Change in total sugars consumption among Canadian children and adults.

BACKGROUND: Free sugars are nutrients of public health concern that have been associated with negative health outcomes, including dental caries in children and excess weight gain. Since national-level free sugars data are not currently available for Canadians, total sugars intake was examined to understand sugars intake in the population. The objective of this analysis was to describe and compare total sugars consumption among Canadians in 2004 and 2015. DATA AND METHODS: Data are from the 2004 and 2015 Canadian Community Health Survey-Nutrition. Separate descriptive analyses of total sugars for children aged 2 to 18 (n=13,919) and adults aged 19 and older (n=31,156) were conducted by year and by misreporting status (under-, plausible and over-reporters), and the top sources of total sugars were identified. Misreporting status was studied to better understand differences in sugars intakes between survey years. T-tests were used to determine significant differences between survey years. RESULTS: In 2015, the average daily total sugars consumption was 101 grams (24 teaspoons) for children aged 1 to 8, 115 grams (27 teaspoons) for children aged 9 to 18, and 85 grams (20 teaspoons) for adults. Sugary beverages, taken together, were the top source of sugars for all age groups. Total sugars consumption decreased from 2004 to 2015 overall, although not by misreporting status. Total sugars from food alone increased from 2004 to 2015, and total sugars from beverages alone decreased, regardless of age or misreporting status. DISCUSSION: The overall decrease in total sugars consumption from 2004 to 2015 may be explained by changes in misreporting. Total sugars from food alone increased, while total sugars from beverages alone decreased. This was true for all age groups and for plausible reporters.

Adequacy of nutritional intake during pregnancy in relation to prepregnancy BMI: results from the 3D Cohort Study.

Our study compares adequacy of nutritional intakes among pregnant women with different prepregnancy BMI and explores associations between nutritional intakes during pregnancy and both prepregnancy BMI and gestational weight gain (GWG). We collected dietary information from a large cohort of pregnant Canadian women (n 861) using a 3-d food record. We estimated usual dietary intakes of energy (E), macronutrients and micronutrients using the National Cancer Institute method. We also performed Pearson's correlations between nutritional intakes and both prepregnancy BMI and GWG. In all BMI categories, intakes considered suboptimal (by comparison with estimated average requirements) were noted for Fe, vitamin D, folate, vitamin B6, Mg, Zn, Ca and vitamin A. Total fat intakes were above the acceptable macronutrient distribution range (AMDR) for 36 % of the women. A higher proportion of obese women had carbohydrate intakes (as %E) below the AMDR (v. normal-weight and overweight women; 19 v. 9 %) and Na intakes above the tolerable upper intake level (v. other BMI categories; 90 v. 77-78 %). In all BMI categories, median intakes of K and fibre were below adequate intake. Intakes of several nutrients (adjusted for energy) were correlated with BMI. Correlations were detected between energy-adjusted nutrient intakes and total GWG and were, for the most part, specific to certain BMI categories. Overweight and obese pregnant women appear to be the most nutritionally vulnerable. Nutrition interventions are needed to guide pregnant women toward their optimal GWG while also meeting their nutritional requirements.

Trends and correlates of frequency of fruit and vegetable consumption, 2007 to 2014.

BACKGROUND: Eating fruit and vegetables is recommended as part of a healthy diet. This study describes trends in the frequency of fruit and vegetable consumption in Canada, the contribution of fruit juice to these trends, and correlates of the frequency of fruit and vegetable consumption. DATA AND METHODS: The data are from the annual Canadian Community Health Survey for the 2007-to-2014 period and pertain to the household population aged 12 or older. Weighted frequencies and cross-tabulations were used to estimate the average frequency of fruit and vegetable consumption by socio-demographic characteristics and body mass index, age-standardized to the 2014 Canadian population. Multivariate logistic regressions were used to examine correlates of frequency of fruit and vegetable intake in 2014. RESULTS: In 2014, Canadians reported consuming fruit and vegetables an average of 4.7 times a day, a slight, but significant, decrease from 5.0 times a day in 2007. The decrease over time was no longer significant when fruit juice was excluded (dropping to an average of 4.1 times a day in both years). Canadians drank less juice in 2014 than in 2007, a decline that was apparent across all age, sex and household income quintiles, all regions, and all weight categories. In 2014, Canadians who reported consuming fruit and vegetables 5 or more times a day tended to be female, in younger age groups, in the highest household income quintile, and neither overweight nor obese. DISCUSSION: Between 2007 and 2014, Canadians' reported frequency of fruit and vegetable consumption was consistently low. Correlates of fruit and vegetable consumption can be used to target nutrition policy and education efforts to improve intake.

