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Background: The diet proposed by the EAT-Lancet Commission, which supports both health and environmental sustainability, provides an opportunity to assess the sustainability of food-based dietary guidelines., Objectives: The primary objective was to assess the alignment of the 2019 Canada's Food Guide (CFG) with the EAT-Lancet diet. To do so, an index assessing adherence to the EAT-Lancet diet was developed and evaluated., Methods: Data from 1147 adults were used from the cross-sectional PRÉDicteurs Individuals, Sociaux et Environnementaux (PREDISE) study conducted between 2015 and 2017 in the province of Québec. The EAT-Lancet Dietary Index (EAT-I) was developed to evaluate adherence to the EAT-Lancet diet. Adherence to the 2019 CFG was assessed using the Healthy Eating Food Index (HEFI)-2019. Associations between the HEFI-2019 score and component scores and the EAT-I score were examined using linear regression models., Results: The mean EAT-I score (/80) in this population was 33.4 points [95% confidence interval (CI): 32.2, 34.6]. EAT-I scores were consistent with expected differences in diet quality between females and males (+6.9 points, 95% CI: 4.8, 9.0) and between adults aged 50-65 y and 18-34 y (+4.3 points, 95% CI: 1.6, 7.0). The mean HEFI-2019 (/80) score was 44.9 points (95% CI: 44.1, 45.7). The HEFI-2019 was strongly associated with the EAT-I (ß = 0.76, 95% CI: 0.72, 0.80). Among the 10 components of the HEFI-2019, components such as the whole-grain foods (ß =4.01, 95% CI: 3.49, 4.52), grain foods ratio (ß =3.65, 95% CI: 3.24, 4.07), plant-based protein foods (ß =2.41, 95% CI: 2.03, 2.78), and fatty acids ratio (ß =3.12, 95% CI: 2.72, 3.51) showed the strongest associations with the EAT-I., Conclusions: These results suggest that recommendations in the 2019 CFG are largely coherent with the EAT-Lancet diet underscoring the complementarity and compatibility of the 2019 CFG for sustainability and health promotion purposes., (Copyright © 2024 American Society for Nutrition. Published by Elsevier Inc. All rights reserved.)

The aim of this study was to assess the association between daily diet costs and the Healthy Eating Food Index (HEFI)-2019, an index that reflects the alignment of dietary patterns to recommendations on healthy food choices in the 2019 Canada's Food Guide (CFG). Dietary intake data from 24 h recalls, completed between 2015 and 2017, of 1147 French-speaking participants of the web-based multicenter cross-sectional PRÉDicteurs Individuels, Sociaux et Environnementaux (PREDISE) study in Quebec were used. Diet costs were calculated from dietary recall data using a Quebec-specific 2015-2016 Nielsen food price database. Usual dietary intakes and diet costs were estimated using the National Cancer Institute's multivariate method. Linear regression models were used to evaluate associations between diet costs and HEFI-2019 scores. When standardized for energy intake, a higher HEFI-2019 score (75th vs. 25th percentiles) was associated with a 1.09 $CAD higher daily diet cost (95% CI, 0.73 to 1.45). This positive association was consistent among different sociodemographic subgroups based on sex, age, education, household income, and administrative region of residence. A higher daily diet cost was associated with a higher HEFI-2019 score for the Vegetables and fruits, Beverage, Grain foods ratio, Fatty acids ratio, Saturated fats, and Free sugars components, but with a lower score for the Sodium component. These results suggest that for a given amount of calories, a greater adherence to the 2019 CFG recommendations on healthy food choices is associated with an increased daily diet cost. This highlights the challenge of conciliating affordability and healthfulness when developing national dietary guidelines in the context of diet sustainability.

The purpose of this study was to develop and validate a questionnaire assessing eating pleasure dimensions in the adult French-speaking population of the province of Québec, Canada. We developed the Eating Pleasure Questionnaire, a 53-item questionnaire. An expert panel evaluated the content validity, and a pre-test was performed with 30 French-speaking Quebecers (15 men and 15 women, mean age = 46 years) to evaluate the face validity. A sample of 300 Quebecers (150 men and 150 women, mean age = 36 years) completed the online questionnaire for validation. The structure of the questionnaire was examined using exploratory factor analysis (EFA). Internal consistency was evaluated with Cronbach's alpha coefficients. Test-retest reliability was assessed using intra class correlation coefficients (ICC) and construct validity, using Pearson's correlations. Evaluation of content validity and face validity led to the clarification of the instructions, the suppression of two items, the addition of two items and some reformulations. The EFA showed a 7-factor structure: 1- health/ideological food choice motives, 2- sensory experiences and individual preferences, 3- social experiences, 4- mindful eating, 5- emotional/situational eating and reward, 6- food preparation process and 7- new experiences. Cronbach's alpha values for the seven factors ranged from 0.67 to 0.86. The total scale Cronbach's alpha was 0.91, which suggests a good internal consistency. The questionnaire appears reliable with ICC ranging from 0.66 to 0.87. It also showed a good construct validity, with expected positive associations with food well-being (how people link food to well-being), intrinsic motivation, and the pleasure orientation (the importance of obtaining pleasure from food). Overall, these analyses suggest that the Eating Pleasure Questionnaire is valid to evaluate eating pleasure dimensions in our population., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Bread is a highly consumed food and an important source of nutrients in the diet of Canadians, underlining the need to improve its nutritional quality. The Food Quality Observatory (Observatory) aimed to evaluate the nutritional value of the sliced bread products available in Quebec (Canada), according to their grain type and main flour. Analyses included comparing the bread's sodium content to Health Canada's daily values (DV) and sodium voluntary targets, comparing the bread's fibre content thresholds with the source of fibre mentioned, and assessing whether the main flour was associated with the nutrient content. The nutritional values of 294 sliced breads available in Quebec were merged with sales data (from October 2016 to October 2017), with 262 products successfully cross-referenced. The results showed that 64% of the breads purchased were 'low' in fibre (i.e., below 2 g per two slices), while 47% were 'high' in sodium (i.e., above 15% DV per two slices). Attention should be paid to 100% refined grain bread and to bread with refined flour as the main flour, since they are great sellers, while showing a less favourable nutrient content. This study shows that there is room for improvement in the nutritional content of Quebec's bread offer, particularly regarding sodium and fibre content.

