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This prospective study investigated associations between cord blood vitamin D, risk factors for low vitamin D, and pregnancy and neonatal outcomes. The study included 65 maternal-fetal dyads delivering between December and February in Saskatoon, Saskatchewan. Eighty-five percent of mothers reported taking daily prenatal vitamin D but 70% of their newborns had insufficient or deficient cord blood vitamin D, suggesting that usual prenatal supplementation may be inadequate to achieve sufficient cord blood vitamin D in most newborns. [ABSTRACT FROM AUTHOR]

Canadians using supplements containing vitamin D are more likely to have 25-hydroxyvitamin D (25(OH)D) levels consistent with the Recommended Dietary Allowance, particularly with the low UVB exposure during the winter. This study aimed to determine these users' characteristics and to examine the relationship between dosage and 25(OH)D using the 2007-2009 Canadian Health Measures Survey ( n = 5604, 6-79 years of age). Logistic regression models examined the odds of supplement use within the preceding 30 days. Thirty-one percent used vitamin D supplements; 58.5% were female. In adjusted analyses, females' odds of supplement use were lower for those 12-19 years old (odds ratio (OR), 0.63; 95% CI, 0.41-0.96) and higher for those 60-79 years old (OR, 4.19; 95% CI, 2.69-6.64) and 40-59 years old (OR, 1.56; 95% CI, 1.10-2.20) compared with those 20-39 years old; their odds of supplement use were also higher for those of higher income (OR, 2.29; 95% CI, 1.26-4.16) and middle income (OR, 1.59; 95% CI, 1.03-2.46), those reporting ≥1 chronic disease (OR, 1.48; 95% CI, 1.06-2.06), and those consuming milk ≥1 time·day−1 (OR, 1.35; 95% CI, 1.14-1.60). For males, increased use was associated with age 60-79 years (OR, 2.41; 95% CI, 1.54-3.77) and 6-11 years (OR, 1.77; 95% CI, 1.19-2.64) and higher income (OR, 2.12; 95% CI, 1.49-3.00) and middle income (OR, 1.55; 95% CI, 1.04-2.31). Use did not vary significantly by race, education, season, body mass index, health, or physical activity. A total of 35.7% of Canadians >50 years old took ≥400 IU of vitamin D; 25(OH)D increased with increasing supplement dosage ( r = 0.33) in winter, but differences between 1-399 IU and 400-999 IU were not significant. Usage and nonusage patterns are important to consider as ways of improving vitamin D intake are pursued. [ABSTRACT FROM AUTHOR]

The article discusses a 2015 Canadian Community Health Survey on the prevalence of vitamin-mineral supplement use for improving micronutrient intake and preventing deficiencies. It states that prevalence was 38% and 53% among Canadian men and women, respectively, and that sociodemographic and lifestyle variables were linked to supplement use, especially among adults. Also noted are independent positive predictors of supplement use like female gender, older age, and higher education level.

Background: Despite progress made to improve access to child health services, mothers' consistent utilization of these services has been constrained by several factors. This study is aimed at assessing the inequalities in key child health service utilization and assess the role of antenatal care (ANC) on subsequent service use.Method: The analysis of the present study was based on the Ethiopian Demographic and Health Surveys, a nationally representative sample of 10,641 children. A health service utilization score was constructed from the affirmative responses of six key child health interventions associated with the most recent birth: ANC service, delivery of the last child at health facilities, postnatal care services, vitamin A intake, iron supplementation and intake of deworming pills by the index child. A mixed effect Poisson regression model was used to examine the predictors of health service utilization and three separate mixed effect logistic regression models for assessing the role of ANC for continued use of delivery and postnatal care services.Results: The results of mixed effect Poisson regression indicate that the expected mean score of health service utilization was lower among non-first birth order children, older and high parity women, those living in polygamous families and women living in households with no access to radio. The score was higher for respondents with better education, women who had previous experience of terminated pregnancy, residing in more affluent households, and women with experiences of mild to high intimate partner violence. Further analysis of the three key health services (ANC, delivery, and postnatal care), using three models of mixed effect logistic regression, indicates consistent positive impacts of ANC on the continuum of utilizing delivery and postnatal care services. ANC had the strongest effects on both institutional delivery and postnatal care service utilization.Conclusion: The findings implicated that maternal and child health services appear as continuum actions/behavior where utilization of one affects the likelihood of the next service types. The study indicated that promoting proper ANC services is very beneficial in increasing the likelihood of mothers utilizing subsequent services such as delivery and postnatal care services. [ABSTRACT FROM AUTHOR]

ObjectiveTo investigate the beverage intake patterns of Canadian adults and explore characteristics of participants in different beverage clusters.DesignAnalyses of nationally representative data with cross-sectional complex stratified design.SettingCanadian Community Health Survey, Cycle 2·2 (2004).SubjectsA total of 14 277 participants aged 19–65 years, in whom dietary intake was assessed using a single 24 h recall, were included in the study. After determining total intake and the contribution of beverages to total energy intake among age/sex groups, cluster analysis (K-means method) was used to classify males and females into distinct clusters based on the dominant pattern of beverage intakes. To test differences across clusters, χ2 tests and 95 % confidence intervals of the mean intakes were used.ResultsSix beverage clusters in women and seven beverage clusters in men were identified. ‘Sugar-sweetened’ beverage clusters – regular soft drinks and fruit drinks – as well as a ‘beer’ cluster, appeared for both men and women. No ‘milk’ cluster appeared among women. The mean consumption of the dominant beverage in each cluster was higher among men than women. The ‘soft drink’ cluster in men had the lowest proportion of the higher levels of education, and in women the highest proportion of inactivity, compared with other beverage clusters.ConclusionsPatterns of beverage intake in Canadian women indicate high consumption of sugar-sweetened beverages particularly fruit drinks, low intake of milk and high intake of beer. These patterns in women have implications for poor bone health, risk of obesity and other morbidities. [ABSTRACT FROM PUBLISHER]