Estimating the Sugars Content of Diets that Follow Eating Well with Canada's Food Guide.

PURPOSE: This research aimed to estimate the percent energy (%E) contribution from total and free sugars in the Eating Well with Canada's Food Guide (CFG) dietary pattern. METHODS: The sugar-containing foods in the Canadian Nutrient File were assigned to 1 of 2 categories: total sugars or free sugars based on the source. The total sugars content of foods containing any amount of free sugars was assigned to the free sugars category. We estimated free sugars content from 8000 simulated diets (500 for each of the 16 age and sex groups), consistent with the CFG dietary pattern. Descriptive statistics were used to examine distributions of %E from total and free sugars by age and sex. RESULTS: The mean %E from total and free sugars of all simulated diets was 21%E and 7%E, respectively. For simulated diets for males and females, 9-18 years of age, the %E from free sugars exceeded 10% at the 75th percentile. Simulated diets for all other age and sex groups exceeded 10%E from free sugars at the 95th percentile. CONCLUSIONS: The majority of the simulated CFG diets met the WHO recommendations to limit free sugars consumption to <10%E. These results will be used to inform future dietary guidance policy development.

Prepregnancy Body Mass Index as a Significant Predictor of Total Gestational Weight Gain and Birth Weight.

PURPOSE: We aimed to describe adherence to gestational weight gain (GWG) recommendations and identify determinants of excessive GWG in a sample of women from Quebec, Canada. METHODS: Data were collected from the multi-centre 3D (Design, Develop, Discover) pregnancy cohort study, which included women who delivered between May 2010 and August 2012 at 9 obstetrical hospitals in Quebec, Canada. GWG was calculated for 1145 women and compared to the 2009 Institute of Medicine (IOM) recommendations. RESULTS: Overall, 51% of participants exceeded the recommendations. Approximately 68% of women with obesity gained weight in excess of the IOM recommendations. The corresponding numbers were 75%, 44%, and 27% in overweight, normal weight, and underweight women, respectively. A prepregnancy BMI of 25 kg/m2 or more was the only significant predictor of exceeding GWG recommendations (OR 3.35, 95% CI 2.44-4.64) in a multivariate model. Birth weight was positively associated with GWG. GWG and prepregnancy BMI could explain 3.13% and 2.46% of the variance in birth weight, respectively. CONCLUSION: About half of women exceeded GWG recommendations, and this was correlated with infant birth weight. This reinforces the need to develop and evaluate strategies, including nutritional interventions, for pregnant women to achieve optimal GWG.

Systematic review of adverse health outcomes associated with high serum or red blood cell folate concentrations.

BACKGROUND: To examine the relationship between reported high serum or red blood cell (RBC) folate status and adverse health outcomes. METHODS: We systematically searched PubMed/Medline and EMBASE (to May 2013), with no limits by study type, country or population, to identify studies reporting high folate concentrations in association with adverse health outcomes. Two reviewers screened studies and extracted data. Study quality was assessed. RESULTS: We included 51 articles, representing 46 studies and 71 847 participants. Quantiles were used by 96% of studies to identify high folate concentrations. Eighty-three percent of serum folate and 50% of RBC folate studies reported a high folate cutoff that corresponded with a clinically normal concentration. Increasing values of reported high folate concentration did not demonstrate a consistent association with risk of adverse health outcomes. Overall, reported high folate concentrations appeared to be associated with a decreased risk of adverse health outcomes, though substantial methodological heterogeneity precluded complex analyses. CONCLUSIONS: Our interpretation was complicated by methodological variability. High folate cutoffs varied and often corresponded with normal or desirable blood concentrations. In general, a negative association appeared to exist between reported high folate status and adverse health outcomes. Consistent methods and definitions are needed to examine high folate status and ultimately inform public health interventions.

Vitamin C status of Canadian adults: Findings from the 2012/2013 Canadian Health Measures Survey.

