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The Canadian Food Intake Screener/Questionnaire court canadien sur les apports alimentaires was developed to rapidly assess alignment of adults’ dietary intake over the past month with the 2019 Canada Food Guide’s healthy food choices recommendations. From July to December 2021, adults (n=154) aged 18-65 years completed the screener and up to two 24-hour dietary recalls. The screener scoring system was aligned with the Healthy Eating Food Index-2019 (HEFI-2019), to the extent possible. ANOVA compared screener scores among subgroups with known differences in diet quality. Using the recall data, the National Cancer Institute multivariate method was used to model HEFI-2019 components, with the screener score as a covariate, and the correlation coefficient between screener and total HEFI-2019 scores was estimated. The mean screener score was 35 points (SD=4.7; maximum, 65), ranging from 25 (1stpercentile) to 45 (99thpercentile). Differences in scores in hypothesized directions were evident by gender identity (p=0.06), perceived income adequacy (p=0.07), education (p=0.02), and smoking status (p=0.003). The correlation between screener and HEFI-2019 scores was 0.53 (SE=0.12). The screener’s moderate construct validity supports its use for rapid assessment of alignment of adults’ intake with the healthy food choices recommendations when comprehensive dietary assessment is not possible.NoveltyThe Canadian Food Intake Screener was developed to rapidly assess alignment of dietary intake with Canada’s Food Guide-2019 healthy food choices recommendations.Scoring is aligned with the Healthy Eating Food Index-2019, to the extent possible.Among a sample of adults, variation in screener scores was noted, mean screener scores differed between some subgroups with known differences in diet quality, and a moderate correlation between screener scores and total Healthy Eating Food Index-2019 scores based on repeat 24-hour dietary recalls was observed.The Canadian Food Intake Screener has moderate construct validity for rapid assessment of overall alignment of adults’ dietary intake with the Canada’s Food Guide-2019 healthy food choices recommendations when comprehensive dietary assessment is not possible.

The objective of this project was to develop a brief self-administered dietary screener, in English and French, to rapidly assess alignment of adults’ dietary intake with the 2019 Canada’ s Food Guide healthy food choices recommendations. In consultation with Health Canada and external advisors (n=15), foundational principles were defined. Existing screeners were scanned, and the healthy food choices recommendations were mapped to inform questions and response options. Cognitive interviews were conducted in English (n=17) and French (n=16) with adults aged 18-65 years from April to June 2021 to assess understanding of questions and face validity; recruitment emphasized variation in sociodemographic characteristics. Face and content validity were assessed with experts in nutrition, surveillance, and public health (n=13 English, 3 French) from April to May 2021. The testing indicated that the screener was well-understood overall but informed refinements to improve comprehension of the questions and their alignment with the healthy food choices recommendations. The resulting Canadian Food Intake Screener/Questionnaire court canadien sur les apports alimentaires includes 16 questions to rapidly assess alignment of intake with the 2019 Canada’ s Food Guide healthy food choices recommendations, including healthy foods and foods to limit, in situations in which comprehensive dietary assessment is not feasible.NoveltyThe Canadian Food Intake Screener was developed to rapidly assess alignment of adults’ dietary intake over the past month with the Food Guide’ s “healthy food choices” recommendations.The screener was developed and evaluated through an iterative process that included three rounds of cognitive interviews in each of English and French, along with ongoing feedback from external advisors and face and content validity testing with a separate panel of content experts.The 16-question screener is intended for use with adults, aged 18-65 years, with marginal and higher health literacy in research and surveillance contexts in which comprehensive dietary assessment is not possible.

OBJECTIVE School readiness is strongly associated with a child's future school success and well-being. The primary objective of this study was to determine whether meeting 24-hour movement guidelines (national physical activity, sedentary behaviors, and sleep recommendations) was associated with school readiness measured with mean scores in each of the 5 developmental domains of the Early Development Instrument (EDI) in Canadian children aged 4 to 6 years. Secondary objectives include examining the following: (1) the association between meeting 24-hour movement guidelines and overall vulnerability in school readiness and (2) the association between meeting individual physical activity, screen use and sleep recommendations, and overall school readiness. METHODS A prospective cohort study was performed using data from children (aged 4-6 years) who participated in a large-scale primary care practice-based research network. RESULTS Of the 739 participants (aged 5.9 + 0.12 years) in this prospective cohort study, 18.2% met the 24-Hour Movement Guidelines. Linear regression models (adjusted for child/family demographic characteristics, number of siblings, immigration status, and annual household income) revealed no evidence of an association between meeting all 24-hour movement guidelines and any of the 5 domains of the EDI (p > 0.05). Adjusted linear regression models revealed evidence of an association between meeting screen use guidelines and the "language and cognitive development" (β = 0.16, p = 0.004) domain, and for the sleep guideline, there was a statistically significant association with the "physical health and well-being" (β = 0.23, p = 0.001), the "language and cognitive development" (β = 0.10, p = 0.003), and the "communication skills and general knowledge" (β = 0.18, p < 0.001) domain. CONCLUSION Early lifestyle interventions targeting screen use and sleep may be beneficial for improving a child's readiness for school.