The study aimed at documenting motivational orientations for the regulation of eating as defined by self-determination theory and their association with sociodemographic characteristics and overall diet quality. As part of the PREDISE study, French-speaking women (n = 550) and men (n = 547), aged 18-65 years, living in the Province of Québec, Canada, completed online validated questionnaires. The Regulation of Eating Behavior Scale, based on the self-determination theory, assessed self-determined and non-self-determined motivation to regulate one's eating behavior. Three web-based 24-h food recalls were completed and used to compute the Canadian Healthy Eating Index 2007 (C-HEI), an indicator of the overall adherence to Canadian guidelines for healthy eating. Multiple linear regressions were performed to assess how regulation styles are associated with the C-HEI. Model 1 included no covariate, model 2 included sociodemographic covariates, and fully adjusted model 3 included as covariates sociodemographic variables as well as variables that were previously associated with diet quality, namely nutrition knowledge and social support for healthy eating. Women (p < 0.0001), older individuals (p = 0.0002), those with a higher education level (p < 0.0001), and non-smokers (p < 0.0001) reported higher self-determined motivation score than their counterparts. Self-determined motivation was positively (model 1: B = 4.67, p < 0.0001; model 2: B = 3.82, p < 0.0001; model 3: B = 3.61, p < 0.0001) and non-self-determined motivation was negatively (model 1: B = -1.62, p = 0.0009; model 2: B = -1.63, p = 0.0006; model 2: B = -1.49, p = 0.0022) associated with C-HEI. The present study suggests that some subgroups of the general adult population show more self-determined motivation for eating, which is associated with a better diet quality independently of individual characteristics and other individual and social determinants of healthy eating. Strategies to help individuals internalize the regulation of eating should be further investigated., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Associations between sugar consumption and cardiometabolic health, taking into account the physical form of sugar-containing foods (liquid vs. solid) and the type of sugars consumed [free sugars (FSs) vs. naturally occurring sugars (NOSs)], remain to be thoroughly documented., Objective: The objective was to examine whether FS and NOS intakes from drinks and solid foods are associated with cardiometabolic risk factors in a sample of French-speaking adults from the province of Quebec, Canada., Methods: Data were collected as part of the cross-sectional PREDISE (PRÉDicteurs Individuels, Sociaux et Environnementaux) study (n = 1019, 18-65 y old; 50% women). FS and NOS intakes were assessed by three 24-h dietary recalls using a self-administered, web-based application. Diet quality was assessed using the Alternative Healthy Eating Index-2010. Participants underwent on-site clinical assessment of cardiometabolic risk factors, including blood pressure, waist circumference, BMI, and fasting blood sampling (glucose, insulin, C-reactive protein, blood lipids). Multivariable linear regression models were performed to examine the associations between sugar intake and cardiometabolic risk factors with sociodemographic characteristics, lifestyle variables, and diet quality entered as covariates., Results: In fully adjusted models, FS intake from drinks was associated with fasting insulin (1.06%; 95% CI: 0.30%, 1.84%; P = 0.006) and with insulin resistance as estimated using the HOMA model (1.01%; 95% CI: 0.19%, 1.84%; P = 0.02). All metabolic variables that were significantly associated with NOS intake from solid foods in minimally adjusted models were no longer significant after entering sociodemographic and lifestyle variables (e.g., educational and income levels, smoking, physical activity, daily energy intake) and diet quality in the models., Conclusions: Our data from an adult sample showed that unfavorable and favorable associations with cardiometabolic risk factors observed, respectively, for FS intake from drinks and NOS intake from foods are mostly explained by sociodemographic and lifestyle variables, as well as by diet quality., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition.)

Objective: The Food Quality Observatory was created in the province of Quebec (Canada) in 2016. In this study, the Observatory aimed to generate a methodology to (1) test the use of sales data combined with nutrient values to characterise the nutritional composition of ready-to-eat (RTE) breakfast cereals offered and purchased in the province of Quebec (Canada) and (2) verify the extent to which a front-of-pack label based on the percentage of daily value (DV) for total sugar, as a strategy to improve the food supply, would be distributed in this food category., Design: Nutritional information were obtained by purchasing each RTE breakfast cereal available in the Greater Montreal area. Cereals were then classified according to their processing type., Setting: The nutritional values of 331 RTE breakfast cereals available in Quebec were merged with sales data covering the period between May 2016 and May 2017. A total of 306 products were successfully cross-referenced., Results: Granola and sweetened cereals were the most available (36·6 % and 19·6 %, respectively) and purchased (19·8 % and 40·9 % of sales, respectively). When compared with other types of cereals, granola cereals had a higher energy, fat, saturated fat, protein content and a lower Na content. A larger proportion of chocolate (65 %) and sweetened cereals (49 %) were above 15 % of the DV for sugar., Conclusions: This study showed that the methodology developed generates important data to monitor nutritional quality of the food supply and ultimately contribute to improve the nutritional quality of processed foods.

