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In 2019, Health Canada released a new iteration of Canada's Food Guide (2019-CFG), which, for the first time, highlighted recommendations regarding eating practices, i.e., guidance on where, when, why, and how to eat. The objective of this study was to develop a brief self-administered screener to assess eating practices recommended in the 2019-CFG among adults aged 18-65 years. Development of the screener items was informed by a review of existing tools and mapping of items onto 2019-CFG recommendations. Face and content validity were assessed with experts in public health nutrition and/or dietary assessment ( n  = 16) and individuals from Government of Canada ( n  = 14). Cognitive interviews were conducted with English-speaking ( n  = 16) and French-speaking ( n  = 16) adults living in Canada to assess face validity and understanding of the screener items. While some modifications were identified to improve relevance or clarity, overall, the screener items were found to be relevant, well-constructed, and clearly worded. This comprehensive process resulted in the Canadian Eating Practices Screener/Questionnaire court canadien sur les pratiques alimentaires, which includes 21 items that assess eating practices recommended in the 2019-CFG. This screener can facilitate monitoring and surveillance efforts of the 2019-CFG eating practices as well as research exploring how these practices are associated with various health outcomes., Competing Interests: This project was funded by Health Canada through a contract to JH. JH has received funding from the Canadian Foundation for Dietetic Research, CIHR, Danone Institute International, Danone Institute North America, Health Canada, and the National Institutes of Health. SIK has received funding from Agriculture and Agri-Food Canada, AI for Good, the Canadian Institutes of Health Research (CIHR), the Canadian Foundation for Dietetic Research, Health Canada, the National Institutes of Health, the Ontario Ministry of Research and Innovation, and the Social Sciences and Humanities Research Council of Canada. SIK is a member of the Health Canada Nutrition Science Advisory Committee and the CIHR Institute of Nutrition, Metabolism, and Diabetes Institute Advisory Board. SL has received funding from CIHR. BL has received funding from CIHR (ongoing), the Fonds de recherche du Québec—Santé (FRQS) (ongoing), Fonds de recherche du Québec—Nature et technologies (NT) (ongoing), the Ministère de la santé et des services sociaux (MSSS) du Québec (ongoing), Health Canada (completed in 2021), and Atrium Innovations (completed in 2019). BL is a member of the Canadian Nutrition Society Advisory Board. The remaining authors have no competing interests to disclose.

Background: Front-of-package labelling regulations proposed by Health Canada in their Healthy Eating Strategy (2016) were finally passed in 2022, but remain unimplemented. This study analyzed interactions that occurred between stakeholders and government related to this policy proposal to identify key themes and policy implications., Methods: A qualitative framework analysis was conducted on publicly available documents for stakeholder correspondences related to front-of-package that occurred between 2016 and 2019 in Health Canada's Meetings and Correspondence on Healthy Eating database. Five sequential steps were applied: familiarization, identifying a thematic framework, indexing, charting, and mapping and interpretation. A complex systems (i.e., a dynamic system with multiple interconnecting components) lens was incorporated in the final step to deepen the analysis., Results: Hundred and seventy-three documents were included, the majority from industry stakeholders ( n  = 108, 62.4%). Three overarching themes were identified: industry trying to control the agenda and resist regulation; questioning the evidence supporting the policy and its impact on the agri-food industry; and dismissing the need and effectiveness of the policy. Incorporating a complex system lens found industry and non-industry stakeholders held markedly different perspectives on how cohesive the system defined by the front-of-package labelling policy was, and the policy impact on its stability. Economic and opportunity costs were the main trade-offs, and symbol misinterpretation considered an unintended consequence by industry. Finally, some stakeholders argued for wider policy scope incorporating more products, while others requested a narrower approach through exemptions., Conclusion: Interactions with industry stakeholders on health food policy proposals require careful consideration, given it may suit their interests to generate delays and policy discordance. Explicitly setting out the principles of engagement and actively encouraging non-industry stakeholder representation provides a more balanced approach to policy consultation and development., 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 © 2023 Jawad, Mulligan, Savona and L'Abbé.)

In 2015, the Pan American Health Organization (PAHO) published sodium targets for packaged foods, which included two distinct levels: one "regional" and one "lower" target. Changes to the sodium content of the food supply in Latin American Countries (LAC) has not been evaluated. A repeated cross-sectional study used food label data from 2015 ( n = 3859) and 2018 ( n = 5312) to determine changes in the proportion of packaged foods meeting the PAHO sodium targets and the distribution in the sodium content of foods in four LAC (Argentina, Costa Rica, Paraguay, Peru). Foods were classified into the 18 food categories in the PAHO targets. The proportion of foods meeting the regional targets increased from 82.9% to 89.3% between 2015 and 2018 ( p < 0.001). Overall, 44.4% of categories had significant decreases in mean sodium content. Categories with a higher proportion of foods meeting the regional and lower targets in 2018 compared to 2015 ( p < 0.05) were breaded meat and poultry, wet and dry soups, snacks, cakes, bread products, flavored cookies and crackers, and dry pasta and noodles. While positive progress has been made in reducing the sodium content of foods in LAC, sodium intakes in the region remain high. More stringent targets are required to support sodium reduction in LAC.