The objective of this study was to determine trends in calcium intake from foods of Canadian adults from 1970-1972 to 2004. We compiled the calcium intake of adults (aged >=19 years) from foods from Nutrition Canada (1970-1972; n = 7036); 9 provincial nutrition surveys (1990-1999; n = 16 915); and the 2004 Canadian Community Health Survey 2.2 (n = 20 197). Where possible, we used published confidence intervals to test for significant differences in calcium intake. In 2004, the mean calcium intake of Canadians was below Dietary Reference Intake recommendations for most adults, with the greatest difference in older adults (>=51 years), in part because the recommended calcium intake for this group is higher (1200 mg) than that for younger adults (1000 mg). The calcium intake of males in every age category was greater than that of females. Calcium intake increased from 1970 to 2004, yet, despite the introduction of calcium-fortified beverages to the market in the late 1990s, increases in calcium intake between 1970 and 2004 were modest. Calcium intakes in provinces were mostly similar in the 1990s and in 2004, except for women in Newfoundland and Labrador, who consumed less, especially in the 1990s, and for young men in 2004 in Prince Edward Island, who consumed more. When supplemental calcium intake was added, mean intakes remained below recommended levels, except for males 19-30 years, but the prevalence of adequacy increased in all age groups, notably for women over 50 years. The calcium intake of Canadian adults remains in need of improvement, despite fortification and supplement use. [ABSTRACT FROM AUTHOR]

There is a need to increase the options for vitamin D fortification. We have developed a method to fortify hard cheese with vitamin D. Our aim was to characterize the bioavailability of vitamin D from fortified cheeses. Eighty adults were randomized to weekly servings of fortified cheddar cheese (DC) (34 g; n = 20); fortified low-fat cheese (DLF) (41 g; n = 10); liquid vitamin D supplement (1 mL), taken with food (DS+) In = 201 or without food (DS-) (n = 10); placebo cheddar cheese In = 101; or placebo supplement In = 10). The treatments contained 28,000 lU cholecalciferol (vitamin D3), equivalent to 4000 lU (100 μg/d). The primary outcome was the comparison of vitamin D bioavailability, as measured by the serum 25-hydroxyvitamin D [25(OH)D] response, between fortified cheeses and supplement. In the placebo groups, initial 25(OH)D, 55.0 ± 25.3 nmol/L, declined over the 8-wk winter protocol, to 50.7 ± 24.2 nmol/L (P = 0.046). In the vitamin D-treated groups, the mean increases in 25(OH)D over 8 wk were: 65.3 ± 24.1 (DC), 69.4 ± 21.7 (DLF), 59.3 ± 23.3 (DS+), and 59.3 ± 19.6 nmol/L (DS-); these changes differed from the placebo groups IP < 0.0001) but not from one another (P= 0.62). Compared with baseline, serum parathyroid hormone decreased with both fortification (P= 0.003) and supplementation (P= 0.012). These data demonstrate that vitamin D is equally bioavailable from fortified hard cheeses and supplements, making cheese suitable for vitamin D fortification. [ABSTRACT FROM AUTHOR]

Provincial nutrition surveys of adults were conducted between 1990 and 1999 in Canada. Eight reports have been issued, and one is forthcoming. The purpose of this study was to estimate the national dietary intake of adult Canadians, using the publicly available data. Group mean-nutrient-intake data from 16 915 adults, aged 18 to 84 years, from published provincial reports were collated by age and sex for each of 9 provinces (Manitoba data were unavailable). Using Canadian census data appropriate to the year of collection, intake data were weighted to provide 1 national intake value for each nutrient, by 8 age and sex categories. In general, the energy and nutrient intake of adults decreased with age. For every age group, with the exception of vitamin C, intake of nutrients by men was greater than that by women. On the basis of a comparison of recently recommended intakes (Dietary Reference Intakes), the nutrients that are of concern because of inadequate intake include dietary fibre, calcium, magnesium, and folate. The data demonstrate the impact of folate fortification on folate intake; the mean intake became twice that of prefortification levels. This study used group mean-intake data; therefore, we cannot make definitive conclusions about the prevalence of inadequacy for the nutrients. Because of limitations with some provincial response rates, our data should not be construed as representative of the Canadian population. However, because these surveys were completed between the 19701972 Nutrition Canada Survey and the 2004 Canadian Community Health Survey, these population-weighted data might be a useful point of comparison for monitoring trends in nutrient intake from food. [ABSTRACT FROM AUTHOR]

The article investigates on the relationship among physical activity, fat mass development and the consumption of sugar drinks in health of girls and boys. Observation was conducted to boys and girls who were 8 to 19 years of age assessing their fat mass, fat-free mass and physical activity, annually. A questionnaire was used to assessed their food and sugar drinks intake. Results showed that there was no relationship between fat mass and sugar drinks while physical activity in boys should be increased to prevent fat mass development.