Primary care providers have a role to play in supporting the development of healthy eating habits, particularly in a child's early years. This study examined the feasibility of implementing the NutriSTEP® screen-a 17-item nutrition risk screening tool validated for use with both toddler and preschooler populations-integrated with an electronic medical record (EMR) in primary care practices in Ontario, Canada, to inform primary care decision-making and public health surveillance.Five primary care practices implemented the NutriSTEP screen as a standardized form into their EMRs. To understand practitioners' experiences with delivery and assess factors associated with successful implementation, we conducted semi-structured qualitative interviews with primary care providers who were most knowledgeable about NutriSTEP implementation at their site. We assessed the quality of the extracted patient EMR data by determining the number of fully completed NutriSTEP screens and documented growth measurements of children.Primary care practices implemented the NutriSTEP screen as part of a variety of routine clinical contacts; specific data collection processes varied by site. Valid NutriSTEP screen data were captured in the EMRs of 80% of primary care practices. Approximately 90% of records had valid NutriSTEP screen completions and 70% of records had both valid NutriSTEP screen completions and valid growth measurements.Integration of NutriSTEP as a standardized EMR form is feasible in primary care practices, although implementation varied in our study. The application of EMR-integrated NutriSTEP screening as part of a comprehensive childhood healthy weights surveillance system warrants further exploration.Les fournisseurs de soins primaires ont un rôle à jouer dans l’acquisition de saines habitudes alimentaires, en particulier au cours des premières années de vie. Cette étude porte sur la faisabilité de l’intégration de NutriSTEP® – un outil valide de dépistage des risques nutritionnels en 17 points chez les tout‑petits et les enfants d’âge préscolaire – au dossier médical électronique (DME) dans les établissements de soins primaires de l’Ontario (Canada), afin d’éclairer la prise de décisions en matière de soins primaires et la surveillance en santé publique.Cinq établissements de soins primaires ont intégré, au moyen d’un questionnaire normalisé, le programme de dépistage NutriSTEP au DME. Afin de comprendre les expériences vécues par les professionnels en la matière et d’évaluer les facteurs associés à la réussite de l’implantation de NutriSTEP, nous avons mené des entrevues semi‑dirigées de nature qualitative auprès des fournisseurs de soins primaires connaissant le mieux les détails de sa mise en oeuvre dans leur établissement. Nous avons évalué la qualité des données extraites des DME en déterminant le nombre de questionnaires de dépistage NutriSTEP dûment remplis et avons consigné les mesures de croissance des enfants.Les établissements de soins primaires ont mis en oeuvre le questionnaire de dépistage NutriSTEP dans le cadre de diverses rencontres cliniques périodiques, avec des processus de collecte de données variables selon l’établissement. Des données de dépistage NutriSTEP valides ont été recueillies dans les DME de 80 % des établissements de soins primaires. Dans près de 90 % de ces dossiers, le questionnaire avait été entièrement rempli et 70 % des dossiers comportaient à la fois un questionnaire de dépistage NutriSTEP valide complet et des mesures de croissance valides.Il est possible d’intégrer NutriSTEP dans les établissements de soins primaires sous la forme d’un questionnaire normalisé dans le DME, même si, dans notre étude, la façon dont NutriSTEP avait été mis en oeuvre variait selon les établissements. L’utilisation, dans le cadre d’un système de surveillance global du poids santé des enfants, du questionnaire de dépistage NutriSTEP intégré au DME mérite d’être étudiée davantage.Primary care practices present an opportunity to identify nutrition risk in children using the NutriSTEP screening tool. Successful implementation of an EMR-integrated NutriSTEP screen varied by primary care practice site. Extraction of NutriSTEP data from EMRs is feasible; extracted data were of good quality. Implementation of an EMR-integrated NutriSTEP screen presents an opportunity to improve the care and management of children and their families, as well as support population health outcomes and health system quality improvement.Les milieux de soins primaires offrent l’opportunité d’identifier les risques nutritionnels chez les enfants en utilisant l’outil de dépistage NutriSTEP. La réussite de l’intégration de l’outil de dépistage NutriSTEP au DME s’est révélée variable d’un établissement de soins primaires à l’autre. L’extraction des données NutriSTEP à partir du DME est possible, et les données extraites se sont révélées de bonne qualité. L’intégration de l’outil de dépistage NutriSTEP au DME offre l’opportunité d’améliorer les soins et la prise en charge des enfants et de leur famille ainsi que de favoriser l’amélioration des résultats en matière de santé de la population et de qualité du système de santé.

Dietetics has changed substantially; a mixed-methods project was undertaken to: (i) gauge interest in the profession history since 1993, (ii) identify preferred format(s), (iii) identify possible topics, and (iv) identify possible key informants. An online bilingual survey was conducted in 2018, with follow-up phone interviews among interested respondents. Survey content was organised as 12 major topics. Respondents were invited via a Dietitians of Canada (DC) newsletter, Facebook groups, and at the DC national conference. Survey data, including respondent-generated topics of interest and interview content, were descriptively analyzed. The online survey garnered 360 responses; 332 (92%) completed more than 10% of the survey and were interested in history. Detailed responses were analyzed (296 English; 36 French); 51 were interviewed. An online timeline was the most preferred format (79%). Review of the rise in technology and obesity, aging, supermarket registered dietitians (RDs), the local/organic movement, Practice-based Evidence in Nutrition (PEN), the changes in training models and scope of practice, public awareness of the profession, and advocacy and unique career paths were of most interest (≥ 50% of respondents). These results confirm interest in the recent history of the profession among RDs and provide guidance on preferred format and topics for further work.

Background The American Academy of Pediatrics recommends developmental screening at multiple visits using both a general developmental tool and an autism spectrum disorder (ASD)-specific tool. The Canadian Paediatric Society recommends screening at a single visit at 18 months. There is no consensus on which tool is best suited for one-time screening. The Infant Toddler Checklist (ITC) identifies children who are at risk for communication impairment, may detect ASD, and may be a useful screening tool at the 18-month visit. Objectives To examine the screening test accuracy of the ITC at the 18-month visit to predict school readiness at kindergarten age. Design/Methods This prospective cohort study included children who attended primary care health supervision visits in Toronto, Canada. Parents completed the ITC at the 18-month visit and teachers completed the Early Development Instrument (EDI - a population-level measure of school readiness in kindergarten) at 4-6 years. An ITC screen is positive if there is concern for expressive speech delay (speech composite below the 10th percentile) and/or other communication delay (social composite, symbolic composite or the total score below the 10th percentile). Children were considered overall vulnerable on the EDI if at least one of five domains was below the 10th percentile of the Ontario population: language and cognitive development; physical health and well-being; social competence; emotional maturity; communication skills and general knowledge. We calculated screening test properties with 95% confidence intervals (CIs), using EDI vulnerability as the criterion measure. We used multivariable regression models to examine the association between the ITC and EDI domains. Results Of 293 children, 30 (10%) had a positive ITC. At follow-up, 54 (18%) children had a teacher-reported EDI vulnerability. The specificity (range, 87%-96%) and negative predictive value (range, 83%-95%) for the ITC were high; false positive rate was low (range, 4%-13%); sensitivity was low (range, 11%-37%). A positive ITC was associated with a lower score in EDI language and cognitive development (b= -0.62, 95% CI: -1.25, -0.18; P=0.046) and EDI communication skills and general knowledge (b= -1.08, 95% CI: -2.10, -0.17; P=0.036). We found no evidence of an association between ITC and EDI vulnerability. Conclusion The ITC at 18 months had high specificity (87%-96%) suggesting that most children with a negative ITC will demonstrate school readiness at 4-6 years. False positive rates were low, minimizing over-diagnosis. The ITC, with its focus on speech and language, communication disorders and ASD, may be a candidate for screening at the 18-month visit.