BACKGROUND: Although vitamin C is not produced in the body, it is important for many biochemical and physiological functions. Little is known about the current vitamin C status of Canadians. This study describes the correlates of vitamin C status in a nationally representative sample of adults. DATA AND METHODS: Data are from the 2012/2013 Canadian Health Measures Survey. Plasma vitamin C (L-ascorbic acid) concentrations were measured among a fasting subsample of respondents aged 20 to 79 (n = 1,615). Vitamin C status, prevalence of deficiency (plasma vitamin C < 11 µmol/L), and use of vitamin C-containing supplements were estimated. Multivariate regression models were used to examine associations between vitamin C status and sociodemographic characteristics, smoking, body mass index, supplement use, and consumption of fruit juice and citrus fruit. RESULTS: The mean plasma vitamin C concentration of adults aged 20 to 79 was 53 µmol/L; fewer than 3% were vitamin C-deficient. Almost 22% took a vitamin C-containing supplement. Concentrations were lower among smokers and people who were obese, and higher among vitamin C supplement users and fruit juice and citrus fruit consumers. Multivariate models showed that supplement use was the strongest and most consistent predictor of vitamin C status; fruit juice and citrus fruit consumption were predictors only among populations with lower vitamin C concentrations (for example, smokers, obese). INTERPRETATION: Few Canadians were vitamin C-deficient. Smokers and people with a higher BMI were most at risk of lower vitamin C concentrations; concentrations were higher among supplement users and consumers of fruit juice and citrus fruit.

Tea consumption in pregnancy as a predictor of pesticide exposure and adverse birth outcomes: The MIREC Study.

INTRODUCTION: Pesticide residues in tea may contribute to exposure during pregnancy; however, the impact on maternal and infant health is not well understood. The aim of this study was to determine whether tea intake in the first trimester was associated with elevated concentrations of various pesticides in maternal blood or urine. Further, we examined the relationship between tea consumption and adverse birth outcomes. METHODS: Data from the Maternal-Infant Research on Environmental Chemicals (MIREC) Study, a pan-Canada pregnancy cohort, were used. All singleton, live births (n=1898) with available biomarkers were included in the analyses. Descriptive statistics were used to characterize the population. The geometric means (GM) of organochlorine (OC) pesticide constituents or metabolites in maternal plasma (lipid adjusted) and organophosphate (OP) pesticide metabolites (adjusted for specific gravity) in maternal urine were calculated for participants who drank regular, green or herbal tea in the first trimester and for those who did not. Differences between groups were examined using chi-square or t-tests. Associations between frequency of drinking tea and adverse birth outcomes were examined using logistic regression (preterm birth and small-for-gestational-age) or generalized linear models (birthweight decile and head circumference). RESULTS: The GM of the OC pesticide constituent trans-nonachlor was 2.74 mg/g lipid, and for metabolites oxychlordane and p,p'-DDE this was 1.94 ng/g lipid and 55.8 ng/g lipid, respectively. OP pesticide metabolite concentrations adjusted for specific gravity, were dimethylphosphate (GM: 3.19 µg/L), dimethylthiophosphate (GM: 3.29 µg/L), dimethyldithiophosphate (GM: 0.48 µg/L), diethlphosphate (GM: 2.46), and diethylthiophosphate (GM: 0.67 µg/L). There was no significant difference in mean concentrations for these OC or OP pesticide constituents or metabolites between tea drinkers - of any type - and non-tea drinkers. Further, no association was found between tea intake and adverse birth outcomes. CONCLUSIONS: Pesticide concentrations did not differ by tea intake. Further, tea intake in the first trimester was not associated with adverse birth outcomes. In this study population, there was no evidence for concern about tea intake being a source of the OP or OC pesticide metabolites measured or adversely affecting birth outcomes; however, tea intake was lower than national Canadian data for women of reproductive age.

Breast, Formula and Combination Feeding in Relation to Childhood Obesity in Nova Scotia, Canada.