Dietary patterns research is being pursued to provide a comprehensive way to characterize dietary exposures and explore diet-disease relationships. This paper outlines the need for further research into dietary pattern methodologies, and introduces papers presented at the Canadian Society for Clinical Nutrition-Canadian Society for Nutritional Sciences (now called Canadian Nutrition Society) Conference, held in Québec City in 2009. Themes that emerged include inconsistency of evidence linking diet patterns to risk of certain diseases, methodological issues around data collection and analysis, and the limitations of dietary pattern research for nutrition policy and recommendations. [ABSTRACT FROM AUTHOR]

Background: In light of the publications (2008-2014) linking calcium intake, mainly from supplements, to the elevated risk of cardiovascular events, there is a need to determine if there have been any changes in usual intakes of calcium among Canadians.Objective: We aimed to examine changes in dietary and total usual intake of calcium among Canadians aged ≥1 y over the period 2004-2015.Methods: We used nutrition data from 2 nationally representative surveys conducted in 2004 and 2015 (CCHS 2004 Cycle 2.2 and CCHS-Nutrition 2015). This study included all the Canadians across 10 provinces, and the analyses were performed across different age/sex groups. We used the National Cancer Institute (NCI) method to estimate the usual intake of calcium and the prevalence of calcium inadequacy. Multiple logistic regression was performed to assess the relation between supplement uses and sociodemographic variables.Results: From 2004 to 2015, the usual intake of calcium from food sources significantly decreased in calcium supplement nonusers (from 872 ± 18.2 mg/d to 754 ± 18.0 mg/d), but not in calcium supplement users. The contribution of calcium from the Milk and alternatives food group significantly decreased by 7.5% and 6.1% in calcium supplement users and nonusers, respectively. The prevalence of calcium supplement use significantly decreased from 2004 to 2015 in the Canadian population, from 27.5% to 22.0%. During this time, the percentage contribution of calcium from supplemental sources significantly decreased among Canadians, especially women. The prevalence of calcium inadequacy increased from 58.0% to 68.0% in supplement nonusers; however, among users of calcium supplements, the prevalence of calcium inadequacy remained at ∼31%.Conclusions: Calcium intake from both food and supplemental sources decreased in the Canadian population over an 11-y period, which must be addressed by policy-makers in their efforts to decrease the high prevalence of calcium inadequacy. [ABSTRACT FROM AUTHOR]

Background: Evidence is lacking to determine whether there have been any changes in dietary or total usual intakes of vitamin D among Canadians, in the light of recent evidence of beneficial health effects beyond bone.Objective: We aimed to examine trends in dietary and total usual intake of vitamin D among Canadians aged ≥1 y.Methods: This study used nationally representative nutrition data from the Canadian Community Health Survey Cycle 2.2 (CCHS 2004) and CCHS Nutrition in 2015. Dietary intake data were collected with use of two 24-h dietary recalls and dietary supplement use was determined by questionnaire. The National Cancer Institute method was used to estimate the usual intake of vitamin D as well as the prevalence of vitamin D inadequacy among Canadians aged ≥1 y.Results: From 2004 to 2015, the usual intake of vitamin D from food significantly decreased (P < 0.05) by 1 μg/d only in vitamin D supplement nonusers. The contribution of Milk and Alternatives food group (i.e., fluid milk, fortified soy beverages, powdered milk, and other milk alternatives) to dietary vitamin D intake significantly decreased (P < 0.05) in both supplement users (by 7.1%) and nonusers (by 5.8%). Prevalence of vitamin D supplement use and percentage contribution of vitamin D from supplemental sources significantly increased (P < 0.05) by 5.0% and 14.9%, respectively, from 2004 to 2015. Total usual intake of vitamin D (food + supplement) significantly increased (P < 0.05) from 15.1 ± 0.3 μg/d in 2004 to 31.5 ± 1.8 μg/d in 2015 in vitamin D supplement users. In contrast to vitamin D supplement nonusers, the prevalence of vitamin D inadequacy significantly decreased (P < 0.05) from 20.6% to 14.1% among users of vitamin D supplements.Conclusions: The prevalence of vitamin D supplement use and the percentage contribution of vitamin D from supplemental sources has increased in the Canadian population over an 11-y period. [ABSTRACT FROM AUTHOR]

This study aimed to determine the effect of a 6-month in-school nutrition education intervention to improve pulse consumption on weight status of adolescent girls in Ethiopia. At the intervention school, 66 girls received bi-monthly lessons that included recipes and tastings. Girls (n = 66) at the control school had usual in-school activities. With pulse-based nutrition education which included discussions and demonstrations, knowledge, attitude and practice scores improved (p < 0.001) in the intervention group while control scores remained low and unchanged. Prevalence of underweight, measured as Body Mass Index (BMI) for age, decreased with the education intervention, from 13.6% to 3% (p = 0.004), while there was no significant change seen in control girls. In Ethiopia, equipping girls in schools with the knowledge and skills to improve food intake by consuming locally grown pulses may mitigate underweight in Ethiopian female adolescents. [ABSTRACT FROM AUTHOR]

Individuals who take medications may benefit from using vitamin and/or mineral supplements (VMS) yet excess supplementation can lead to overuse (daily intake exceeding the tolerable upper intake level (UL)). This study assessed VMS use of medically complex, community-living, older adults. A chart review of 229 patients ≥50 years with new medication assessments between 2014 and 2017 indicated that 76.9% of patients used ≥1 VMS daily. The UL for one or more nutrients was exceeded by 39.8% of supplement users. [ABSTRACT FROM AUTHOR]