In 2019, Canada's Food Guide (CFG) was updated from the 2007 version. This study developed a food-based nutrient profile model (NPM) to evaluate the alignment of packaged food and beverage products with CFG 2019 and compared it with CFG 2007. Packaged products from the University of Toronto's Food Label Information Program 2017 database were evaluated in terms of their alignment with CFG 2007 (using the Health Canada Surveillance Tool (HCST)) and CFG 2019 (using our newly developed CFG 2019 NPM). Agreement in alignment (e.g., products "in line" according to CFG 2019 NPM and in Tiers 1 or 2 according to the HCST) was calculated and differences in alignment and reasons for differences were quantified and described. Overall agreement in product alignment between CFG 2007 and 2019 was 81.9%, with fewer products aligned with CFG 2019: 16.4% vs. 31.8%, (χ 2 = 189.12, p  < 0.001). Differences in alignment varied across food categories (0.0-73.8%), explained by differences in CFG 2019, reflected in the CFG 2019 NPM (e.g., emphasis on avoiding processed foods, encouraging whole grains and low-fat dairy). This study presents a first step in assessing packaged foods' alignment with CFG 2019; future work is needed to evaluate broader dietary adherence to the updated recommendations. Novelty: A food-based nutrient profile model was developed based on the 2019 CFG and tested on packaged foods by comparing it with the nutrient-based HCST, based on CFG 2007. Most (82%) packaged products were "not in line" with either CFG version.

Background: Canadian federal restrictions on food marketing to children (children's marketing) were proposed in 2016 as Bill S-228, the Child Health Protection Act , which subsequently died on the parliamentary table. This study quantified the interactions (meetings, correspondence and lobbying) related to Bill S-228 and children's marketing by different stakeholders with the federal government., Methods: Interactions between all stakeholders and government related to children's marketing and Bill S-228 (Sept. 1, 2016-Sept. 30, 2019) were analyzed. These included the "Meetings and correspondence on healthy eating" database, detailing interactions between stakeholders and Health Canada related to nutrition policies; and Canada's Registry of Lobbyists, reporting activities of paid lobbyists. We categorized the interactions by stakeholder type (industry, nonindustry and mixed), and analyzed the number and type of interactions with different government offices., Results: We analyzed 139 meetings, 65 lobbying registrants, 215 lobbying registrations and 3418 communications related to children's marketing and Bill S-228. Most interactions were from industry stakeholders, including 84.2% of meetings (117/139), 81.5% of lobbying registrants (53/65), 83.3% of lobbying registrations (179/215) and 83.9% of communications (2866/3418). Most interactions (> 80%) in the highest-ranking government offices were by industry., Interpretation: Industry stakeholders interacted with government more often, more broadly and with higher ranking offices than nonindustry stakeholders on subjects related to children's marketing and Bill S-228. Although further research is needed to analyze the nature of the discourse around children's marketing, it is apparent that industry viewpoints were more prominent than those of nonindustry stakeholders., Competing Interests: Competing interests: None declared., (© 2021 Joule Inc. or its licensors.)

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

Food environment policies play a critical role in shaping food choices, diets, and health outcomes. This study endeavored to characterize and evaluate the current food environment policies in Canada using the Healthy Food Environment Policy Index (Food-EPI) to compare policies in place or under development in Canada as of 1 January 2017 to the most promising practices internationally. Evidence of policy implementation from the federal, provincial, and territorial governments was collated and verified by government stakeholders for 47 good practice indicators across 13 policy and infrastructure support domains. Canadian policies were rated by 71 experts from across Canada, and an aggregate score of national and subnational policies was created. Potential policy actions were identified and prioritized. Canadian governments scored 'high' compared to best practices for 3 indicators, 'moderate' for 14 indicators, 'low' for 25 indicators, and 'very little or none' for 4 indicators. Six policy and eight infrastructure support actions were prioritized as the most important and achievable. The Food-EPI identified some progress and considerable gaps in policy implementation in Canada, and highlights a particular need for greater attention to prioritized policies that can help to shift to a health-promoting food environment.