Nutrition in early childhood is important for healthy growth and development. Achieving school readiness is considered one of the most important developmental milestones for young children.The purpose of this study is to determine if nutritional risk in early childhood is associated with school readiness in kindergarten.A prospective cohort study was conducted through The Applied Research Group for Kids (TARGet Kids!) primary care research network in Toronto, Canada, 2015-2020. Nutritional risk was measured (18 mo to 5 y) using validated parent-completed questionnaires called Nutrition Screening for Toddlers and Preschoolers (NutriSTEP). High nutritional risk was categorized as scores ≥21. School readiness was measured using the validated teacher-completed Early Developmental Instrument (EDI), which measures 5 developmental domains in kindergarten (2 y of schooling, ages 4-6 y, before they enter grade 1). Vulnerability indicates scores lower than a population-based cutoff at the 10th percentile on at least 1 domain. Multiple logistic and linear regression models were conducted adjusting for relevant confounders.The study included 896 children: 53% were male, 9% had high nutritional risk, and 17% were vulnerable on the EDI. A 1-SD increase in NutriSTEP total score was associated with 1.54 times increased odds of being vulnerable on the EDI among children in year 2 of kindergarten (P = 0.001). High nutritional risk cutoff was associated with 4.28 times increased odds of being vulnerable on the EDI among children in year 2 of kindergarten (P 0.001). NutriSTEP total score and high nutritional risk were associated with lower scores on all 5 EDI domains, with the strongest association observed for the domains of language and cognitive development and communication skills and general knowledge.Higher nutritional risk in early childhood is associated with lower school readiness in year 2 of kindergarten. Nutritional interventions early in life may offer opportunities to enhance school readiness. This trial was registered www.clinicaltrials.gov as NCT01869530.

Background The primary aim of this study was to determine if screen use in early childhood is associated with overall vulnerability in school readiness at ages 4 to 6 years, as measured by the Early Development Instrument (EDI). Secondary aims were to: (1) determine if screen use was associated with individual EDI domains scores, and (2) examine the association between screen use and EDI domains scores among a subgroup of high screen users. Methods This prospective cohort study was carried out using data from young children participating in a large primary care practice-based research network in Canada. Logistic regression analyses were run to investigate the association between screen use and overall vulnerability in school readiness. Separate linear regression models examined the relationships between children’s daily screen use and each separate continuous EDI domain. Results A total of 876 Canadian participants participated in this study. Adjusted logistic regression revealed an association between increased screen use and increased vulnerability in school readiness (p = 0.05). Results from adjusted linear regression demonstrated an association between higher screen use and reduced language and cognitive development domain scores (p = 0.004). Among high screen users, adjusted linear regression models revealed associations between increased screen use and reduced language and cognitive development (p = 0.004) and communication skills and general knowledge domain scores (p = 0.042). Conclusions Screen use in early childhood is associated with increased vulnerability in developmental readiness for school, with increased risk for poorer language and cognitive development in kindergarten, especially among high users.

Objective:To determine if nutritional risk in early childhood is associated with parent-reported school concerns.Design:A prospective cohort study conducted through the TARGet Kids! primary care research network (2011–2018). Nutritional risk was measured between 18 months and 5 years of age using validated parent-completed NutriSTEP® questionnaires with eating behaviour and dietary intake subscores (0 = lowest and 68 = highest total nutritional risk score). Parent-reported school concerns were measured at school age (4–10 years of age) and included: speech and language; learning; attention; behaviour; social relationships; physical coordination; fine motor coordination and self-help skills and independence. The primary outcome was any parent-reported school concerns, and individual school concerns were used as secondary outcomes. Multiple logistic regression models were conducted adjusting for clinically relevant confounders to assess the relationship between nutritional risk and school concerns.Setting:Toronto, Canada.Participants:Children aged 18 months to 10 years.Results:The study included 3655 children, 52 % were male, mean NutriSTEP® score was 14·4 (sd 6·4). Each 1 sd increase in NutriSTEP® total score was associated with a 1·18 times increased odds of school concerns (adj OR: 1·18, 95 % CI 1·07, 1·28, P = 0·0004), and high nutritional risk was associated with a 1·42 times increased odds of school concerns (adj OR: 1·42, 95 % CI 1·13, 1·78, P = 0·002).Conclusions:Nutritional risk in early childhood was associated with school concerns. Nutritional interventions in early childhood may reveal opportunities to enhance school outcomes.

