Dietary Sugar and Anthropometrics among Young Children in the Guelph Family Health Study: Longitudinal Associations.

Purpose: Our understanding of the influence of sugar intake on anthropometrics among young children is limited. Most existing research is cross-sectional and has focused on sugar-sweetened beverages. The study objective was to investigate longitudinal associations between young children's total, free, and added sugar intake from all food sources at baseline with anthropometric measures at baseline and 18 months.Methods: The Guelph Family Health Study (GFHS) is an ongoing randomized controlled trial and a family-based health promotion study. Food records and anthropometric data were collected at baseline (n = 109, 55 males; 3.7 ± 1.1 y, mean ± SD) and 18 months (n = 109, 55 males; 5.1 ± 1.1 y) of the GFHS pilots. Associations between sugar intakes and anthropometrics were estimated using linear regression models with generalized estimating equations adjusted for age, sex, household income, and intervention status.Results: Total sugar intake was inversely associated with body weight at 18 months (P = 0.01). There was no effect of time on any other associations between total, free, and added sugar intakes and anthropometrics.Conclusions: Early life dietary sugar intakes may not relate to anthropometric measures in the short term. Further investigation into potential associations between dietary sugar intakes and anthropometric variables over longer time periods is warranted.

Dietary Sugar Research in Preschoolers: Methodological, Genetic, and Cardiometabolic Considerations.

Excess dietary sugar intake increases the risk of unhealthy weight gain, an important cardiometabolic risk factor in children. To further our understanding of this relationship, we performed a narrative review using two approaches. First, research examining dietary sugar intake, its associations with cardiometabolic health, impact of genetics on sweet taste perception and intake, and how genetics moderates the association of dietary sugar intake and cardiometabolic risk factors in preschool-aged children 1.5-5 years old is reviewed. Second, methodological considerations for collecting and analyzing dietary intake of sugar, genetic information, and markers of cardiometabolic health among young children are provided. Our key recommendations include the following for researchers: (1) Further longitudinal research on sugar intake and cardiometabolic risk factors is warranted to inform policy decisions and guidelines for healthy eating in preschool-aged children. (2) Consistency in sugar definitions is needed across research studies to aid with comparisons of results. (3) Select dietary collection tools specific to each study's aim and sugar definition(s). (4) Limit subjectivity of dietary assessment tools as this impacts interpretation of study results. (5) Choose non-invasive biomarkers of cardiometabolic disease until the strengths and limitations of available biomarkers in preschool-aged children are clarified. (6) Select approaches that account for the polygenic nature of cardiometabolic disease such as genome risk scores and genome wide association studies to assess how genetics moderates the relationship between dietary sugar intake and cardiometabolic risk. This review highlights potential recommendations that will support a research environment to help inform policy decisions and healthy eating policies to reduce cardiometabolic risk in young children.

Breakfast Quality of Preschool-aged Canadian Children.

Purpose: To investigate the breakfast quality of preschool-aged children through a comparison of their energy and nutrient intakes at breakfast to published benchmarks for a balanced breakfast.Methods: Dietary data were collected for 163 children aged 3-5 years enrolled in the Guelph Family Health Study using one parent-reported online 24-hour recall and analyzed for energy and nutrient intakes. Breakfast quality was assessed by tallying the frequency of participants whose nutrient and energy intakes at their breakfast meal met the recommendations for a balanced breakfast established by the International Breakfast Research Initiative (IRBI).Results: Almost all participants (98%) consumed breakfast, and most participants (82.5%) met the energy IRBI recommendation. However, the majority of participants did not meet the IRBI recommendations for breakfast intakes of most macronutrients and micronutrients. In particular, fewer than 25% of participants met the IRBI recommendations for breakfast intakes of dietary fibre, niacin, folate, vitamin C, calcium, potassium and zinc.Conclusions: Almost all preschool-aged children in this study consumed breakfast, but the nutritional quality of their breakfast did not meet recommendations for most nutrients. These results can inform nutrition education and intervention programs for children that aim to improve the nutritional quality of breakfast.

Cheese Intake is Inversely Associated with LDL Cholesterol in Young Children.