Canadians' food purchases consist largely of packaged processed and ultra-processed products, which typically fall outside the "core" foods recommended by Canada's Food Guide (CFG). Almost half of packaged products in Canada carry nutrition marketing (i.e., nutrient content and health claims). This study assessed whether packaged foods carrying nutrition marketing align with recommendations outlined in the 2007 CFG. Label data ( n = 9376) were extracted from the 2013 Food Label Information Program (FLIP). Label components (including nutrition marketing) were classified using the International Network for Food and Obesity/NCDs Research, Monitoring and Action Support (INFORMAS) labelling taxonomy. The Health Canada Surveillance Tool (HCST) was used to assess the alignment of products to CFG. Each food or beverage was classified into one of five groups (i.e., Tier 1, Tier 2, Tier 3, Tier 4, "Others"). Products in Tier 1, 2 or water were considered "in line with CFG". Most products in the analyzed sample were classified as Tier 2 (35%) and Tier 3 (27%). Although foods with nutrition marketing were significantly more likely to align to CFG recommendations ( p < 0.001), many products not "in line with CFG" still carried nutrition marketing. This study provides important baseline data that could be used upon the implementation of the new CFG.

Marketing unhealthy foods and beverages to children (M2K) fosters poor dietary patterns, increasing obesity and noncommunicable disease risk. Federal restrictions on M2K have been under development in Canada since 2016; however, at present, M2K is mostly self-regulated by food companies. This study aimed to compare M2K on Canadian websites of food companies with and without voluntary policies or commitments in this area. A systematic content analysis of company websites was conducted in spring/summer 2017 for major packaged food (n = 16), beverage (n = 12), and restaurant chain (n = 13) companies in Canada. M2K policies were sourced from company websites and published corporate documents. Sixteen companies (43%) reported national and/or global M2K policies, while 21 companies (57%) had no published policies. The websites of Canadian companies (n = 154) were scanned for child-directed products and marketing; type and frequency of marketing techniques were recorded. Child-directed marketing appeared on 19 websites of 12 companies (32%), including 9 companies with M2K policies. Websites featured products with unconventional flavours, colours, shapes, or child-oriented packaging, and used promotional characters, contests, games, activities, or lettering and graphics appealing to children. The nutritional quality of products marketed to children was evaluated using a nutrient profile model developed by Health Canada for proposed M2K regulations. Of the 217 products marketed to children, 97% exceeded Health Canada's proposed ∼5% Daily Value threshold for saturated fat, sodium, and/or sugars, 73% of which were products from 9 companies with policies. These findings highlight the limitations of self-regulation in restricting M2K on food company websites, reinforcing the need for government regulations.

Nutrient profile (NP) models, tools used to rate or evaluate the nutritional quality of foods, are increasingly used by government bodies worldwide to underpin nutrition-related policies. An up-to-date and accessible list of existing NP models is currently unavailable to support their adoption or adaptation in different jurisdictions. This study used a systematic approach to develop a global resource that summarizes key characteristics of NP models with applications in government-led nutrition policies. NP models were identified from an unpublished WHO catalog of NP models last updated in 2012 and from searches conducted in different databases of the peer-reviewed (n = 3; e.g., PubMed) and gray literature (n = 15). Included models had to meet the following inclusion criteria (selected) as of 22 December 2016: 1) developed or endorsed by governmental or intergovernmental organizations, 2) allow for the evaluation of individual food items, and 3) have publicly available nutritional criteria. A total of 387 potential NP models were identified, including n = 361 from the full-text assessment of >600 publications and n = 26 exclusively from the catalog. Seventy-eight models were included. Most (73%) were introduced within the past 10 y, and 44% represent adaptations of ≥1 previously built model. Models were primarily built for school food standards or guidelines (n = 27), food labeling (e.g., front-of-pack; n = 12), and restriction of the marketing of food products to children (n = 10). All models consider nutrients to limit, with sodium, saturated fatty acids, and total sugars being included most frequently; and 86% also consider ≥1 nutrient to encourage (e.g., fiber). No information on validity testing could be identified for 58% of the models. Given the proliferation of NP models worldwide, this new resource will be highly valuable for assisting health professionals and policymakers in the selection of an appropriate model when the establishment of nutrition-related policies requires the use of nutrient profiling.

