Advances in methods for characterizing dietary patterns: A scoping review.

There is a growing focus on better understanding the complexity of dietary patterns and how they relate to health and other factors. Approaches that have not traditionally been applied to characterize dietary patterns, such as machine learning algorithms and latent class analysis methods, may offer opportunities to measure and characterize dietary patterns in greater depth than previously considered. However, there has not been a formal examination of how this wide range of approaches has been applied to characterize dietary patterns. This scoping review synthesized literature from 2005-2022 applying methods not traditionally used to characterize dietary patterns, referred to as novel methods. MEDLINE, CINAHL, and Scopus were searched using keywords including machine learning, latent class analysis, and least absolute shrinkage and selection operator (LASSO). Of 5274 records identified, 24 met the inclusion criteria. Twelve of 24 articles were published since 2020. Studies were conducted across 17 countries. Nine studies used approaches that have applications in machine learning to identify dietary patterns. Fourteen studies assessed associations between dietary patterns that were characterized using novel methods and health outcomes, including cancer, cardiovascular disease, and asthma. There was wide variation in the methods applied to characterize dietary patterns and in how these methods were described. The extension of reporting guidelines and quality appraisal tools relevant to nutrition research to consider specific features of novel methods may facilitate complete and consistent reporting and enable evidence synthesis to inform policies and programs aimed at supporting healthy dietary patterns.

Development, validity and reliability assessment of the Canadian Food Literacy Measure.

Food literacy is a growing area of interest given its potential to support healthy and sustainable diets. Most existing food literacy measures focus on nutrition and food skills but fail to address food systems and socio-environmental aspects of food literacy. Further, measures developed and tested in the Canadian context are lacking. The objective of this project was to develop and test the validity and reliability of a brief self-administered measure, in French and English, designed to assess multiple dimensions of food literacy among adults living in Canada. The 23-item Canadian Food Literacy Measure was developed through an iterative process that included assessment of face and content validity through expert review (n=20) and cognitive interviews (n=20), and construct validity and reliability, i.e., internal consistency through an online survey (n=154). The results indicate that the measure is well understood by both English- and French-speaking adults. The measure's construct validity is demonstrated by the observed differences in total scores in hypothesized directions by gender (p=0.003), age (p=0.007), education level (p=0.002), health literacy (p<0.001) and smoking status (p=0.001) and the significant positive correlation (r = 0.29; p=0.002) between total scores and fruit and vegetable intake. The measure also has high internal consistency with a Cronbach's coefficient alpha of 0.80. This measure can be used in surveillance studies to provide insight into the food literacy of adults living in Canada and in epidemiologic research that aims to explore how food literacy is associated with a variety of health outcomes.

Prevalence of micronutrient inadequacy differs by severity of food insecurity among adults living in Canada in 2015.

Household food insecurity is generally associated with poorer quality diets in Canada, but whether household food insecurity heightens the probability of inadequate micronutrient intakes is unknown. The objective of this research was to investigate how prevalence of micronutrient inadequacy differed by severity of household food insecurity among adults in Canada. Using the 2015 Canadian Community Health Survey Nutrition, this study included participants aged 19-64 years who completed up to two 24 h dietary recalls and provided details about household food insecurity (n = 9486). Children and older adults were not included due to sample size limitations. Usual micronutrient intake distributions were estimated by a four-level measure of food insecurity status using the National Cancer Institute method. Welch's t tests assessed differences in prevalence of inadequacy for selected micronutrients. Prevalence differed for some micronutrients among those living in marginally and moderately food insecure compared to food-secure households. The greatest differences in prevalence of inadequacy were observed between severely food-insecure and food-secure households: vitamin A (60.0%, SE = 11.9 vs. 40.6%, SE = 2.7, p < 0.0001), vitamin B6 (42.7%, SE = 9.1 vs. 12.8%, SE = 2.5, p < 0.0001), folate (39.4%, SE = 10.0 vs. 15.9%, SE = 2.2, p < 0.0001), vitamin C (63.3%, SE = 5.2 vs. 29.1%, SE = 2.8, p < 0.0001), calcium (78.6%, SE = 6.4 vs. 58.7%, SE = 1.3, p < 0.0001), magnesium (75.6%, SE = 9.5 vs. 48.7%, SE = 1.2, p < 0.0001), and zinc (34.9%, SE = 10.0 vs. 23.2%, SE = 2.4, p = 0.0009). Apparent underreporting also differed by severity of food insecurity, with increased underreporting observed with worsening food insecurity. The probability of inadequate micronutrient intakes among adults rises sharply with more severe household food insecurity in Canada.

