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To investigate the impact of simulated patients on dietetics students' and interns' communication and nutrition-care competence. Pre-post observational study in which students' communication and nutrition-care competence was evaluated during the first and final clinical nutrition simulations in winter, 2017. University of Guelph, Canada. Seventeen undergraduate students enrolled in Applied Clinical Skills (NUTR*4120) and 15 graduate students/interns enrolled in Practicum in Applied Nutrition II (FRAN*6720). Selected communication and nutrition-care performance indicators (PI) (undergraduates = 18; graduate = 33) included in the Canadian Integrated Competencies for Dietetic Education and Practice, each measured out of a maximum of 3 points. Grand means of communication and nutrition-care PI scores were compared across 2 time points using paired t tests, at a significance level of.05. Undergraduates' (n = 15) communication and nutrition-care PI scores increased by 0.9 ± 0.35 (49.7%) and 0.8 ± 0.22 (45.8%) points, respectively (both P <.001). Graduate students' communication and nutrition-care PI scores increased by 0.4 ± 0.45 (18.5%) and 0.7 ± 0.59 (37.9%) points, respectively (both P <.01). Simulated patients incorporated into clinical nutrition courses increase dietetics students' and interns' communication and nutrition-care competence. More research using comprehensive practice-based competency assessment tools is needed in larger samples of students and interns. [ABSTRACT FROM AUTHOR]

The objective of this study was to examine the relationship between leisure time physical activity (LTPA) and common risk factors for cardiovascular disease (CVD) and type 2 diabetes in community-dwelling adults with chronic spinal cord injury (SCI). LTPA was measured using the Physical Activity Recall Assessment for People with SCI in 76 men and women with chronic (>=1 year) paraplegia or tetraplegia, living in or near Hamilton, Ontario. Body mass index (BMI), waist circumference, body composition (fat mass (FM) and fat-free mass (FFM)), blood pressure, and biochemical data were collected. Thirty-seven percent (n = 28 participants) were inactive, reporting no LTPA whatsoever, and were compared with an equal-sized group consisting of the most active study participants (>=25 min of LTPA per day). After adjusting for significant covariates, BMI (18.7%), %FM (19.4%), and C-reactive protein (143%) were all lower, and %FFM was higher (7.2%), in active participants (all p ≤ 0.05). Ten percent of active participants vs. 33% of inactive participants were insulin resistant (p = 0.03). Waist circumference (17.6%) and systolic blood pressure (15.3%) were lower in active vs. inactive participants with paraplegia (both p ≤ 0.05), but not tetraplegia. In conclusion, greater daily LTPA is associated with lower levels of selected CVD and type 2 diabetes risk factors in individuals living with SCI. Whether this relationship translates into a lower incidence of these chronic diseases has yet to be determined. [ABSTRACT FROM AUTHOR]

Metabolic syndrome (MetS) comprises an array of metabolic risk factors including abdominal obesity, dyslipidemia, hypertension, and glucose intolerance. Individuals with MetS are at elevated risk for diabetes and cardiovascular disease. Central to the etiology of MetS is an interrelated triad comprising inflammation, abdominal obesity, and aberrations in fatty acid metabolism, coupled with the more recently recognized changes in metabolism during the postprandial period. We review herein preliminary evidence regarding the role of dietary n-3 polyunsaturated fatty acids in modulating each of the components of the triad of adiposity, inflammation, and fatty acid metabolism, with particular attention to the role of the postprandial period as a contributor to the pathophysiology of MetS. [ABSTRACT FROM AUTHOR]

Abstract: Greater average weight losses (2.5 kg over 12 weeks) have been reported for low-carbohydrate diets (<90 g/day) compared with traditional low-fat (<25% of energy), hypocaloric diets, implying a 233 kcal/day greater energy deficit. It has therefore been suggested that a low-carbohydrate diet may provide a metabolic advantage (an increase in energy expenditure), resulting in a positive effect on weight loss and maintenance. However, a review of studies in which 24-hour energy expenditure was measured did not provide evidence to support a metabolic advantage of low-carbohydrate diets and showed little evidence of a metabolic advantage of high-protein (>25% of energy) diets. Nonetheless, diets high in protein, but either low or modest in carbohydrate, have resulted in greater weight losses than traditional low-fat diets. We speculate that it is the protein, and not carbohydrate, content that is important in promoting short-term weight loss and that this effect is likely due to increased satiety caused by increased dietary protein. It has been suggested that the increased satiety might help persons to be more compliant with a hypocaloric diet and achieve greater weight loss. The current evidence, combined with the need to meet all nutrient requirements, suggests that hypocaloric weight-loss diets should be moderate in carbohydrate (35% to 50% of energy), moderate in fat (25% to 35% of energy), and protein should contribute 25% to 30% of energy intake. More studies of the efficacy of weight-loss and weight-maintenance diets that address protein content are needed. In addition, controlled studies of total energy expenditure or physical activity measured under free-living conditions that directly compare high-protein diets with those containing low and moderate carbohydrate content should also be performed. [Copyright &y& Elsevier]