Vitamin D is an essential nutrient for bone health and may influence the risks of respiratory illness, adverse pregnancy outcomes, and chronic diseases of adulthood. Because many countries have a relatively low supply of foods rich in vitamin D and inadequate exposure to natural ultraviolet B (UVB) radiation from sunlight, an important proportion of the global population is at risk of vitamin D deficiency. There is general agreement that the minimum serum/plasma 25‐hydroxyvitamin D concentration (25(OH)D) that protects against vitamin D deficiency–related bone disease is approximately 30 nmol/L; therefore, this threshold is suitable to define vitamin D deficiency in population surveys. However, efforts to assess the vitamin D status of populations in low‐ and middle‐income countries have been hampered by limited availability of population‐representative 25(OH)D data, particularly among population subgroups most vulnerable to the skeletal and potential extraskeletal consequences of low vitamin D status, namely exclusively breastfed infants, children, adolescents, pregnant and lactating women, and the elderly. In the absence of 25(OH)D data, identification of communities that would benefit from public health interventions to improve vitamin D status may require proxy indicators of the population risk of vitamin D deficiency, such as the prevalence of rickets or metrics of usual UVB exposure. If a high prevalence of vitamin D deficiency is identified (>20% prevalence of 25(OH)D < 30 nmol/L) or the risk for vitamin D deficiency is determined to be high based on proxy indicators (e.g., prevalence of rickets >1%), food fortification and/or targeted vitamin D supplementation policies can be implemented to reduce the burden of vitamin D deficiency–related conditions in vulnerable populations. Here we report the outcome of a working group convened in January and March 2017 by the Sackler Institute for Nutrition Science at the New York Academy of Sciences and the Bill & Melinda Gates Foundation to assess the global prevalence and disease burden of vitamin D deficiency, and population‐based strategies to improve vitamin D status, particularly in low‐ and middle‐income countries. The working group aimed to examine definitions of vitamin D deficiency based on biomarkers and correlations with disease or health outcomes. [ABSTRACT FROM AUTHOR]

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

Given the lack in a valid biomarker to assess dietary calcium intake (dCa i ), reproducible estimation of usual dCa i is crucial for better understanding of its interaction with health outcomes in specific populations. This study tested the hypothesis that a calcium-focused food frequency questionnaire (FFQ) may be used to estimate dCa i of women ≥50 years residing in a multicultural environment (Montreal, Canada). One hundred and eight women (age, 63.1 ± 7.7 years; 98% postmenopausal) completed the FFQ twice and 4 nonconsecutive 24-hour recalls (24HRs) over 1 month. Medians of dCa i were compared by Wilcoxon signed rank test. Reproducibility and relative validity of the FFQ were assessed by Spearman correlation ( r s ) and Cohen's weighted kappa ( κ w). Agreement was further assessed by cross-classification by quartiles, Bland-Altman plot, and sensitivity and specificity analyses. The median (interquartile range) dCa i estimated by the FFQ and 24HRs were 723 (524-1033) mg/d and 854 (666-1068) mg/d, respectively ( P < .001). The FFQs had a strong correlation ( r s = 0.72, P < .001) and moderate agreement ( κ w = 0.55). The FFQ and 24HRs were moderately correlated ( r s = 0.65, P < .001). Cross-classification showed moderate agreement ( κ w = 0.42), with 85% of the participants classified into identical or contiguous quartiles and 2.8% into extreme opposite quartiles. According to the Bland-Altman plot, the FFQ underestimated dCa i with a bias of 99 mg/d (95% limits of agreement, −677 to +480 mg/d). Sensitivity and specificity of identifying intakes <1000 mg/d were 90% and 57%, respectively. This FFQ is a useful tool to discriminate dCa i <600 and ≥1000 mg/d in postmenopausal women and to rank dCa i in epidemiological studies. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Vitamin D: A Place in the Sun?" by Andrew Grey and Mark Bolland in the July 12, 2010 issue.

Complementary foods (CFs) in Ethiopia are cereal based and adding locally grown pulses (legumes) to CF would provide needed nutrients. To assess the effects of nutrition education (NEd) using Health Belief Model (HBM) in promoting pulses for CF, a 6-month quasi-experimental study was conducted in 160 mother-child pairs. Knowledge, attitude, and practice (KAP) questions were given to mothers at baseline, midline, and endline, along with anthropometric measurements of children. NEd involving discussions and recipe demonstrations was given twice monthly for 6 months to the intervention group (n = 80) while control mothers received usual education. At baseline, mothers’ KAP scores were low at both sites; at 3 and 6 months of NEd, mean KAP scores of mothers increased (p < 0.05) compared to the control site. Significant improvements in children’s mean weight, weight for height, and weight for age occurred in the intervention site only. Nutritional status of children improved after providing mothers with pulse-based NEd. [ABSTRACT FROM AUTHOR]

: ObjectiveWomen of reproductive age are advised to consume supplements or fortified foods containing at least 400 μg/d folic acid for the prevention of neural tubes defects. Concerns exist about the adverse effects of folic acid on zinc status.: MethodsSeventy-eight women (18 to 49 y) were assigned for 12-wk to receive either a placebo or a 400 μg/d folic acid supplement.: ResultsAt 12-wk mean (95% CI) red cell folate increased by 431 (350–511) nmol/L in the supplemented group relative to placebo (P < 0.001) but there was no change in plasma zinc in either group (P = 0.213).: ConclusionsFolic acid supplementation does not reduce plasma zinc concentrations in women of childbearing age. [Copyright &y& Elsevier]

