Relationship between Adherence to the 2019 Canada's Food Guide Recommendations on Healthy Food Choices and Nutrient Intakes in Older Adults.

BACKGROUND: Following Canada's food guide (CFG) recommendations should ensure adequate nutrient intakes. Older adults have increased needs for certain nutrients and nutrient density; the extent to which adherence to CFG recommendations can help reduce inadequate nutrient intakes is unknown. OBJECTIVES: We aimed to assess the relationship between adherence to CFG recommendations on healthy food choices and intake of key nutrients in adults 65 y and older from the Canadian Community Health Survey 2015 - Nutrition. METHODS: Secondary analysis of data from 4093 older adults of the Canadian Community Health Survey 2015 - Nutrition (mean age, 73.6 y, 54% females). Dietary intakes were measured using an interviewer-administered 24-h dietary recall, including 1 repeat in a subsample (42%). The National Cancer Institute multivariate method was used to estimate usual (i.e., long-term) dietary intakes. Adherence to CFG recommendations was measured using the Healthy Eating Food Index (HEFI)-2019 score. Simple linear and logistic regression models estimated the effect of increased HEFI-2019 score on usual nutrient intakes and the prevalence of inadequate nutrient intakes (i.e., below the estimated average requirements), respectively. RESULTS: Compared with the prevalence of inadequate intakes at median HEFI-2019 score (46.4/80 points), a higher HEFI-2019 (+11 points) was associated with reductions in the prevalence of inadequate intakes of magnesium, vitamin B6 and protein [-19.8% (95% confidence interval (CI): -30.8, -8.9), -12.7% (95% CI: -22.5, -3.0), and -4.7% (95% CI: -9.4, -0.1), respectively]. In contrast, data for higher HEFI-2019 scores were compatible with increased prevalence of inadequate intakes of folate, vitamin D, and calcium [4.0% (95% CI: -8.4, 16.3), 2.6% (95% CI: 1.1, 4.0), and 2.3% (95% CI: -3.0, 7.5), respectively]. CONCLUSIONS: Based on dietary intakes of Canadian older adults in 2015, increasing the degree of adherence to CFG recommendations on healthy food choices may reduce nutrient intake inadequacy for most key nutrients except folate, vitamin D, and calcium.

Transitioning to sustainable dietary patterns: learnings from animal-based and plant-based dietary patterns in French Canadian adults.

Introduction: Many dietary guidelines promote the substitution of animal proteins with plant-based proteins for health benefits but also to help transitioning toward more sustainable dietary patterns. The aim of this study was to examine the food and nutrient characteristics as well as the overall quality and costs of dietary patterns consistent with lower intakes of animal-based protein foods and with higher intakes of plant-based protein foods among French Canadian adults. Methods: Dietary intake data, evaluated with 24 h recalls, from 1,147 French-speaking adults of the PRÉDicteurs Individuels, Sociaux et Environnementaux (PREDISE) study conducted between 2015 and 2017 in Québec were used. Usual dietary intakes and diet costs were estimated with the National Cancer Institute's multivariate method. Consumption of animal- and plant-based protein foods was classified into quarters (Q) and differences in food and nutrient intakes, Healthy Eating Food Index (HEFI)-2019 scores and diet costs across quarters were assessed using linear regression models adjusted for age and sex. Results: Participants with lower intakes of animal-based protein foods (Q1 vs. Q4) had a higher HEFI-2019 total score (+4.0 pts, 95% CI, 0.9 to 7.1) and lower daily diet costs (-1.9 $CAD, 95% CI, -2.6 to -1.2). Participants with higher intakes of plant-based protein foods (Q4 vs. Q1) had a higher HEFI-2019 total score (+14.6 pts, 95% CI, 12.4 to 16.9) but no difference in daily diet costs (0.0$CAD, 95% CI, -0.7 to 0.7). Discussion: In a perspective of diet sustainability, results from this study among French-speaking Canadian adults suggest that a shift toward a dietary pattern focused primarily on lower amounts of animal-based protein foods may be associated with a better diet quality at lower costs. On the other hand, transitioning to a dietary pattern focused primarily on higher amounts of plant-based protein foods may further improve the diet quality at no additional cost.

Adhering to Canada's Food Guide Recommendations on Healthy Food Choices Increases the Daily Diet Cost: Insights from the PREDISE Study.