Background Household food insecurity (FI), even at marginal levels, is associated with poor child health outcomes. The Nutrition Screening Tool for Every Preschooler (NutriSTEP®) is a valid and reliable 17-item parent-completed measure of nutrition risk and includes a single item addressing FI which may be a useful child-specific screening tool. We evaluated the diagnostic test properties of the single NutriSTEP® FI question using the 2-item Hunger Vital Sign™ as the criterion measure in a primary care population of healthy children ages 18 months to 5 years. Results The sample included 1174 families, 53 (4.5%) of which were marginally food secure. An affirmative response to the single NutriSTEP® question “I have difficulty buying food I want to feed my child because food is expensive” had a sensitivity of 85% and specificity of 91% and demonstrated good construct validity when compared with the Hunger Vital Sign™. Conclusion The single NutriSTEP® question may be an effective screening tool in clinical practice to identify marginal food security in families with young children and to link families with community-based services or financial assistance programs including tax benefits. Trial registration TARGet Kids! practice-based research network (Registered June 5, 2013 at www.clinicaltrials.gov; NCT01869530); www.targetkids.ca

OBJECTIVE: To test the feasibility, acceptability and preliminary impact of Parents and Tots Together (PTT), a family-based obesity prevention intervention, in Canada. PARTICIPANTS: Canadian parents of preschoolers (aged 2–5 years). SETTING: Ontario Early Years centres in southwestern Ontario. INTERVENTION: A pilot randomized controlled trial involving 48 parents who received either the PTT intervention ( n = 27) or an attention-matched control home safety intervention ( n = 21). To evaluate the feasibility of PTT, we assessed participant retention and outcome evaluation completion rates. To evaluate acceptability, we assessed program attendance and parents’ responses to program satisfaction surveys. To evaluate preliminary impact, we assessed children’s body mass index (BMI) at baseline, after intervention (end of 9-week intervention) and at 9-month follow-up. As well, at each time point, parents completed surveys assessing stress and self-efficacy related to parenting, children’s sleep, activity, TV viewing and diet. OUTCOMES: Retention rates were high in the intervention (93%) and control (84%) study arms, and 87% of parents reported that they would highly recommend PTT to a friend. At 9-month follow-up, intervention parents reported lower parenting stress ( β ＾ = 15.83, 95% confidence interval [CI] -29.57, -2.07, p = 0.02) and greater self-efficacy in managing their child’s behaviour ( β ＾ = 0.16, 95% CI 0.002, 0.33, p = 0.05) than control parents. PTT had minimal influence on children’s weight-related behaviours and BMI. CONCLUSIONS: The results suggest that PTT can feasibly be implemented and tested in the Canadian context. Preliminary impact results suggest that the program may be effective in changing general parenting; however, program content should be modified to adequately address children’s weight-related behaviours.

NutriSTEP(®) screens for nutritional risk in preschoolers (3-5 years of age). Availability has been limited to paper versions. The objective is to test reliability for Internet and Onscreen use.Two studies were conducted with parents in several Ontario Early Years Centres (Internet (n = 63)) and in the community and schools in Timmons, Guelph, and Ottawa, Ontario (Onscreen (n = 64)). Parents completed NutriSTEP(®) either on paper or using Internet or Onscreen versions. Two weeks later, the alternate mode was completed. Reliability was assessed using Intraclass Correlations (ICC) and Pearson Correlations (PC) on total and attribute scores, Kappa coefficients (κ) for risk, and Wilcoxon Signed Rank Test for responses on individual questions.For total scores, Internet and Onscreen ICCs were 0.94 and 0.91, respectively, with PCs of 0.89 and 0.84, respectively. Attribute scores were 0.69-0.91 (ICC) and 0.70-0.84 (PC) for Internet, and 0.81-0.92 (ICC) and 0.68-0.85 (PC) for Onscreen. κ amongst risk categories was 0.58 (P = 0.000) for Internet and 0.50 (P = 0.000) for Onscreen. For individual dichotomized questions, 5 of 17 (Onscreen and Internet) were excellent (κ0.75); 11 of 17 (Internet) and 9 of 17 (Onscreen) were adequate (0.40κ0.75); 0 of 17 (Internet) and 2 of 17 (Onscreen) questions were poor (κ0.4) in agreement between modes.Internet and Onscreen versions of NutriSTEP(®) are reliable.

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 [Formula: see text] = –3.45, p = 0.02; father [Formula: see text] = –1.74, p = 0.01), as were their healthy home environment scores (mother [Formula: see text] = –8.36, p < 0.001; father [Formula: see text] = –2.69, p = 0.04). Mothers’ encouragement of balance and variety was associated with lower nutrition risk ([Formula: see text] = –8.88, p = 0.01), whereas mothers’ use of food as a reward was associated with higher nutrition risk ([Formula: see text] = 4.67, p < 0.001). Fathers’ modelling of healthy behaviours was associated with lower nutrition risk ([Formula: see text] = –2.21, p = 0.01), whereas fathers’ restriction for health ([Formula: see text] = 2.21, p = 0.03) and pressure-to-eat scores ([Formula: see text] = 3.26, p =

Many young Canadian adults are not meeting dietary calcium recommendations. This is concerning as adequate calcium is important throughout young adulthood to maximize peak bone mass for osteoporosis prevention. There are limited studies that have explored young adults' perceptions toward calcium and health. Our objectives were to determine young adults' (18-34 years) knowledge of calcium in relation to health, facilitators and barriers to adequate calcium intake, and to explore both their suggestions for individual strategies to increase calcium intake and ways to communicate calcium-related messaging to this population. Eight gender-specific focus groups (18 men; 35 women) were conducted using a semistructured interview guide, guided by social cognitive theory. Deductive thematic analysis was used to generate themes. Participants perceived adequate calcium intake to be important for children and older adults but were uncertain of the benefits for their own age group. Perceived positive outcomes (e.g., aesthetics such as strong nails) associated with adequate calcium intake were cited as a motivator to increase intake. Perceived barriers to achieving increased calcium intake included the high cost and inconvenience of milk products and negative practices of dairy farmers. Participants suggested planning healthy well-balanced meals and forming a habit of consuming calcium-rich foods as individual strategies to increase calcium intake. Strategies to convey calcium-related information to young adults included increasing awareness of the importance of calcium via credible sources of information and developing nutrition education curricula. Social media and advertising were perceived as ineffective. Our findings provide key information for nutrition education initiatives.