Purpose: To assess how nutrition knowledge is associated with global diet quality and to investigate whether sociodemographic characteristics (ie, sex, age, education, income, marital status, and living with children or not) moderate this association., Design: Cross-sectional web-based study., Participants: The PREDISE study aims at identifying correlates of adherence to healthy eating guidelines in French-speaking adults from the Province of Quebec, Canada., Subjects: A probability sample of 1092 participants (50% female)., Measures: The Nutrition Knowledge Questionnaire and 24-hour food recalls from which the Canadian Healthy Eating Index (C-HEI) was calculated., Analysis: Multiple linear regressions performed to assess how nutrition knowledge is associated with the C-HEI. Interaction terms tested to evaluate whether sociodemographic characteristics moderate the association between nutrition knowledge and the C-HEI., Results: Nutrition knowledge (B = 0.141 [95% CI: 0.075-0.208], P < .0001) was identified as a significant correlate of the C-HEI. Education significantly moderated the association between nutrition knowledge and the C-HEI ( P interaction = .0038), with a significative association among participants with a lower education level (B = 0.295 [95% CI: 0.170-0.421], P < .0001) but not among participants with a higher education level (B = 0.077 [95% CI: -0.004 to 0.157], P = .06). Whether participants lived with or without children also significantly moderated the association ( P interaction = 0.0043); nutrition knowledge was associated with the C-HEI only in participants who were not living with children (B = 0.261 [95% CI: 0.167 to 0.355], P < .0001)., Conclusion: This study suggests that the association between nutrition knowledge and adherence to healthy eating guidelines is not the same in different subgroups of the population. Interventions aiming at increasing nutrition knowledge may be a promising approach to improve diet quality, especially among individuals with a lower education.

Background: Social media represent cost-effective platforms to advance the dissemination and uptake of health research to improve population health. However, there is limited evidence available to support researchers overcome methodological challenges related to recruitment and retention of participants in studies using social media for delivering behavior change interventions. This study aims to describe the recruitment and the retention strategies used in a randomized controlled trial (RCT) that evaluated a blog-delivered healthy eating intervention among mothers of preschoolers and school-aged children., Methods: Eighty-four adult mothers of children aged between two and 12 years old living in Quebec City, Quebec, Canada, were recruited between October 2015 and February 2017 using traditional methods (e.g. institutional email lists, flyers, newspapers, and word of mouth) and Facebook advertisements. Retention rates were calculated at the end of the 6-month intervention and at a 12-month follow-up assessment. Sociodemographic characteristics, Internet use behaviors and retention rates of mothers recruited through traditional methods and Facebook were compared using Wilcoxon-Mann-Whitney tests and Fisher exact tests., Results: Of the 196 mothers who responded to the recruitment call, 87 (44.4%) were eligible and 84 (42.9%) were randomized to the trial, representing a recruitment success of 76.4% (84/110) from the planned sample size target. Among those, a minority (3.6%) were recruited using Facebook. Those mothers presented similar sociodemographic characteristics to those recruited using traditional methods. Retention rates were 73.8% and 66.7% at 6 and 12 months, respectively, with similar rates between mothers recruited using Facebook and traditional methods. Various challenges associated with population retention were highlighted with lack of time being mothers' main reason for withdrawing from the study., Conclusions: The methodological challenges experienced during the conduct of the blog-delivered healthy eating intervention allowed to draw upon several lessons regarding the recruitment process and the retention of mothers of preschoolers and school-aged children to inform future social media-delivered research. Recommendations for future research include exploring mothers' perceptions and preferences to tailor social media recruitment, ensure that interventions are delivered to them using social media platforms that are already integrated into their routine, and are providing remote outcome assessments to increase participant retention., Trial Registration: Clinical Trial Protocol NCT03156803 . Registered on 17 May 2017, retrospectively registered.

In the context of low consumption of vegetables and fruits and milk and alternatives among Canadian mothers and children, novel strategies are needed to improve maternal and child nutrition. This study evaluated the long-term effects of an evidence-informed healthy eating blog on dietary intakes and food-related behaviours of mothers and their child. The study presents a secondary outcome analysis of a randomised controlled trial in which 84 mothers (mean age of 37.6 ± 6.7 years) of 2- to 12-year-old children living in Quebec City, Canada, were randomly assigned to a dietary intervention delivered through a healthy eating blog written by a registered dietitian (RD; n = 42) or a control group (n = 42) during a period of 6 months. Dietary intakes, maternal eating behaviours, food parenting practices, and body weight were measured at baseline, 3 months, at the end of the intervention (6 months), and 6-month post-intervention (12 months). Differences between groups were assessed with mixed linear models. Globally, this study found no evidence of long-term differences in mean dietary intakes in mothers exposed to the blog and their children as well as other food-related outcomes and body weight compared with the control condition. Potential predictors of adherence to dietary recommendations in mothers and children (e.g., involvement of children in household food activities) were identified. In conclusion, a healthy eating blog written by an RD did not result in evidence of any long-term differences in dietary intakes and food-related behaviours in mothers and their children compared with the control condition., (© 2020 The Authors. Maternal & Child Nutrition published by John Wiley & Sons, Ltd.)

This study aimed to measure the influence of the Chefs in Action program (3 cooking workshops) on cooking skills, nutrition knowledge, and attitudes towards healthy eating in children attending summer day camps and compare it with a single cooking workshop. Groups of children (8-12 years) were randomly assigned to the intervention group (n = 25) or to 1 of 3 comparison groups performing a single workshop (group 1, n = 16; group 2, n = 36; group 3, n = 24). Two dietitians evaluated cooking skills during the workshops. Nutrition knowledge and attitudes towards healthy eating were assessed before and after the intervention. No improvement in cooking skills was observed in the intervention group ( P  = 0.25). The intervention group's cooking skills score was significantly higher than comparison group 1 ( P  < 0.001). Nutrition knowledge was significantly improved in the intervention group and the comparison group 3 ( P  < 0.0001) but no effect on attitudes towards healthy eating was observed ( P group × time  = 0.36). In conclusion, the Chefs in Action program positively impacted nutrition knowledge in children. The results also suggest that the type of recipe may influence nutrition knowledge and cooking skills. Further studies are needed to better assess the degree of difficulty required in cooking workshop recipes to improve cooking skills in children.