Objective: Approximately 25 % of Canadian children aged 4-8 years fail to meet the recommended dietary allowance (RDA) of calcium (Ca). Young children's food choices are primarily determined by their parents. No interventions have directly targeted parents as a medium through which to increase children's Ca consumption. This study compared the effectiveness of a Ca-specific intervention targeted towards parents, with generic dietary advice on the Ca consumption of children aged 4-10 years.Design: A parallel two-arm randomised controlled trial was conducted.Setting: The study was conducted across Canada. Both conditions received information on the RDA of Ca and an index of intake requirements. Material sent to the intervention condition included behavioural strategies to increase dietary Ca consumption, information on the benefits of dietary Ca intake and messages addressing perceived barriers to the consumption of Ca-rich foods.Participants: A total of 239 parents (93 % mothers) of children aged 4-10 years who consumed less than the RDA of Ca were randomly assigned in a 1:1 allocation ratio.Results: There was a significant increase in total Ca intake and Ca from dairy for children at weeks 8, 34 and 52 (P ≤ 0·001) in both conditions. Parental Ca intake and amount spent on dairy products did not significantly increase following the intervention.Conclusions: Provision of daily Ca requirements with regular reminders could impact parents' delivery of Ca-rich foods to their children. This finding is important for public health messaging as it suggests that parents are a potent medium through which to promote Ca intake in children. [ABSTRACT FROM AUTHOR]

In Canada, little is known about how food parenting practices are associated with young children's dietary intakes and no studies have examined food parenting practices of Canadian fathers. This study aimed to examine associations between food parenting practices and preschool-age children's nutrition risk. We conducted a cross-sectional analysis of thirty-one 2-parent families; 31 mothers, 31 fathers, and 40 preschool-age children. Parents completed an adapted version of the Comprehensive Feeding Practices Questionnaire. We calculated children's nutrition risk using their NutriSTEP score. To account for sibling association, we used generalized estimating equations, adjusting for child age, sex, household income, and parental body mass index. Both mothers' and fathers' involvement of children in meal preparation were associated with lower child nutrition risk (mother = -3.45, p = 0.02; father = -1.74, p = 0.01), as were their healthy home environment scores (mother = -8.36, p < 0.001; father = -2.69, p = 0.04). Mothers' encouragement of balance and variety was associated with lower nutrition risk ( = -8.88, p = 0.01), whereas mothers' use of food as a reward was associated with higher nutrition risk ( = 4.67, p < 0.001). Fathers' modelling of healthy behaviours was associated with lower nutrition risk ( = -2.21, p = 0.01), whereas fathers' restriction for health ( = 2.21, p = 0.03) and pressure-to-eat scores ( = 3.26, p = <0.001) were associated with higher nutrition risk. No associations were found between child nutrition status and parental emotion regulation, control, monitoring, or restriction for weight. In conclusion, both mothers' and fathers' food parenting practices are associated with their children's nutrition status. Fathers should be included in food parenting practices interventions. [ABSTRACT FROM AUTHOR]

There are no clinically relevant tools to easily identify CVD risk in adults with spinal cord injury (SCI), despite CVD being an established long-term complication of SCI. Our objectives were to (1) determine prevalence of metabolic syndrome (MetS) in this population using four published definitions and to compare this to prevalence in the general population (GP), and (2) develop a more sensitive definition of MetS for the SCI population. 38 community-dwelling men with SCI to date have participated in a cross-sectional study in which fasting lipids, insulin, glucose, C-reactive protein and anthropometric data were measured. MetS prevalence was determined using World Health Organization (WHO), National Cholesterol Education Program (NCEP), National Heart, Lung and Blood Institute / American Heart Association (NHLBI/AHA) and International Diabetes Federation (IDF) definitions. Agreement between definitions ranged from kappa values of-0.54 (WHO and IDF, NS) to 0.72 (NCEP and NHLBI, P<0.001). Prevalence of MetS ranged from 2.8% (WHO) to 21.1% (IDF) in SCI subjects and 13.2% (NHLBI/AHA) to 30.0% (IDF) in GP. Data collection and analysis are underway to develop a more sensitive MetS definition for this population. Most current MetS definitions are in fair to poor agreement and likely underestimate MetS prevalence in the SCI population relative to GP. [ABSTRACT FROM AUTHOR]