Background: The Canadian government recently committed to introduce legislation to restrict the commercial marketing of unhealthy foods and beverages to children. Objective: We compared the degree of strictness and agreement between nutrient profile (NP) models relevant to marketing restrictions by applying them in the Canadian context. Design: With the use of data from the University of Toronto 2013 Food Label Information Program ( n = 15,342 prepackaged foods), 4 NP models were evaluated: the Food Standards Australia New Zealand-Nutrient Profiling Scoring Criterion (FSANZ-NPSC), the WHO Regional Office for Europe (EURO) model, the Pan American Health Organization (PAHO) model, and a modified version of the PAHO model (Modified-PAHO), which did not consider the extent of food processing because the application of this characteristic was prone to ambiguity. The number and proportion of foods that would be eligible for marketing to children was calculated with the use of each model, overall and by food category. Results: The Modified-PAHO and PAHO models would permit only 9.8% (95% CI: 9.4%, 10.3%) and 15.8% (95% CI: 15.3%, 16.4%) of foods, respectively, followed by the EURO model [29.8% (95% CI: 29.0%, 30.5%)]. In contrast, the FSANZ-NPSC would consider almost half of prepackaged foods as eligible for marketing to children [49.0% (95% CI: 48.2%, 49.8%)]. Cross-classification analyses showed that only 8.1% of foods would be eligible based on all models (e.g., most pastas without sauce). Subanalyses showed that each model would be more stringent when evaluating food items that specifically target children on their package ( n = 747; from 1.9% of foods eligible under Modified-PAHO to 24.2% under FSANZ-NPSC). Conclusions: The degree of strictness and agreement vary greatly between NP models applicable to marketing restrictions. The discrepancies between models highlight the importance for policy makers to carefully evaluate the characteristics underlying such models when trying to identify a suitable model to underpin regulations restricting the marketing of unhealthy foods to children., (© 2017 American Society for Nutrition.)

Background: Serving sizes on the Nutrition Facts table (NFt) on Canadian packaged foods have traditionally been unregulated and non-standardized. The federal government recently passed legislation to regulate the serving sizes listed on the NFt. The objective of this study was to compare the serving sizes on food product NFts to the recommendations in the 2003 Nutrition Labelling regulation (Schedule M) reference amounts, the Canadian Food Inspection Agency (CFIA) ranges, and Canada's Food Guide recommendations. An additional objective was to determine if food and beverage products that report smaller serving sizes have a higher calorie density, compared to similar products with a larger serving size., Methods: Data for 10,487 products were retrieved from the 2010 Food Label Information Program (FLIP) database and categorized according to Schedule M categories. Correlations between calorie density and manufacturer stated serving size were tested and the proportion of products meeting recommendations were tabulated., Results: 35% of products had serving sizes on the NFt that were smaller than the Schedule M reference amount and 23% exceeded the reference amount. 86% of products fell within the CFIA's recommended serving size ranges; however, 70% were within the lower-half of the range. Several bread and juice categories exceeded CFG's recommendations, while several dairy product categories were smaller than the recommendations. Of the 50 Schedule M sub-categories analyzed, 31 (62%) exhibited a negative correlation between serving size and calorie density., Conclusion: While most products fell within the CFIA's recommended serving size ranges, there was a tendency for products with a higher calorie density to list smaller serving sizes.

Background: Dietary pattern analysis represents a departure from the traditional focus on single foods and nutrients and provides a comprehensive understanding of the role of the diet in chronic disease prevention and etiology. Dietary patterns of Canadians have not been evaluated comprehensively with the use of an updated a priori dietary quality index., Objectives: We aimed to update the Dietary Guidelines for Americans Adherence Index (DGAI) on the basis of the 2015 Dietary Guidelines for Americans (DGA), to evaluate the construct validity and reliability of the revised index, and to examine whether closer adherence to this index is associated with a lower risk of obesity with or without an accompanying chronic disease., Design: Data from 11,748 participants (≥18 y of age) in the cross-sectional Canadian Community Health Survey cycle 2.2 were used in weighted multivariate analyses. Multinomial logistic regression was used to test the association between diet quality and obesity risk., Results: With the use of principal component analyses, the multidimensionality of the 2015 DGAI was confirmed, and its reliability was shown with a high Cronbach's α = 0.75. Moving from the first to the fourth (healthiest) quartile of the 2015 DGAI score, there was a trend toward decreased energy (2492 ± 26 compared with 2403 ± 22 kcal, respectively; ±SE) and nutrients of concern (e.g., sodium), whereas intakes of beneficial nutrients increased (P-trend < 0.05). In the age- and sex-adjusted model, a lack of adherence to the 2015 DGA recommendations increased the OR of being unhealthy obese from 1.42 (95% CI: 1.02, 1.99) in quartile 3 to 2.08 (95% CI: 1.49, 2.90) in quartile 2 to 2.31 (95% CI: 1.65, 3.23) in the first quartile of the 2015 DGAI score, compared with the fourth quartile (healthiest) (P-trend < 0.0001). The odds of being obese without a chronic disease (healthy obese) and having a chronic disease without being obese also increased in the lowest DGAI quartile compared with the highest DGAI quartile, albeit not as much as in the unhealthy obese group., Conclusion: The 2015 DGAI provides a valid and reliable measure of diet quality among Canadians., (© 2016 American Society for Nutrition.)

