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To date, the impacts of school-based, peer-led nutrition education initiatives have not been summarized or assessed collectively. This review presents the current evidence, identifies knowledge gaps, and provides recommendations for future research. PubMed, Scopus, ERIC and Google Scholar were searched for refereed Canadian and American primary studies published between January 2000 and November 2013, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Seventeen articles (11 programs) from Canada (24%) and the United States (76%) were identified. The results were summarized in terms of the study population, program design and main outcomes. Common outcome measures included healthy eating knowledge (n = 5), self-efficacy or attitudes towards healthy eating (n = 13), dietary measures (n = 9) and body mass index (n = 4), all of which tended to improve as a result of the programs. More research is needed to ascertain the effect of improvements in knowledge, self-efficacy and attitudes towards healthy eating on food behaviors. When evaluated, programs were generally well received, while the long-term maintenance of positive impacts was a challenge. Studies of sustainability and feasibility to promote long-term impact are a logical next step.

Background: Canadian Aboriginal youth have poorer diet quality and higher rates of overweight and obesity than the general population. This research aimed to assess the impact of simple food provision programs on the intakes of milk and alternatives among youth in Kashechewan and Attawapiskat First Nations (FNs), Ontario, Canada. Methods: A pilot school snack program was initiated in Kashechewan in May 2009 including coordinator training and grant writing support. A supplementary milk and alternatives program was initiated in Attawapiskat in February 2010. Changes in dietary intake were assessed using Web-based 24-hour dietary recalls in grade 6 to 8 students, pre- and 1-week post-program, with a 1-year follow-up in Kashechewan. Student impressions were collected after 1?week using open-ended questions in the Web survey. Teacher and administrator impressions were collected via focus groups after 1?year in Kashechewan. Results: After 1?week, calcium intake increased in Kashechewan (805.9?plus or minus ?552.0 to 1027.6?plus or minus ?603.7?mg, p?= 0.044); however, improvements were not sustained at 1?year; milk and alternatives (1.7?plus or minus?1.7 servings to 2.1?plus or minus?1.4 servings, p?=?0.034) and vitamin D (2.5?plus or minus?2.6 to 3.5?plus or minus?3.4 micrograms, p?=?0.022) intakes increased in Attawapiskat. Impressions of the programs were positive, though limited resources, staff, facilities, and funding were barriers to sustaining the consistent snack provision of the 1-week pilot phase. Conclusion: These illustrations show the potential of snack programs to address the low intakes of milk and alternatives among youth in remote FNs. Community-level constraints must be addressed for sustained program benefits. (Contains 3 tables.)

Background: Among students, little is known about the physical and social context of eating lunch. The objective of this study was to determine if food intake (including the type of food and beverages and portion sizes) was associated with specific aspects of the physical and social lunch environment (location, with whom lunch was consumed, who prepared the food, and where the food was originally purchased). Methods: A total of 1236 participants (males = 659, females = 566) in grades 6 (n = 359), 7 (n = 409), and 8 (n = 463) from southern Ontario, Canada, completed the Food Behavior Questionnaire during the 2005-2006 academic year. Results: A total of 8159 foods and 2200 beverages were consumed during the lunch meal, which contributed to 552 kcal (SD = 429) or 30% (SD = 16) of total daily energy intake (kcal/day). Higher amounts of energy, meats and alternatives, other foods, fried foods, and pizza were consumed when participants ate in between places or at a restaurant/fast food outlet (compared with at home or school, p less than 0.05) and/or when prepared by friends or others (compared with themselves or family members, p less than 0.05). A large number of participants (46%) reported consuming sugar-sweetened beverages during lunch, despite a school board-level policy restricting the sales of "junk food," which appears to be brought from home. Conclusions: Our findings support schools in policy efforts that restrict fast food access (by leaving school grounds, preventing fast food companies from coming onto school grounds, or restricting sugar-sweetened beverage sales in vending machines) and that eating in between places should be discouraged. (Contains 3 tables.)