The aim of this study was to assess the association between daily diet costs and the Healthy Eating Food Index (HEFI)-2019, an index that reflects the alignment of dietary patterns to recommendations on healthy food choices in the 2019 Canada's Food Guide (CFG). Dietary intake data from 24 h recalls, completed between 2015 and 2017, of 1147 French-speaking participants of the web-based multicenter cross-sectional PRÉDicteurs Individuels, Sociaux et Environnementaux (PREDISE) study in Quebec were used. Diet costs were calculated from dietary recall data using a Quebec-specific 2015-2016 Nielsen food price database. Usual dietary intakes and diet costs were estimated using the National Cancer Institute's multivariate method. Linear regression models were used to evaluate associations between diet costs and HEFI-2019 scores. When standardized for energy intake, a higher HEFI-2019 score (75th vs. 25th percentiles) was associated with a 1.09 $CAD higher daily diet cost (95% CI, 0.73 to 1.45). This positive association was consistent among different sociodemographic subgroups based on sex, age, education, household income, and administrative region of residence. A higher daily diet cost was associated with a higher HEFI-2019 score for the Vegetables and fruits, Beverage, Grain foods ratio, Fatty acids ratio, Saturated fats, and Free sugars components, but with a lower score for the Sodium component. These results suggest that for a given amount of calories, a greater adherence to the 2019 CFG recommendations on healthy food choices is associated with an increased daily diet cost. This highlights the challenge of conciliating affordability and healthfulness when developing national dietary guidelines in the context of diet sustainability.

Greater adherence to the 2019 Canada's Food Guide recommendations on healthy food choices reduces the risk of cardiovascular disease in adults: a prospective analysis of UK Biobank data.

BACKGROUND: Canada's Food Guide (CFG) was profoundly revised in 2019, but the extent to which adherence to recommendations on healthy food choices reduces the risk of cardiovascular disease (CVD) is unknown. OBJECTIVES: The aim of this study was to examine how greater adherence to the 2019 CFG's recommendations on healthy food choices influences the risk of incident CVD. METHODS: Participants were a sample of adults without history of CVD, diabetes, or cancer from the UK Biobank prospective cohort study. Usual dietary intakes were estimated by modeling data from repeated Web-based 24-h dietary recalls using the National Cancer Institute multivariate method. Adherence to key CFG recommendations on healthy food choices was assessed using the Healthy Eating Food Index (HEFI)-2019, which has a maximum of 80 points. The CVD outcome was a composite of fatal and nonfatal myocardial infarction and ischemic stroke. Cox regression models adjusted via inverse probability weighting were used to estimate CVD risks. Counterfactual models were used to interpret risks of hypothetical changes in the HEFI-2019 score. RESULTS: A total of 136,698 participants met the eligibility criteria (55% females; mean age: 57.2 y; range: 40-75 y). During the 11-y follow-up, there were 2843 cases of incident CVD. Compared with no change in the HEFI-2019 score, increasing the HEFI-2019 score of all participants to the 90th percentile of the score distribution (58.1 points) hypothetically reduced the risk of CVD by 24% (RR: 0.76; 95% CI: 0.58, 0.94; absolute risk difference: -0.58%). CONCLUSIONS: These results suggest that greater adherence to the 2019 CFG recommendations on healthy food choices reduces the 11-y risk of CVD in middle-aged and older adults.

The effect of consuming voluntarily fortified food and beverages on usual nutrient intakes in the Canadian population.

BACKGROUND: In Canada, regulatory changes have expanded marketing opportunities for voluntarily fortified products (VFPs), with micronutrient additions permitted at levels well in excess of human requirements. OBJECTIVE: To examine how the consumption of VFPs relates to usual nutrient intakes in the Canadian population. DESIGN: The 2015 Canadian Community Health Survey comprises single 24-h dietary intake recalls on a population-representative sample of 20,487 individuals aged 1 year and older, with second recalls on a subset of 7,608. The intake data included 15 food codes denoting VFP (e.g. energy drinks, fortified beverages, cereals, and bars). We assessed VFP consumption and estimated usual intake distributions for riboflavin, niacin, zinc, and vitamins A, B6, B12, and C for VFP consumers and non-consumers 14-50 years old (n = 8,442) using the National Cancer Institute method. We applied the 'shrink and add' method to estimate usual intakes among supplement users and assessed apparent benefits and risks by comparing usual intake distributions to EARs and ULs. RESULTS: Only 2.4% of the population reported any consumption of VFP on the first 24-h recall. VFP consumers were overrepresented in the upper quartile of population intake distributions for niacin, riboflavin, vitamin B6, vitamin B12, and zinc. The median usual intakes of VFP consumers were 24-111% higher than the median usual intakes of non-consumers, and VFP consumers had significantly lower prevalence of inadequacy for riboflavin and vitamins A, B6, B12, and C. Irrespective of VFP consumption, usual intake distributions reached the ULs for vitamin A and zinc with the addition of supplement intakes. DISCUSSION: Given the limited differentiation of VFP in this survey, we have likely underestimated nutrient exposure levels. CONCLUSIONS: VFP consumption was associated with elevated usual nutrient intakes, but we found limited evidence that it protected consumers from nutrient inadequacies or propelled intakes above tolerable upper levels.