Purpose: To determine if intake (servings/day) of total dairy and/or dairy subtypes (milk, cheese, and yogurt) were associated with biomarkers related to dyslipidemia, insulin sensitivity and inflammation in a sample of cardio-metabolically healthy young children from the Guelph Family Health Study at the University of Guelph, Guelph, Ontario, Canada.Methods: Baseline data from 42 children (aged 2.0-6.2 years) from 33 families who provided a dietary assessment and a fasted blood sample were included in this cross-sectional analysis. Linear and logistic regressions using generalized estimating equations were used for analysis and models were adjusted for age, gender, and household income.Results: In total, 42 children (3.74 ± 1.23 years old; mean (± SD)) consumed median (25th percentile, 75th percentile) servings/day of 1.70 (1.16, 2.81) for total dairy, 0.74 (0.50, 1.70) for milk, 0.63 (0.00, 1.16) for cheese, and 0.00 (0.00, 0.38) for yogurt. Cheese intake was significantly inversely associated with LDL cholesterol (-0.16 (95% CI: -0.29, -0.03) mmol/L per serving; P = 0.02)). No other associations between dairy intake and biomarkers were significant.Conclusions: Cheese intake was inversely associated with LDL cholesterol in this preliminary study of cardio-metabolically healthy young children, thereby warranting further research on dairy intake and cardiometabolic risk factors.

Canned Beans Decrease Serum Total and LDL Cholesterol in Adults with Elevated LDL Cholesterol in a 4-wk Multicenter, Randomized, Crossover Study.

BACKGROUND: Practical risk reduction strategies are needed to address cardiovascular disease. Beans can decrease LDL cholesterol; however, research into different daily amounts and varieties is warranted. OBJECTIVES: To examine the effects of canned beans (daily rotation of black, navy, pinto, dark red kidney, white kidney) in 1-cup (1CB, 180 g) and ½-cup (½CB, 90 g) daily amounts compared with a 1-cup white rice (WR) control on serum lipid and glycemic biomarkers in adults with elevated LDL cholesterol. METHODS: Adults [n = 73, mean ± SD age: 48.1 ± 14.2 y; BMI (in kg/m2): 25.9 ± 4.22; fasting serum LDL cholesterol: 3.0-5.0 mmol/L] consumed 1CB, ½CB, and WR for 4-wk treatment periods separated by ≥4-wk washouts in a multicenter, randomized, crossover study. Fasting serum LDL cholesterol (primary outcome) and other lipids and glycemic biomarkers (secondary outcomes) were measured on study days 1 and 29 of each treatment period with study day 29 values compared using repeated-measures ANCOVA, including study day 1 values as covariates. RESULTS: Treatment completion was n = 66 for 1CB, n = 68 for ½CB, and n = 64 for WR. Total cholesterol on study day 29 was lower for 1CB (P = 0.04) but not ½CB (P = 0.77) compared with WR (-5.46%, -2.74%, -0.65% changes from study day 1, respectively) and did not differ between 1CB and ½CB (P = 0.17). LDL cholesterol on study day 29 was also lower for 1CB (P = 0.002) but not ½CB (P = 0.30) compared with WR (-8.08%, -3.84%, +0.49% changes from study day 1, respectively) and did not differ between 1CB and ½CB (P = 0.11). Other lipids and glycemic biomarkers did not differ among treatments. CONCLUSIONS: Consumption of 1 cup (180 g) of canned beans of multiple varieties decreased total and LDL cholesterol in adults with elevated LDL cholesterol, supporting a practical strategy for cardiovascular disease risk reduction. This trial was registered at clinicaltrials.gov as NCT03830970.

Diet Quality of Canadian Preschool Children: Associations with Socio-demographic Characteristics.

Purpose: To examine associations between preschoolers' diet quality and parent and child socio-demographic variables.Methods: Cross-sectional analysis with 117 preschoolers. Parents reported socio-demographics and their children's diet using 3-day food records. Diet quality was assessed using the Healthy Eating Index (HEI) 2015. Linear regression models were used to analyze associations between socio-demographics and HEI scores.Results: A total of 86% of children had an HEI-2015 score in the "needs improvement" category (51-80 out of a maximum of 100). Children's overall HEI-2015 score was inversely associated with children's age (ß = -0.19, 95% CI -0.37, -0.02). Parental education was positively associated with children's overall HEI score (ß = 9.58, 95% CI 3.81, 15.35) and with scores for total fruit (ß = 1.00, 95% CI 0.39, 1.76), vegetables (ß = 1.11, 95% CI 0.03, 2.18), total protein (ß = 1.06, 95% CI 0.28, 1.84), and seafood/plant protein (ß = 1.67, 95% CI 0.43, 2.89) components. Children who identified as Caucasian (ß = 4.29, 95% CI 2.46, 6.14), had a Caucasian parent (ß = 3.01, 95% CI 0.78, 5.25), or parents who were born in Canada (ß = 2.32, 95% CI 0.53, 4.11) had higher scores for dairy.Conclusion: Our results suggest that preschoolers' diet quality needs improvement and that children's diet quality varies by children's age and parental education level.

