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BACKGROUND: Historically, the voluntary addition of micronutrients to foods in the United States has been regarded as an important means to lessen problems of nutrient inadequacy. With expanding voluntary food fortification and widespread supplement use, it is important to understand how voluntary food fortification has an impact on the likelihood of excessive usual intakes. Our objective was to investigate whether individuals in the United States with greater frequency of exposure to micronutrients from voluntarily fortified foods (vFF) are more likely to have usual intakes approaching or exceeding the respective tolerable upper intake levels (UL). SUBJECTS/METHODS: The National Cancer Institute method was applied to data from the 2007-2008 National Health and Nutrition Examination Survey (NHANES) to estimate the joint distribution of usual intake from both vFF and non-vFF sources for 12 nutrients and determine the probability of consuming these nutrients from vFF on a given day. For each nutrient, we estimated the distribution of usual intake from all food sources by quintile of probability of consuming vFF and compared the distributions with ULs. RESULTS: An increased probability of consuming zinc, retinol, folic acid, selenium and copper from vFF was associated with a greater risk of intakes above the UL among children. Among adults, increased probability of consuming calcium and iron from vFF was associated with a greater risk of intakes above the UL among some age/sex groups. CONCLUSION: The high nutrient exposures associated with vFF consumption in some population subgroups suggest a need for more careful weighing of the risks and benefits of uncontrolled food fortification. European Journal of Clinical Nutrition (2013) 67, 592-597; doi: 10.1038/ejcn.2013.51; published online 6 March 2013 Keywords: voluntary food fortification; NHANES; tolerable upper intake level, INTRODUCTION In the United States, fortification of any non-standardized food with a vitamin or mineral is permitted at the discretion of the manufacturer. (1) Voluntary nutrient additions are guided by [...]

Objectives: A number of studies have pointed to the pressure that housing costs can exert on the resources available for food. The objectives of the present study were to characterise the relationship between the proportion of income absorbed by housing and the adequacy of household food expenditures across the Canadian population and within income quintiles; and to elucidate the impact of receipt of a housing subsidy on adequacy of food expenditures among low-income tenant households.Design: The 2001 Survey of Household Spending, conducted by Statistics Canada, was a national cross-sectional survey that collected detailed information on expenditures on goods and services. The adequacy of food spending was assessed in relation to the cost of a basic nutritious diet.Setting: Canada.Subjects: The person with primary responsibility for financial maintenance from 15 535 households from all provinces and territories.Results: As the proportion of income allocated to housing increased, food spending adequacy declined significantly among households in the three lowest income quintiles. After accounting for household income and composition, receipt of a housing subsidy was associated with an improvement in adequacy of food spending among low-income tenant households, but still mean food spending fell below the cost of a basic nutritious diet even among subsidised households.Conclusions: This study indicates that housing costs compromise the food access of some low-income households and speaks to the need to re-examine policies related to housing affordability and income adequacy. [ABSTRACT FROM AUTHOR]

Objective: To determine the extent to which identified nutrient inadequacies in the dietary intakes of a sample of food-insecure women could be ameliorated by increasing their access to the 'healthy' foods they typically eat.Design: Merged datasets of 226 food-insecure women who provided at least three 24-hour dietary intake recalls over the course of a month. Dietary modelling, with energy adjustment for severe food insecurity, explored the effect of adding a serving of the woman's own, and the group's typically chosen, nutrient-rich foods on the estimated prevalence of nutrient inadequacy.Setting and Subjects: One study included participants residing in 22 diverse community clusters from the Atlantic Provinces of Canada, and the second study included food bank attendees in Toronto, Ontario, Canada. Of the 226 participants, 78% lived alone with their children.Results: While nutritional vulnerability remained after modelling, adding a single serving of either typically chosen 'healthy' foods from women's own diets or healthy food choices normative to the population reduced the prevalence of inadequacy by at least half for most nutrients. Correction for energy deficits resulting from severe food insecurity contributed a mean additional 20% improvement in nutrient intakes.Conclusions: Food-insecure women would sustain substantive nutritional gains if they had greater access to their personal healthy food preferences and if the dietary compromises associated with severe food insecurity were abated. Increased resources to access such choices should be a priority. [ABSTRACT FROM AUTHOR]