A food-level substitution analysis assessing the impact of replacing regular-fat dairy with lower fat dairy on saturated fat intake at a population level in Canada.

BACKGROUND: The 2019 Canada's Food Guide recommends the consumption of lower fat dairy products to reduce saturated fat (SFA) intakes. OBJECTIVES: The objective of this study was to assess the impact of such recommendation on SFA intake at a population level in Canada. METHODS: Analyses were conducted based on dietary intakes from the nationally representative 2015 Canadian Community Health Survey-Nutrition (unweighted n = 20,103). Dietary intake was assessed using 24-h dietary recalls. Food-based substitution modeling analyses were conducted by replacing all regular-fat dairy products reported by an equal amount of a corresponding lower fat dairy product. Regular-fat dairy products included milks ≥2% fat, cheeses >25% fat, and yogurts ≥2% fat. Corresponding lower fat replacement products were 1% fat milks, 10-25% fat cheeses, and <2% fat yogurts. The National Cancer Institute method was used to account for within-person variation in dietary intakes. RESULTS: Replacing all regular-fat dairy products consumed by Canadians (ages ≥2 y) by a corresponding lower fat product reduced the population's SFA intake from 10.8% of total energy intake (%E; 95% CI: 10.7%, 11.0%) to 10.0%E (95% CI: 9.8%, 10.2%). This reduction was mostly attributable to the milk and cheese substitutions (mean SFA reductions of -0.3%E each). The proportion of the population with an SFA intake <10%E was 34.7% (95% CI: 31.2%, 38.2%) before substitution and 51.5% (95% CI: 47.5%, 55.5%) after substitution. CONCLUSIONS: This food-based substitution modeling analysis suggests that SFA intakes at a population level are slightly reduced if all regular-fat dairy products consumed by Canadians were replaced by a lower fat dairy product. Approximately half of the population would still consume SFAs in excess of 10%E even if all regular-fat dairy consumed were replaced by lower fat dairy.

Associations of Intake of Free and Naturally Occurring Sugars from Solid Foods and Drinks with Cardiometabolic Risk Factors in a Quebec Adult Population: The PREDISE (PRÉDicteurs Individuels, Sociaux et Environnementaux) Study.

BACKGROUND: Associations between sugar consumption and cardiometabolic health, taking into account the physical form of sugar-containing foods (liquid vs. solid) and the type of sugars consumed [free sugars (FSs) vs. naturally occurring sugars (NOSs)], remain to be thoroughly documented. OBJECTIVE: The objective was to examine whether FS and NOS intakes from drinks and solid foods are associated with cardiometabolic risk factors in a sample of French-speaking adults from the province of Quebec, Canada. METHODS: Data were collected as part of the cross-sectional PREDISE (PRÉDicteurs Individuels, Sociaux et Environnementaux) study (n = 1019, 18-65 y old; 50% women). FS and NOS intakes were assessed by three 24-h dietary recalls using a self-administered, web-based application. Diet quality was assessed using the Alternative Healthy Eating Index-2010. Participants underwent on-site clinical assessment of cardiometabolic risk factors, including blood pressure, waist circumference, BMI, and fasting blood sampling (glucose, insulin, C-reactive protein, blood lipids). Multivariable linear regression models were performed to examine the associations between sugar intake and cardiometabolic risk factors with sociodemographic characteristics, lifestyle variables, and diet quality entered as covariates. RESULTS: In fully adjusted models, FS intake from drinks was associated with fasting insulin (1.06%; 95% CI: 0.30%, 1.84%; P = 0.006) and with insulin resistance as estimated using the HOMA model (1.01%; 95% CI: 0.19%, 1.84%; P = 0.02). All metabolic variables that were significantly associated with NOS intake from solid foods in minimally adjusted models were no longer significant after entering sociodemographic and lifestyle variables (e.g., educational and income levels, smoking, physical activity, daily energy intake) and diet quality in the models. CONCLUSIONS: Our data from an adult sample showed that unfavorable and favorable associations with cardiometabolic risk factors observed, respectively, for FS intake from drinks and NOS intake from foods are mostly explained by sociodemographic and lifestyle variables, as well as by diet quality.