Canadian research on dietary intake of calcium and vitamin D in young children is limited. This cross-sectional analysis investigated dietary intake and food sources of calcium and vitamin D among 265 preschool-aged children (3.6 ± 1.2 years) in the Guelph Family Health Study via one 24-h dietary recall completed by their parents using the Automated Self-Administered 24-H Dietary Assessment Tool 2016-Canadian version. Median intakes of calcium and vitamin D were 827 mg d−1 [Interquartile range (IQR) = 522] and 4.0 μg d−1 (IQR = 3.6), respectively. The two most frequently consumed dairy food sources for both nutrients were fluid cow's milk (78%, n = 206) and cheese (60%, n = 160), whereas the most frequently consumed non-dairy food sources for calcium were fruits (92%, n = 243), bakery products (92%, n = 243), and water (92%, n = 243), and for vitamin D it was bakery products (74%, n = 196). Findings raise concern about low intakes of calcium and vitamin D in young Canadian children. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to explore barriers and facilitators of the provision of dairy and plant-based dairy alternatives (PBDA) by parents of preschool-age children, a previously unexplored area of research.Design: Five focus groups of parents were conducted and audio-recorded. Verbatim transcripts were analysed using thematic analysis.Setting: University of Guelph, in Guelph, ON, Canada in 2019.Participants: Thirty-two (n 19 mothers, 13 fathers) parents of preschool-age children. Most (59 %) were university or college educated.Results: Facilitators common to both dairy and PBDA provision included perceived nutritional benefits, such as dairy's Ca, protein and fat content, and PBDA's protein content, and the perception that PBDA adds variety to the diet. Facilitators unique to dairy v. PBDA provision included the taste of, familiarity with, and greater variety and accessibility of dairy products, specifically child-friendly products. A facilitator unique to PBDA v. dairy provision was ethical concerns regarding dairy farming practices. Barriers common to both dairy and PBDA provision included perceived cost, concerns regarding the environmental impact of production, and high sugar content. Barriers specific to dairy included use of antibiotics and hormones in dairy production. A barrier specific to PBDA was the use of pesticides.Conclusion: Behaviour change messages targeting parents of preschoolers can emphasise the nutrition non-equivalence of dairy and some PBDA and can educate parents on sources of affordable, unsweetened dairy and PBDA. [ABSTRACT FROM AUTHOR]

Osteoporosis is a major public health concern in Canada and worldwide. Although much is known about bone health in older adults, little is known about bone health in young, healthy Canadian men and women. The objectives of this research were to describe bone mineral density (BMD) of young, healthy adults living in southern Ontario, Canada, and to identify predictors of BMD in this population. Two-hundred and fifty-eight Caucasian men and women aged 18-33 years completed health and physical activity questionnaires along with a calcium and vitamin D specific food frequency questionnaire. Height and mass were measured. BMD of the total hip, femoral neck, spine, and total body was measured using dual energy X-ray absorptiometry. Among men, body mass, weight-bearing physical activity, and calcium intake were significant predictors of BMD. Among women, body mass, calcium intake, and family history of osteoporosis significantly predicted log BMD. The predictors of BMD in young Canadian men and women identified in this study may inform the development of longitudinal studies designed to examine the influence of lifestyle factors on BMD in young adults. [ABSTRACT FROM AUTHOR]

Background: Excessive intake of sugar in young children is a public health concern. Our study objectives were to examine intakes of total, free and added sugar among preschool-aged children and to investigate their associations with body weight, body mass index Z-scores, percent fat mass and waist circumference. Methods: The cross-sectional cohort study included preschool-aged children between 1.5 and 5 years of age, enrolled in pilot studies of the Guelph Family Health Study, Guelph, Ontario, from 2014 to 2016. Daily intake of total sugar was determined using a food processor software; daily intakes of free and added sugar, and food sources were determined through manual inspection of 3-day food records. Anthropometric measures were completed by trained research staff. We used linear regression models with generalized estimating equations to estimate associations between sugar intakes and anthropometric measures. Results: We included 109 children (55 girls and 54 boys) in 77 families. Mean daily intakes were 86 (standard deviation [SD] 26) g for total sugar, 31 (SD 15) g for free sugar and 26 (SD 13) g for added sugar. Of participants, 80% (n = 87) had intakes of free sugar greater than 5% of their daily energy intake. The most frequent food sources of free and added sugar were bakery products. A weak inverse association between free sugar intake (kcal/1000 kcal) and waist circumference (cm) (β = −0.02, 95% confidence interval −0.04 to −0.0009) was found, but no significant associations were noted between sugar intake and other anthropometric measures. Interpretation: Most of the preschool-aged children in this study had free sugar intakes greater than current recommendations; overall, their total, free and added sugar intakes were not associated with the anthropometric measures. This study can be used to inform policy development for sugar intake in young children and apprise early intervention programs. [ABSTRACT FROM AUTHOR]