OBJECTIVE: Unhealthy dietary and physical inactivity patterns inspired many initiatives promoting healthy youth and healthy schools in Alberta between 2005 and 2008. The purpose of this study was to examine differences in the prevalence of lifestyle risk factors for type 2 diabetes (T2D) between two province-wide samples of Alberta adolescents (2005 and 2008). METHODS: The dietary and physical activity (PA) patterns of Alberta youth were assessed in two cross-sectional studies of grade 7-10 students, one in 2005 (n=4936) and one in 2008 (n=5091), using a validated web-survey. For each diabetes risk factor, participants were classified as either at risk or not at risk, depending on their survey results relative to cut-off values. Chi-square tests and logistic regression models were used to determine differences in risk factor prevalence between 2005 and 2008. RESULTS: Compared to 2005, mean BMI, energy intake, fat intake, glycemic index (GI) and glycemic load (GL) were lower in 2008 (p CONCLUSIONS: Improvements were observed between 2005 and 2008 in terms of the proportion of adolescents having specific risk factors for T2D. The cause of these changes could not be determined. Continued monitoring of adolescent lifestyle habits and monitoring of exposure to health promotion programming is recommended. KEY WORDS: Type 2 Diabetes Mellitus; adolescents; prevalence; risk factors; diet; physical activity OBJECTIF: Les habitudes alimentaires malsaines et l'inactivite physique ont inspire de nombreuses initiatives de promotion de la sante des jeunes et des ecoles en Alberta entre 2005 et 2008. Nous avons cherche a examiner les differences dans la prevalence des facteurs de risque lies aux habitudes de vie pour le diabete de type 2 (DT2) entre deux echantillons provinciaux d'adolescents albertains (2005 et 2008). METHODE: Les habitudes d'alimentation et d'activite physique des jeunes de l'Alberta ont ete evaluees a la faveur de deux etudes transversales aupres d'eleves de la 7e a la 10e annee, l'une en 2005 (n=4 936) et l'autre en 2008 (n=5 091), a l'aide d'un sondage en ligne valide. Pour chaque facteur de risque du diabete, les participants ont ete classes comme etant a risque ou non a risque selon leurs reponses au sondage par rapport aux valeurs limites. Des tests du khi-carre et des modeles de regression logistique ont servi a determiner les differences dans la prevalence des facteurs de risque entre 2005 et 2008. RESULTATS: Comparativement a 2005, l'IMC moyen, l'apport energetique, l'apport en matieres grasses, l'indice glycemique (IG) et la charge glycemique (CG) etaient plus faibles en 2008 (p CONCLUSIONS: Des ameliorations ont ete observees entre 2005 et 2008 dans la proportion d'adolescents presentant les facteurs de risque propres au DT2. Nous n'avons pas pu determiner la cause de ces changements. Il est recommande de continuer a surveiller les habitudes de vie des adolescents et leur exposition aux programmes de promotion de la sante. MOTS CLES: diabete de type 2; adolescent; prevalence; facteurs de risque; regime alimentaire; exercice physique La traduction du resume se trouve a la fin de l'article., Unhealthy dietary and physical activity patterns are prevalent among Canadian youth (1,2) and are implicated in increasing rates of early onset type 2 diabetes that have been observed in Canada. [...]

Abstract Background Complementary feeding is currently recommended after six months of age, when the nutrients in breast milk alone are no longer adequate to support growth. Few studies have examined macro- and micro-nutrient intakes from complementary foods (CF) only. Our purpose was to assess the sources and nutritional contribution of CF over the first year of life. Methods In July 2003, a cross-sectional survey was conducted on a nationally representative sample of mothers with infants aged three to 12 months. The survey was administered evenly across all regions of the country and included a four-day dietary record to assess infants' CF intakes in household (tablespoon) measures (breast milk and formula intakes excluded). Records from 2,663 infants were analyzed for nutrient and CF food intake according to 12 categories. Mean daily intakes for infants at each month of age from CF were pooled and compared to the Dietary Reference Intakes for the respective age range. Results At three months of age, 83% of infants were already consuming infant cereals. Fruits and vegetables were among the most common foods consumed by infants at all ages, while meats were least common at all ages except 12 months. Macro- and micro-nutrient intakes from CF generally increased with age. All mean nutrient intakes, except vitamin D and iron, met CF recommendations at seven to 12 months. Conclusions Complementary foods were introduced earlier than recommended. Although mean nutrient intakes from CF at six to 12 months appear to be adequate among Canadian infants, further attention to iron and vitamin D intakes and sources may be warranted.