The decision on patients' competency to manage their affairs and take care of themselves requires a rigorous evaluation process and consistency among practice settings. Research indicates there is a lack of resources to guide healthcare and social service professionals in the interprofessional decision-making process that such an evaluation requires. A web-based tool, the Competency Assessment Tool (CAT), was designed to assist professionals in that process. The authors conducted a usability study with a beta version of the CAT. The objectives of this study were to: (1) explore what is needed to support its use in community-based and specialized settings; and (2) identify barriers to and facilitators of implementation. A major concern was the perceived onerous nature of the tool. Participants indicated a need for different versions of the tool, depending on the complexity of the evaluation. They want to be directed to areas in the tool based on their field of expertise and want adjustments to functionalities related to collaborative work. This study highlights the importance of the awareness of User Experience (UX) considerations at the outset of the design process, to limit the impact of required modifications and facilitate implementation in the workplace.

Background: Although social media such as blogs are still considered innovative communication technologies, some registered dietitians (RDs) are using them to promote healthy eating; however, evidence regarding the effects of healthy eating blogs on users' diet is lacking., Objective: This study evaluated the effects of an evidence-informed healthy eating blog written by an RD on dietary intakes, with a focus on vegetables and fruit and milk and alternatives consumption, and food-related behaviors of Canadian mothers., Design: This study was a parallel, randomized, controlled trial., Participants/setting: Data were collected from 84 French-speaking adult mothers of children aged between 2 and 12 years living in Quebec City, Quebec, Canada, who were recruited between October 2015 and February 2017 using institutional e-mail lists, flyers, newspapers, social media advertisements, and word of mouth., Intervention: The intervention was exclusively delivered through an evidence-informed healthy eating blog-integrating theory-based intervention methods to improve diet quality by increasing vegetables and fruit and milk and alternatives consumption in mothers-for 6 months at a dose of one new post written by an RD each week. Mothers could engage with the RD and fellow participants by posting comments on the blog., Main Outcome Measures: Main outcomes were daily intakes of vegetables and fruit and milk and alternatives. Outcome assessments were performed at baseline, 3 months, and at the end of the 6-month intervention., Statistical Analysis: Differences between the groups were examined using mixed linear models., Results: At 6 months, no significant difference was observed between groups for intakes of vegetables and fruit (P=0.923), milk and alternatives (P=0.271), or food-related behaviors and body weight (P=0.180)., Conclusions: A healthy eating blog, at a dose of 1 post per week, had no effects on dietary intakes, food-related behaviors, and body weight of mothers after 6 months. Methodologic issues are discussed to inform future health behavior research using blogs to promote healthy eating., (Copyright © 2020 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

The objectives were to assess whether social support for healthy eating and perceived food environment are associated with diet quality, and to investigate if sociodemographic characteristics moderate these associations. A probability sample of French-speaking adults from the Province of Québec, Canada, was recruited in the context of the PREDISE study. Participants reported their perceptions of supportive and non-supportive actions related to healthy eating from close others at home and outside of home ( n = 952), and of the accessibility to healthy foods ( n = 1035). The Canadian Healthy Eating Index (C-HEI) was calculated based on three Web-based 24 h food recalls. Multiple linear regression models showed that supportive (B = 1.50 (95% CI 0.46, 2.54)) and non-supportive (B = -3.06 (95% CI -4.94, -1.18)) actions related to healthy eating from close others at home were positively and negatively associated with C-HEI, respectively, whereas actions from close others outside of home were not. The negative association between non-supportive actions occurring at home and C-HEI was stronger among participants with lower (vs. higher) levels of education ( p interaction = 0.03). Perceived accessibility to healthy foods was not associated with C-HEI ( p > 0.05). These results suggest that the social environment may have a stronger influence on healthy eating than the perceived physical environment. This adds support for healthy eating promotion programs involving entire families, especially for more socioeconomically disadvantaged individuals, whose efforts to eat healthily may be more easily thwarted by non-supportive households.

Background.: In occupational therapy practice, client assessments are essential for establishing treatment priorities and determining the effectiveness of interventions. However, occupational therapists' assessment practices are not well documented., Purpose.: This work aimed to provide an overview of the assessment practices of Quebec occupational therapists based on the person-environment-occupation components and clienteles., Method.: A cross-sectional survey was conducted using an online survey that was sent to occupational therapists in Quebec., Findings.: In paediatrics, occupational therapists tend to use standardized tools to assess physical and neurological abilities. Adult assessment focuses mainly on physical abilities and productivity. For seniors, assessment focuses mainly on functional aspects (physical abilities, personal care, and home safety) and screening for cognitive difficulties., Implications.: Occupational therapy assessment mostly focuses on physicial abilities. To ensure a holistic approach, more occupational and environmental components should be included in the assessment practices.

The objective of this study was to characterize the intakes of different types of sugars in an age- and sex-representative sample of French-speaking adults from five regions of the Province of Québec, Canada, enrolled in the cross-sectional PREDISE (PRÉDicteurs Individuels, Sociaux et Environnementaux) study ( n = 1147, 18-65 years old; 50.2% women). Because only total sugar content of foods and beverages is available in the Canadian Nutrient File (CNF) 2015, the initial step of this study was thus to build a database of free and naturally occurring sugars content of each food item and recipe included in the R24W, which is an automated, self-administered, web-based, 24-h dietary recall validated to estimate nutrient intakes in French-speaking adults of the Province of Québec. Total sugars were manually differentiated into free and naturally occurring sugars using a systematic algorithm based on previously published systematic algorithms. The World Health Organization (WHO)'s free sugar definition was used to differentiate total sugars into free and naturally occurring sugars. Dietary intake estimates were assessed using three 24-h dietary recalls completed with the R24W. Mean total, free, and naturally occurring sugar intakes were 116.4 g (19.3% of daily energy intake (%E)), 72.5 g (11.7%E), and 44.0 g (7.5%E), respectively. Over half (57.3%) of the overall sample did not meet the WHO's recommendation to consume less than 10%E from free sugars. Women had a higher %E from naturally occurring sugars than men and being younger was associated with a greater %E from free sugars. Sugar intakes among French-speaking adults from the Province of Québec were mainly in the form of free sugars, with the majority of the population exceeding the WHO recommendation regarding free sugar intake. This suggests that public health efforts towards reducing free sugar intake in this population are relevant and necessary, considering that overconsumption of free sugars negatively influences health outcomes.