Breastfeeding has been rigorously studied in relation to childhood obesity prevention. Few studies have examined whether combination feeding­breast milk and formula­may also be protective against obesity. This study aimed to investigate the relationship between breastfeeding duration, combination feeding and overweight and obesity among Canadian school children. We analyzed data from a 2011 cross-sectional, population based survey (n = 5,560), which included self-reported infant feeding behaviours, a food frequency questionnaire and measured height and weight. Multilevel regression methods were used to examine the association between breastfeeding duration and overweight and obesity adjusting for socioeconomic status, diet quality and physical activity. Thirty-four percent of children were breastfed for <1 week or never while 32% were breastfed for at least 6 months. In the fully adjusted model, children who were only formula fed or who were combination fed for <6 months were more likely to be overweight or obese relative to children who were only breastfed (OR 1.29, 95% CI 1.04-1.60 and OR 1.35, 95% CI 1.09-1.69, respectively). When examining overweight and obese children separately, those who were only formula fed were more likely obese (OR 1.57, 95% CI 1.10-2.25) relative to their peers who were only breastfed. And those who were combination fed for <6 months relative to those only breastfed were more likely to be overweight (OR 1.29, 95% CI 1.01-1.66). Breastfeeding, in the absence of formula feeding, appears to have a protective effect on childhood obesity. While combination feeding confers less benefit than only breastfeeding, it is more desirable than formula feeding alone. Strategies and social policies are needed to promote exclusive and longer breastfeeding duration and should be integrated with comprehensive efforts to prevent childhood obesity and to reduce the burden of chronic diseases in the long term.

The direction of the difference between Canadian and American erythrocyte folate concentrations is dependent on the assay method employed: a comparison of the Canadian Health Measures Survey and National Health and Nutrition Examination Survey.

Fortification of select grain products with folic acid and periconceptional supplementation recommendations in Canada and the USA have improved folate status, and have been associated with a reduced risk of neural tube defects. In the present study, we aimed to conduct a comparison of erythrocyte folate concentrations from the 2007-9 Canadian Health Measures Survey (CHMS) and the 2007-8 US National Health and Nutrition Examination Survey (NHANES). Erythrocyte folate concentration was assessed in participants aged 6-79 years (CHMS, n 5248; NHANES, n 7070). To account for different folate assays employed - Immulite 2000 immunoassay (CHMS) and microbiological assay (NHANES) - a conversion equation was generated (n 152 adults) to adjust the CHMS data. t Tests were used to examine country differences. Median Canadian erythrocyte folate concentrations (method-adjusted) were lower than those of Americans (988 and 1100 nmol/l, respectively), but unadjusted median Canadian erythrocyte folate concentrations were higher (1250 nmol/l). The upper 95% CI boundary of the method-adjusted Canadian erythrocyte folate distribution overlapped that of the American erythrocyte folate concentrations, while the lower 95% CI boundary of the method-adjusted Canadian erythrocyte folate data was below the American distribution. In summary, the fact that erythrocyte folate concentrations were either higher or lower in Canadians compared with Americans, depending on whether an adjustment was made to account for assay differences, suggests that caution must be exercised in evaluating erythrocyte folate data from different countries because analytical methods are not readily comparable. Furthermore, we cannot unequivocally conclude that there are true differences in erythrocyte folate concentrations between the Canadian and American populations in the post-fortification era.

Evaluating a fruit and vegetable program: in eastern Ontario schools.

PURPOSE: Effectiveness was evaluated for a fruit and vegetable program developed to encourage Canadian elementary school children to eat the recommended number of daily servings. Also examined was whether the program modified children's personal factors, perceived social environment, and perceived physical environment. METHODS: A prospective, quasi-experimental trial was conducted to compare the eight schools receiving the intervention curriculum (Freggie Friday schools [FFS]) with six control schools (CS). A food frequency questionnaire was used to measure differences in fruit and vegetable consumption. Personal factors, perceived social environment, and perceived physical environment supporting fruit and vegetable consumption were assessed with an adapted version of the validated Pro Children study questionnaire. RESULTS: Of the 942 children who completed the baseline assessment, 807 also completed the follow-up questionnaire (FFS, 450; CS, 357). A mixed-effects regression model indicated no significant intervention effects on fruit or vegetable consumption, snack food consumption, or knowledge or attitudes related to fruit and vegetable consumption. CONCLUSIONS: The results suggest that an intervention based on a single visit from an external group, followed by teacher-led programming, may be an ineffective method of eliciting dietary behaviour change in this population. Future programs may need to implement multicomponent intervention designs.

Folate status of the population in the Canadian Health Measures Survey.