IntroductionSchool readiness is a multidimensional construct that includes cognitive, behavioural and emotional aspects of a child’s development. School readiness is strongly associated with a child’s future school success and well-being. The Early Development Instrument (EDI) is a reliable and valid teacher-completed tool for assessing school readiness in children at kindergarten age. A substantial knowledge gap exists in understanding how early child growth, health behaviours, nutrition, cardiometabolic risk and development impact school readiness. The primary objective was to determine if growth patterns, measured by body mass index trajectories in healthy children aged 0–5 years, are associated with school readiness at ages 4–6 years (kindergarten age). Secondary objectives were to determine if other health trajectories, including health behaviours, nutrition, cardiometabolic risk and development, are associated with school readiness at ages 4–6 years. This paper presents the Fit for School Study protocol.Methods and analysisThis is an ongoing prospective cohort study. Parents of children enrolled in the The Applied Health Research Group for Kids (TARGet Kids!) practice-based research network are invited to participate in the Fit for School Study. Child growth, health behaviours, nutrition, cardiometabolic risk and development data are collected annually at health supervision visits and linked to EDI data collected by schools. The primary and secondary analyses will use a two-stage process: (1) latent class growth models will be used to first determine trajectory groups, and (2) generalised linear mixed models will be used to examine the relationship between exposures and EDI results.Ethics and disseminationThe research ethics boards at The Hospital for Sick Children, Unity Health Toronto and McMaster University approved this study, and research ethics approval was obtained from each school board with a student participating in the study. The findings will be presented locally, nationally and internationally and will be published in peer-reviewed journals.Trial registration numberNCT01869530.

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.

BACKGROUND Preventing childhood obesity is a public health priority, and primary care is an important setting for early intervention. Authors of a recent national guideline have identified a need for effective primary care interventions for obesity prevention and that parent perspectives on interventions are notably absent from the literature. Our objective was to determine the perspectives of primary care clinicians and parents of children 2-5 years of age on the implementation of an obesity prevention intervention within team-based primary care to inform intervention implementation. METHODS We conducted focus groups with interprofessional primary care clinicians (n = 40) and interviews with parents (n = 26). Participants were asked about facilitators and barriers to, and recommendations for implementing a prevention program in primary care. Data were recorded and transcribed, and we used directed content analysis to identify major themes. RESULTS Barriers existed to addressing obesity-related behaviours in this age group and included a gap in well-child primary care between ages 18 months and 4-5 years, lack of time and sensitivity of the topic. Trust and existing relationships with primary care clinicians were facilitators to program implementation. Offering separate programs for parents and children, and addressing both general parenting topics and obesity-related behaviours were identified as desirable. INTERPRETATION Despite barriers to addressing obesity-related behaviours within well-child primary care, both clinicians and parents expressed interest in interventions in primary care settings. Next steps should include pilot studies to identify feasible strategies for intervention implementation.

To report bone mineral density (BMD) in young, reportedly healthy Canadian women and to determine whether lifestyle factors that have been associated with bone health in older women are also associated with BMD in young women.We recruited a convenience sample of 52 female undergraduate students in the Applied Human Nutrition program at the University of Guelph, Ontario, Canada. BMD was measured at the femoral neck, lumbar spine (L1 to L4), and whole body using a Discovery Wi (Hologic Inc.) dual-energy x-ray absorptiometer. Subjects completed a questionnaire to collect demographics, medical history, physical activity levels, and dietary habits; in addition, a subset of subjects (n = 31) completed a food frequency questionnaire to collect data on calcium and vitamin D intake. BMD data were examined using T- and Z-score classifications established by the World Health Organization (WHO); multiple regression analysis was used to predict BMD with biological and lifestyle variables.Mean BMD measured at the femoral neck, lumbar spine, and whole body was 0.863 ± 0.11, 1.019 ± 0.09, and 1.085 ± 0.07 g/cm(2), respectively. Body mass and body mass index were significantly positively correlated with BMD at all 3 sites. Television watching, lactose intolerance, number of alcoholic drinks consumed per week, and age were used to develop a linear regression model to predict whole-body BMD (r(2) = 0.727, p0.001).Based on criteria established by the WHO, women in this group presented with lower than expected BMD.

Nutrition screening with NutriSTEP (Nutrition Screening Tool for Every Preschooler) requires parents to complete a 17-item, self-administered questionnaire and follow through with appropriate recommendations. Parents’ perceptions of screening and referral procedures can be used to evaluate the process of an ethical child nutrition screening program. Targeted implementation of NutriSTEP took place in 3 diverse Ontario communities using an assisted or self-referral model. Of the 364 respondents, 264 parents consented to a follow-up telephone interview, with 164 (62%) interviews conducted in English or French. The interview focused on parents’ reasons for participating, their perspectives of screening and referral processes, and any perceived barriers to, concerns about, and benefits of screening. Most parents reported that screening confirmed their perception of risk; reminded them about healthy preschool diets and areas to improve; increased their nutrition awareness, motivation, and confidence; and informed them about additional information sources. Some barriers to seeking referrals or further education included not being concerned, no time for referrals or dietary changes, and not knowing where to go for more information. Overall, nutrition risk screening using NutriSTEP was well accepted, yet referral uptake was modest. Efforts are needed to encourage parents of children at risk to follow through with recommendations.