Background: There is very limited knowledge on the magnitude to which foods with low nutritive value constitute the diet of adults from the province of Quebec. The extent to which these foods impact cardiometabolic risk is also poorly documented. The objective was to assess the contribution of low nutritive value foods to total energy intake (E) and to examine associations with cardiometabolic risk factors among French-speaking adults from 5 administrative regions of the Province of Quebec., Methods: As part of the cross-sectional PREDISE Study, 1147 adults (50.2% women; mean [SD] age, 43.2 [4.6] years) participated in a web-based investigation. Dietary intake data were obtained using a validated web-based self-administered 24-h recall, the R24W, completed on three occasions. Foods with low nutritive value were defined as foods exceeding predetermined thresholds for the following nutrients: saturated fat, sugar or sodium as well as beverages and ingredients not recommended in Canada's Food Guide 2019. A total of 1019 participants underwent on-site clinical assessment of cardiometabolic risk factors., Results: Participants consumed on average 29.0%E (95%CI, 28.2-29.7) as low nutritive value foods, to which pastries (18%), alcohol (15%), sweets (13%), chips/popcorn (6%) and sugar-sweetened beverages (6%) contributed the most. Low nutritive value foods contributed more to total E in men than in women (30.7%E vs. 27.5%E, respectively; P < 0.0001). In fully-adjusted linear regression models, increments of 250 kcal/d from low nutritive value foods were associated with higher body mass index (+ 1.7 kg/m 2 ; 95%CI 1.2 to 2.2), higher waist circumference (+ 0.6 cm; 95%CI, 0.1 to 1.1), cholesterol: HDL cholesterol ratio (+ 0.12 mmol/L; 95%CI, 0.01 to 0.24 and triglycerides (+ 7.8%; 95%CI, 3.0 to 12.8)., Conclusions: Low nutritive value foods contribute near 30% of total daily energy intake of French-speaking adults of the Province of Quebec and are associated with increased waist circumference and an unfavourable lipid profile. Addressing consumption of low nutritive value foods at the population level is a potential strategy to attenuate the burden of chronic diseases.

Introduction: Bathing is the most problematic activity of daily living for aging adults, and the ability to perform it is influenced by physical capabilities that decrease with age. Drowning is an under-documented event related to bathing for older adults. This study investigates the circumstances of these tragedies, to prevent them., Methods: Census of 2005-2014 bathtub drownings in the province of Quebec (Canada) involving victims aged 65+. Coroner's reports were analyzed using a grid based on factors previously associated with bath-related drownings in literature, iteratively modified., Results: Among the 92 bathtub drowning victims inventoried, 42% were aged 65+. The average age of older victims is 79 (65-97, ±9 years). Main probable cause of drowning is a cardiac problem, although only 19% of victims had a medical history of heart disease. Most victims were alone in their apartment or residence when drowning occurred. Risky periods appear to be springtime, Sundays, and evenings. Despite expectations, relevant information about the physical environment is very scarce., Conclusions: At least 39 Quebecers, aged 65+, drowned in their bathtubs over a 10-year period. More older adults than children are victims of bathtub drownings in community-dwellings. It seems that bathing may induce heart distress, leading to an appreciable number of drownings., Practical Implications: Since cardiac health problems are present in these deplorable events, promoting access to safety devices in the environment (emergency button, grab bars) and modified personal hygiene habits (bathing chair, showering) might be potential ways to prevent drowning and improve safety in older adults while they perform their personal hygiene, an essential activity for health and human dignity., (Copyright © 2019 Elsevier Ltd and National Safety Council. All rights reserved.)

The main objective of this study was to compare self-rated diet quality with a more comprehensive score of diet quality and to assess the ability of self-rated diet quality to predict adherence to healthy eating guidelines. This study also aimed to evaluate the influence of individual characteristics on the association between self-rated diet quality and the overall diet quality score. As part of the PRédicteurs Individuels, Sociaux et Environnementaux (PREDISE) study, 1045 participants (51% women) from the Province of Québec, Canada, self-rated their diet quality ("In general, would you say that your dietary habits are excellent, very good, good, fair, or poor?"). Three Web-based 24-h food recalls were completed, generating data for the calculation of the Canadian Healthy Eating Index (C-HEI) score, an overall diet quality indicator. Participants rated their diet quality as excellent (2.4%), very good (22.7%), good (49.5%), fair (20.3%), or poor (5.1%). C-HEI scores differed significantly between diet ratings, in the expected direction (p < 0.0001). Self-rated diet quality predicted adherence to healthy eating guidelines (i.e., C-HEI > 68) with a sensitivity of 44.5% and a specificity of 81.5% (C-statistic = 0.63). Sex significantly modified the association between self-rated diet quality and C-HEI score (p interaction = 0.0131); women had higher C-HEI scores than did men in the "good" and "fair" ratings. Self-rated diet quality can be useful in obtaining an overview of the diet quality of a population, but the results of this study suggest that such data should be used with caution given their poor ability to predict adherence to healthy eating guidelines. Individual characteristics may influence one's ability to appropriately self-evaluate diet quality.