BACKGROUND: Low folate concentrations are inversely associated with birth defects, including neural tube defects, congenital heart disease and oral clefts. Conversely, high folate concentrations may be associated with adverse outcomes, including increased risk of colorectal cancer among those with pre-existing neoplasms. The purpose of our study was to investigate the folate status of a nationally representative sample of Canadians, including a subset of women of childbearing age. METHODS: We examined red blood cell folate concentrations among members of the general population aged 6-79 years (n = 5248) and separately among women of childbearing age (15-45 yr, n = 1162), as recorded by the Canadian Health Measures Survey and measured by immunologic assay. We assessed the data for significant differences by age, sex and socioeconomic status. RESULTS: Less than 1% of Canadians showed folate deficiency (red blood cell folate < 305 nmol/L) and 40% showed high folate concentrations (> 1360 nmol/L). Among women of childbearing age, 22% showed concentrations below those considered optimal for maximal neural tube defect-risk reduction (< 906 nmol/L). Significant differences by age and socio-economic status, but not sex, were evident in median red blood cell folate concentrations, although concentrations in all groups exceeded recommended levels. No differences by age or income were found among women of child-bearing age. INTERPRETATION: Folate deficiency is virtually nonexistent in the Canadian population, although high folate concentrations are evident. Additional research is needed to better understand the determinants of red blood cell folate among women of childbearing age who have concentrations below levels that are maximally protective against neural tube defects. Ongoing monitoring of the folate status of Canadians and the relationship between red blood cell folate and health outcomes is warranted.

Relative reinforcing value of energy-dense snack foods in overweight and obese adults.

PURPOSE: Obese people find energy-dense food more reinforcing than do their non-obese peers, and reinforcement influences food intake. We examined how the degree of adiposity, measured by body mass index (BMI), is associated with the relative reinforcing value of energy-dense snack foods versus fruits and vegetables in overweight and obese people. METHODS: Ninety-two overweight or obese students in introductory psychology courses completed questionnaires on age, sex, BMI, hunger, smoking status, dietary restraint, and hedonic (liking) ratings for energy-dense snack foods and fruits and vegetables. The questionnaire also was used to evaluate the relative reinforcing value of these snack foods in comparison with fruits and vegetables. RESULTS: The BMI predicted the relative reinforcing value of energy-dense snack food. This positive relationship remained significant after we controlled for age, sex, dietary restraint, hunger, smoking status, and snack food hedonics. CONCLUSIONS: The greater the degree of overweight and obesity, the greater the motivation to obtain energy-dense snack foods. Because the rewarding value of food is a strong determinant of energy intake, a useful approach to preventing and treating obesity may be introducing pharmacological or behavioural nutrition intervention to reduce the rewarding value of energy-dense snack foods, or increasing the rewarding value of fruits and vegetables.

Paint your plate: effectiveness of a point-of-purchase display.

PURPOSE: This study was conducted to determine consumer understanding and retention of nutrition information presented at grocery stores during the Paint Your Plate campaign via two approaches: interactive display events and brochure distribution. METHODS: Data were collected at 17 grocery stores in northern Ontario. Eleven stores held interactive display events with public health staff, a display, resources, and food samples. Six stores only distributed brochures. A total of 688 participants completed a baseline questionnaire, and 432 consented to a three-month follow-up telephone call. Of these, 201 were randomly selected to participate. RESULTS: Participants at interactive display events were six times more likely than participants receiving brochures to identify a serving size of fruit and vegetables (odds ratio [OR]=5.88; 95% confidence interval [CI]: 4.05, 8.54) and 23 times more likely to identify the recommended number of servings of fruit and vegetables (OR=22.67; 95% CI: 14.29, 35.98). However, at follow-up, there was no significant difference between type of event and the ability to answer correctly. CONCLUSIONS: Interactive displays increased immediate knowledge but failed to increase retention, a finding that suggests consistent presence of the message is needed to reinforce initial understanding and retention. More emphasis should be placed on directing funding toward increasing the frequency and duration of promotional efforts.

Children's preference for large portions: prevalence, determinants, and consequences.