The relationship between household food insecurity and overweight or obesity among children and adults in Canada: a population-based, propensity score weighting analysis.

Household food insecurity is independently associated with adverse health outcomes among Canadians, but its association with overweight and obesity is poorly understood partly because of limited attention to confounding. This study assessed the relationship between food insecurity status and overweight/obesity in Canada. Cross-sectional data for individuals aged 2-64 years were drawn from the 2004 and 2015 Canadian Community Health Survey-Nutrition. Overweight/obesity was defined using body mass index calculated with measured height and weight. Food insecurity status was assessed with the 18-item Household Food Security Survey Module. The relationship was examined among preschool children (n = 2007), girls (n = 5512), boys (n = 5507), women (n = 8317), and men (n = 7279) using propensity score weighted logistic regressions to control for confounding. Relative to their food-secure counterparts, girls in moderately food-insecure households (39.7% vs. 28.5%), boys in severely food-insecure households (54.4% vs. 35.0%), and women in moderately and severely food-insecure households (58.9% and 73.1% vs. 50.7%) had higher overweight/obesity prevalence; men in moderately food-insecure households had a lower prevalence (48.9% vs. 66.3%). With propensity score weighting, no association existed between food insecurity and overweight/obesity among preschool children, girls, boys, or men. For women, moderate (adjusted odds ratio (AOR): 1.61; 95% confidence interval (95%CI): 1.06-2.47) and severe (AOR: 2.33; 95%CI: 1.22-4.44) food insecurity was positively associated with overweight/obesity; the association was strongest for severe food insecurity and obesity (AOR: 3.38; 95%CI: 1.60-7.16). Additional research is needed to better understand the nature of the relationship among women. Problems of food insecurity and overweight/obesity among Canadian children and men should not be conflated in public health interventions.

Construct validity and reliability of the Canadian Eating Practices Screener to assess eating practices based on 2019 Canada's Food Guide recommendations.

For the first time since its introduction, the 2019 Canada's Food Guide (2019-CFG) highlighted specific guidance on eating practices, i.e., recommendations on where, when, why, and how to eat. The Canadian Eating Practices Screener / Questionnaire court canadien sur les pratiques alimentaires was developed to assess eating practices based on the 2019-CFG healthy eating recommendations. The objective of this cross-sectional study was to assess the construct validity and reliability of the Canadian Eating Practices Screener. From July to December 2021, adults (n = 154) aged 18-65 years completed a sociodemographic questionnaire and the screener. Construct validity was assessed by examining variability in screener scores, by comparing screener scores among subgroups with hypothesized differences in eating practices, and by examining the correlation between screener scores and fruit and vegetable intake. Reliability, i.e., internal consistency, was assessed by calculating Cronbach's coefficient alpha. Screener item scores were summed to provide a total score ranging from 21 to 105. The mean screener score was 76 (SD = 8.4; maximum, 105), ranging from 53 (1st percentile) to 92 (99th percentile). Differences in total scores in hypothesized directions were observed by age (p = 0.006), perceived income adequacy (p = 0.09), educational attainment (p = 0.002), and smoking status (p = 0.09), but not by gender or health literacy level. The correlation between screener scores and fruit and vegetable intake was 0.29 (p = 0.002). The Cronbach's coefficient alpha was 0.79, suggesting acceptable to high internal consistency. Study findings provide preliminary evidence of the screener's construct validity and reliability, supporting its use to assess eating practices based on the 2019-CFG healthy eating recommendations.

Development of the Canadian Eating Practices Screener to assess eating practices based on 2019 Canada's Food Guide recommendations.

In 2019, Health Canada released a new iteration of Canada's Food Guide (2019-CFG), which, for the first time, highlighted recommendations regarding eating practices, i.e., guidance on where, when, why, and how to eat. The objective of this study was to develop a brief self-administered screener to assess eating practices recommended in the 2019-CFG among adults aged 18-65 years. Development of the screener items was informed by a review of existing tools and mapping of items onto 2019-CFG recommendations. Face and content validity were assessed with experts in public health nutrition and/or dietary assessment (n = 16) and individuals from Government of Canada (n = 14). Cognitive interviews were conducted with English-speaking (n = 16) and French-speaking (n = 16) adults living in Canada to assess face validity and understanding of the screener items. While some modifications were identified to improve relevance or clarity, overall, the screener items were found to be relevant, well-constructed, and clearly worded. This comprehensive process resulted in the Canadian Eating Practices Screener/Questionnaire court canadien sur les pratiques alimentaires, which includes 21 items that assess eating practices recommended in the 2019-CFG. This screener can facilitate monitoring and surveillance efforts of the 2019-CFG eating practices as well as research exploring how these practices are associated with various health outcomes.