To examine the association between self-reported food skills and diet quality along with measured food waste among a sample of Canadian parents. Cross-sectional data from surveys to assess food skills, 3-day food records to assess the Healthy Eating Index (HEI)-2015, and food waste measured by household waste audits. Guelph-Wellington, Ontario. Parents (n = 130) with children aged 2–8 years. HEI-2015 scores, daily per capita avoidable and unavoidable food waste (grams). Linear regression using generalized estimating equations to determine unstandardized β estimates of associations between food skills and dependent variables. Models were adjusted for multiple testing, gender, and level of education. Food safety knowledge for cooking hot foods (β = 4.3, P = 0.05), planning (β = 4.5, P = 0.001), and conceptualizing food (β = 4.0, P = 0.03) were positively associated with HEI-2015 scores. Knowledge related to best before dates (β = 25.3, P = 0.05; β = 12.1, P = 0.04), conceptualizing food (β = 34.1, P = 0.01; β = 13.8, P = 0.02), and mechanical techniques (β = 39.2, P = 0.01; β = 20.5, P = 0.004) were associated with more avoidable and unavoidable food waste, respectively. Addressing higher-level food skills with a focus on efficient food preparation practices that make use of all edible portions of foods could play an important role in minimizing food waste and improving diet quality. Additional research in other countries and in a larger, more socioeconomically diverse sample is needed to confirm these findings. [ABSTRACT FROM AUTHOR]

There is growing evidence of an association between the relative reinforcing value of food (RRVF; how hard a child is willing to work for a food versus a non-food reinforcer) and weight across many life stages, but few studies have examined this association among preschool age children. This study investigated the association between the RRVF (measured as the food reinforcing ratio (FRR)) and body mass index (BMI) z-score and percent fat mass (%FM), in 3 year-old children. The sample was comprised of 33 children who were 3 years of age (36-47 months). Children selected their favourite food reinforcer (cookie) and non-food (audiobook) reinforcer to be used in the FRR task, which was delivered using a sequential progressive fixed ratio reward schedule. Child height, weight and percent body fat using bioelectrical impedance analysis were assessed by trained research staff. Linear regression analyses showed that FRR was significantly and positively associated with BMI z-scores. FRR was not significantly associated with %FM. Findings from this study support the RRVF as a potential risk factor in the development of childhood obesity. Longitudinal research involving larger sample sizes would strengthen future research exploring associations between RRVF and body composition in preschool age children. [ABSTRACT FROM AUTHOR]

Objective: This study explored the feasibility and acceptability of using Motivational Interviewing (MI) in the home setting with families of preschoolers.Methods: Using mixed-methods pilot data from an MI-based obesity prevention intervention delivered via home visits by health educators (HEs) with 44 families (n = 17 four home visit group; n = 14 two home visit group), we examined: 1) fidelity of MI adherence by HEs; 2) parents' perceptions of the intervention; and 3) HEs insights pertaining to the intervention's delivery.Results: Multiple measures of MI fidelity were deemed to exceed defined proficiency levels. Ninety-three percent of families reported being "satisfied" to "very satisfied" with the intervention. HEs reported building a high level of trust with families and gaining a thorough understanding of familial context. Parents appreciated how HEs' were knowledgeable and provided personalized attention when discussing health goals. Some parents suggested more directive advice and follow-up visits as ways to improve the intervention.Conclusion: Home-based MI was conducted with a high level of fidelity, was well accepted by families and practitioners.Practice Implications: Our findings from parents and MI practitioners provide key learnings that can inform future behavior change interventions that propose to use MI within the home setting. [ABSTRACT FROM AUTHOR]