BACKGROUND: Proliferation of large portions of snack and fast foods parallels dramatic increases in childhood obesity. This study investigates the prevalence, determinants, and consequences of large portions in children's diets. METHODS: As part of the 2003 Children's Lifestyle and School-performance Study, we surveyed 4,966 children in Nova Scotia regarding their usual portion sizes of french fries, meats, vegetables, and potato chips using three-dimensional graduated food models. We measured heights and weights and assessed dietary intake with the Harvard Youth Adolescent Food Frequency Questionnaire. Diet quality was summarized using the Diet Quality Index International (DQI-I). Parents were surveyed on food habits and socioeconomic background. STATISTICAL ANALYSIS: We used multilevel regression methods to examine determinants of children's large portion size choice and to evaluate the effect of this selection on energy intake, diet quality, and overweight. RESULTS: Children reported preference for portions of french fries, meats, and potato chips that are larger and vegetable portions that are smaller than what is recommended. Children from socioeconomically disadvantaged families or who frequently eat while watching television and in fast-food restaurants preferred larger portions of french fries and potato chips. Consequences of consuming large portions of these foods included poor diet quality and increased energy intake. Consuming large portions of vegetables was associated with lower energy intake and better diet quality. CONCLUSIONS: Successful marketing of large portions of french fries and potato chips may be at the expense of diet quality and appropriate energy intake. Policy regulations and nutrition education emphasizing appropriate portion sizes provide opportunities to prevent overweight and improve future health.

Adequacy of nutritional intake from food and supplements in a cohort of pregnant women in Québec, Canada: the 3D Cohort Study (Design, Develop, Discover).

Background: Assessments of the dietary intakes in various populations suggest that pregnant women have difficulty meeting all their nutritional requirements through diet alone. Few large-scale studies have considered both food sources and supplements in assessing the adequacy of nutritional intakes during pregnancy.Objective: Our study aimed to assess nutritional intakes during pregnancy by examining dietary sources and supplements. It then compared these findings with Dietary Reference Intakes.Design: We conducted a nutrition study in a large pregnancy cohort using a 3-d food record during the second trimester of pregnancy. Detailed information about supplement consumption was obtained by interview at each prenatal visit. We estimated the distribution of total usual intakes for energy, macronutrients, and micronutrients for 1533 pregnant women.Results: A third of the participants had total fat intakes that exceeded the Acceptable Micronutrient Distribution Range. A majority of women (85%) had sodium intakes above the Tolerable Upper Intake Level (UL). Median intakes for fiber and potassium were lower than Adequate Intakes. Dietary intakes of vitamin B-6, magnesium, and zinc were below the Estimated Average Requirements (EARs) for 10-15% of the women. A majority of the women had dietary intakes below the EARs for iron (97%), vitamin D (96%), and folate (70%). When we considered micronutrient intakes from both food and supplements, we found that the prevalence of inadequate intake was <10% for all nutrients except vitamin D (18%) and iron (15%), whereas 32% and 87% of the women had total intakes above the ULs for iron and folic acid, respectively.Conclusions: The level of intake of some nutrients from food alone remains low in the diets of pregnant women. Supplement use reduces the risk of inadequate intake for many micronutrients, but diet-related issues during pregnancy remain and deserve to be addressed in public health interventions. This trial was registered at clinicaltrials.gov as NCT03113331.

Developing an Evidence Review Cycle Model for Canadian Dietary Guidance.

Formulating dietary guidance involves navigating a large volume of substantive, conflicting evidence. Canada's guidance is determined after periodic evidence reviews. Health Canada identified the need for a more formal and systematic process to gather, assess, and analyze evidence. This led to the development of the Evidence Review Cycle model for Canada's dietary guidance. The Evidence Review Cycle consists of 5 steps that form a dynamic, iterative process to promote evidence-based, transparent, and proactive decision making. Resulting actions may include enhancing the implementation of guidance, revising guidance, or developing new guidance. Here, the development of this model is described, including considerations for implementation.

Is there a relationship between tea intake and maternal whole blood heavy metal concentrations?