Purpose: To report the outcomes of a Health at Every Size (HAES) intervention in a real-world setting., Design: Quasi-experimental design evaluating eating behaviors and psychological factors., Setting: The HAES intervention is offered in Health and Social Services Centers in Québec (Canada)., Participants: For this study, 216 women (body mass index [BMI]: 35.76 [6.80] kg/m 2 ) who participated to the HAES intervention were compared to 110 women (BMI: 34.56 [7.30] kg/m 2 ) from a comparison group., Intervention: The HAES intervention is composed of 14 weekly meetings provided by health professionals. It focuses on healthy lifestyle, self-acceptance, and intuitive eating., Measures: Eating behaviors (ie, flexible restraint, rigid restraint, disinhibition, susceptibility to hunger, intuitive eating, and obsessive-compulsive eating) and psychological correlates (ie, body esteem, self-esteem, and depression) were assessed using validated questionnaires at baseline, postintervention, and 1-year follow-up., Analysis: Group, time, and interaction effects analyzed with mixed models., Results: Significant group by time interactions were found for flexible restraint ( P = .0400), disinhibition ( P < .0001), susceptibility to hunger ( P < .0001), intuitive eating ( P < .0001), obsessive-compulsive eating ( P < .0001), body-esteem ( P < .0001), depression ( P = .0057), and self-esteem ( P < .0001), where women in the HAES group showed greater improvements than women in the comparison group at short and/or long term., Conclusion: The evaluation of this HAES intervention in a real-life context showed its effectiveness in improving eating-, weight-, and psychological-related variables among women struggling with weight and body image.

Background: Regular monitoring of the population's food and nutrient intake is essential to develop effective nutrition-focused public health policies. The aim of this study was to provide dietary intake estimates using an age- and sex-representative sample of French-speaking adults with Internet access from 5 administrative regions in the province of Quebec, Canada., Methods: PRÉDicteurs Individuels, Sociaux et Environnementaux (PREDISE) is a multicentre cross-sectional study that used a Web-based approach to collect individual, social, and environmental data on factors associated with adherence to dietary recommendations. Dietary intake was estimated from the average of 3 validated Web-based 24-hour recalls., Results: Mean (± SD) age of the 1147 participants (50.2% women) was 43.2 ± 4.6 years and median body mass index was 26.3 (interquartile range, 23.3-30.3). Less than 25% of participants met Canada's Food Guide recommendations for vegetables and fruit intake (prevalence, 23.6%; 95% confidence interval [CI], 21.1-26.0). Most participants reported consuming more than 2300 mg of sodium (prevalence, 80.5%; 95% CI, 78.2-82.7) and more than 10% energy as saturated fats (prevalence, 74.2%; 95% CI, 71.6-76.7). Mean Canadian Healthy Eating Index score on a scale of 0-100 was 54.5 (95% CI, 53.8-55.2), reflecting relatively poor diet quality according to current dietary recommendations., Conclusions: Self-reported dietary intakes measured using a new validated Web-based 24-hour recall in this sample of French-speaking adults from Quebec and with access to Internet suggest low adherence to current Canadian dietary guidelines. These data emphasize the need for more effective nutrition-focused public health policies to maximize cardiovascular disease prevention at the population level., (Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Genome-wide association studies (GWASs) have identified several genes associated with obesity. The mechanisms through which these genes affect body weight are not fully characterized. Recent studies suggest that eating behavior (EB) traits could be involved, but only a few EB traits were investigated., Objective: This study aimed to investigate whether genetic susceptibility to obesity is mediated by EB traits (cognitive restraint, disinhibition, hunger) and their subscales. We hypothesized that EB traits, and their subscales, partly mediate this association., Design: Adult individuals (n = 768) who participated in the Quebec Family Study were included in this cross-sectional study. A genetic risk score (GRS) of obesity was calculated based on the 97 genetic variants recently identified in a GWAS meta-analysis of body mass index (BMI). EB traits and their subscales were assessed with the use of the Three-Factor Eating Questionnaire. Regression analyses with age and sex as covariates were used to investigate the associations between GRS, EB traits, BMI, and WC and whether the association between GRS and obesity is mediated by EB traits, which represents the indirect effect of GRS on obesity., Results: The GRS of obesity was positively associated with BMI (β = 0.19 ± 0.04, P < 0.0001) and WC (β = 0.46 ± 0.10, P < 0.0001). Regression analyses also revealed that the association between GRS of obesity and BMI was partly mediated by disinhibition and susceptibility to hunger (βindirect = 0.09 ± 0.03, P = 0.0007, and βindirect = 0.04 ± 0.02, P = 0.02, respectively). Habitual and situational susceptibility to disinhibition (βindirect = 0.08 ± 0.03, P = 0.002 and βindirect = 0.05 ± 0.02, P = 0.003, respectively) as well as internal and external locus of hunger (βindirect = 0.03 ± 0.02, P = 0.03 for both) were also found to mediate the association between GRS of obesity and BMI. The same trends were observed with WC., Conclusions: The results of this study indicate that the genetic susceptibility to obesity is partly mediated through undesirable EB traits, which suggests that they could be targeted in obesity treatment and prevention. This trial was registered at clinicaltrials.gov as NCT03355729.

Objective: The present study aimed to develop and validate a questionnaire assessing social support for healthy eating in a French-Canadian population., Design: A twenty-one-item questionnaire was developed. For each item, participants were asked to rate the frequency, in the past month, with which the actions described had been done by family and friends in two different environments: (i) at home and (ii) outside of home. The content was evaluated by an expert panel. A validation study sample was recruited and completed the questionnaire twice. Exploratory factor analysis was performed on items to assess the number of subscales. Internal consistency reliability was assessed using Cronbach's ɑ. Test-retest reliability was evaluated with intraclass correlations between scores of the two completions., Setting: Online survey., Subjects: Men and women from the Québec City area (n 150)., Results: The content validity assessment led to a few changes, resulting in a twenty-two-item questionnaire. Exploratory factor analysis revealed a two-factor structure for both environments, resulting in four subscales: supportive actions at home; non-supportive actions at home; supportive actions outside of home; and non-supportive actions outside of home. Two items were removed from the questionnaire due to low loadings. The four subscales were found to be reliable (Cronbach's ɑ=0·82-0·94; test-retest intraclass correlation=0·51-0·70)., Conclusions: The Social Support for Healthy Eating Questionnaire was developed for a French-Canadian population and demonstrated good psychometric properties. This questionnaire will be useful to explore the role of social support and its interactions with other factors in predicting eating behaviours.