To compare resting metabolic rate (RMR) measured by indirect calorimetry versus RMR predicted by several published formulas in a sample of healthy young women.RMR was measured using indirect calorimetry and predicted using 6 commonly used equations (Nelson, 1992; Mifflin, 1990; Owen, 1986; Schofield(Weight), 1985; Schofield(Weight and Height), 1985; Harris-Benedict, 1919) in 47 reportedly healthy young females (age = 22.8 ± 2.9 years; body mass index = 21.8 ± 2.1 kg/m(2)). Comparisons between measured versus predicted RMR were conducted using paired t tests, and agreement using Pearson's correlation coefficient, analysis of variance, and the method of Bland-Altman.All 6 equations overestimated measured RMR by 140-738 kcal/d (all p0.001). The proportion of subjects for whom measured versus predicted RMR differed by ±10% ranged from 74% (Nelson) to 100% (Harris-Benedict). The adjusted coefficients of determination (R(2)) between measured and predicted RMR ranged from 0.13 to 0.19 (all p0.05). Bland-Altman analysis R(2) values ranged from 0.03 (p = 0.233; Harris-Benedict) to 0.72 (p = 0.000; Owen). Given its continued popularity, we modified the Harris-Benedict equation (RMR(modified Harris-Benedict) (kcal/d) = 738 / (RMR(Harris-Benedict) - 738)). Doing so reduced the mean difference between measured and predicted RMR from +738 kcal/d to -0.53 kcal/d (p = 0.984).No equation performed well, and none should be used interchangeably with measured RMR. We recommend that a new equation be validated for, and prospectively tested in, young women. In the interim, RMR should be measured in this population or predicted using the modified Harris-Benedict equation that we developed.

ObjectiveFolic acid food fortification has successfully reduced neural tube defect-affected pregnancies across Canada. The effect of this uncontrolled public health intervention on folate intake among Canadian children is, however, unknown. Our objectives were to determine folic acid intake from food fortification and whether fortification promoted adequate folate intakes, and to describe folic acid-fortified food usage among Ontario preschoolers.DesignCross-sectional data were used from the NutriSTEP™ validation project with preschoolers recruited using convenience sampling. Mean daily total folate and folic acid intakes were estimated from 3 d food records, which included multivitamin supplement use. Comparisons were made to Dietary Reference Intakes, accounting for and excluding fortificant folic acid, to determine the prevalence of inadequate and excessive intakes.SettingCanada.SubjectsTwo hundred and fifty-four preschoolers (aged 3–5 years).ResultsAll participants (130 girls, 124 boys) ate folic acid-fortified foods and 30 % (n76) used folic acid-containing supplements. Mean (se) fortificant folic acid intake was 83 (2) μg/d, which contributed 30 % and 50 % to total folate intake for supplement users and non-users, respectively. The prevalence of total folate intakes below the Estimated Average Requirement was ConclusionsFolic acid food fortification promotes dietary folate adequacy and did not appear to result in excessive folic acid intake unless folic acid-containing supplements were consumed.

This study describes fruit juice consumption and associated factors for a sample of Ontario preschoolers and determines potential relationships between intake and body mass index (BMI). Secondary data analysis was conducted on growth, dietary, and demographic data collected during the validation of NutriSTEP (Nutrition Screening Tool for Every Preschooler) with 254 preschoolers, aged 3 to 5 years. Dietary data were collected through parent-completed 3-day food intake records. BMI was determined using child weight and height measurements taken by a registered dietitian. Demographic characteristics were gathered using an 8-item standardized questionnaire adapted from Statistics Canada. Bivariate analyses were performed to determine associations with juice intake, BMI category, and child, parental, and family characteristics. Almost one quarter (23.6%) of the preschoolers were at risk of being overweight or were overweight, 73.2% were within the normal range, and 3.1% were underweight. Overall, 88.1% of the children consumed 100% fruit juice during the intake period, with a mean intake of 210 ± 183.1 mL/d. Fifty-seven percent consumed more than 125 mL/d of fruit juice, and 31.1% consumed more than 250 mL/d, whereas US recommendations limit intake to 125 to 175 mL/d. No significant differences were seen in fruit juice intake among the BMI categories or with selected child, parental, or family characteristics. Consuming 100% fruit juice does not appear to be associated with preschoolers' BMI, but further longitudinal research is needed in larger, more diverse groups to confirm this finding. Meanwhile, increased parent education around appropriate beverage intake, including fruit juice, is warranted.

The obesity epidemic in North America has focused attention on the health risks of excess weight gain. The transition from high school to university is a critical period for weight gain, commonly referred to as the Freshman 15. The purpose of this study was to investigate the effect of the transition from high school to university on anthropometrics and physical and sedentary activities in males. A total of 108 males completed 3 study visits: the summer prior to first year university, and the ends of the first and second semesters. Outcome measures were body mass, height, body mass index (BMI), body fat, waist circumference, hip circumference, waist:hip ratio, dietary intake, and participation in physical and sedentary activities. Between the summer prior to and the end of first year university, male students experienced a significant weight gain, of 3.0 kg, with significant increases in BMI, body fat, waist circumference, hip circumference, and waist:hip ratio. Energy and nutrient intake did not change. Final body mass was significantly predicted by intention for body mass to stay the same, relative to weight loss intention. Fast aerobic physical activity significantly decreased between the summer prior to and the end of first year university, while slow aerobic physical activity, strength training, and flexibility training did not change. Computer and studying time significantly increased, while television time and hours of nightly sleep significantly decreased between the summer prior to and the end of first year university. Weekly alcoholic drinks and binge drinking frequency significantly increased over this time period. In conclusion, between the summer prior to and the end of first year university, male students gained an average of 3.0 kg, with increases in related anthropometrics. These changes may be due to body mass change intention and (or) the observed decreased physical and increased sedentary activities, but appear to be unrelated to dietary intake.