The aim of this analysis was to examine the association between tea intake during pregnancy and maternal and infant metal exposures. Data from the Maternal-Infant Research on Environmental Chemicals (MIREC) Study, a pan-Canadian pregnancy cohort, were used. All participants with a gestational age of ⩾20 weeks (n=1954) with available biomarkers were included. Geometric means (GMs) for lead, arsenic, mercury, cadmium and manganese in maternal (first and third trimesters) and cord blood, as well as speciated arsenic in maternal urine in the first trimester, were calculated for participants who drank regular, green or herbal tea and for those who did not. Differences between groups were examined using chi-square tests. Adjusted least squares geometric means (LSGMs) were estimated by tea intake, controlling for factors such as country of birth, coffee intake and maternal smoking. Concentrations of all metals were above the limits of detection in most participants in the first trimester: lead (GM): 0.62 µg/dl), mercury (GM: 2.99 nmol/l); cadmium (GM 1.93 nmol/l), arsenic (GM 9.75 nmol/l) and manganese (GM 160.1 nmol/l). Adjusted LSGMs for lead in the first trimester were higher for tea drinkers than for those who were non-tea drinkers (LSGM 0.65 µg/dl, 95%CI: 0.62, 0.69 and 0.61 µg/dl, 95%CI: 0.59, 0.62), and there was evidence of a dose-response relationship for green and herbal tea. Those who consumed herbal tea in the third trimester had significantly higher third trimester maternal and cord blood lead concentrations than non-herbal tea drinkers. This study provides evidence of an association between blood lead concentrations and green or herbal tea consumption. However, the GM blood lead concentrations of the highest tea consumers were still less than 1 µg/dl and within the normal range of blood lead concentrations in the Canadian population.

Prevalence and correlates of high red blood cell folate concentrations in the Canadian population using 3 proposed cut-offs.

A distinct shift towards higher folate concentrations has emerged in Canada. These higher concentrations have known benefits, including prevention of neural tube defects, but concerns have been raised regarding potential associations with adverse health outcomes. The aim of this research was to propose cut-offs for high red blood cell (RBC) folate concentrations and identify their correlates. RBC folate was measured in a nationally representative cross-sectional sample of Canadians (N = 5248) aged 6 to 79 years. RBC folate concentrations were adjusted from the IMMULITE 2000 immunoassay to a microbiologic assay. The population was characterized at 3 RBC folate cut-offs: 1450 nmol/L, 1800 nmol/L, and 2150 nmol/L. We used t tests to examine differences by age, sex, income, and body mass index (BMI) at each cut-off and logistic regression to explore associations with folic acid supplement intake. The prevalence of high RBC folate was 16%, 6%, and 2% at thresholds of 1450 nmol/L, 1800 nmol/L, and 2150 nmol/L, respectively. Females, those aged 60 to 79 years, and overweight or obese participants had the greatest prevalence of having high RBC folate at each cut-off. Folic acid supplement users were more likely than non-users to have high RBC folate concentrations. Older age, higher BMI, and folic acid supplement use were identified as correlates of high folate status. A high RBC folate concentration cut-off will advance the field towards consistent measurement and reporting of high folate status. This may facilitate future investigation of associations between RBC folate concentrations at the upper end of the distribution and health outcomes.

Obesity, lifestyle and socio-economic determinants of vitamin D intake: a population-based study of Canadian children.

OBJECTIVE: Vitamin D intake in childhood is primarily for the prevention of rickets. Inconsistent evidence has associated adequate blood concentrations with a decreased risk of certain health conditions. Further, obese individuals may have lower vitamin D status. The estimated average requirement (EAR) for children recently doubled to 400 IU/day. Our aim was to examine dietary intake of vitamin D in different body mass index (BMI) categories, in addition to assessing determinants. METHODS: Data from two provincial surveys of grade 5 children, including a food frequency questionnaire and measured BMI, were used. Rao-Scott chi-square statistic tested the bivariate association between provinces and adequate dietary vitamin D intake. Key correlates were examined using multi-level logistic regression. RESULTS: Those below the EAR differed between Alberta (78%) and Nova Scotia (81%). Those drinking <2 glasses of milk/day had 0.02 times the odds of meeting the EAR (95% CI: 0.01-0.02) compared to those drinking more. No significant difference was observed for BMI, though those consuming <1 glass of milk/day were more likely to be obese than those consuming ≥2 glasses/day. Income and physical activity were negatively correlated with meeting the EAR. CONCLUSION: Many children did not meet the EAR for vitamin D from dietary sources and milk consumption was an important determinant. Given trends towards a more sedentary lifestyle and limited sun exposure, we recommend prioritizing public health efforts to support dietary vitamin D intake alongside interventions to increase physical activity and reduce sedentary behaviour. Further investigation is required to determine the need for targeted strategies for obese children.