Poor nutrition in adolescent girls poses critical health risks on future pregnancy and birth outcomes especially in developing countries. Our purpose was to assess nutritional status and dietary intake of rural adolescent girls and determine pulse and food intake patterns associated with poor nutritional status. A cross-sectional community-based study was conducted in a traditional pulse growing region of southern Ethiopia on 188 girls between 15 to 19 years of age, with 70% being from food insecure families. Prevalence of stunting (30.9%) and underweight (13.3%) were associated with low food and nutrient intake. Diets were cereal-based, with both animal source foods and pulses rarely consumed. Improving dietary intakes of female adolescents with nutrient dense foods would ensure better health for themselves and for the next generation. [ABSTRACT FROM PUBLISHER]

Studies examining vitamin D status among children living in sunny climates indicated that children did not receive adequate vitamin D, however, this has not been looked at among children living in Ethiopia. In this study, we determined vitamin D deficiency and its predictors among school children aged 11–18 years, examining circulating 25-hydroxy vitamin D [25(OH)D]. The school-based cross-sectional study was conducted in schools in Adama Town (n = 89) and in rural Adama (n = 85) for a total sample of 174. Students were randomly selected using multi-stage stratified sampling method from both settings. Socioeconomic status of parents and demographic, anthropometric, sun exposure status and blood 25(OH)D levels were obtained. Vitamin D deficiency, defined as circulating levels of 25(OH)D <50 nmol/L, was found in 42% of the entire study participants. Prevalence of deficiency was significantly higher among students in urban setting compared to rural (61.8% vs 21.2%, respectively, p<0.001). After controlling for potential confounders using multivariable logistic regression model, duration of exposure to sunlight, amount of body part exposed to sunlight, place of residence, maternal education, body fatness, having TV/computer at home and socioeconomic status were significant predictors of vitamin D deficiency. The findings suggest that Vitamin D deficiency was prevalent in healthy school children living both in urban and rural areas of a country with abundant year round sunshine providing UVB, with the prevalence of deficiency being significantly higher among urban school children who were less exposed to sunlight. Behaviour change communication to enhance exposure to ultraviolet light is critical to prevent vitamin D deficiency in tropical country like Ethiopia. Further study is required to assess the deleterious effect of its deficiency on bone mineral homeostasis of growing children in Ethiopia during their most critical period of bone development. [ABSTRACT FROM AUTHOR]

Poor complementary feeding practices contribute to infants and young children (IYC) malnutrition, with lack of protein-containing food and micronutrients as major concerns. A cross-sectional survey was conducted to assess the dietary diversity, nutrient contents and use of pulse crops in complementary feeding at Taba kebele, Southern Ethiopia. A questionnaire was used to collect socio-demographic and dietary diversity data from a random sample of 128 mother-child pairs. A one day weighed food record assessed IYC median nutrient intake. Focus group discussion explored mothers' perceptions and use of pulse crops in complementary food preparation. Dietary diversity assessment found that 43.7% consumed pulses, and only 18.7% consumed meat and 26.6% eggs. Focus group discussion showed that mothers had little interest in incorporating pulses into complementary foods. Raising awareness of mothers/caregivers on food diversification and promoting the inclusion of pulses in food preparation for infants and young children are vital to nutritional status of IYC. [ABSTRACT FROM AUTHOR]

Context: The natural health product, BeneFlax, is a standardized flaxseed [ Linum usitatissimum L. (Linaceae)] lignan enriched product with evidence of product quality and known quantity of the bioactive component, lignan. The acceptance of this natural health product for its various health benefits requires greater evidence of its safety in the general population. Objective: We determined whether flaxseed lignan causes clinical hypoglycemia or hypotension in healthy older adults as an important aspect of safety. Materials and methods: Participants aged 49-87 years were randomized in a double-blind trial to receive flaxseed lignan (543 mg/day in BeneFlax) or placebo while completing a 6-month walking program. The 94 participants who completed the study were stratified by age (<65 years versus ≥65 years) and treatment category to determine whether older adults were more susceptible to adverse effects. Results: After 6 months of treatment, average plasma glucose level (5.4 ± 0.6 mmol/L), systolic blood pressure (127 ± 14 mm Hg), and diastolic blood pressure (80 ± 9 mm Hg) were within normal clinical range. Controlling for sex and body mass index covariates resulted in no observed differences between plasma glucose or blood pressure measurements between treatment or age groups ( p > 0.05). No incidents of hypoglycemia or hypotension were observed during BeneFlax treatment, suggesting that 543 mg falls at or below the no observable adverse effect level (NOAEL). Discussion and conclusion: These data suggest the flaxseed lignan product BeneFlax does not pose a risk of hypoglycemia or hypotension in healthy adults aged 49-87 years. [ABSTRACT FROM AUTHOR]

Vitamin-mineral supplementation may offer older adults health and cognition-related benefits but overuse may contribute to polypharmacy. We examined the prevalence of supplement usage in long-term care facility (LTC) residents (≥65 years of age). As cognition may be affected by nutrition, we also examined use in those with diagnosis of dementia and those with no dementia diagnosis. The prevalence of supplement usage and overall 'pill count' from pharmaceutical use was assessed in 189 LTC residents and a subsample of 56 older adults with dementia diagnosis, respectively. Participants were residing in an LTC facility of a mid-size metropolitan area during 2009. The average use of supplements was 1.0 per day for all residents, with 35% taking vitamin D supplements, 20% multivitamins, and 26% calcium. Supplement use was similar ( p ≥ 0.05) for those with dementia diagnosis (53%, average 2.0 per day) and for those without such diagnosis (45%, average 2.2 per day). Usage ranged between 1-6 supplements per day. In both of these groups, ∼73% of users were taking vitamin D. The number of prescribed medications ranged from 4 to 24 (average 10.2) in a subsample of residents whose supplement intake was 0 to 6 (average 2). These findings suggest an overall low rate of supplement use, with no significant differences ( p ≥ 0.05) in use between residents with and without dementia diagnosis. However, some residents were at risk for supplement overuse. [ABSTRACT FROM AUTHOR]

