377 ± 1144 kcal/day, which was below the EE (4917 ± 693 kcal/day), despite having ~5685 kcal available in the field rations. A significant body weight loss of 2.7% was associated with the average daily energy deficit of 2539 ± 1396 kcal. As a result, participants demonstrated voluntary anorexia. Such results may have important implications for the impairment of performance and health under longer duration operations.

Dietary intake tools are used in epidemiological and interventional studies to estimate nutritional intake. The past-month Canadian Diet History Questionnaire II (CDHQII) has not yet been validated. This study aimed to assess the validity of the CDHQII in adults by comparing dietary results from the CDHQII to the same participants' 24-h recalls consisting of two weekdays and one weekend day. The recalls were collected using the validated multiple-pass method. Participants were asked to complete both tools at baseline, and again at 3-month follow-up. The study further aimed to determine which dietary intake tool was preferred by study participants by comparing completion rates. Data collection occurred at baseline (pre-intervention) and 3-month follow-up (post-intervention). Paired sample t -tests were conducted to compare means for the following nutrients (grams and %kcal): calories, protein, carbohydrates, total fat, saturated fat, unsaturated fat and sodium. Intraclass correlation coefficients of agreement and coefficients of variation were further calculated. Chi-square tests were used to determine the dietary assessment method with the greatest participant completion rate. At baseline ( n = 104), there were no significant differences between the results of the CDHQII and three 24-h recalls (averaged), with overall moderate correlation coefficients. At 3-months ( n = 53), there were significant differences ( p < 0.05) between dietary intake collection methods for all nutrients assessed in this study, except for saturated fat (%kcal), unsaturated fat (%kcal), protein (%kcal) and sodium (mg). Correlation coefficients were moderate. A significantly greater proportion of participants completed the three 24-h recalls compared to the CDHQII after 3 months (completion rates of 67.2% vs. 50.8% of the sample, respectively). The CDHQII provided estimates of mean nutritional intake (calories, macronutrients and sodium) that were comparable to mean intake established from three 24-h recalls, at baseline and was validated in a sample of primarily middle-aged, college-educated, Caucasian female adults with overweight and obesity for mean baseline or cross-sectional measurement only but not for assessing individual/patient dietary intake in clinical practice (r = 0.30-0.68). This tool was not validated at 3-month follow-up. Additionally, participants preferred the three 24-h recalls to the online, past-month CDHQII.

Objective: The objective of this study is to assess how renal registered dietitians (RDs) in Canada perceive the value of Subjective Global Assessment (SGA) to assess protein-energy wasting for clients with chronic kidney disease., Design and Methods: A sequential exploratory mixed method approach included 2 focus groups (n = 6 and 8) and a national survey (n = 54). Two online focus groups were conducted 1 month apart followed by an online survey. Participants included renal RDs working with Stage 5 chronic kidney disease (dialysis and non-dialysis) patients., Results: Five main themes (consistency, organizational/environment, confidence, interpretation, and education) emerged. Renal RDs support using a tool to provide a standardized process for nutrition assessment and feel SGA is an effective educational tool; however, barriers such as time, privacy, confidence in the tool, as well as ability to perform physical assessment, interpretation, and subjectivity limit the use of SGA. Renal RDs feel that it is important to examine nutrition interventions in conjunction with SGA results., Conclusion: The main results of the study describing the limitations to the clinical use of the SGA tool revolve around RDs' time, confidence, ability to interpret the SGA tool, and how SGA is used by administration. The results support the need for educators and administrators to communicate the use of SGA results and provide education opportunities focusing on the use of validated, reliable, responsive tools to assess nutrition status as well as hands-on physical assessment. In some situations, an alternative validated version of SGA or screening tool may be appropriate., (Copyright © 2019 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Food intake varies among long-term care (LTC) residents and, as a result, some residents are at risk for protein-energy malnutrition and its consequences, such as sarcopenia. The present study aimed to determine whether eating occasions, as well as other factors that may vary with eating occasions (e.g. family/volunteer presence), were associated with energy and protein intake at meals and snacks., Methods: The present study comprised a secondary analysis of the cross-sectional Making the Most of Mealtimes study, including 630 residents (median age 88.00 years, range 62-107 years; 197 males) from 32 Canadian LTC homes. An analysis of variance compared protein and energy intake at meals and snacks. Mixed repeated measures linear regression testing for meal and relevant covariates (e.g. family/volunteer presence) was also conducted., Results: Energy and protein intake was significantly associated with eating occasions (F = 44.31, P < 0.001; F = 12.72, P < 0.001), with the greatest energy intake at breakfast, and the greatest protein intake at dinner. Regression analysis confirmed these findings when considering other factors. Covariates associated with higher intake included: being male (+79 kcal; +3.4 g protein), living on a dementia care unit (+39 kcal; +2.1 g protein) and family/volunteer presence at meals (+58 kcal; +2.5 g protein). Intake was lowest in the oldest age group (-59 kcal; -3.6 g protein) and for those sometimes requiring eating assistance (-36 kcal; -2.0 g protein)., Conclusions: Energy and protein intake appears to be associated with eating occasions. Based on these exploratory findings, LTC homes may consider providing more protein-dense foods at breakfast. Protein and energy dense snacks could also be used more extensively to support intake., (© 2019 The British Dietetic Association Ltd.)