Objectives: To examine the associations of adiposity, dietary restraint and other personal characteristics with energy reporting quality.Design/subjects: Secondary analysis of 230 women and 158 men from the 1997/98 Ontario Food Survey.Methods: Energy reporting quality was estimated by ratios of energy intake (EI) to both basal metabolic rate (BMR) and total energy expenditure (TEE). Multivariate regression analyses were conducted to examine energy reporting quality between two dietary recalls and in relation to body mass index (BMI) with adjustment for potential confounders. Energy reporting quality was explored across categories of age, BMI, income, education, dieting status and food insecurity through analysis of variance (ANOVA).Results: From the ANOVA, energy reporting quality was associated with BMI group, age category and weight loss for men and women, as well as with education among women (P 0.05). EI:BMR and EI:TEE on the first and second 24-hour recalls were positively related (P < 0.0001 for men and women). A higher proportion of variance in energy reporting quality was explained for women than for men (R2 = 0.19 and 0.14, respectively).Conclusions: Studies of diet and adiposity are probably hindered to some extent by BMI-related variation in energy reporting quality. Methods to address this issue are urgently needed if population surveys will continue to serve as the primary source of dietary intake data. [ABSTRACT FROM AUTHOR]

Food insecurity became recognized as a problem in Canada in the early 1980s when community groups began to establish charitable food assistance programs in response to concerns that people in their midst were going hungry. Since then, the number of Canadians affected by food insecurity has grown, but food charity remains the primary response. Children's feeding programs, prenatal nutrition programs, and a number of smaller scale, community development programs have also been instituted. However, growing recognition of the limitations of these efforts to address food problems rooted in chronically inadequate household incomes has led to a renewed emphasis on advocacy for social policy reforms. [ABSTRACT FROM AUTHOR]

Objectives: To compare food expenditure patterns between low-income households and higher- income households in the Canadian population, and to examine the relationship between food expenditure patterns and the presence or absence of housing payments among low-income households.Design: Secondary data analysis of the 1996 Family Food Expenditure Survey conducted by Statistics Canada.Setting: Sociodemographic data and 1-week food expenditure data for 9793 households were analysed.Subjects: Data were collected from a nationally representative sample drawn through stratified multistage sampling. Low-income households were identified using Statistics Canada's Low Income Measures.Results: Total food expenditures, expenditures at stores and expenditures in restaurants were lower among low-income households compared with other households. Despite allocating a slightly greater proportion of their food dollars to milk products, low-income households purchased significantly fewer servings of these foods. They also purchased fewer servings of fruits and vegetables than did higher-income households. The effect of low income on milk product purchases persisted when the sample was stratified by education and expenditure patterns were examined in relation to income within strata. Among low-income households, the purchase of milk products and meat and alternatives was significantly lower for households that had to pay rents or mortgages than for those without housing payments.Conclusions: Our findings indicate that, among Canadian households, access to milk products and fruits and vegetables may be constrained in the context of low incomes. This study highlights the need for greater attention to the affordability of nutritious foods for low-income groups. [ABSTRACT FROM AUTHOR]

This study investigated food intake patterns and contextual factors related to household food insecurity with hunger among a sample of 153 women in families seeking charitable food assistance in Toronto. Women in households characterized by food insecurity with severe or moderate hunger over the past 30 d (as assessed by the Food Security Module) reported lower intakes of vegetables and fruit, and meat and alternatives than those in households with no hunger evident. Women were more likely to report household food insecurity with hunger over the past 12 mo and 30 d if they also reported longstanding health problems or activity limitations, or if they were socially isolated. The circumstances that women identified as precipitating acute food shortages in their households included chronically inadequate incomes; the need to meet additional, unusual expenditures; and the need to pay for other services or accumulated debts. Women who reported delaying payments of bills, giving up services, selling or pawning possessions, or sending children elsewhere for a meal when threatened with acute food shortages were more likely to report household food insecurity with hunger. These findings suggest that expenditures on other goods and services were sometimes foregone to free up money for food, but the reverse was also true. Household food insecurity appears inextricably linked to financial insecurity. [ABSTRACT FROM AUTHOR]

A study of food insecurity and nutritional adequacy was conducted with a sample of 153 women in families receiving emergency food assistance in Toronto, Canada. Contemporaneous data on dietary intake and household food security over the past 30 d were available for 145 of the women. Analyses of these data revealed that women who reported hunger in their households during the past 30 d also reported systematically lower intakes of energy and a number of nutrients. The effect of household-level hunger on intake persisted even when other economic, socio-cultural, and behavioral influences on reported dietary intake were considered. Estimated prevalences of inadequacy in excess of 15% were noted for Vitamin A, folate, iron, and magnesium in this sample, suggesting that the low levels of intake associated with severe household food insecurity are in a range that could put women at risk of nutrient deficiencies. [ABSTRACT FROM AUTHOR]