Unhealthy eating is the leading risk for death and disability globally. As a result, the World Health Organization (WHO) has called for population health interventions. One of the proposed interventions is to ensure healthy foods are available by implementing healthy food procurement policies. The objective of this systematic review was to evaluate the evidence base assessing the impact of such policies. A comprehensive review was conducted by searching PubMed and Medline for policies that had been implemented and evaluated the impact of food purchases, food consumption, and behaviors towards healthy foods. Thirty-four studies were identified and found to be effective at increasing the availability and purchases of healthy food and decreasing purchases of unhealthy food. Most policies also had other components such as education, price reductions, and health interventions. The multiple gaps in research identified by this review suggest that additional research and ongoing evaluation of food procurement programs is required. Implementation of healthy food procurement policies in schools, worksites, hospitals, care homes, correctional facilities, government institutions, and remote communities increase markers of healthy eating. Prior or simultaneous implementation of ancillary education about healthy eating, and rationale for the policy may be critical success factors and additional research is needed.

The tolerable upper intake levels (UL) for zinc for children were based on limited data and there is concern that the UL may be set too low. The first effect of excessive zinc intake is a reduction in copper status. The primary objective of this study was to examine the effect of zinc supplementation on copper status in children. Healthy, 6- to 8-y-old boys from Ontario, Canada were assigned to take a placebo (n = 10) or 5 mg (n = 10), 10 mg (n = 9), or 15 mg (n = 8) of zinc supplement daily for 4 mo in a double-blinded, placebo-controlled, randomized trial. Biochemical measures were evaluated at baseline and after 2 and 4 mo of supplementation. Food records were completed near the baseline and 4-mo visits. Age and anthropometric measurements did not differ (P > 0.05) between treatment groups at baseline. Mean zinc intakes from food alone (10.9-14.8 mg zinc/d) approached or exceeded the UL of 12 mg/d. Compared with the placebo group, the zinc groups had a greater change in the urine zinc:creatinine ratio at 4 mo (P = 0.02). Traditional (plasma copper and ceruloplasmin activity) and more sensitive biomarkers of copper status, including erythrocyte SOD1 activity and the erythrocyte CCS:SOD1 protein ratio, were unchanged in zinc-supplemented boys, demonstrating that copper status was not depressed. Serum lipid measures and hemoglobin concentrations were also unaffected and gastrointestinal symptoms were not reported. These data provide evidence in support of the need for reexamining the current UL for zinc for children.

Purpose: The effectiveness of different front-of-pack nutrition rating systems and symbols (FOPS) has not been studied among Canadians. We pilot tested an online FOPS survey with consumers., Methods: Members of the Guelph Food Panel were randomly exposed to traffic light, Percent Daily Value, Health Check, and Smart Pick logos on mock food packages and were asked to rate the FOPS on a Likert-type scale. The FOPS were rated on consumers' ability to understand them, credibility, and influence on purchase decisions. Participants also provided feedback on the survey., Results: Participants (n=337) deemed the survey appropriate in length and language, and provided suggestions for improving survey clarity. More than 50% of the respondents believed that FOPS should be present on all food packages (65.1%) and should be government regulated (53.0%). The Percent Daily Value symbol was rated highest with respect to liking, credibility, helpfulness, and influence, but was the least understood. When they used direct comparison, consumers preferred the traffic light symbol (53.1%) over the Percent Daily Value (40.0%), Health Check (6.7%), and Smart Pick (0.3%) symbols., Conclusions: The survey was revised as a result of the pilot study feedback. Preliminary findings from this pilot study suggest that consumers prefer a single, government-regulated symbol, and value more complex FOPS, like the Percent Daily Value symbol, despite finding them harder to understand.

Restaurant foods are associated with excessive energy intake and poor nutritional quality. In 2017, the Healthy Menu Choices Act mandated food service establishments with ≥20 outlets in Ontario to display the energy content on menus. To examine the potential impact of menu labelling, nutrition information for 18,760 menu items were collected from 88 regulated and 53 unregulated restaurants. Descriptive statistics were calculated for serving size, energy, saturated fat, sodium and total sugars. Quantile regression was used to determine the differences between regulated and unregulated restaurants. The energy content of menu items from regulated restaurants (median (95% CI): 320 kcal (310, 320)) was significantly lower than those from unregulated restaurants (470 kcal (460, 486), p < 0.001). Saturated fat, sodium and total sugars were significantly lower in regulated restaurants (4 g (4, 4), 480 mg (470, 490) and 7 g (6, 7), respectively) than in unregulated restaurants (6 g (6, 6), 830 mg (797, 862) and 8 g (8, 9), respectively, p < 0.001). This study showed that menu items from regulated restaurants had smaller serving size, lower levels of energy and nutrients of public health concern compared to those from the unregulated restaurants, suggesting potential downstream beneficial effects of menu labelling in lowering caloric content and nutrients of public health concern in foods. [ABSTRACT FROM AUTHOR]