ObjectiveLittle is known of the beverage intake patterns of Canadian children or of characteristics within these patterns. The objective was to determine beverage intake patterns among Canadian children and compare intakes of fourteen types of beverages, along with intakes of vitamin C and Ca, and sociodemographic factors across clusters.DesignDietary information was collected using one 24 h recall. Sociodemographic data were collected by interview. Cluster analysis was used to determine beverage intake patterns. Pearson's χ2 and 95 % CI were used to test differences across clusters.SettingData from the Canadian Community Health Survey Cycle 2·2.SubjectsChildren aged 2–18 years with plausible energy intake and complete sociodemographic data (n 10 038) were grouped into the following categories: 2–5-year-old boys and girls, 6–11-year-old girls, 6–11-year-old boys, 12–18-year-old girls and 12–18-year-old boys.ResultsFive beverage clusters emerged for children aged 2–5 years, six clusters for children aged 6–11 years (both sexes) and four clusters for those aged 12–18 years (both sexes). Sweetened beverage clusters appeared in all age–sex groups. Intakes of sweetened beverages ranged from 553 to 1059 g/d and contributed between 2 % and 18 % of total energy intake. Girls 6–11 years of age in the ‘soft drink’ cluster had lower Ca intake compared with other clusters in that age–sex group. Age and ethnicity differed across clusters for most age–sex groups. Differences for household food security status and income were found; however, no pattern emerged.ConclusionsPatterns in beverage intake among Canadian children include beverages that are predominantly sugar sweetened. Public health nutrition professionals can use knowledge about beverage patterns among children, as well as the characteristics of these groups, in the development of nutritional programmes and policies. [ABSTRACT FROM PUBLISHER]

Abstract: In Canada, school meals are regarded as important for social, educational, and nutritional reasons and have been provided for several years because of concerns about the health and welfare of children, especially those from low-income households. They are generally offered as local community organization and individual schools, are not regulated by law, and have no set national nutrition standards. The Canadian scientific literature lacks quantitative information on the nutritional adequacy of school meals. Better and more evaluation of such programs would encourage and guide administrators to assess other local programs in a similar fashion. Here, we describe the dietary assessment process of 1 school meal program in Canada and the nutritional adequacy of the meals. Throughout 10 years (1997-2007), the contents of 159 lunches and 90 breakfasts were collected mainly from elementary schools participating in the Child Hunger and Education Program Good Food, Inc''s school nutrition program initiative in Saskatoon, Saskatchewan, Canada. We collected, weighed, and analyzed food samples from meals served to children at participating schools. We then compared their nutrient content against standards based on the Dietary Recommended Intakes for children aged 4 to 8 and 9 to 13 years using one third of the recommendations as the standard for lunches and one fourth for breakfasts. Overall, both meals had a good nutrient profile and met the standards for most analyzed macronutrients and micronutrients throughout the years. Although energy was persistently low, vitamin and mineral contents were often above the standards, reflecting a tendency to offer nutrient-dense foods in lieu of energy-dense foods. The rigorous methodology described in this manuscript can be followed to assess other small local programs. Furthermore, the dietary assessment presented can encourage not only the implementation of school meal programs in other locations but also the assessment of already existing programs—a clear need in the scientific literature. [Copyright &y& Elsevier]

Previous research indicates that circulating vitamin D levels are low in many otherwise healthy adults and that there is considerable seasonal variation in 25-hydroxyvitamin D 125(OH)D] concentrations at high latitudes. We examined seasonal variation in 25(OH)D levels in a sample of young adults of diverse ancestry living in the Greater Toronto Area. Three hundred and fifty-one 1351) healthy young adults completed both a fall and winter visit during this study. The study was conducted over 2 y )y 1: fall 2007 to winter 2008 andy 2: fall 2008 to winter 2009). At both visits, each participants serum 25(OH)D concentration was measured. Information was also obtained on skin pigmentation (measured via reflectometer), vitamin D intake, and extent of sun exposure. Overall, the serum 25(OH)D concentration was 54.4 ± 1.3 nmol/L in the fall and 38.4 ± 1.1 nmol/L in the winter. Concentrations differed among ancestral groups at both visits (P < 0.001), with South Asians and East Asians having substantially lower concentrations than Europeans. Skin pigmentation 1r2 = 0.14; p < 0.001), supplemental vitamin D intake (r2 = 0.09; P< 0.0011, sun exposure (r2= 0.04; P< 0.001), and study year )r2 = 0.02; P= 0.0171 were predictors of fall 25(OH)D concentrations. During the wintertime, serum 25(OH)D concentrations were associated with concentrations taken in the fall (r2 = 0.45; P < 0.001), supplemental (r2 = 0.15; P < 0.001) and dietary vitamin D intake (r2 = 0.06; P < 0.001), and with study year = 0.02; P = 0.009). Our study confirms that serum 25(OH)D concentrations undergo strong seasonal variation at high latitudes and are influenced by vitamin D intake, skin pigmentation, and sun exposure. [ABSTRACT FROM AUTHOR]

The article presents a reprint of the article "Vitamin D in adult health and disease: a review and guideline statement from Osteoporosis Canada," by David A. Hanley and colleagues, which appeared at www.cmaj.ca. It discusses a study which explores the role played by vitamin D in fractures and on various diseases including diabetes mellitus, malignancies and cardiovascular ones. It concludes that calcium and vitamin D3 supplementation increases bone density in men over 50 years old.