Abstract Title An exploration of socioeconomic variation in lifestyle factors and adiposity in the Ontario Food Survey through structural equation models. Background Socioeconomic indicators have been inversely associated with overweight and obesity, with stronger associations observed among women. The objective of the present secondary analysis was to examine the relationships among socioeconomic measures and adiposity for men and women participating in the Ontario Food Survey (OFS), and to explore lifestyle factors as potential mediators of these associations. Methods The cross-sectional 1997/98 OFS collected anthropometric measurements, a food frequency questionnaire, data on socio-demographics (age, sex, income, and education) and physical activity from 620 women and 467 men, ages 18 to 75. Based on the 2003 Health Canada guidelines, waist circumference and BMI values were used to derive least risk, increased risk, and high risk adiposity groups. Structural equation modeling was conducted to examine increased risk and high risk adiposity in relation to education and income, with leisure time physical activity, fruit and vegetable intake, and smoking status included as potential mediators of these associations. Results The probability of high risk adiposity was directly associated with education (β-0.19, p < 0.05) and income (β-0.22, p < 0.05) for women, but not for men. Fruit and vegetable intake was a marginally significant mediator of the relationship between education and high risk adiposity for women. Increased risk adiposity was not associated with income or education for men or women. Conclusion The socioeconomic context of adiposity continues to differ greatly between men and women. For women only in the OFS, fruit and vegetable intake contributed to the inverse association between education and high risk adiposity; however, additional explanatory factors are yet to be determined.

In both Canada and the United States, nutrition labeling is now mandatory for most packaged foods. The labeling is intended to help consumers select foods that can contribute to a healthful diet, but current label values are based on outdated notions of nutrient requirements. The Committee on Use of Dietary Reference Intakes in Nutrition Labeling has recommended that the reference values used for nutrition labeling be based on a population-weighted Estimated Average Requirement (EAR) for any nutrient for which requirements have been estimated. This value approximates the median of the distribution of nutrient requirements for individuals who are members of the target population for food labels. It provides the most scientifically valid, single point of comparison for an appraisal of the probable contribution of a specific food to the overall nutrient needs of individuals in the target population. In contrast, a reference value based on a population coverage approach would understate the nutrient contribution of the food item relative to the requirements of the vast majority of individuals in the target population and thus offer misinformation rather than positive guidance to the consumer. Copyright © 2006 American Society for Nutrition [ABSTRACT FROM AUTHOR]

Background: "Diet cost" refers to a methodological approach developed by Drewnowski et al. to estimate individual daily diet costs, where cost vectors are derived by matching prices from food supply data to the food sources of reported intakes from dietary assessment tools. The dietary assessment method and food price collection approach have been found to vary diet cost estimates. There is a need to better understand how food supply prices might be better standardized and attached to price individuals' diets., Objectives: To conduct a scoping review to examine Drewnowski's diet cost method, with a focus on a detailed description and charting of cost estimation measures and methods used to price individuals' consumed diets., Methods: Five databases were searched from the inception of each database to March 2023. Included articles comprised analyses of individual-level dietary assessment data matched to food prices to assign estimates of individual daily diet costs., Results: A total of 55 articles were included, published between 1999 and 2022 from 17 countries. In all studies, cost estimates were intended to be representative of price exposures among individual respondents' dietary assessment data. All studies derived cost estimates from separately collected food prices. A total of 34 (62%) of included articles collected food prices from retail (supermarket) audits. A minority of studies (19, 35%) reported the number of food prices used to cost diets, and those varied widely, ranging from 57 to nearly 4600 distinct foods priced per study., Conclusions: In the absence of a standardized approach to study the relationship between diet costs and dietary adequacy, this scoping review has described methodological concepts and parameters used to price individuals' consumed diets. Our review shows that despite common arithmetic to calculate cost vectors, there is substantial variation in the methods used to select and attach prices from the food supply to self-reported dietary intake assessments., Competing Interests: Conflict of interest GL report financial support by Canadian Institutes of Health Research. CLM report financial support by Canadian Institutes of Health Research and Canada Research Chairs Program. MH reports financial support was provided by Canada Research Chairs Program. All other authors report no conflicts of interest., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Different food price sources and dietary assessment tools may impact the estimation of diet costs and hamper our understanding of the relationship between diet costs and dietary intakes., Objectives: We aimed to investigate the effect of 3 diet cost derivation methods, with increasing numbers of food prices and geographic specificity, holding consistent the dietary assessment tool, on the estimation of diet costs overall and by food group., Methods: We matched 24-h dietary recall data from the 2015 Canadian Community Health Survey-Nutrition (CCHS-N) to food price data from 3 Canadian Consumer Price Index (CPI) food price lists; national short list, national long list, and provincial long list. We compared the daily ($/day) and energy-adjusted ($/2000 kcal) diet costs overall and by food groups for the overall population (4+), children (4-18), and adults (19+)., Results: The proportion of dietary intakes (grams) that were covered by CPI prices significantly increased from the national short list to the national long list but did not significantly differ from the national long list to the provincial long list. The national short list resulted in the highest daily and energy-adjusted diet costs overall. No difference in diet costs was noted between the national and provincial long lists. Diet costs for 4 food groups-additions, sweets, fruits, and vegetables, which were poorly covered by the national short list-significantly differed using the national and provincial long lists. All 3 diet cost methods were significantly correlated with energy intakes; however, a strong/very strong correlation was detected for children, and a weak/moderate correlation for adults., Conclusions: The choice of food price data may introduce bias in the diet cost estimate, as well as limiting our understanding of how individuals allocate their diet costs. Refinement of diet cost estimation methodology and measures can strengthen future studies of how consumers allocate their purchases to their diets., Competing Interests: Conflict of interest The authors report no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Household food insecurity is generally associated with poorer quality diets in Canada, but whether household food insecurity heightens the probability of inadequate micronutrient intakes is unknown. The objective of this research was to investigate how prevalence of micronutrient inadequacy differed by severity of household food insecurity among adults in Canada. Using the 2015 Canadian Community Health Survey Nutrition, this study included participants aged 19-64 years who completed up to two 24 h dietary recalls and provided details about household food insecurity ( n  = 9486). Children and older adults were not included due to sample size limitations. Usual micronutrient intake distributions were estimated by a four-level measure of food insecurity status using the National Cancer Institute method. Welch's t tests assessed differences in prevalence of inadequacy for selected micronutrients. Prevalence differed for some micronutrients among those living in marginally and moderately food insecure compared to food-secure households. The greatest differences in prevalence of inadequacy were observed between severely food-insecure and food-secure households: vitamin A (60.0%, SE  =  11.9 vs. 40.6%, SE = 2.7, p  < 0.0001), vitamin B6 (42.7%, SE = 9.1 vs. 12.8%, SE = 2.5, p  < 0.0001), folate (39.4%, SE = 10.0 vs. 15.9%, SE = 2.2, p  < 0.0001), vitamin C (63.3%, SE = 5.2 vs. 29.1%, SE = 2.8, p  < 0.0001), calcium (78.6%, SE = 6.4 vs. 58.7%, SE = 1.3, p  < 0.0001), magnesium (75.6%, SE = 9.5 vs. 48.7%, SE = 1.2, p  < 0.0001), and zinc (34.9%, SE = 10.0 vs. 23.2%, SE = 2.4, p  = 0.0009). Apparent underreporting also differed by severity of food insecurity, with increased underreporting observed with worsening food insecurity. The probability of inadequate micronutrient intakes among adults rises sharply with more severe household food insecurity in Canada., Competing Interests: None to declare.