Background: The political activities of industry stakeholders must be understood to safeguard the development and implementation of effective public health policies.Methods: A quantitative descriptive study was performed using data from Canada's Registry of Lobbyists to examine the frequency and governmental target of lobbying that occurred between various types of stakeholders (i.e., industry versus non-industry) and designated public office holders (DPOH) regarding Health Canada's Healthy Eating Strategy, from September/2016 to January/2021. Initiatives of interest were revisions to Canada's Food Guide, changes to the nutritional quality of the food supply, front-of-pack nutrition labelling and restrictions on food marketing to children.Results: The majority of registrants (88%), and corporations and organizations (90%) represented in lobbying registrations had industry ties. Industry-affiliated stakeholders were responsible for 86% of communications with DPOH, interacting more frequently with DPOH of all ranks, compared to non-industry stakeholders. Most organizations and corporations explicitly registered to lobby on the topic of marketing to children (60%), followed by Canada's Food Guide (48%), front-of-pack nutrition labelling (44%), and the nutritional quality of the food supply (23%). The food and beverage industry, particularly the dairy industry, was the most active, accounting for the greatest number of lobbying registrations and communications, followed by the media and communication industry.Conclusions: Results suggest a strategic advantage of industry stakeholders in influencing Canadian policymakers. While some safeguards have been put in place, increased transparency would allow for a better understanding of industry discourse and help protect public health interests during the policy development process. [ABSTRACT FROM AUTHOR]

Background: The release of the Canadian Community Health Survey (CCHS), Nutrition 2015 provides a unique opportunity since CCHS 2004 to investigate food choices of Canadian children and adolescents at a national level. Objective: This study examined the quality and quantity of food choices of children ages 2–8 years and adolescents 9–18 years, using Health Canada's Surveillance Tool Tier System 2014. It is hypothesized that Canadian children and adolescents are consuming diets poor in nutritional quality based on evidence from the last national nutrition survey in 2004. Design: Intakes from CCHS 2015, 24-h dietary recall were categorized into Health Canada's Tiers 1–4, based on CNF/CFG classification system and thresholds for nutrients to limit i.e., total fat, saturated fats, sugars, and sodium to assess quality of food choices. Additionally, dietary intakes were grouped according to Canada's 2007 food guide servings as the 2019 food guide was not available. Results: Majority of foods reported by children 2–18 years were categorized as Tier 2 and Tier 3 foods. Investigation of energy contributions from the Tier 4 and "other foods" represented 21–25% of daily calorie intake and of these foods, high fat and/or high sugar foods contributed majority of daily calories to these categories. Conclusions: This study showed Canadian children 2–18 years are consuming diets high in nutrients recommended to limit. Evidence from this study provides a unique opportunity to improve the nutritional quality of foods, and the food choices of children. [ABSTRACT FROM AUTHOR]

Background: Serving sizes on the Nutrition Facts table (NFt) on Canadian packaged foods have traditionally been unregulated and non-standardized. The federal government recently passed legislation to regulate the serving sizes listed on the NFt. The objective of this study was to compare the serving sizes on food product NFts to the recommendations in the 2003 Nutrition Labelling regulation (Schedule M) reference amounts, the Canadian Food Inspection Agency (CFIA) ranges, and Canada's Food Guide recommendations. An additional objective was to determine if food and beverage products that report smaller serving sizes have a higher calorie density, compared to similar products with a larger serving size.Methods: Data for 10,487 products were retrieved from the 2010 Food Label Information Program (FLIP) database and categorized according to Schedule M categories. Correlations between calorie density and manufacturer stated serving size were tested and the proportion of products meeting recommendations were tabulated.Results: 35% of products had serving sizes on the NFt that were smaller than the Schedule M reference amount and 23% exceeded the reference amount. 86% of products fell within the CFIA's recommended serving size ranges; however, 70% were within the lower-half of the range. Several bread and juice categories exceeded CFG's recommendations, while several dairy product categories were smaller than the recommendations. Of the 50 Schedule M sub-categories analyzed, 31 (62%) exhibited a negative correlation between serving size and calorie density.Conclusion: While most products fell within the CFIA's recommended serving size ranges, there was a tendency for products with a higher calorie density to list smaller serving sizes. [ABSTRACT FROM AUTHOR]