Nutrition is vital for optimal growth and development of young children. Nutrition risk screening can facilitate early intervention when followed by nutritional assessment and treatment. NutriSTEP (Nutrition Screening Tool for Every Preschooler) is a valid and reliable nutrition risk screening questionnaire for preschoolers (aged 3–5 years). A need was identified for a similar questionnaire for toddlers (aged 18–35 months). The purpose was to develop a reliable and valid Toddler NutriSTEP. Toddler NutriSTEP was developed in 4 phases. Content and face validity were determined with a literature review, parent focus groups (n = 6; 48 participants), and experts (n = 13) (phase A). A draft questionnaire was refined with key intercept interviews of 107 parents/caregivers (phase B). Test–retest reliability (phase C), based on intra-class correlations (ICC), Kappa (κ) statistics, and Wilcoxon tests was assessed with 133 parents/caregivers. Criterion validity (phase D) was assessed using Receiver Operating Characteristic (ROC) curves by comparing scores on the Toddler NutriSTEP to a comprehensive nutritional assessment of 200 toddlers with a registered dietitian (RD). The Toddler NutriSTEP was reliable between 2 administrations (ICC = 0.951, F = 20.53, p < 0.001); most questions had moderate (κ ≥ 0.6) or excellent (κ ≥ 0.8) agreement. Scores on the RD nutrition risk rating and the Toddler NutriSTEP were correlated (r = 0.67, p < 0.000). The area under the ROC curve for moderate and high RD risk ratings were 84.6% and 82.7%, respectively. Cut-points of ≥21 (sensitivity 86%; specificity 61%) (moderate risk) and ≥26 (sensitivity 95%; specificity 63%) (high risk) were determined. The Toddler NutriSTEP questionnaire is both reliable and valid for screening for nutritional risk in toddlers.

We investigated the influence of body size at birth, feeding of mother's milk versus formula, or standard-term formula versus energy- or nutrient-enriched formula on the growth and whole body bone mineral content (BMC), lean and fat mass (using dual-energy X-ray absorptiometry) of low-birth-weight (LBW) infants to term-adjusted age. LBW infants who were appropriate for gestational age were lighter and shorter than term-born infants (n = 46) but had a higher percent fat mass (19-28% vs. 15 +/- 7%). For LBW infants fed standard formula or mother's milk after hospital discharge, the mean BMC expressed either as a function of weight (17 +/- 2, 19 +/- 2 vs. 20 +/- 2 g/kg) or length (1.1 +/- 0.2, 1.1 +/- 0.2 vs. 1.5 +/- 0.2 g/cm) was more than 1 SD below term infant values. However, infants fed a nutrient-enriched formula from hospital discharge had BMC within 1 SD below term infants. Infants who were born small, compared to appropriate for gestational age, compared to infants of similar birth weight had lower percent body fat (16 +/- 6 vs. 19 +/- 5) and lower BMC (47 +/- 3 vs. 62 +/- 5 g) at term age. Both size at birth and diet influence patterns of growth and body composition in early life in very-low-birth-weight (VLBW) infants. The long-term significance of these variable growth patterns in VLBW infants in early life requires further investigation.

Introduction and Rationale Weight change and, specifically, weight loss are common in residents of long-term care facilities (LTCFs). The occurrence of weight change results from multifactorial processes, some of which can be considered nutrition risk factors. Meal rounds can be a continuous quality improvement activity to readily identify nutrition risk factors that can influence weight change. Methods This brief report will describe the activity of meal rounds and how they can be used to improve nutrition services. Baseline data from a previously published study on 37 residents will provide proportions of nutrition risk factors identified during meal rounds that can influence weight change. Outcomes Feeding and eating difficulties are prevalent in residents with dementia (eg, agitation 29.7%, resisting assistance 21.6%). Early identification of these difficulties using meal rounds may be a means of preventing weight change and promoting quality nutrition care in LTCFs. The proposed intervention of meal rounds conducted as described can improve the quality of nutrition services in LTCFs.

Dual energy X-ray absorptiometry (DXA) and air displacement plethysmography (ADP) are commonly used to assess body composition. Accurate body fat measures are valuable in a variety of populations. Because DXA, the reference standard, is expensive and labour-intensive, determining whether these two methods are interchangeable is important.Forty-five female undergraduate students aged 21 to 33 with body mass indexes of 18.3 to 28.6 kg/m² were recruited from the University of Guelph. Each participant underwent one full-body DXA scan and one ADP assessment, to determine total percent fat mass (%FM).The Pearson's correlation between %FM(DXA) (27.1 ± 4.8) and %FM(ADP) (26.1 ± 5.5) indicated good association (r=0.88, p0.01). While Bland-Altman analysis revealed no systematic bias between the two methods (R2=0.07, p=0.08), large intraindividual variation occurred (95% confidence interval: -5.86% to 4.11%); this was related to height, weight, body-surface area, and lung volume.The two methods were significantly correlated. Mean %FM was not significantly different and no systematic bias between methods was observed. These findings indicate that ADP and DXA may be used interchangeably for determining %FM at the group level in healthy young women; a large intraindividual variation between the methods precludes interchangeability at the individual level.

Measured resting metabolic rate (RMR) was compared with predicted RMR in a sample of young, non-obese women.In 52 women aged 19 to 30 with a body mass index of 16 to 29 kg/m2, RMR was measured with a MedGem indirect calorimeter and predicted with five commonly used equations: the Harris-Benedict (1919), Mifflin (1989), Owen (1985), Schofield (weight) (1985), and Schofield (weight and height) (1985) equations. Measured RMR and predicted RMR were compared through the use of various measures.In comparison with the measured RMR, the RMR predicted with four of the five equations was significantly higher (by 16 to 225 kcal/day, p0.001). At the group level, the Owen equation performed best and captured the greatest proportion of individuals (65%) for whom predicted RMR differed from measured RMR by less than 10%. With the other four equations, residuals exceeded 10% for more than two-thirds of participants. For the Harris-Benedict, Mifflin, and Owen equations, every 100 kcal/day increase in measured RMR was associated with a 6% to 8% decrease in error. The optimal prediction range (within 10% of the measured RMR) was different for each: Owen equation 1105 to 1400 kcal/day, Mifflin equation 1280 to 1595 kcal/day, and Harris-Benedict equation 1345 to 1630 kcal/day.Prediction equations should be modified according to the amount of corresponding percentage error. Where possible, RMR should be measured. Barring this, the Owen equation should be used for young, non-obese women.

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.