Household food insecurity is independently associated with adverse health outcomes among Canadians, but its association with overweight and obesity is poorly understood partly because of limited attention to confounding. This study assessed the relationship between food insecurity status and overweight/obesity in Canada. Cross-sectional data for individuals aged 2-64 years were drawn from the 2004 and 2015 Canadian Community Health Survey-Nutrition. Overweight/obesity was defined using body mass index calculated with measured height and weight. Food insecurity status was assessed with the 18-item Household Food Security Survey Module. The relationship was examined among preschool children ( n  = 2007), girls ( n  = 5512), boys ( n  = 5507), women ( n  = 8317), and men ( n  = 7279) using propensity score weighted logistic regressions to control for confounding. Relative to their food-secure counterparts, girls in moderately food-insecure households (39.7% vs. 28.5%), boys in severely food-insecure households (54.4% vs. 35.0%), and women in moderately and severely food-insecure households (58.9% and 73.1% vs. 50.7%) had higher overweight/obesity prevalence; men in moderately food-insecure households had a lower prevalence (48.9% vs. 66.3%). With propensity score weighting, no association existed between food insecurity and overweight/obesity among preschool children, girls, boys, or men. For women, moderate (adjusted odds ratio (AOR): 1.61; 95% confidence interval (95%CI): 1.06-2.47) and severe (AOR: 2.33; 95%CI: 1.22-4.44) food insecurity was positively associated with overweight/obesity; the association was strongest for severe food insecurity and obesity (AOR: 3.38; 95%CI: 1.60-7.16). Additional research is needed to better understand the nature of the relationship among women. Problems of food insecurity and overweight/obesity among Canadian children and men should not be conflated in public health interventions., Competing Interests: The authors declare there are no competing interest.