Background: Analyzing the effects of dietary patterns is an important approach for examining the complex role of nutrition in the etiology of obesity and chronic diseases. Objectives: The objectives of this study were to characterize the dietary patterns of Canadians with the use of a priori, hybrid, and simplified dietary pattern techniques, and to compare the associations of these patterns with obesity risk in individuals with and without chronic diseases (unhealthy and healthy obesity). Design: Dietary recalls from 11,748 participants (≥18 y of age) in the cross-sectional, nationally representative Canadian Community Health Survey 2.2 were used. A priori dietary pattern was characterized with the use of the previously validated 2015 Dietary Guidelines for Americans Adherence Index (DGAI). Weighted partial least squares (hybrid method) was used to derive an energy-dense (ED), high-fat (HF), low-fiber density (LFD) dietary pattern with the use of 38 food groups. The associations of derived dietary patterns with disease outcomes were then tested with the use of multinomial logistic regression. Results: An ED, HF, and LFD dietary pattern had high positive loadings for fast foods, carbonated drinks, and refined grains, and high negative loadings for whole fruits and vegetables ($|0.17|). Food groups with a high loading were summed to form a simplified dietary pattern score. Moving from the first (healthiest) to the fourth (least healthy) quartiles of the ED, HF, and LFD pattern and the simplified dietary pattern scores was associated with increasingly elevated ORs for unhealthy obesity, with individuals in quartile 4 having an OR of 2.57 (95% CI: 1.75, 3.76) and 2.73 (95% CI: 1.88, 3.98), respectively (P-trend < 0.0001). Individuals who adhered the most to the 2015 DGAI recommendations (quartile 4) had a 53% lower OR of unhealthy obesity (P-trend < 0.0001). The associations of dietary patterns with healthy obesity and unhealthy nonobesity were weaker, albeit significant. Conclusions: Consuming an ED, HF, and LFD dietary pattern and lack of adherence to the recommendations of the 2015 DGAI were associated with a significantly higher risk of obesity with and without accompanying chronic diseases. [ABSTRACT FROM AUTHOR]

Interest in the health effects of foods by both industry and consumers has put a spotlight on the role of health claims on foods in Canada. The current regulatory framework governing the use of different health claims on foods in Canada is described and compared with international approaches. Similarities were observed in how risk-reduction claims for serious diseases are managed in the United States, European Union and proposed by Food Standards Australia New Zealand, including the need for premarket authorization and the requirement for a high level of certainty based on the totality of evidence in substantiating this type of claim. However, approaches to permitting function claims other than those for the well-established functions of known nutrients are divergent among the jurisdictions compared. Canada also differs from other jurisdictions in not establishing core nutritional criteria for foods carrying disease risk-reduction claims. A brief over- view of the status in Canada of a number of disease risk-reduction claims that have been approved in the United States, based on significant scientific agreement under the Nutrition Labeling and Education Act or through authoritative statements under the Food and Drug Administration Modernization Act, is also provided. [ABSTRACT FROM AUTHOR]

Fortification with calcium to increase dietary intakes of this mineral is currently under evaluation in Canada. To model the potential dietary consequences of food fortification, data from a large national survey of Canadians (n = 1543) were used. Food fortification scenarios were based on reference amounts for labeling requirements. Consumption of milk, cheese and other dairy products was associated with high calcium intakes, and there was a low prevalence of inadequacy in men < 50 y old; however, other age-sex groups had lower intakes. The aim of the fortification modeling was to determine which scenario would most effectively reduce the proportion of the population with low intakes of calcium while minimizing the proportion of individuals who exceeded the tolerable upper intake level (UL). Given the correlation between energy and calcium (r = 0.60, P < 0.01), it appeared that any fortification scenario sufficient to increase the mean intake for women to near the adequate intake led to 6-7% of the men having calcium intakes above the UL. The results suggest that fortification of widely consumed foods is not a realistic way to address the issue of low calcium intakes and illustrate the need for concern about the growing use of fortification practices. [ABSTRACT FROM AUTHOR]

Nutrient profiling (NP) models are useful tools for objectively and transparently quantifying the nutritional quality of packaged foods and beverages. Many NP models incorporate ingredients beneficial for health (e.g., fruits, vegetables, nuts, legumes (FVNL)) in addition to less healthful nutrients or components, assigning points based on the proportion of the product that contains FVNL ingredients. However, with food labelling in most countries lacking mandatory quantitative ingredient declarations (QUIDs), there is potential for the estimation of FVNL points to be ambiguous and inconsistent. The purpose of this article was to describe the development and application of methodology for estimating FVNL points for products without QUIDs, based on the position of FVNL components within the ingredients list. Using this method, FVNL points were calculated for packaged foods and beverages in the University of Toronto Food Label Information Program 2017 database (n = 17,337). Distributions of FVNL points were examined overall and by food category. This study provides evidence of the feasibility of this method in distinguishing between products with differing amounts of FVNL ingredients. This method will be valuable for researchers and policymakers in ensuring consistent, objective and reproducible estimations of FVNL points—and consequently, assessments of product healthfulness—for food supplies without QUIDs. [ABSTRACT FROM AUTHOR]