Background: Healthy eating blogs are knowledge translation tools used by nutrition and dietetics practitioners for helping people improve their health behaviors and food choices., Objective: Our aim was to explore women's perceptions of the usefulness and ease of use of healthy eating blog (HEB) characteristics that might increase potential users' intention to use them as tools to improve their dietary habits., Design: We conducted qualitative research using semi-structured individual interviews., Participants: Thirty-three women (mean age of 44 years; range=27 to 61 years) living in the Quebec City, Canada, metropolitan area were studied., Intervention: Four existing HEBs, written by French-Canadian registered dietitians (RDs) whose main objective was the promotion of a healthy diet, were explored by women during individual interviews. A standardized open-ended interview questionnaire based on the Technology Acceptance Model was used to identify women's perceptions about characteristics of type of blog content delivery, RD blogger's delivery of information, blog layout, and blog design., Main Outcome Measures: Women's perceptions toward the contribution of HEB characteristics to the usefulness and ease of use of those tools to improve their dietary habits were measured., Analyses Performed: Interviews were audiorecorded, transcribed verbatim, coded, and analyzed through an inductive content analysis using NVivo software., Results: The most useful characteristics of type of blog content delivery identified by women were recipes, hyperlinks, and references. Among characteristics of RD blogger's delivery of information, most women reported that interaction between blog readers and the RD blogger created a sense of proximity and of connection that was helpful for improving their dietary behaviors. Women's perceptions toward various characteristics of blog layout and design were also discussed., Conclusions: Incorporating specific characteristics when designing HEBs should be considered by RDs and future research to promote the use of those tools to support dietary behavior change efforts of internet users., (Copyright © 2018 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Given that traditional interventions promoting the adoption of a healthy diet are having limited impacts on the population's food choices and eating behaviours, researchers and health practitioners could explore alternative strategies such as the use of eating pleasure to promote healthy eating. To inform future interventions using this approach, this study aimed to explore how a sample of Quebecers perceives and defines eating pleasure and healthy eating. Specific objectives were to verify what commonalities can be found between their definitions of eating pleasure and healthy eating, and what differences can be observed in their answers based on their sex and body mass index (BMI). Twelve focus groups were conducted in Quebec City, Canada, among women and men with a normal weight and with obesity (n = 92). Verbatim transcripts were double-coded using NVivo10. Participants mostly defined eating pleasure through food characteristics related to sensory qualities and psychosocial contexts. In contrast, they mostly mentioned food characteristics related to nutritional quality and ways to regulate eating behaviours to define healthy eating. Most salient perceptions were similar among subgroups based on sex or BMI. Results showed that in participants' perceptions, the concepts of eating pleasure and healthy eating were different, but appeared to be mostly compatible, which makes the integration of eating pleasure a promising avenue for interventions promoting healthy eating., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: The increase in overweight and obesity in adolescents and its health-related consequences highlight the need to develop strategies, which could help them adopt healthy eating habits. The objective of this study was to evaluate the impact of an innovative web-based school nutrition intervention (Team Nutriathlon) aimed at promoting the consumption of vegetables and fruit (V/F) and milk and alternatives (M/A) in high school students and to identify facilitators and/or barriers influencing its success., Methods: Ten classes of first and second year secondary students (grades 7 and 8) from the Québec City region were randomized into two groups (control n = 89 and intervention n = 193). Participants in the intervention (Team Nutriathlon) were to increase their consumption of V/F and M/A using an innovative web-based platform, developed for this study, over 6 weeks. The control group followed the regular school curriculum. The number of servings of V/F and M/A consumed by students per day was compared between the two groups before, during, immediately after and 10 weeks after the intervention using a web-based platform. Main outcome measures included V/F and M/A servings and facilitators and/or barriers of program success. Repeated measures linear fixed effects models were used to assess the impact of Team Nutriathlon on V/F and M/A consumption. A P-value of <0.05 was considered significant., Results: Students in the intervention reported a significant increase of 3 servings and 1.8 servings per day of V/F and M/A, respectively, compared to the control group (P < 0.05); however, this was only observed in the short-term. Some factors contributing to the success of Team Nutriathlon included the team aspect of the program, use of the technology and recording results outside of classroom hours., Conclusion: Team Nutriathlon represents an innovative web-based nutrition program which positively impacts V/F and M/A consumption among high school students. Using web-based or technological platforms may help youth adopt healthy eating habits that will have implications later in adulthood; however, further studies are needed to determine their long-term effects., Trial Registration: NCT03117374 (retrospectively registered).

Objective: The present study aimed to develop and validate a nutrition knowledge questionnaire in a sample of French Canadians from the province of Quebec, taking into account dietary guidelines., Design: A thirty-eight-item questionnaire was developed by the research team and evaluated for content validity by an expert panel, and then administered to respondents. Face validity and construct validity were measured in a pre-test. Exploratory factor analysis and covariance structure analysis were performed to verify the structure of the questionnaire and identify problematic items. Internal consistency and test-retest reliability were evaluated through a validation study., Setting: Online survey., Subjects: Six nutrition and psychology experts, fifteen registered dietitians (RD) and 180 lay people participated., Results: Content validity evaluation resulted in the removal of two items and reformulation of one item. Following face validity, one item was reformulated. Construct validity was found to be adequate, with higher scores for RD v. non-RD (21·5 (sd 2·1) v. 15·7 (sd 3·0) out of 24, P<0·001). Exploratory factor analysis revealed that the questionnaire contained only one factor. Covariance structure analysis led to removal of sixteen items. Internal consistency for the overall questionnaire was adequate (Cronbach's α=0·73). Assessment of test-retest reliability resulted in significant associations for the total knowledge score (r=0·59, P<0·001)., Conclusions: This nutrition knowledge questionnaire was found to be a suitable instrument which can be used to measure levels of nutrition knowledge in a Canadian population. It could also serve as a model for the development of similar instruments in other populations.