Objective: To examine the relationship between household food insecurity and healthcare costs in children living in Ontario, Canada., Methods: We conducted a cross-sectional, population-based study using four cycles of the Canadian Community Health Survey (2007-2008, 2009-2010, 2011-2012, 2013-2014) linked with administrative health databases (ICES). We included Ontario children aged 1-17 years with a measure of household food insecurity (Household Food Security Survey Module) over the previous 12 months. Our primary outcome was the direct public-payer healthcare costs per child over the same time period (in Canadian dollars, standardized to year 2020). We used gamma-log-transformed generalized estimating equations accounting for the clustering of children to examine this relationship, and adjusted models for important sociodemographic covariates. As a secondary outcome, we examined healthcare usage of specific services and associated costs (e.g. visits to hospitals, surgeries)., Results: We found that adjusted healthcare costs were higher in children from food-insecure than from food-secure households ($676.79 [95% CI: $535.26, $855.74] vs. $563.98 [$457.00, $695.99], p = 0.047). Compared with children living in food-secure households, those in insecure households more often accessed hospitals, emergency departments, day surgeries, and home care, and used prescription medications. Children from food-secure households had higher usage of non-physician healthcare (e.g. optometry) and family physician rostering services., Conclusion: Even after adjusting for measurable social determinants of health, household food insecurity was associated with higher public-payer health services costs and utilization among children and youth. Efforts to mitigate food insecurity could lessen child healthcare needs, as well as associated costs to our healthcare systems., (© 2023. The Author(s) under exclusive license to The Canadian Public Health Association.)

Background: Household food insecurity (HFI) has been associated with suboptimal breastfeeding practices. Postpartum factors reported by caregivers include stressful life circumstances and maternal diet quality concerns. It is unknown whether prenatal breast milk feeding intentions, a well-established predictor of breastfeeding outcomes, differ by HFI status. We explored associations between HFI and prenatal intentions to feed any and only breast milk in the first 6 months postpartum, and achievement of these intentions., Methods: We utilized data from self-identified biological mothers with children 6-12 months of age who responded to a retrospective, cross-sectional online infant feeding survey conducted in Nova Scotia, Canada. HFI (yes/no) was assessed using the Household Food Security Survey Module. Prenatal intentions to feed any and only breast milk were assessed based on responses to five options for infant milk feeding plans. Achievement of intentions was assessed by breast milk and formula feeding practices in the first 6 months. Multivariable logistic regressions were conducted, adjusting for maternal socio-demographics., Results: Among 459 respondents, 28% reported HFI; 88% intended to feed any breast milk and 77% intended to feed only breast milk, with no difference by HFI status. Of those intending to feed any breast milk, 99% succeeded, precluding further analysis. Among mothers who intended to provide only breast milk, only 51% achieved their intention, with lower odds among those with HFI (aOR 0.54, 95% CI 0.29-0.98)., Conclusion: HFI was not associated with intentions for feeding breast milk in the first 6 months postpartum, but mothers with HFI were less likely to achieve their intention to provide only breast milk. Further research is needed to understand the underlying reasons for this and to guide intervention designs to address HFI and help mothers reach their breastfeeding goals., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Francis, Mildon, Tarasuk and Frank.)

Objective: The objective of this systematic review is to synthesise the evidence on public policy interventions and their ability to reduce household food insecurity (HFI) in Canada., Design: Four databases were searched up to October 2023. Only studies that reported on public policy interventions that might reduce HFI were included, regardless of whether that was the primary purpose of the study. Title and abstract screening, full-text screening, data extraction, risk of bias and certainty of the evidence assessments were conducted by two reviewers., Results: Seventeen relevant studies covering three intervention categories were included: income supplementation, housing assistance programmes and food retailer subsidies. Income supplementation had a positive effect on reducing HFI with a moderate to high level of certainty. Housing assistance programmes and food retailer studies may have little to no effect on HFI; however, there is low certainty in the evidence that could change as evidence emerges., Conclusion: The evidence suggests that income supplementation likely reduces HFI for low-income Canadians. Many questions remain in terms of how to optimise this intervention and additional high-quality studies are still needed.

This commentary represents a dialogue on key aspects of disease-related malnutrition (DRM) from leaders and experts from academia, health across disciplines, and several countries across the world. The dialogue illuminates the problem of DRM, what impact it has on outcomes, nutrition care as a human right, and practice, implementation, and policy approaches to address DRM. The dialogue allowed the germination of an idea to register a commitment through the Canadian Nutrition Society and the Canadian Malnutrition Task Force in the UN/WHO Decade of Action on Nutrition to advance policy-based approaches for DRM. This commitment was successfully registered in October 2022 and is entitled CAN DReaM (Creating Alliances Nationally for Policy in Disease-Related Malnutrition). This commitment details five goals that will be pursued in the Decade of Action on Nutrition. The intent of this commentary is to record the proceedings of the workshop as a stepping stone to establishing a policy-based approach to DRM that is relevant in Canada and abroad., Competing Interests: The authors declare there are no competing interests.