Background and Purpose: To determine the construct validity of the Mealtime Relational Care Checklist (M-RCC) when used with individual residents., Methods: Data was collected from 639 residents from 32 long-term care homes; M-RCC was completed at three meals for each resident and averaged. Bivariate analyses determined associations between the M-RCC and other resident level and dining room level measures., Results: Resident M-RCC was positively and significantly ( p < .05) associated with three of five summary scales from Dining Environment Audit Protocol and Meal Time Scan as well as resident malnutrition risk ( r s = 0.23). M-RCC was negatively associated with protein intake (gram per kilogram body weight; r s = -0.13) and Cognitive Performance Score ( t -value = 4.48)., Conclusions: The resident level M-RCC was significantly associated with other measures in expected directions demonstrating construct validity., (© Copyright 2019 Springer Publishing Company, LLC.)

Chronic liver disease places patients at increased risk of malnutrition that can be challenging to identify clinically and treat. Nutrition support is a key aspect of the management of these patients as it has an impact on their quality of life, morbidity, and mortality. There are significant gaps in the literature regarding the optimal nutrition support for patients with different types of liver diseases and the impact of these interventions on long-term outcomes. This Position Paper summarizes the available literature on the nutritional aspects of the care of patients with chronic liver diseases. Specifically, the challenges associated with the nutritional assessment of these subjects are discussed, and recently investigated approaches to determining the patients' nutritional status are reviewed. Furthermore, the pathophysiology of the malnutrition seen in the context of chronic liver disease is summarized and monitoring, as well as treatment, recommendations are provided. Lastly, suggestions for future research studies are described.

The ideal tool for determination of malnutrition risk or malnutrition in long term care (LTC) is elusive. This study compares prevalence, association with resident risk factors and sensitivity (SE) and specificity (SP) of malnutrition or risk categorization in 638 residents from 32 LTC homes in Canada using four tools: the Mini-Nutritional Assessment Short Form (MNA-SF); Patient-Generated Subjective Global Assessment (PG-SGA) Global Category Rating and the Pt-Global webtool; and the interRAI Long Term Care Facility undernutrition trigger. Prevalence was most common with MNA-SF (53.7%) and lowest with InterRAI (28.9%), while the PG-SGA Global Category Rating (44%) was higher than the Pt-Global webtool (33.4%). Tools were consistently associated with resident covariates with few exceptions. The PG-SGA Global Category Rating demonstrated the best sensitivity and specificity when compared to all other tools. Further work to determine the predictive validity of this tool in LTC residents is required.