Association between diet quality and food waste in Canadian families: a cross-sectional study.

BACKGROUND: Higher diet quality has been associated with greater amounts of food waste among adults in the United States. This study aims to build on previous work by examining the association between diet quality and food waste, as assessed using detailed waste audits, among a sample of Canadian families. METHODS: This cross-sectional study used data from 85 Canadian families with young children. Parent and children diet quality was assessed using the Healthy Eating Index-2015 (HEI-2015), calculated from 3-day food records. Household food waste was measured using detailed waste audits conducted over multiple weeks and these data were used to calculate daily per capita food waste. Linear regression was used to explore the association between parent and child HEI-2015 scores and daily per capita total avoidable and unavoidable food waste, as well as daily per capita avoidable and unavoidable food waste in the following categories: 1) fruits and vegetables, 2) milk, cheese and eggs, 3) meat and fish, 4) breads and cereals, 5) fats and sugars. RESULTS: Parent HEI-2015 scores ranged from 37 to 92 (out of 100) and 81% of parents' diets scored in the "Needs Improvement (51-80)" category. Parent and child diet quality scores were significantly correlated (r = 0.61; P < 0.0001) and 82% of children's diets scored in the "Needs Improvement" category. On average, households produced 107 g of avoidable food waste and 52 g of unavoidable food waste per person per day. Fruits and vegetables were the highest contributor for both avoidable and unavoidable food waste. Both parent and child HEI-2015 scores were not significantly associated with total daily per capita avoidable or unavoidable food waste. However, parent HEI-2015 scores were positively associated with daily per capita avoidable fruit and vegetable waste (Unstandardized ß = 1.05; 95%CI: 0.11, 1.99; P = 0.03) and daily per capita unavoidable fruit and vegetable waste (Unstandardized ß = 0.60; 95%CI: 0.03, 1.17; P = 0.04), after adjusting for household income. CONCLUSION: This is the first study to explore the association between diet quality and food waste using detailed waste audits. Future research should explore effective strategies towards improving diet quality while simultaneously reducing food waste, especially of fruits and vegetables.

Frequency of fruit juice consumption and association with nutrient intakes among Canadians.

BACKGROUND: In Canada, studies on consumption of 100% fruit juice and nutrient intakes are limited. AIM: This study aimed to evaluate nutrient intakes and adequacy of intake by frequency of fruit juice consumption. METHODS: Individuals ≥1 year (n = 34,351) participating in the Canadian Community Health Survey, 2004 with a 24-hour dietary recall and reported usual frequency of fruit juice consumption (assumed to be 100% juice) were categorized by frequency of consumption as <0.5, ≥0.5 to <1.5, or ≥1.5 times/day. RESULTS: More frequent consumption of fruit juice (≥0.5 times/day) was associated with higher intakes of total fruits and vegetables, whole fruits, energy, total sugars, vitamin C and potassium. More frequent consumption of fruit juice was associated with improved intake adequacy of vitamin C for adults. CONCLUSIONS: Fruit juice consumption contributes to increased intakes of vitamin C and potassium as well as energy and total sugars, thus presenting a trade-off for consumers to balance.

Dairy and Plant-Based Dairy Alternatives Purchasing Habits of Guelph-Based Families with Preschool-Aged Children.