Background: Food insecurity is a serious public health problem and is linked to the mental health of children and adolescents; however, its relationship with mental health service use is unknown. We sought to estimate the association between household food insecurity and contact with health services for mental or substance use disorders among children and adolescents in Ontario, Canada., Methods: We used health administrative data, linked to 5 waves of the Canadian Community Health Survey, to identify children and adolescents (aged 1-17 yr) who had a household response to the Household Food Security Survey Module. We identified contacts with outpatient and acute care services for mental or substance use disorders in the year before survey completion using administrative data. We estimated prevalence ratios for the association between household food insecurity and use of mental health services, adjusting for several confounding factors., Results: The sample included 32 321 children and adolescents, of whom 5216 (16.1%) were living in food-insecure households. Of the total sample, 9.0% had an outpatient contact and 0.6% had an acute care contact for a mental or substance use disorder. Children and adolescents in food-insecure households had a 55% higher prevalence of outpatient contacts (95% confidence interval [CI] 41%-70%), and a 74% higher prevalence of acute care contacts (95% CI 24%-145%) for a mental or substance use disorder, although contacts for substance use disorders were uncommon., Interpretation: Children and adolescents living in a food-insecure household have greater use of health services for mental or substance use disorders than those living in households without food insecurity. Focused efforts to support food-insecure families could improve child and adolescent mental health and reduce strain on the mental health system., Competing Interests: Competing interests: Kelly Anderson reports funding from the Department of Psychiatry Seed Fund Competition, the Petro Canada Young Innovator Award and the Canadian Institutes of Health Research. Kristin Clemens reports honoraria from the CPD Network and the Canadian Medical and Surgical Knowledge Translation Research Group. No other competing interests were declared., (© 2023 CMA Impact Inc. or its licensors.)

Objective: To assess the prevalence, severity and socio-demographic predictors of household food insecurity among vulnerable women accessing the Canada Prenatal Nutrition Program (CPNP) and to examine associations between household food insecurity and breastfeeding practices to 6 months., Design: Cohort investigation pooling data from two studies which administered the 18-item Household Food Security Survey Module at 6 months postpartum and collected prospective infant feeding data at 2 weeks and 2, 4 and 6 months. Household food insecurity was classified as none, marginal, moderate or severe. Logistic regression analyses were performed to assess predictors of household food insecurity and associations between household food security (any and severity) and continued and exclusive breastfeeding., Setting: Three Toronto sites of the CPNP, a federal initiative targeting socially and/or economically vulnerable women., Participants: 316 birth mothers registered prenatally in the CPNP from 2017 to 2020., Results: Household food insecurity at 6 months postpartum was highly prevalent (44 %), including 11 % in the severe category. Risk of household food insecurity varied by CPNP site ( P < 0·001) and was higher among multiparous participants (OR 2·08; 95 % CI 1·28, 3·39). There was no association between the prevalence or severity of food insecurity and continued or exclusive breastfeeding to 6 months postpartum in the adjusted analyses., Conclusions: Household food insecurity affected nearly half of this cohort of women accessing the CPNP. Further research is needed on household food insecurity across the national CPNP and other similar programmes, with consideration of the implications for programme design, service delivery and policy responses.

Objectives: Household food insecurity is almost four times more prevalent among adolescents than among older adults in Canada, and it adversely affects their health. Our objective was to describe the sociodemographic and geographic patterning of household food insecurity among adolescents., Methods: Our analytic sample comprised all 12-17-year-old respondents to the 2017-2018 Canadian Community Health Survey with complete data on household food insecurity (n = 8416). We used bivariate and multivariable logistic regression models to identify respondent- and household-level sociodemographic characteristics associated with household food insecurity., Results: The prevalence of household food insecurity among adolescents was 20.7%. The adjusted odds of food insecurity were significantly elevated among adolescents who identified as Black or Indigenous (aOR 1.80), those living with a single parent (aOR 1.60), those living with a greater number of children ≤ 5 years (aOR 1.45) or 12-17 years (aOR 1.25), those in rented accommodation (aOR 1.98), those in households with only secondary school education (aOR 1.38), and those in households reliant on social assistance (aOR 2.03). Higher before-tax income was protective (aOR 0.99). In comparison with Ontario, the adjusted odds of food insecurity among adolescents were higher in Nunavut (aOR 6.77), Northwest Territories (aOR 2.11), and Alberta (aOR 1.48), and lower in Manitoba (aOR 0.66)., Conclusion: The markedly higher odds of exposure to household food insecurity among adolescents who are Black or Indigenous and those living in households characterized by markers of social and economic disadvantage highlight the need for more effective policy interventions to protect vulnerable families from this hardship., (© 2023. The Author(s).)