The Nutrition Care Process (NCP), created by the Academy of Nutrition and Dietetics, provides a framework that encourages critical thinking and promotes uniform documentation by Registered Dietitians (RD). Additionally, it creates a link between the nutrition assessment, nutrition intervention, and the predicted or actual nutrition outcome. NCP has been integrated into a number of institutions in Canada and internationally. A committee of nonmanagement RDs at the Hospital for Sick Children led the Department of Clinical Dietetics in adopting the NCP. The committee developed and consecutively delivered a tailored education plan to 5 groups of RDs within the department. Additional resources were developed to complement the learning plan. The committee administered informal pre- and post-education surveys to measure outcomes. RDs reported receiving adequate training and felt confident implementing NCP into their practice. Adopting the NCP was well-received and RDs within the department continue to integrate it into their current practice.

The objective of this study was to identify key elements from the 2007 Canada's Food Guide that should be included in a diet quality score aiming to reflect the risk of metabolic syndrome (MetS). Dietary intakes of 998 adults (mean age: 43.2 years, 50% women) were used to obtain the Canadian Healthy Eating Index 2007 (C-HEI 2007) and Alternative Healthy Eating Index 2010 (AHEI) scores, as well as a dietary pattern (DP) generated by the reduced rank regression (RRR) method. Based on these three scores, a modified version of the C-HEI 2007 (Modified C-HEI) was then proposed. The prevalence ratio (PR) of MetS was examined across diet quality scores using multivariate binomial regression analysis. A higher AHEI, Modified C-HEI, and a lower score for DP were all associated with a significantly lower prevalence of MetS (PR = 0.42; 95% confidence interval (CI) 0.28, 0.64; PR = 0.39; 95% CI 0.23, 0.63; and PR = 0.48; 95% CI 0.31, 0.74, respectively), whereas C-HEI 2007 was not (PR = 0.68; 95% CI 0.47, 1.00). Results suggest that a Modified C-HEI that considers key elements from the C-HEI 2007 and the AHEI, as well the DP, shows that participants with a higher score are less likely to have MetS.

Purpose: This study reports on dietitian use of the Nutrition Care Process Terminology (NCPT) diagnosis of malnutrition based on Subjective Global Assessment (SGA). Methods: Nutrition assessment reports for adults in medical, surgical, and cardiac units in 13 Canadian hospitals were retrospectively examined for a 6-week period in 2014. Reports with a SGA and NCPT diagnosis were included regardless of why the patient was seen by the dietitian. Results: Of the 932 nutrition assessment reports, 857 (92%) included an SGA. Based on SGA, the prevalence of mild to moderate malnutrition (SGA B) and severe malnutrition (SGA C) was 53.4% (n = 458) and 10.0% (n = 86), respectively. When categorized as severely malnourished, the most common NCPT diagnoses were "malnutrition" (n = 55, 72.4%), "inadequate oral intake" (n = 11, 14.5%), and "inadequate protein-energy intake" (n = 10,13.1%). Among those with SGA B and C, the assignment of the NCPT malnutrition diagnosis was 19.8% (n = 95). Conclusions: Dietitians play a key role in the prevention, identification, and treatment of malnutrition in the hospitalized patient and are well positioned to take a leadership role in improving its documentation. Ongoing audits, staff support, and training regarding NCPT use may improve the application of the malnutrition diagnosis. Future research examining dietitian barriers to using the malnutrition diagnosis would be valuable.