Purpose: To investigate dairy and plant-based dairy alternatives (DPBDA) purchasing habits, including comparisons among locations of purchase and among subtypes of DPBDA, of families with preschool-aged children.Methods: Expenditures on food and DPBDA were calculated using grocery and food receipts collected for 3 weeks from 51 households in and around Guelph, Ontario, Canada. DPBDA were coded by subtypes (alternatives, cheese/yogurt, cow's milk, cream, and ice cream/other) and by locations of purchase, which were coded as big-box, discount, high-end, local/other, and midrange stores. Logistic regression using generalized estimating equations was used to investigate odds of purchasing DPBDA by location of purchase. All models included family income and number of children as potential confounders.Results: Ninety-eight percent of families purchased cheese/yogurt, 92% purchased cow's milk, and 35% of families purchased plant-based dairy alternatives. Families were more likely to purchase DPBDA from big-box stores than discount, midrange, or local/other stores (P < 0.01) and were more likely to purchase cheese/yogurt than dairy alternatives, cream, or ice cream/other subtypes (P < 0.01). Odds of purchasing were not different between cheese/yogurt and cow's milk.Conclusion: Families' DPBDA purchasing habits differ by purchase location and subtype. Further research is warranted to understand the factors affecting these purchasing habits.

Food Type and Lentil Variety Affect Satiety Responses but Not Food Intake in Healthy Adults When Lentils Are Substituted for Commonly Consumed Carbohydrates.

BACKGROUND: Lentils have potential to increase satiety and may contribute to a body weight management strategy; however, the effects on satiety of replacing common food ingredients with lentils within food products remain largely unknown. OBJECTIVE: The aim of this study was to determine the effects of replacing wheat and rice with 2 lentil varieties within muffins and chilies on satiety, test-meal food intake, and 24-h energy intake. METHODS: Healthy adults consumed muffins or chilies in which wheat or rice was substituted with green (61.8 g) or red (54 g) lentils in 2 randomized crossover studies (muffin study: n = 24, mean ± SE age: 25.4 ± 0.9 y, BMI (in kg/m2): 23.2 ± 0.5; chili study: n = 24, age: 25.7 ± 1.0 y, BMI: 23.2 ± 0.5), with ≥1-wk washout periods between study visits and studies. Subjective appetite sensations measured over 180 min were summarized with total area under the curve (AUC), food intake was measured at an ad libitum test meal, and 24-h energy intake was measured using weighed food records. Treatment effects were compared within each study using repeated-measures ANCOVA (subjective appetite sensations) and ANOVA (food intake, 24-h energy intake). RESULTS: Green, but not red, lentil chili significantly increased fullness AUC (17.5%, P = 0.02) and decreased desire to eat AUC (20.1%, P = 0.02) and prospective food consumption AUC (16.7%, P = 0.04) compared with rice chili, with no significant differences between chili treatments for test-meal food intake or 24-h energy intake. Muffin treatments did not significantly differ for any outcomes. CONCLUSIONS: Replacing rice with green, but not red lentils within chili increases satiety but does not decrease food intake, whereas replacing wheat with lentils within muffins does not increase satiety or decrease food intake in healthy adults. Further study of the role of lentil replacement in food products in body weight management is warranted. This trial was registered at clinicaltrials.gov as NCT03128684.

Taste Sensitivity and Taste Preference Measures Are Correlated in Healthy Young Adults.

Taste is fundamentally important for food selection. Although measures of taste sensitivity and preference have been refined over several decades, it remains largely unknown how these measures relate to each other and to food preferences. The objectives of this study were to examine, in healthy adults (age 24.6 ± 0.6 years, n = 49), 1) correlations among measures of taste sensitivity, including detection threshold (DT) and suprathreshold sensitivity (ST), and taste preference (PR) within sweet, salt, sour, umami, and [...] fat tastes; and 2) underlying associations [...] among DT, ST, and PR measurements using principal component analysis. DTs and STs were negatively correlated within each taste modality. Salt, sweet, and umami DTs and STs were positively and negatively correlated with PRs, respectively. No correlations were observed between sour and fat DTs, STs, and PRs. Two principal components accounted for 41.9% of the variance and produced 3 clear clusters consisting of DTs, STs, or PRs from each taste modality. Sweet PR and fat ST deviated from the clusters and may, therefore, be driven by different factors. No associations were observed between measured PR and ST with self-reported food PRs. Overall, this study provides evidence that higher sensitivities only to salt, sweet, or umami taste are associated with a decrease in the PR for these tastes. These findings demonstrate the importance of investigating taste sensitivity together with PR to gain a more complete understanding of the determinants of food selection.

Health claims and information sources in relation to bean consumption in older adults.