Introduction: Food insecurity-the inadequate access to food due to financial constraints-affects 1 in 6 households in Canada, with serious health implications. Family benefit programs supplementing income have shown potential in mitigating the risk of food insecurity, but there is little understanding of their protective effects. The authors aimed to estimate the impacts of the additional Canada Child Benefit provided to families with children aged <6 years on household food insecurity., Methods: The authors sampled 28,435 households receiving Canada Child Benefit with children aged <8 years from the Canadian Income Survey 2018-2020 fielded in 2019-2021 and analyzed in 2022. Households without children aged <6 years were 1:1 propensity-score matched to those with children aged <6 years, who received up to $1,068 in additional Canada Child Benefit per child annually. The authors compared the 2 groups' 12-month food insecurity likelihood after matching. Subsample analyses were performed by household income, housing tenure, and household type., Results: Receipt of the additional Canada Child Benefit ($724 on average) was associated with 2.89 (95% CI=1.35, 4.42) percentage points lower probability of experiencing food insecurity among recipients with children aged <6 years (from 24.30% to 21.42%). The association was similar across socioeconomic subgroups and significant among all but high-income earners and mortgage-free homeowners., Conclusions: The authors found plausibly causal evidence that the more generous Canada Child Benefit for Canadian families with young children reduces their probability of food insecurity. Increasing benefits for economically disadvantaged households, characterized by low incomes, single parenthood, and renting (versus owning), may improve the program's efficiency and equity in supporting families' food security., (Copyright © 2023 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Background: The results of several recent campus-based studies indicate that over half of post-secondary students in Canada are food insecure, but the vulnerability of this group has not been considered in research on predictors of food insecurity in the Canadian population. Our objectives were to (1) compare the prevalence of food insecurity among post-secondary students and non-students of similar age; (2) examine the relationship between student status and food insecurity among young adults while accounting for sociodemographic characteristics; and (3) identify the sociodemographic characteristics associated with food insecurity among post-secondary students., Methods: Using data from the 2018 Canadian Income Survey, we identified 11,679 young adults aged 19-30 and classified them into full-time postsecondary students, part-time post-secondary students, and non-students. Food insecurity over the past 12 months was assessed with the 10-item Adult Scale from the Household Food Security Survey Module. Multivariable logistic regression analyses were used to estimate the odds of food insecurity by student status while accounting for sociodemographic characteristics, and to identify sociodemographic characteristics predictive of food insecurity among post-secondary students., Results: The prevalence of food insecurity was 15.0% among full-time postsecondary students, 16.2% among part-time students, and 19.2% among non-students. After adjusting for sociodemographic factors, full-time postsecondary students had 39% lower odds of being food insecure as compared to non-students (aOR 0.61, 95% CI 0.50-0.76). Among postsecondary students, those with children (aOR 1.93, 95%CI 1.10-3.40), those living in rented accommodation (aOR 1.60, 95%CI 1.08-2.37), and those in families reliant on social assistance (aOR 4.32, 95%CI 1.60-11.69) had higher adjusted odds of food insecurity, but having at least a Bachelor's degree appeared protective (aOR: 0.63, 95% CI 0.41-0.95). Every $5000 increase in adjusted after-tax family income was also associated with lower adjusted odds of food insecurity (aOR 0.88, 95%CI 0.84-0.92) among post-secondary students., Conclusions: In this large, population-representative sample, we found that young adults who did not attend post-secondary school were more vulnerable to food insecurity, particularly severe food insecurity, than full-time post-secondary students in Canada. Our results highlight the need for research to identify effective policy interventions to reduce food insecurity among young, working-age adults in general., (© 2023. The Author(s).)