Background: Improving the detection and treatment of malnourished patients in hospital is needed to promote recovery., Aim: To describe the change in rates of detection and triaging of care for malnourished patients in 5 hospitals that were implementing an evidence-based nutrition care algorithm. To demonstrate that following this algorithm leads to increased detection of malnutrition and increased treatment to mitigate this condition., Methods: Sites worked towards implementing the Integrated Nutrition Pathway for Acute Care (INPAC), including screening (Canadian Nutrition Screening Tool) and triage (Subjective Global Assessment; SGA) to detect and diagnose malnourished patients. Implementation occurred over a 24-month period, including developmental (Period 1), implementation (Periods 2-5), and sustainability (Period 6) phases. Audits (n = 36) of patient health records (n = 5030) were conducted to identify nutrition care practices implemented with a variety of strategies and behaviour change techniques., Results: All sites increased nutrition screening from Period 1, with three achieving the goal of 75% of admitted patients being screened by Period 3, and the remainder achieving a rate of 70% by end of implementation. No sites were conducting SGA at Period 1, and sites reached the goal of a 75% completion rate or referral for those identified to be at nutrition risk, by Period 3 or 4. By Period 2, 100% of patients identified as SGA C (severely malnourished) were receiving a comprehensive nutritional assessment. In Period 1, the nutrition diagnosis and documentation by the dietitian of 'malnutrition' was a modest 0.37%, increasing to over 5% of all audited health records. The overall use of any Advanced Nutrition Care practices increased from 31% during Period 1 to 63% during Period 6., Conclusion: The success of this multi-site study demonstrated that implementation of nutrition screening and diagnosis is feasible and leads to appropriate care. INPAC promotes efficiency in nutrition care while minimizing the risk of missing malnourished patients., Trial Registration: Retrospectively registered ClinicalTrials.gov Identifier: NCT02800304, June 7, 2016., (Copyright © 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Introduction: Celiac disease (CD) is an autoimmune disease requiring lifelong adherence to the gluten-free diet (GFD). The GFD has significant nutritional limitations which may result in poor diet quality (DQ). We hypothesized that biopsy-proven children with CD (CCD) would have dietary patterns characterized by high saturated fat/simple sugar intake with a low micronutrient density contributing to lower DQ when compared to children with mild-gastrointestinal complaints (GI-CON). In addition, we hypothesized that ethnicity may further impact DQ., Methods: Socio-demographic (age, CD duration, parent/child ethnicity, education), household characteristics, anthropometric, dietary intake (24-h recalls), gastrointestinal pain and adherence was collected in CCD (n = 243) and GI-CON (n = 148). Dietary patterns were determined using k-mean Cluster Analysis., Results: GI-CON had significantly lower DQ than CCD (p < 0.001). Most CCD and GI-CON (>80%) had dietary patterns characterized by1) Western Diet (Cluster 1: %BMR: 110-150, low DQ, high fat, moderate CHO, high sodium) and 2) High Fat-Western Diet (Cluster 2: %BMR:130-150, low DQ, high Fat, high processed meats, high fat dairy products, CHO. Fewer children (<20%) had Prudent, Lower Fat/High Carbohydrate dietary patterns (% BMR:100-150, higher DQ, lower fat/sodium, higher CHO) with a greater proportion of non-Caucasian CCD consuming a Prudent dietary pattern. Seventy-seven percent and 37.5% of CCD and GI-CON, respectively, did not meet estimated average requirements for folate (p < 0.001)., Conclusions: CCD and GI-CON have predominantly Western dietary patterns with low DQ, particularly GI-CON. Non-caucasian CCD consume more prudent dietary patterns with higher DQ. Nutrition education is warranted to ensure optimal DQ in children with chronic gastrointestinal diseases., (Copyright © 2019 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Objectives: A new, web-based, 24-h recall (R24 W) was developed and programmed to assess adherence to Canadian dietary guidelines by automatically generating the Canadian Healthy Eating Index 2007 (C-HEI 2007). The aim of the present study was to determine the relative validity of the R24 W in terms of its ability to generate C-HEI 2007 scores that match those derived from a food record (FR)., Methods: A total of 57 women and 50 men filled a 3-d FR and three 24-h food recalls with the R24 W. C-HEI 2007 was calculated with both dietary assessment tools and compared using de-attenuated correlations and kappa scores. Internal validity (correlations between total score and components) and external validity (comparison of the C-HEI 2007 by sex and age groups) were compared between the two dietary assessment methods., Results: The average C-HEI 2007 score obtained with the R24 W (59.4 ± 11.8) was significantly lower than the one obtained with the FR (62.6 ± 11.1). However, the de-attenuated correlation coefficient between C-HEI 2007 obtained either with R24 W or FR was 0.80 (P < 0.01) and 91.6% of participants were classified in the same or adjacent quartile of C-HEI 2007 with both tools. Women obtained a higher C-HEI 2007 mean score (P < 0.01) with both methods and older adults (age: >51 y) received a higher score than younger adults (age: 18-30 y; P < 0.01) with the R24 W but not with the FR (P = 0.22)., Conclusions: Although the R24 W yields lower C-HEI 2007 scores compared with data from FR, the classification of individuals was highly consistent between the two measurements., (Copyright © 2018 Elsevier Inc. All rights reserved.)