Bean consumption can reduce chronic disease risk and improve diet quality; however, bean consumption among North Americans is low. Since health claims and other information sources could increase bean consumption, their exploration is warranted, particularly among older adults, a population well positioned to benefit. The purpose of this study was to explore bean consumption among older adults (≥65 years old) in relation to health claims and other information sources. A mixed-methods explanatory sequential study design utilizing a between strategy data collection approach was used. Community-dwelling older adults (n = 250; 76.0% female) completed a validated researcher-administered questionnaire to explore bean consumption, awareness and reading of health claims, the likelihood of health claims influencing bean consumption, and current and preferred sources of nutrition and/or health information regarding beans. The questionnaire was followed up with 10 semi-structured focus groups (n = 46; 76.1% female). Awareness of nutrient content, nutrient function, therapeutic and disease risk reduction claims was reported by 94.4%, 64.0%, 79.6% and 77.2% of participants, respectively. Among those aware, these health claims were read by 91.5%, 85.6%, 87.9% and 88.6% of participants, respectively. The prevalence of bean consumption was 51.2% and participants (46.8%) most frequently indicated that all health claims would equally increase their likelihood of bean consumption. Participants (72.0%) reported that they would like more information about the nutrition and/or health properties of beans, with their most common preferred sources including food labels (54.8%), brochures (51.2%) and the internet (47.2%). This research advances the literature on how health claims relate to eating behaviour and can inform regulatory and food industry scientists about consumer perception to bean health claims, and healthcare professionals about preferred information sources for their clients.

Prevalence and Characteristics Associated with Modified Texture Food Use in Long Term Care: An Analysis of Making the Most of Mealtimes (M3) Project.

Purpose: To describe the prevalence and characteristics of modified-texture food (MTF) consumers when applying standard diet terminology. Methods: Making the Most of Mealtimes (M3) is a cross-sectional multi-site study including 32 long-term care (LTC) homes located in 4 Canadian provinces. Resident characteristics were collected from health records using a defined protocol and extraction form. Since homes used 67 different terms to describe MTFs, diets were recategorized using the International Dysphagia Diet Standardization Initiative Framework as a basis for classification. Results: MTFs were prescribed to 47% (n = 298) of participants (n = 639) and prevalence significantly differed among provinces (P < 0.0001). Various resident characteristics were significantly associated with use of MTFs: dysphagia and malnutrition risk, dementia diagnosis, prescription of oral nutritional supplements; lower body weight and calf circumference; greater need for physical assistance with eating; poor oral health status; and dependence in all activities of daily living. Conclusions: This is the first study that used a diverse sample of LTC residents to determine prevalence of MTF use and described consumers. The prevalence of prescribed MTFs was high and diverse across provinces in Canada. Residents prescribed MTFs were more vulnerable than residents on regular texture diets. These findings add value to our understanding of MTF consumers.

Carbohydrate Replacement of Rice or Potato with Lentils Reduces the Postprandial Glycemic Response in Healthy Adults in an Acute, Randomized, Crossover Trial.

Background: The postprandial blood glucose response (PBGR) following carbohydrate replacement of high-glycemic index (GI) foods with pulses, in a mixed meal, has not been accurately defined. Objective: We aimed to determine the extent to which PBGR and relative glycemic response (RGR) are lowered when half of the available carbohydrate (AC) from rice or potato is replaced with cooked lentils. Methods: Using a crossover design, 2 groups of 24 healthy adults randomly consumed 50 g AC from control white rice alone [mean ± SD body mass index (BMI, in kg/m2): 24.3 ± 0.5; mean ± SD age: 27.7 ± 1.2 y], instant potato alone (BMI: 24.0 ± 0.5; age: 27.4 ± 1.2 y), or the same starch source in a 50:50 AC combination with each of 3 types of commercially available lentils (large green, small green, split red). Fasting and postprandial blood samples were analyzed for glucose and insulin, and used to derive incremental area under the curve (iAUC), RGR, and maximum concentration (Cmax). Treatment effects were assessed with the use of repeated-measures ANOVA within the rice and potato treatments. Results: In comparison to rice alone, blood glucose iAUC and Cmax (P < 0.001) were lowered after consumption of rice with large green (P = 0.057), small green (P = 0.002), and split red (P = 0.006) lentils. Blood glucose iAUC and Cmax were also significantly lowered (P < 0.0001) after consumption of potato combined with each lentil, compared to potato alone. Plasma insulin iAUC and Cmax were significantly (P < 0.001) decreased when lentils were combined with potato, but not with rice. The RGRs of rice and potato were lowered by ∼20% and 35%, respectively, when half of their AC was replaced with lentils. Conclusions: Replacing half of the AC from high-GI foods with lentils significantly attenuates PBGR in healthy adults; this can contribute to defining a health claim for pulses and blood glucose lowering. This trial was registered at clinicaltrials.gov as NCT02426606.