Food insecurity, the inadequate access to food due to financial constraints, affects one-sixth of Canadian households, with substantial health implications. We examine the impact of unemployment and the mitigating effect of Employment Insurance (EI) on household food insecurity in Canada. Using the Canadian Income Survey 2018-2019, we sampled 28,650 households with adult workers 18-64 years old. We used propensity score matching to pair the 4085 households with unemployed workers with 3390 households with only continuously employed workers on their propensity towards unemployment. Among unemployed households, we also matched 2195 EI recipients with 950 nonrecipients. We applied adjusted logistic regression to the two matched samples. Food insecurity affected 15.1% of the households without unemployed workers and 24.6% of their unemployed counterparts, including 22.2% of EI recipients and 27.5% of nonrecipients. Unemployment was associated with 48% (adjusted odds ratio [aOR] 1.48, 95% confidence interval [CI] 1.32-1.66; 5.67 percentage points) higher likelihood of food insecurity. This association was significant and similar across income levels, full-time and part-time workers, and household compositions. EI receipt was associated with 23% (aOR 0.77, 95% CI 0.66-0.90; 4.02 percentage points) lower likelihood of food insecurity, but this association was only significant among households with lower income, full-time workers, and children under 18. The findings suggest a broad impact of unemployment on working adults' food insecurity and a substantial mitigating effect by EI on select unemployed workers. Making EI more generous and accessible for part-time workers may help alleviate food insecurity., Competing Interests: Declaration of Competing Interest We declare no conflict of interest., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objectives: The prevalence of household food insecurity in Newfoundland and Labrador (NL) fell sharply between 2007 and 2011, but it appears to have risen since then. Our objective was to compare the prevalence of food insecurity between 2011-2012 and 2017-2018 in relation to population socio-demographic characteristics., Methods: Our analytic sample comprised all NL households in the Canadian Community Health Survey (CCHS) cycles 2011-2012 and 2017-2018, n = 6800. We stratified the prevalence of household food insecurity for each cycle by socio-demographic characteristics and applied multivariable logistic regression models to determine food insecurity odds in 2017-2018 compared with 2011-2012 after controlling for socio-demographic covariates. Interactions of covariates with survey cycle were tested and models stratified when warranted., Results: The prevalence of food insecurity rose from 12.0% (95% CI 10.5, 13.6) in 2011-2012 to 14.7% (95% CI 13.1, 16.6) in 2017-2018. After adjusting for household socio-demographic variables, the odds of food insecurity was 1.49 (95% CI 1.27, 1.75) in 2017-2018. The prevalence of food insecurity had increased significantly among unattached individuals, renters, households with low educational attainment, and households with income above the Low Income Measure, with concomitant increases in the contribution of these groups to the total provincial prevalence of food insecurity in 2017-2018 compared with that in 2011-2012., Conclusion: The odds of food insecurity among NL households increased significantly from 2011-2012 to 2017-2018. Given the serious negative health implications of household food insecurity, the province should draw on the lessons from its earlier success in food insecurity reduction to reverse the current trend., (© 2021. The Author(s) under exclusive license to The Canadian Public Health Association.)

Objective: To examine the relationship between the dietary quality of Canadian children and adults and household food insecurity status., Design: Dietary intake was assessed with one 24-h recall. Households were classified as food secure or marginally, moderately or severely food insecure based on their responses to the Household Food Security Survey Module. We applied multivariable analyses of variance to determine whether % energy from ultra-processed foods, fruit and vegetable intake, Healthy Eating Index (HEI) scores, macronutrient composition and micronutrient intakes per 1000 kcal differed by food insecurity status after accounting for income, education and region. Analyses were run separately for children 1-8 years and 9-18 years and men and women 19-64 years of age., Setting: Ten provinces in Canada., Participants: Respondents to the 2015 Canadian Community Health Survey-Nutrition, aged 1-64 years, with complete food insecurity data and non-zero energy intakes, N 15 909., Results: Among adults and children, % energy from ultra-processed foods was strongly related to severity of food insecurity, but no significant trend was observed for fruit and vegetable intake or HEI score. Carbohydrate, total sugar, fat and saturated fat intake/1000 kcal did not differ by food insecurity status, but there was a significant negative trend in protein/1000 kcal among older children, a positive trend in Na/1000 kcal among younger children and inverse associations between food insecurity severity and several micronutrients/1000 kcal among adults and older children., Conclusions: With more severe household food insecurity, ultra-processed food consumption was higher, and diet quality was generally lower among both adults and children.

Background: Food insecurity, inadequate access to food due to financial constraints, is a major public health issue in the United States and Canada, where the same 18-item questionnaire is used to monitor food insecurity. Researchers often assume that findings on food insecurity from the 2 countries are comparable with each other, but there are between-country differences in how food insecurity status is determined., Objectives: We aimed to compare the distribution of household food insecurity in the Canadian population applying the US and Canadian classification schemes. We also examined the extent to which associations between food insecurity and adults' health differ under the 2 schemes., Methods: We used the population-representative Canadian Community Health Survey 2005-2017 linked to administrative health records. Food insecurity was measured by the Household Food Security Survey Module. Adults 18 y and older with valid food insecurity status were included from all jurisdictions except Quebec (n = 403,200). We cross-tabulated food insecurity status classified by the US and Canadian schemes. We also fitted logistic regressions on self-reported and objective health measures adjusting for confounders., Results: Applying the Canadian classification scheme, 7.7% of households were food insecure; the number fell to 6.0% with the US scheme. Associations between food insecurity status and health measures were mostly similar across classification schemes, although the associations between food insecurity and self-reported health were slightly larger if the US scheme was applied. Marginal food security/insecurity was associated with worse health measures irrespective of the classification scheme. United States-Canada discordance in classification of marginal food security/insecurity had a limited effect on health prediction., Conclusions: United States-Canada differences in classification affected the apparent distribution of household food insecurity but not the associations between food insecurity and measures of adult health. Marginal food security/insecurity should be set apart from the food-secure group for trend monitoring and health research., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition.)