The International Breakfast Research Initiative (IBRI) set out to derive nutritional recommendations for a balanced breakfast using a standardized analysis of national nutrition surveys from Canada, Denmark, France, Spain, UK and the US. In all countries, the frequency of breakfast consumption by age was high and U-shaped with children and older adults having a higher frequency of breakfast consumption. Breakfast contributed 16% to 21% of daily energy intake. In all countries, breakfast was a carbohydrate- and nutrient-rich meal, providing more carbohydrates (including sugars), thiamin, riboflavin, folate, calcium, potassium, and magnesium, and less vitamin A, fats and sodium relative to its contribution to daily energy intakes. Breakfast consumers were stratified by tertiles of the Nutrient Rich Foods (NRF) index, used as a measure of diet quality. Breakfast intakes associated with the top tertile of NRF, along with the Codex Alimentarius international food standards and World Health Organization (WHO) diet guidelines, were used to derive the proposed nutrient recommendations. The goal was to preserve the nutrient density of existing breakfasts, while addressing concerns regarding added sugars, saturated fats, dietary fiber, and vitamin D. This initiative is unique in seeking to derive nutrient recommendations for a specific meal using the observed nutritional profile of such meal.

Background: eaTracker ® is Dietitians of Canada's online nutrition/activity self-monitoring tool accessible via website and mobile app. The purpose of this research was to evaluate the eaTracker ® mobile app based on user perspectives., Methods: One-on-one semi-structured interviews were conducted with adult eaTracker ® mobile app users who had used the app for ≥ 1 week within the past 90 days. Participants ( n = 26; 89% female, 73% 18⁻50 years) were recruited via email. Interview transcripts were coded using first level coding and pattern coding, where first level codes were grouped according to common themes., Results: Participants mentioned several positive aspects of the mobile app which included: (a) Dashboard displays; (b) backed by dietitians; (c) convenience and ease of use; (d) portion size entry; (e) inclusion of food and physical activity recording; and (f) ability to access more comprehensive information via the eaTracker ® website. Challenges with the mobile app included: (a) Search feature; (b) limited food database; (c) differences in mobile app versus website; and (d) inability to customize dashboard displayed information. Suggestions were provided to enhance the app., Conclusion: This evaluation provides useful information to improve the eaTracker ® mobile app and also for those looking to develop apps to facilitate positive nutrition/physical activity behavior change.

Competing Interests: Competing interests: None declared.

Background: Maternal overweight or obesity (OWOB) is linked to gestational diabetes, fetal macrosomia and higher rates of caesarean delivery., Objectives: The study aims to assess whether maternal pre-pregnancy OWOB is associated with infant overweight in a sex-dependent manner, independent of microbiota-altering variables., Methods: Weight and length measurements of 955 mother-infant pairs were obtained from the Canadian Healthy Infant Longitudinal Development cohort. Maternal pre-pregnancy weight was defined as follows: normal, overweight (25 ≤ body mass index < 30) and obese (body mass index ≥ 30). Age and sex-adjusted weight-for-length z-scores >97th percentile were classified as infant overweight at age 1 year. Associations between pre-pregnancy and infant overweight were determined by linear and logistic regression, adjusting for covariates., Results: Maternal pre-pregnancy OWOB were associated with infant weight-for-length and overweight risk at 1 year. Except for pre-pregnancy obesity, these associations were not attenuated appreciably after adjustment for birth mode, exclusivity of breastfeeding, exposure to antibiotics and infant sex. Yet only boys born to mothers with obesity were three times more likely to become overweight at age 1 independent of microbiota-altering variables. Pre-pregnancy obesity was associated with weight-for-length in male and female infants., Conclusions: Maternal pre-pregnancy OWOB increases the risk of infant overweight, and this association is more evident in male infants., (© 2018 World Obesity Federation.)