Examining the Advantages of Using Multiple Web-Based Dietary Assessment Instruments to Measure Population Dietary Intake: The PREDISE Study.

BACKGROUND: Combining traditional dietary assessment instruments has been suggested to improve precision of dietary intake estimates. However, this has not been investigated using web-based 24-h recall (R24W) or a web-based food-frequency questionnaire (wFFQ). OBJECTIVE: The aim of this study was to compare different combinations of web-based instruments to assess population-level dietary intake estimates (means and percentiles) and their precision, either with or without statistical modeling of within-person day-to-day variations. METHODS: As part of the cross-sectional PREDISE study, 1025 French-speaking adults completed 3 randomly allocated R24W and 1 wFFQ within 21 d. Crude estimates of intake were generated from either 1 or 3 repeated R24W. The National Cancer Institute (NCI) method was used to account for within-person variation. Usual intakes were modeled from 1 R24W repeated in a subsample (40%) and from 3 R24W, with or without consideration of data from the wFFQ. RESULTS: Using crude data from 3 R24W increased precision of estimates and modified distribution of intakes compared with using data from only 1 R24W. Using NCI-modeled data from 3 repeated R24W had no impact on the precision around mean intakes but increased precision of low and high percentiles intake estimates compared with NCI-modeled data from a partially repeated R24W. Considering data from a wFFQ in combination with data derived from 3 R24W did not influence the precision of intake estimates of most foods and nutrients. CONCLUSIONS: The data suggest that relying on repeated measures of food and nutrient intake through R24W is preferable to single assessment when within-person variation is not considered. Data also suggest that when NCI modeling is applied, using 3 R24W only improves the precision of low and high percentiles intake estimates compared with using a partially repeated web-based recall.

Saturated Fats from Butter but Not from Cheese Increase HDL-Mediated Cholesterol Efflux Capacity from J774 Macrophages in Men and Women with Abdominal Obesity.

Background: Recent evidence suggests that the association between dietary saturated fatty acids (SFAs) and coronary artery disease risk varies according to food sources. How SFAs from butter and cheese influence HDL-mediated cholesterol efflux capacity (CEC), a key process in reverse cholesterol transport, is currently unknown. Objective: In a predefined secondary analysis of a previously published trial, we have examined how diets rich in SFAs from either cheese or butter influence HDL-mediated CEC, compared with diets rich in either monounsaturated fatty acids (MUFAs) or polyunsaturated fatty acids (PUFAs). Methods: In a randomized crossover controlled consumption trial, 46 men and women with abdominal obesity consumed 5 isocaloric diets, each for 4 wk. Two diets were rich in SFAs either from cheese (CHEESE) or butter (BUTTER) [12.4-12.6% of energy (%E) as SFAs, 32%E as fat, 52%E as carbohydrates]. In 2 other diets, SFAs (5.8%E) were replaced with either MUFAs from refined olive oil (MUFA) or PUFAs from corn oil (PUFA). Finally, a lower fat and carbohydrate diet was used as a control (5.8%E as SFAs, 25.0%E as fat, 59%E as carbohydrates; CHO). Post-diet HDL-mediated CEC was determined ex vivo using radiolabelled J774 macrophages incubated with apolipoprotein B-depleted serum from the participants. Results: Mean (±SD) age was 41.4 ± 14.2 y, and waist circumference was 107.6 ± 11.5 cm in men and 94.3 ± 12.4 cm in women. BUTTER and MUFA increased HDL-mediated CEC compared with CHEESE (+4.3%, P = 0.026 and +4.7%, P = 0.031, respectively). Exploring the significant diet × sex interaction (P = 0.044) revealed that the increase in HDL-mediated CEC after BUTTER compared with CHEESE was significant among men (+6.0%, P = 0.047) but not women (+2.9%, P = 0.19), whereas the increase after MUFA compared with CHEESE was significant among women (+9.1%, P = 0.008) but not men (-0.6%, P = 0.99). Conclusion: These results provide evidence of a food matrix effect modulating the impact of dairy SFAs on HDL-mediated CEC with potential sex-related differences that deserve further investigation. This trial was registered at clinicaltrials.gov as NCT02106208.