Food preferences and dietary habits are heavily influenced by taste perception. There is growing interest in characterizing taste preferences based on genetic variation. Genetic differences in the ability to perceive key tastes may impact eating behavior and nutritional intake. Therefore, increased understanding of taste biology and genetics may lead to new personalized strategies, which may prevent or influence the trajectory of chronic disease risk. Recent advances show that single nucleotide polymorphisms (SNPs) in the CD36 fat taste receptor are linked to differences in fat perception, fat preference, and chronic-disease biomarkers. Genetic variation in the sweet taste receptor T1R2 has been shown to alter sweet taste preferences, eating behaviors, and risk of dental caries. Polymorphisms in the bitter taste receptor T2R38 have been shown to influence taste for brassica vegetables. Individuals that intensely taste the bitterness of brassica vegetables ("supertasters") may avoid vegetable consumption and compensate by increasing their consumption of sweet and fatty foods, which may increase risk for chronic disease. Emerging evidence also suggests that the role of genetics in taste perception may be more impactful in children due to the lack of cultural influence compared to adults. This review examines the current knowledge of SNPs in taste receptors associated with fat, sweet, bitter, umami, and salt taste modalities and their contributions to food preferences, and chronic disease. Overall, these SNPs demonstrate the potential to influence food preferences and consequently health. [ABSTRACT FROM AUTHOR]

Abdominal fat increases cardiovascular disease (CVD) risk. Despite a higher prevalence of CVD in the chronic spinal cord injury (SCI) population, abdominal fat in those with vs. without SCI has not been determined. Our objectives were to (1) compare total (TAT), visceral (VAT), subcutaneous (SAT) and the ratio of visceral to subcutaneous (V/S) abdominal adipose tissue in adults with chronic SCI with that of age-, sex- and waist circumference (WC)-matched able-bodied (AB) controls; and (2) determine the relationship between WC and VAT in both groups. 28 adults (14 SCI, 14 AB) participated in this cross-sectional study. Abdominal fat was quantified by computed tomography. WC was measured at three sites (lowest rib, iliac crest, midpoint between the two). The V/S ratio was 45% greater in the SCI vs. AB group (0.48±0.23 vs. 0.33±0.14, p<0.05). After adjusting for differences in body weight, TAT and SAT were not different, however VAT was 64% greater in the SCI group (p<0.01). WC at all sites was associated with VAT in both groups (SCI: 0.863 ≤ r ≤ 0.892, AB: 0.821 ≤ r ≤ 0.852, both p<0.001). Analysis of metabolic risk factors is in progress. The higher VAT and V/S ratio may explain, in part, the higher prevalence of CVD in those with SCI. WC appears to be a valid surrogate measure of VAT in this population, providing a tool for clinicians to identify those at risk for CVD. [ABSTRACT FROM AUTHOR]

Background: Home-based lifestyle behaviour interventions show promise for treating and preventing childhood obesity. According to family theories, engaging the entire family unit, including parents, to change their family behaviour and dynamics may be necessary to prevent the development of childhood obesity. However, little is known about how these interventions, which may change the family dynamics and weight-related behaviours of parents, affect weight outcomes in parents. Our objective was to examine the effect of a pilot home-based childhood obesity prevention intervention on measures of anthropometrics and body composition in Canadian parents. Methods: Forty-four families with children aged 1.5–5 years were randomized to one of three groups: 4 home visits with a health educator, emails, and mailed incentives (4 HV); 2 home visits, emails, and mailed incentives (2 HV); or general health emails (control). Both the 2 HV and 4 HV intervention were conducted over a period of 6 months. Body composition and anthropometric outcomes were measured at baseline and at 6 months and 18 months from baseline. Results: In parents with baseline body mass index (BMI) ≥ 25 kg/m2, the 2 HV group had significantly lower body mass and waist circumference at 6-month (CI = -5.85,-0.14 kg;-5.82,-0.30 respectively) and 18-month follow-up (CI = -7.57,-1.21 kg;-9.30,-2.50 cm respectively) when compared to control, and significantly lower BMI at 18-month follow-up when compared to control (CI = -2.59,-0.29 kg/m2). In parents with baseline BMI < 25 kg/m2, the 4 HV group had significantly lower percentage fat mass (CI = -3.94,-0.12%), while the 2 HV group had significantly lower body mass (CI = -2.56,-0.42 kg) and BMI (CI = -0.77,-0.08 kg/m2) at 6-month follow-up, both compared to control; these effects were not maintained at 18-month follow-up. Conclusions: This study provides support that a home-based childhood obesity prevention intervention may improve weight outcomes among parents. Future research should explore how home-based interventions influence family behaviour and dynamics to impact weight outcomes in children and their parents. Trial registration: Prospectively registered August 2014, clinical trial identifier NCT02223234. [ABSTRACT FROM AUTHOR]