The objective of the current study was to characterize the relationship between diet quality and body composition in participants living with IBD, specifically Crohn's disease (CD) or ulcerative colitis (UC), in Atlantic Canada. Participants from the Atlantic Partnership for Tomorrow's Health (PATH) study are residents of one of the four Atlantic Canada provinces. Participants who completed the dietary questionnaire and had body composition measured were included in the study (n = 12,462 without IBD, n = 111 CD, n = 119 UC). A greater number of participants with IBD reported having multiple chronic conditions compared to those without IBD. Those with UC had statistically higher body weight and body mass index (BMI) compared to those without IBD. Overall, significant positive correlations were observed between adiposity and servings of refined grains, and meats and alternatives such as eggs and fish, whereas negative correlations were observed with servings of vegetables, fruit, whole grains, and alternatives such as tofu, and nuts/seeds. Participants with IBD (both CD and UC) consumed more refined grains than those without IBD. Using logistic regression analysis, participants consuming more servings of vegetables and whole grains were less likely to have CD where as those consuming more serving of fruit and bean/legumes were less likely to have UC. In the Atlantic PATH cohort, which includes a region of the world with a high incidence of IBD, distinct differences in adiposity and diet quality were observed in individuals with specific types of IBD compared to those without. There is a need for collaborative efforts to address weight management and diet quality issues in those living with IBD in the Atlantic Canadian region., Competing Interests: The authors have declared that no competing interests exist.

The older adult population in Canada is growing, creating a greater demand for long-term care (LTC) facilities. Seniors living in LTC are more vulnerable to malnutrition, making it important to implement nutrition screening tools on a routine basis. The purpose of this study was to explore the practices of Registered Dietitians (RDs) related to nutritional screening, nutritional assessment, and follow-ups conducted within LTC facilities. This study also explored possible barriers hindering the application of these practices. Nine RDs from two health regions in Southern Saskatchewan completed a phone interview to address nutrition care practices/policies and barriers in LTC facilities. Results showed a considerable amount of variability in nutrition care practices for screening and assessment with lack of time identified as the greatest barrier. These findings highlight the importance of having consistent policies and a sufficient amount of RDs available in LTC facilities to provide the expected level of nutrition care for residents.

Background: Survivors of childhood acute lymphoblastic leukemia (cALL) experience cardiometabolic and bone complications after treatments. This study aimed at developing and validating an interview-administrated food frequency questionnaire (FFQ) that will serve to estimate the impact of nutrition in the development of long-term sequalea of French-Canadian cALL survivors., Methods: The FFQ was developed to assess habitual diet, Mediterranean diet score, nutrients promoting bone health and antioxidants. It was validated using a 3-day food record (3-DFR) in 80 cALL survivors (50% male) aged between 11.4 and 40.1 years (median of 18.0 years). Reproducibility was evaluated by comparing FFQs from visit 1 and 2 in 29 cALL survivors., Results: When compared to 3-DFR, the mean values for macro- and micronutrient intake were overestimated by our FFQ with the exception of lipid-related nutrients. Correlations between nutrient intakes derived from the FFQs and the 3-DFRs showed moderate to very good correlations (0.46-0.74). Intraclass correlation coefficients assessing FFQ reproducibility ranged from 0.62 to 0.92, indicating moderate to good reliability. Furthermore, classification into quartiles showed more than 75% of macro- and micronutrients derived from FFQs 1 and 2 classified into the same or adjacent quartile., Conclusions: Overall, our results support the reproducibility and accuracy of the developed FFQ to appropriately classify individuals according to their dietary intake. This validated tool will be valuable for future studies analyzing the impact of nutrition on cardiometabolic and bone complications in French-speaking populations.