In this study, we measured concentrations of Cr in hair, serum, and urine of men who were previously employed in the leather tanning industry. Concentrations of Cr in hair and serum were significantly lower than corresponding values obtained during their employment and were comparable to levels obtained for controls in a previous study. These results suggest that Cr III accumulated from employment in the leather tanning industry does not result in long-term elevation of Cr concentrations in the body.

Objective: To assess the impact of the 1996–2005 integrated community-based micronutrient and health (MICAH) programme on linear growth retardation (stunting) in Malawian preschool children living in rural areas. Design: Prospective study of three large-scale cross-sectional surveys conducted in 1996, 2000 and 2004 in MICAH and Comparison populations. Setting: Rural areas in Malawi. Subjects: Preschool children (6?0–59?9 months) from randomly selected households (474 from the 1996 baseline survey; 1264 from 2000 MICAH areas; 1500 from 2000 Comparison areas; 1959 from 2004 MICAH areas; and 1008 from 2004 Comparison areas), who responded to a household questionnaire, were weighed and measured using standard protocols. Results: At the baseline in 1996, the prevalence of stunting (60?2 %) was very high. By 2000, the prevalence of stunting had declined to 50?6 % and 56? 0% (x 2 5 7?8, P 5 0?005) in MICAH and Comparison areas, respectively. In 2004, the prevalence of stunting did not differ significantly between MICAH and Comparison areas (43? 0% v .4 5? 1% ;x 2 5 1?11, P 5 0?3). Severe stunting affected 34?7 % of children at baseline, which declined to 15?8 % and 17? 1% (x 2 5 0?86, P 5 0?4) in MICAH and Comparison areas, respectively, by 2004. Regional variations existed, with proportionately fewer children from the Northern region being stunted compared to their Central and Southern region counterparts. Conclusion: Given the length of implementation, wide-scale coverage and positive impact on child growth in Phase I (1996–2000), the MICAH programme is a potential model for combating linear growth retardation in rural areas in Malawi, although the catch-up improvement in Comparison areas during Phase II (2000–2004) cannot be adequately explained.

To examine if zinc food fortification makes a significant contribution to dietary zinc intake and to describe zinc-fortified food usage, amongst Canadian preschoolers.Cross-sectional data were used from the NutriSTEP validation project for which preschoolers (3-5 years) from across Ontario were recruited using convenience sampling. Three-day food records were used to estimate mean daily zinc intake and children were stratified by age group for analysis. Comparisons were then made to the Dietary Reference Intakes, whilst accounting for zinc from zinc-fortified foods and supplements and also whilst excluding zinc from zinc-fortified foods, to determine the prevalence of inadequate (Estimated Average Requirement (EAR)) and excessive (Tolerable Upper Intake Level (TUL)) zinc intakes. The contributions (%) made to total zinc intake by zinc-fortified foods, unfortified foods and zinc-containing supplements were determined as were contributions made to zinc intake by zinc-fortified foods, categorized by fortified-food type.Fewer than a third (30%, n = 76) of participants ate zinc-fortified foods and only 3% (n = 7) used a zinc-containing supplement. Including the contribution from zinc-fortified foods, 25% (n = 32) of 3-year-olds (n = 128) had mean zinc intake (range 7.0-7.6 mg/day) marginally above the TUL (7 mg/day). Zinc-fortified foods contributed only 2.3 +/- 5.8% (mean% +/- SD) to total zinc intake. The mean intake of the 25% of 3-year-olds above the TUL is attributed to their higher mean energy and protein intakes (p0.001) as compared to 3-year-olds not consuming zinc at levels above the TUL. Even excluding zinc-fortified foods, the prevalence of inadequate zinc intakes (EAR) (n = 254) was zero. Fortified breakfast cereals contributed most (77 +/- 41%) (mean% +/- SD) to zinc intake derived from zinc-fortified foods.Overall, zinc-fortified foods and supplements contributed minimally to the total dietary zinc intake amongst these preschoolers. These children did not have inadequate intakes of zinc and intakes in excess of the TUL were only evident in the youngest age group. Food fortification and parental choice to use a multivitamin-mineral supplement did not appear to play a role in either preventing inadequate or causing excessive zinc intake.

Resume Les monokines, telles que l'interleukine (IL-1), le tumor necrosis factor alpha (TNFα) et les interferons (IFN), jouent un role majeur dans les processus inflammatoires, immunologiques et metaboliques. Parmi les effets qui leur sont attribues figurent l'anorexie, la stimulation de la neoglucogenese, la synthese hepatique des proteines de l'inflammation, des modifications des concentrations sanguines en zinc, en fer et en cuivre, une augmentation de l'activation des lymphocytes, et une activation indirecte des cellules tueuses (LAK) activees par les lymphokines. Le retentissement d'une alteration de l'etat nutritionnel sur la production et l'activite des monokines n'a pas ete etudie en detail. La denutrition proteique severe entraine une diminution de la production d'IL-1 in vitro et une faible reponse tissulaire a l'IL-1 in vivo. En ce qui concerne l'influence d'une denutrition legere ou moderee, les rares resultats ne permettent pas de conclure. Les consequences d'une malnutrition proteique ou proteinoenergetique sur les activites TNFα et IFN sont encore moins bien connues.

Purpose: The child care setting can help preschoolers develop healthy eating habits. Establishing such habits may increase preschoolers’ likelihood of carrying them into adulthood, which can decrease the risk of nutrition-related chronic diseases. Challenges in supporting preschoolers’ healthy eating were investigated among child care staff.Methods: Three focus group interviews were conducted with 29 child care staff members. Audiotapes of the sessions were transcribed.Results: Several themes were identified from the analysis of the transcripts. An intrapersonal (individual) factor was children's picky eating. Interpersonal factors (interactions) included perceptions that parents do not encourage their children to eat in a healthy way, and that child care staff's use of practices were inconsistent with health professional recommendations. Physical environment factors included perceptions that healthy food was not accessible at child care centres and that children have unhealthy food at home.Conclusions: Program planners and health professionals can develop and implement strategies to overcome some of the identified challenges to supporting preschoolers’ healthy eating.