The 2014 Health Canada's Surveillance Tool, Tier System (HCST) is a nutrient profiling model developed to evaluate adherence of food choices to dietary recommendations. With the recent release of the nationally representative Canadian Community Health Survey-Nutrition (CCHS-N) 2015, this study used HCST to evaluate nutritional quality of the dietary intakes of Canadians in the CCHS-N. Dietary intakes were ascertained using 24-hour dietary recalls from Canadians adults ≥19 years (N = 13,605). Foods were categorized into four Tiers based on degree of adherence to dietary recommendations according to thresholds for sodium, total fat, saturated fats, and sugars. Tier 1 and Tier 2 represented "recommended foods", Tier 3 represents foods to "choose less often", and Tier 4 represented foods "not recommended". Across all dietary reference intakes (DRI) groups, most foods were categorized as Tier 1 for Vegetable and Fruits (2.2–3.8 servings/day), Tier 2 for Grain Products (2.9–3.4 servings/day), Tier 3 for Milk and Alternatives (0.7–1 serving/day) or for Meat and Alternatives (1.1–1.6 servings/day). Consumption of foods from Tier 4 and "other foods" such as high fat/sugary foods, sugar-sweetened beverages, and alcohol, represented 24–26% and 21–23% kcal/day, for males and females, respectively. Canadians are eating more foods categorized as Tier 1–3, rather than Tier 4. Adults with the highest intakes of Tier 4 and "other foods" had lower intakes of macronutrients and increased body mass index. These findings can be used by policy makers to assist in identifying targets for food reformulation at the nutrient level and quantitative guidance to support healthy food choices. [ABSTRACT FROM AUTHOR]

Many consumers believe that foods labelled with fat claims (e.g. low fat) are lower in calories than comparable regular foods and are therefore helpful for weight management. However, it is unknown whether such foods are actually lower in calories. Our aims were to determine 1) the relative proportion of foods carrying fat claims among various food categories within the Canadian marketplace; and 2) whether foods with fat claims are actually lower in calories than comparable foods without claims. The Food Label Information Program 2010, a database of Canadian foods developed at the University of Toronto, was used to compare the calorie content of products with and without fat claims within a given food subcategory, as defined by Schedule M of the Food and Drug Regulations. Median differences of 25% or greater were deemed nutritionally significant, as that is the minimum difference required for comparative claims such as "reduced" and "lower" in the Food and Drug Regulations. Fat claims were present on up to 68% of products in a given food subcategory. Products with fat claims were not significantly lower in both fat and calories compared to comparable products without fat claims in more than half of the subcategories (24 out of 40) analyzed. Conversely, in 16 subcategories, foods with fat claims were at least 25% lower in calories; however, for many of these foods, the absolute difference in calories was small, i.e., for 9 of the 16 subcategories, the absolute difference between foods with and without fat claims was <50 calories, even though the relative percent difference was high. This research suggests that foods with fat claims may be misleading consumers and undermining their efforts to manage body weight or prevent obesity. [ABSTRACT FROM AUTHOR]

The author discusses aspects of the proposal by Health Canada which aim to provide information on the sugar content of prepackaged foods to improve Canadians' health through food choices. Topics include the declaration on the inclusion of added sugar on the nutrition label, the benchmark of the dietary recommendation for sugar, and the population-level benefits of the proposal.

Regulatory changes in Canada will require food labels to have a benchmark [% Daily Value, %DV] for total sugars, based on 100 g/day, while US labels will require a %DV for added sugars, based on 50 g/day. The objective of this study was to compare two labelling policies, a total sugars DV (100 g/day) and a free sugars DV (50 g/day) on food labels. This cross-sectional analysis of the Food Label Information Program database focussed on top sources of total sugars intake in Canada (n = 6924 foods). Products were categorized as "less healthy" using two sets of criteria: a) free sugars levels exceeding the WHO guidelines (≥10% energy from free sugars); and b) exceeding healthfulness cut-offs of the Food Standards Australia New Zealand Nutrient Profiling Scoring Criterion (FSANZ-NPSC). The proportion of "less healthy" products with ≥15%DV (defined as "a lot" of sugars i.e. high in sugars, based on Health Canada's %DV labelling footnote and educational message for dietary guidance) were compared for each sugar labelling scenario. The free sugars DV showed better alignment with both methods for assessing "healthfulness" than the total sugars DV. The free sugars DV identified a greater proportion of "less healthy" foods with ≥15%DV, based on both the FSANZ-NPSC (70% vs. 45%, p < .0001) and WHO guidelines (82% vs. 55%, p < .0001); particularly in sweet baked goods, sugars and preserves, chocolate bars, confectionery, and frozen desserts categories. Compared to total sugars DV labelling, using a free sugars DV identified more "less healthy" foods. Findings support the adoption of free sugars labelling. [ABSTRACT FROM AUTHOR]