A review of the associations between single nucleotide polymorphisms in taste receptors, eating behaviors, and health.

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

Prevalence of inadequate micronutrient intakes of Canadian long-term care residents.

This study determines the prevalence of inadequate micronutrient intakes consumed by long-term care (LTC) residents. This cross-sectional study was completed in thirty-two LTC homes in four Canadian provinces. Weighed and estimated food and beverage intake were collected over 3 non-consecutive days from 632 randomly selected residents. Nutrient intakes were adjusted for intra-individual variation and compared with the Dietary Reference Intakes. Proportion of participants, stratified by sex and use of modified (MTF) or regular texture foods, with intakes below the Estimated Average Requirement (EAR) or Adequate Intake (AI), were identified. Numbers of participants that met these adequacy values with use of micronutrient supplements was determined. Mean age of males (n 197) was 85·2 (sd 7·6) years and females (n 435) was 87·4 (sd 7·8) years. In all, 33 % consumed MTF; 78·2 % (males) and 76·1 % (females) took at least one micronutrient pill. Participants on a MTF had lower intake for some nutrients (males=4; females=8), but also consumed a few nutrients in larger amounts than regular texture consumers (males=4; females =1). More than 50 % of participants in both sexes and texture groups consumed inadequate amounts of folate, vitamins B6, Ca, Mg and Zn (males only), with >90 % consuming amounts below the EAR/AI for vitamin D, E, K, Mg (males only) and K. Vitamin D supplements resolved inadequate intakes for 50-70 % of participants. High proportions of LTC residents have intakes for nine of twenty nutrients examined below the EAR or AI. Strategies to improve intake specific to these nutrients are needed.

Guelph Family Health Study's Home-Based Obesity Prevention Intervention Increases Fibre and Fruit Intake in Preschool-Aged Children.

PURPOSE: The Guelph Family Health Study (GFHS) pilot was designed to examine the feasibility and effectiveness of a home-based obesity prevention intervention on health behaviours and obesity risk. The objective of this analysis was to determine the effect of the 6-month intervention on preschool-aged children's dietary intakes. METHODS: Families with children aged 1.5-5 years old were randomized to receive one of the following: 4 home visits with a health educator as well as tailored emails and mailed incentives (4HV; n = 19 children); 2 home visits with a health educator as well as tailored emails and mailed incentives (2HV; n = 14 children); or general health advice through emails (control; n = 12 children). Three-day food records were completed by parents for their children before and after the 6-month intervention and analyzed for 3-day average intakes of energy, nutrients, and MyPlate food groups. RESULTS: After the 6-month intervention, the 4HV group had significantly higher fibre intake and the 4HV and 2HV groups had significantly higher fruit intake, both compared with the control group. CONCLUSIONS: This study provides support for a home-based intervention approach to improve the diet quality of preschool-aged children.

Snacking Patterns of Preschool-Aged Children: Opportunity for Improvement.

PURPOSE: Dietary patterns established in childhood track into adulthood. Despite this, little research has explored preschoolers' snacking. This study examined snacking patterns (frequency, quality, quantity) of preschool-aged boys and girls. METHODS: Cross-sectional data were collected on 52 children (23 males; 3.4 ± 1.1 years of age; BMI 16.1 ± 1.4 kg/m2) enrolled in the Guelph Family Health Study pilot. Parent-reported 3-day food records were analyzed for children's snacking patterns including frequency (number of snacking occasions per day), quantity (percent energy from snacks) and quality (inclusion of food groups from Eating Well with Canada's Food Guide, macronutrient distribution, sugary and salty snacks). Mann-Whitney U tests examined sex differences in snacking patterns. RESULTS: Ninety-six percent of children snacked daily, consuming a mean of 2.3 ± 0.7 snacks per day. Snacks accounted for one-third of daily energy. 78% of boys' versus 63% of girls' snacks contained a food group (P = 0.016). Boys consumed significantly fewer sugary snacks (0.5 ± 0.4 vs 0.9 ± 0.6 snacks per day, P = 0.016), although the percent of snack calories from sugar for both boys and girls was high (group mean 37.2 ± 6.7%). CONCLUSIONS: Nearly all preschoolers in this study snacked daily, and consumed a variety of snack foods. Boys' and girls' snacking preferences begin to diverge early in life. Preschool children should be encouraged to consume healthful snacks.