Intuitive eating is an adaptive eating style based on the reliance on physiological cues to determine when, what, and how much to eat. The Intuitive Eating Scale-2 (IES-2) is a validated four-subscale tool measuring the degree of adherence to intuitive eating principles. The present series of studies aimed at evaluating the psychometric properties of a French-Canadian adaptation of the IES-2 for the adult population. The factor structure, the reliability (internal consistency and test-retest), the construct validity, and the discriminant validity were evaluated in 334 women and 75 men from the Province of Québec, Canada, across two studies. A confirmatory factor analysis upheld that the four-factor structure of the original IES-2 was adequate for the present sample of French-Canadians. The scale demonstrated adequate internal consistency and test-retest reliability. Construct validity evidence was obtained with the significant associations between intuitive eating and psychological and eating-related variables. Intuitive eating was negatively associated with eating disorder symptomatology and with food- and weight-preoccupation, and positively associated with body-esteem and well-being. The French-Canadian IES-2 was also able to discriminate between genders and body mass index categories. The properties of this new version of the IES-2 are demonstrative of a reliable and valid tool to assess intuitive eating in the French-Canadian adult population of the Province of Québec., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objective: It is commonly recognized that genetic, environmental, behavioral, and social factors are involved in the development of obesity. The family environment may play a key role in shaping children's eating behaviors. The purpose of this study was to estimate the degree of familial resemblance in eating behavioral traits (cognitive dietary restraint, disinhibition, and susceptibility to hunger)., Research Methods and Procedures: Eating behavioral traits were assessed with the Three-Factor Eating Questionnaire in 282 men and 402 women (202 families) from the Quebec Family Study. Familial resemblance for each trait (adjusted for age, sex, and BMI) was investigated using a familial correlation model., Results: The pattern of familial correlation showed significant spouse correlation for the three eating behavior phenotypes, as well as significant parent-offspring and sibling correlations for disinhibition and susceptibility to hunger. According to the most parsimonious model, generalized heritability estimates (including genetic and shared familial environmental effects) reached 6%, 18%, and 28% for cognitive dietary restraint, disinhibition, and susceptibility to hunger, respectively., Discussion: These results suggest that there is a significant familial component to eating behavioral traits but that the additive genetic component appears to be small, with generalized heritability estimates ranging from 6% to 28%. Thus, non-familial environmental factors and gene-gene and gene-environmental interactions seem to be the major determinants of the eating/behavioral traits.

Background: Obesity is frequently associated with eating disorders, and evidence indicates that both conditions are influenced by genetic factors. However, little is known about the genes influencing eating behaviors., Objective: The objective was to identify genes associated with eating behaviors., Design: Three eating behaviors were assessed in 660 adults from the Quebec Family Study with the use of the Three-Factor Eating Questionnaire. A genome-wide scan was conducted with a total of 471 genetic markers spanning the 22 autosomes to identify quantitative trait loci for eating behaviors. Body composition and macronutrient and energy intakes were also measured., Results: Four quantitative trait loci were identified for disinhibition and susceptibility to hunger. Of these, the best evidence of linkage was found between a locus on chromosome 15q24-q25 and disinhibition (P <0.0058) and susceptibility to hunger (P <0.0001). After fine-mapping, the peak linkage was found between markers D15S206 and D15S201 surrounding the neuromedin beta (NMB) gene. A missense mutation (p.P73T) located within the NMB gene showed significant associations with eating behaviors and obesity phenotypes. The T73T homozygotes were 2 times as likely to exhibit high levels of disinhibition (odds ratio: 1.8; 95% CI: 1.07, 2.89; P=0.03) and susceptibility to hunger (odds ratio: 1.9; 95% CI: 1.15, 3.06; P=0.01) as were the P73 allele carriers. Six-year follow-up data showed that the amount of body fat gain over time in T73T subjects was >2 times that than in P73P homozygotes (3.6 compared with 1.5 kg; P <0.05)., Conclusion: The results suggest that NMB is a very strong candidate gene of eating behaviors and predisposition to obesity.

The purpose of the present cross-sectional study was to compare eating behaviours (cognitive dietary restraint, disinhibition and susceptibility to hunger), dietary profile and physiological variables according to the practice of dieting: current dieting; history of dieting in the 10-year period that preceded the study; no dieting during the same period. Dieting history, anthropometric markers of adiposity, RMR, dietary profile (3 d food record) and eating behaviours (three-factor eating questionnaire) were determined in a sample of 244 men and 352 women. A greater proportion of women (31.8 %) than men (16.8 %) reported that they had been on a diet over the past 10 years (P=0.0001). In both genders, current and past dieters had a higher BMI (P<0.05) than non-dieters and current dieters had lower reported energy intakes than past dieters and non-dieters (only in women) (P<0.05). Current and past dieters also had higher scores for all eating behaviours and their subscales (P<0.05; except for susceptibility to hunger in men) compared with non-dieters (adjusted for age, reported energy intake, percentage of dietary fat, BMI and RMR). Moreover, for each dieting-history category, women had significantly higher scores for cognitive dietary restraint than men (P<0.05). In conclusion, the present study showed that current and past dieters had higher scores for cognitive dietary restraint and disinhibition compared with non-dieters. As disinhibition has previously been associated with a greater risk of subsequent weight gain, interventions aimed at preventing an increase in disinhibition may be promising for long-term weight maintenance.

Objective: To put into relationship the dietary and anthropometric profile of men and women with their eating behaviors (cognitive dietary restraint, disinhibition, and susceptibility to hunger) and to assess whether gender and obesity status influence these associations., Research Methods and Procedures: Anthropometric measurements (including visceral adipose tissue accumulation), dietary profile (3-day food record), and eating behaviors (Three-Factor Eating Questionnaire) were determined in a sample of 244 men and 352 women., Results: Women had significantly higher cognitive dietary restraint and disinhibition scores than men (p < 0.0001). In both genders, scores for disinhibition and susceptibility to hunger, but not for cognitive dietary restraint, were higher in obese subjects than in overweight and nonobese subjects (p < 0.05). Positive correlations were observed between rigid restraint and most of the anthropometric variables studied (0.12