Long-term care (LTC) physical and psychosocial mealtime environments have been inconsistently assessed due to the lack of a standardized measure. The purpose of this study was to examine the construct validity of a new standardized observational measure, the Mealtime Scan (MTS), using the Making Most of Mealtimes data collected on 639 residents in 82 dining rooms in 32 LTC homes. The MTS includes physical, social, and person-centered care summary scales scored from 1 to 8. Mean ratings on these summary scales were moderate for physical (5.6 SD 0.9), social (5.0 SD 0.9), and person-centered care (PCC; 5.5 SD 0.8). Regression analyses determined which items within the MTS were associated with these summary scales: physical - music (B = 0.27, p = 0.04), number of staff passing food (B = -0.11, p = 0.03), number of residents (B = -0.03, p = 0.01); social - social sound (B =  0.31 p < 0.0001), number of residents requiring eating assistance (B = 0.11, p = 0.02); PCC - lighting (B = 0.01 p = 0.04), and total excess noise (B = 0.05, p < 0.0001). The Mealtime Relational Care Checklist (M-RCC) was associated positively with ratings on all three summary scales. Correlations revealed that the MTS summary scales were associated with other constructs: Dining Environment Audit Protocol functionality scale, resident and dining room level M-RCC, Mini Nutritional Assessment- Short Form, and resident Cognitive Performance Scale. These results demonstrate that the MTS summary scales exhibit construct validity, as the ratings were associated with expected observed mealtime characteristics and correlated with dining room and resident level constructs in anticipated directions.

Background: Research has demonstrated the importance of physical environments at mealtimes for residents in long term care (LTC). However, a lack of a standardized measurement to assess physical dining environments has resulted in inconsistent research with potentially invalid and unreliable conclusions. The development of a standardized, construct valid instrument that assesses dining rooms is imperative to systematically examine physical environments in LTC. The purpose of this study was to determine the construct validity of the new Dining Environment Audit Protocol (DEAP) tool., Methods: Secondary data collected from the Making Most of Mealtimes (M3) study was used for this analysis. Data were collected in 32 long term care homes, which included 82 dining rooms and 639 residents. A variety of resident and dining room level constructs were compared to the summative scales found on the DEAP using Spearman correlations and Student t-tests. A regression analysis identified individual characteristics assessed with DEAP that were associated with the summative scales of homelikeness and functionality., Results: Regression analysis (p < 0.05) identified that the DEAP homelikeness scale was positively associated with a view of the garden/green space, presence of a clock and a posted menu. The functionality scale was positively associated with number of chairs and lighting, while negatively associated with furniture with rounded edges and clutter. Additionally, the functionality scale was positively associated (p < 0.05) with the Mealtime Scan physical scale (ρ = 0.52), the dining room Mealtime-Relational Care Checklist (M-RCC) (ρ = 0.25), the DEAP total score (ρ = 0.56), and the Mini Nutritional Assessment- Short Form (ρ = 0.26). Homelikeness was positively associated (p < 0.05) with the DEAP total score (ρ = 0.53), staff Person Directed Care score (ρ = 0.49) and the resident Cognitive Performance Scale (t = 2.56), while negatively associated with energy (ρ = -0.26) and protein intake (ρ = -0.24). The homelikeness and functionality scales were also associated with one another (ρ = 0.26)., Conclusion: The construct validity of the DEAP was supported through significant correlations with a variety of measures that are theoretically related to the homelikeness and functionality of LTC dining rooms. This secondary analysis supports the use of the DEAP in future research to quantify the physical environment of LTC dining rooms. Protocol registered with ClinicalTrials.gov ID: NCT02800291; Registered retrospectively June 7, 2016.

The Integrated Nutrition Pathway for Acute Care (INPAC) is an evidence and consensus based pathway developed to guide health care professionals in the prevention, detection, and treatment of malnutrition in medical and surgical patients. From 2015 to 2017, the More-2-Eat implementation project (M2E) used a participatory action research approach to determine the feasibility, and evaluate the implementation of INPAC in 5 hospital units across Canada. Based on the findings of M2E and consensus with M2E stakeholders, updates have been made to INPAC to enhance feasibility in Canadian hospitals. The learnings from M2E have been converted into an online toolkit that outlines how to implement the key steps within INPAC. The aim of this short report is to highlight the updated version of INPAC, and introduce the implementation toolkit that was used to support practice improvements towards this standard.