The article presents a reprint of the study "Vitamin D in adult health and disease: a review and guideline statement from Osteoporosis Canada (summary)," by David A. Hanley and colleagues, which appeared on the web site www.cmaj.ca. It highlights a study regarding the relation of vitamin D in osteoporosis, using previous related studies from MEDLINE database and Cochrane Library. It also discusses various topics on vitamin D including its role in other diseases, sources, and supplementation.

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]

A randomized double-blind placebo controlled study design was used to assess the effects of flaxseed lignan complex supplementation during exercise training on a metabolic syndrome composite score and osteoporosis risk in older adults. A total of 100 subjects (>=50 years) were randomized to receive flaxseed lignan (543 mg·day-1 in a 4050 mg complex) or placebo while completing a 6 month walking program (30-60 min·day-1, 5-6 days·week-1). Fasting serum glucose, triacylglycerol (TAG), high-density lipoprotein (HDL) cholesterol, low-density lipoprotein cholesterol, total cholesterol, interleukin-6, and tumor necrosis factor-α were measured every 2 months, while body composition, bone mineral density, and resting blood pressure were assessed at baseline and at 6 months. A composite Z score of 6 risk factors for metabolic syndrome (fasting glucose, HDL cholesterol, TAG, abdominal adiposity, blood pressure, and inflammatory cytokines) was calculated at baseline and at 6 months. Men taking placebo increased metabolic syndrome composite Z score (p < 0.05), but there were no changes in the other groups. A significant group × sex × time interaction was noted for TAG (p = 0.017) and diastolic blood pressure (p = 0.046), with men taking flaxseed lignan decreasing diastolic blood pressure relative to men taking placebo, and men taking placebo increasing TAG relative to men taking flax lignan. There were no differences between groups for change in bone measures, body composition, lipoproteins, or cytokines. Males taking the flaxseed lignan complex reduced metabolic syndrome score relative to men taking placebo, but a similar trend was not seen in females. Flaxseed lignan had no effect on bone mineral density or content, body composition, lipoproteins, glucose, or inflammation. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to an article regarding tympanostomy tube placement that was published in a previous issue.

Abstract: Certain beverages contribute energy, protein, vitamins, and minerals. North American adolescents have shifted their beverage intake from predominantly milk to predominantly sugary beverages. Intake of these sugary beverages, in sufficient quantity, may increase the risk of bone fractures, may contribute to obesity, and may lead to tooth decay. This study evaluated the effectiveness of a school-nutrition education program (Fluids Used Effectively for Living) on nutrition knowledge, attitude, and self-reported behavior of grade 9 students in Saskatchewan, Canada. Two classes of grade 9 students, 1 (n = 33) in a high school in Saskatoon (n = 33) and 1 (n = 24) in a large high school in Prince Albert, Saskatchewan, received the peer educator intervention. Two other classes in the 2 cities (n = 24 and n = 24, respectively) were controls. Six sessions of Fluids Used Effectively for Living nutrition education were delivered by using 2 peer educator models (multiple and single), and the intervention was delivered in a 45-minute weekly class session over a 6-week period. After the intervention, students in these 2 peer educator classes decreased their sugary beverage intake significantly, which was sustained for 3 months. Students in the control self-taught class increased their juice intake at the end of the year. The significant decrease of juice and sugary beverage intakes in the single model peer educator class disappeared after Bonferroni correction. Carbonated sugary beverage intake of students in the control self-taught classes declined, but it was not sustainable at the 3-month follow-up. A peer educator school-based nutrition education approach can lead to a decrease in sugary beverage intake in high school children. [Copyright &y& Elsevier]

The effect of dietary protein on bone mass measures at different life stages is controversial. We investigated the influence of protein intake on bone mass measures in young adults, considering the influence of calcium intake through adolescence. Subjects were 133 young adults (59 males, 74 females) who were participating in the Saskatchewan Pediatric Bone Mineral Accrual Study (1991-1997, 2003-2006). At adulthood, their mean age was 23 y. We assessed dietary intake via serial 24-h recalls carried out at least once yearly. Total body (TB) bone mineral content (BMC) and TB bone mineral density (BMD) were assessed annually using Dual energy X-ray absorptiometry. We determined TB-BMC net gain from the age of peak height velocity (PHV) to early adulthood. We analyzed data from all subjects and subsets based on sex and calcium intake using multiple regression. TB-BMC significantly increased from age at PHV to early adulthood by 41% in males and 37% in females. Height, weight, physical activity, and sex were significant predictors of TB-BMC, TB-BMC net gain, and TB-BMD among all subjects. Protein intake predicted TB-BMC net gain in all subjects (beta = 0.11; P = 0.015). In females at peri-adolescence or early adulthood with adequate calcium intake (>1000 mg/d), protein intake positively predicted TB-BMC, TB-BMC net gain, and TB-BMD (P < 0.05). Our results indicate that when calcium intake is adequate, protein intake has a beneficial effect on the bone mass of young adult females. Protein, in the absence of sufficient calcium, does not confer as much benefit to bone. [ABSTRACT FROM AUTHOR]