Effect of vitamin D supplementation on oral glucose tolerance in individuals with low vitamin D status and increased risk for developing type 2 diabetes (EVIDENCE): A double-blind, randomized, placebo-controlled clinical trial.

AIMS: Low serum 25-hydroxyvitamin-D (25(OH)D) concentrations are associated with insulin resistance, ß-cell dysfunction and type 2 diabetes. We conducted a 24-week double-blind, randomized, placebo-controlled trial to examine the effect of 28 000 IU of vitamin D3 once weekly on plasma glucose after a 2 hour-75 g oral glucose tolerance test (2hrPC glucose), insulin sensitivity and ß-cell function. STUDY DESIGN AND METHODS: A total of 71 participants with serum 25(OH)D ≤65 nmol/L, impaired fasting glucose and elevated glycated hemoglobin were randomly assigned to receive 28 000 IU of vitamin D3 (VitD; n = 35) or placebo (n = 36) in cheese once weekly for 24 weeks. The primary outcome was the change in 2hPC glucose. Secondary outcomes were fasting glucose, fasting and postprandial insulin, indices of insulin sensitivity and ß-cell function, glycated hemoglobin and lipid profile. Participants underwent an oral glucose tolerance test to determine 2hPC glucose. RESULTS: Mean baseline serum 25(OH)D was 48.1 and 47.6 nmol/L in the VitD and placebo groups, respectively. Serum 25(OH)D significantly increased to 98.7 nmol/L (51 nmol/L increase; P < .0001) in the VitD group. No significant differences in fasting ( P = .42) or 2hPC glucose ( P = .55) or other indices of glucose metabolism, including ß-cell function and insulin sensitivity, were observed between groups. A subgroup analysis of individuals with 25(OH)D < 50 nmol/L and prediabetes did not change these results. The VitD group exhibited a significant reduction in LDL cholesterol (-0.27 vs 0.01 mmol/L, P = .03). CONCLUSION: Weekly doses of vitamin D3 in individuals with suboptimal vitamin D levels who were at risk for type 2 diabetes did not improve oral glucose tolerance or markers of glycaemic status.

Making the Most of Mealtimes (M3): protocol of a multi-centre cross-sectional study of food intake and its determinants in older adults living in long term care homes.

BACKGROUND: Older adults living in long term care (LTC) homes are nutritionally vulnerable, often consuming insufficient energy, macro- and micronutrients to sustain their health and function. Multiple factors are proposed to influence food intake, yet our understanding of these diverse factors and their interactions are limited. The purpose of this paper is to fully describe the protocol used to examine determinants of food and fluid intake among older adults participating in the Making the Most of Mealtimes (M3) study. METHODS: A conceptual framework that considers multi-level influences on mealtime experience, meal quality and meal access was used to design this multi-site cross-sectional study. Data were collected from 639 participants residing in 32 LTC homes in four Canadian provinces by trained researchers. Food intake was assessed with three-days of weighed food intake (main plate items), as well as estimations of side dishes, beverages and snacks and compared to the Dietary Reference Intake. Resident-level measures included: nutritional status, nutritional risk; disease conditions, medication, and diet prescriptions; oral health exam, signs of swallowing difficulty and olfactory ability; observed eating behaviours, type and number of staff assisting with eating; and food and foodservice satisfaction. Function, cognition, depression and pain were assessed using interRAI LTCF with selected items completed by researchers with care staff. Care staff completed a standardized person-directed care questionnaire. Researchers assessed dining rooms for physical and psychosocial aspects that could influence food intake. Management from each site completed a questionnaire that described the home, menu development, food production, out-sourcing of food, staffing levels, and staff training. Hierarchical regression models, accounting for clustering within province, home and dining room will be used to determine factors independently associated with energy and protein intake, as proxies for intake. Proportions of residents at risk of inadequate diets will also be determined. DISCUSSION: This rigorous and comprehensive data collection in a large and diverse sample will provide, for the first time, the opportunity to consider important modifiable factors associated with poor food intake of residents in LTC. Identification of factors that are independently associated with food intake will help to develop effective interventions that support food intake. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT02800291 , retrospectively registered June 7, 2016.