Abstract: Over the past 25 years, adolescents'' intake of soft drinks doubled, arousing health concerns such as obesity, tooth decay, and inadequate bone accrual. In the absence of national data for determining a trend of beverage intake in Canadian adolescents, we examined beverage consumption and its relationship with calcium intake of grade 9 students living in Saskatoon, at 3 time points from 1991 to 2004. Intake data from 2 studies at the University of Saskatchewan were used. Subjects were 98 (45 boys, 53 girls), 62 (31 boys, 31 girls), and 58 (40 boys, 18 girls) grade 9 students during 1991 to 1993, 1995 to 1997, and 2003 to 2004, respectively; the age range spanned from 14 to 16 years. Dietary intakes were assessed via serial 24-hour recalls, during which the name and quantity of each food and beverage consumed in last 24 hours were reported. One-way analysis of variance or its nonparametric equivalent was used to assess differences over time. Beverages were classified into 3 groups: milk, juice, and soft drinks (excluding noncaloric beverages). Percent contribution of milk to total beverage intake was significantly decreased in boys and girls from 1991 to 2004. In girls only, a significant negative trend in calcium intake was observed over time. Percent contribution of fruit juice significantly increased in boys and girls over time. There was a significant negative association between milk intake and consumption of noncarbonated soft drinks in both sexes (P < .001). Milk was substituted by noncarbonated soft drinks more than by carbonated beverages, and girls were more at risk for this substitution than boys. [Copyright &y& Elsevier]

New Zealand children, particularly those of Māori and Pacific ethnicity, may be at risk for low vitamin D status because of low vitamin D intakes, the country's latitude (35-46 degrees S), and skin color. The aim of this study was to determine 25-hydroxyvitamin D concentrations and their determinants in a national sample of New Zealand children aged 5-14 y. The 2002 National Children's Nutrition Survey was designed to survey New Zealand children, including oversampling of Māori and Pacific children to allow ethnic-specific analyses. A 2-stage recruitment process occurred using a random selection of schools, and children within each school. Serum 25-hydroxyvitamin D concentration [mean (99% CI) nmol/L] in Māori children (n = 456) was 43 (38,49), in Pacific (n = 646) 36 (31,42), and in New Zealand European and Others (NZEO) (n = 483) 53 (47,59). Among Māori, Pacific, and NZEO, the prevalence (%, 99% CI) of serum 25-hydroxyvitamin D deficiency (<17.5 nmol/L) was 5 (2,12), 8 (5,14), and 3 (1,7), respectively. The prevalence of insufficiency (<37.5 nmol/L) was 41 (29,53), 59 (42,75), and 25 (15,35), respectively. Multiple regression analysis found that 25-hydroxyvitamin D concentrations were lower in winter than summer [adjusted mean difference (99% CI) nmol/L; 15 (8,22)], lower in girls than boys [5 (1,10)], and lower in obese children than in those of "normal" weight [6 (1,11)]. Relative to NZEO, 25-hydroxyvitamin D concentrations were lower in Māori [9 (3,15)] and Pacific children [16 (10,22)]. Ethnicity and season are major determinants of serum 25-hydroxyvitamin D. There is a high prevalence of vitamin D insufficiency in New Zealand children, which may or may not contribute to increased risk of osteoporosis and other chronic disease. There is a pressing need for more convincing evidence concerning the health risks associated with the low vitamin D status in New Zealand children. [ABSTRACT FROM AUTHOR]

Background: The location and time of snack consumption may influence the composition, nutrient content and portion sizes of snacks. In this study, we aimed to determine and compare the time, location and frequency of snack consumption among different age groups of Canadians.Methods: Nationally representative dietary data from the 2015 Canadian Community Health Survey (CCHS) were used (19,677 participants aged ≥2 years). Dietary data were obtained using 24-h dietary recalls. Participants were categorized according to the frequency of snack consumption (1 time, 2-3 times, ≥4 times). The snack consumption over 24 h was divided into four time periods: before 10 am, 10 am to 3 pm, 3 pm to 8 pm and 8 pm to 12 am. Meal and snack location was categorized as at home; someone else's home; restaurants; and other.Results: Snacking 2-3 times per day was the most common reported frequency (53.0%). Snacking at home (73.0%) was more prevalent than snacking away from home (27.0%). The most frequently reported time for snacking among Canadians was 3 pm to 8 pm (36.3%), and the least frequently reported time was before 10 am (8.1%). Snacking contributed to a high proportion of Milk and Alternatives (23.7%) and Vegetables and Fruit (23.4%) food groups and lesser proportions of Grain Products (15.4%) and Meat & Alternatives (9.4%) food groups among Canadians.Conclusions: Home is the main location, 3 pm to 8 pm is the main time, and 2-3 times per day is the most common reported frequency for snacking. A full understanding of snacking behaviors is needed in order to develop targeted strategies to improve the quality of snack food choices. [ABSTRACT FROM AUTHOR]

Abstract: Vitamin D is largely obtained through sun-induced skin synthesis and less from dietary sources, but during Canadian winters, skin synthesis is non-existent. The objective of this study was to estimate vitamin D intakes in Canadians from food sources. Data used in this study included food intakes of Canadians reported in the 2004 Canadian Community Health Survey Cycle 2.2 (CCHS 2.2), a nationally representative sample of 34,789 persons over the age of 1 year. The mean±SD dietary intake of vitamin D from food of Canadians was 5.8±0.1μg/day, with males 9–18 years having the highest mean intakes (7.5±0.2μg/day) and females 51–70 years having the lowest intakes (5.2±0.3μg/day). Males in all age groups had higher intakes than females and White Canadians had higher vitamin D intakes than Non-Whites in most age sex groups. Milk products contributed 49% of dietary vitamin D followed by meat and meat-alternatives (31.1%). The majority of Canadians consume less than current recommended intake of vitamin D from food. Consideration should be given to strategies to improve vitamin D intake of Canadians by increasing both the amount of vitamin D added to foods and range of foods eligible for fortification. [ABSTRACT FROM AUTHOR]