The Canadian Food Intake Screener for assessing alignment of adults' dietary intake with the 2019 Canada's Food Guide healthy food choices recommendations: scoring system and construct validity.

NOVELTY: The Canadian Food Intake Screener was developed to rapidly assess alignment of dietary intake with the 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, reasonable 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 h 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.

Development of the Canadian Food Intake Screener to assess alignment of adults' dietary intake with the 2019 Canada's Food Guide healthy food choices recommendations.

NOVELTY: The 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.

Micronutrient deficiencies are frequent in adult patients with and without celiac disease on a gluten-free diet, regardless of duration and adherence to the diet.

OBJECTIVES: The only treatment for celiac disease (CD) is a strict gluten-free diet (GFD). Nutritional deficiencies are common in CD; however, how this is influenced by the presence of symptoms, duration of CD, and compliance of GFD is less clear. The objective of this study was to compare nutritional deficiencies in patients with CD to those of nonceliac populations on a GFD. The secondary outcomes were to compare deficiencies in short- (<2 y) versus long-term (≥2 y) GFD, and in those with persistent symptoms versus asymptomatic. METHODS: We included patients seen at the McMaster Celiac Clinic from June 2018 to August 2020. GFD adherence was assessed with the Celiac Dietary Adherence Test, and CD serology, vitamins, and trace minerals were measured in blood samples. We enrolled 221 patients, including 182 patients with CD and 39 controls. RESULTS: Overall, 103 of 182 patients with CD (56.6%) were following a GFD for >2 y and 119 patients (69.2%) were symptomatic. The most common micronutrient deficiencies were zinc (48.3%), ferritin (16.9%), and vitamin D (33.3%). There were no differences in micronutrient deficiencies between patients with CD and nonceliac controls, short- and long-term GFDs, or those strictly compliant with GFD and those who were fairly compliant (P > 0.05). CONCLUSIONS: These data suggest that nutrient deficiencies may be related more to GFD nutritional inadequacy rather than malabsorption.

The relationship between diet quality and the severity of household food insecurity in Canada.

OBJECTIVE: To examine the relationship between the dietary quality of Canadian children and adults and household food insecurity status. DESIGN: Dietary intake was assessed with one 24-h recall. Households were classified as food secure or marginally, moderately or severely food insecure based on their responses to the Household Food Security Survey Module. We applied multivariable analyses of variance to determine whether % energy from ultra-processed foods, fruit and vegetable intake, Healthy Eating Index (HEI) scores, macronutrient composition and micronutrient intakes per 1000 kcal differed by food insecurity status after accounting for income, education and region. Analyses were run separately for children 1-8 years and 9-18 years and men and women 19-64 years of age. SETTING: Ten provinces in Canada. PARTICIPANTS: Respondents to the 2015 Canadian Community Health Survey-Nutrition, aged 1-64 years, with complete food insecurity data and non-zero energy intakes, N 15 909. RESULTS: Among adults and children, % energy from ultra-processed foods was strongly related to severity of food insecurity, but no significant trend was observed for fruit and vegetable intake or HEI score. Carbohydrate, total sugar, fat and saturated fat intake/1000 kcal did not differ by food insecurity status, but there was a significant negative trend in protein/1000 kcal among older children, a positive trend in Na/1000 kcal among younger children and inverse associations between food insecurity severity and several micronutrients/1000 kcal among adults and older children. CONCLUSIONS: With more severe household food insecurity, ultra-processed food consumption was higher, and diet quality was generally lower among both adults and children.

Single Nucleotide Polymorphisms in Taste Receptor Genes Are Associated with Snacking Patterns of Preschool-Aged Children in the Guelph Family Health Study: A Pilot Study.

Snacking is an integral component of eating habits in young children that is often overlooked in nutrition research. While snacking is a substantial source of calories in preschoolers' diets, there is limited knowledge about the factors that drive snacking patterns. The genetics of taste may help to better understand the snacking patterns of children. The rs1761667 single nucleotide polymorphism (SNP) in the CD36 gene has been linked to fat taste sensitivity, the rs35874116 SNP in the TAS1R2 gene has been related to sweet taste preference, and the rs713598 SNP in the TAS2R38 gene has been associated with aversion to bitter, green leafy vegetables. This study seeks to determine the cross-sectional associations between three taste receptor SNPs and snacking patterns among preschoolers in the Guelph Family Health Study. Preschoolers' snack quality, quantity, and frequency were assessed using three-day food records and saliva was collected for SNP genotyping (n = 47). Children with the TT genotype in TAS1R2 consumed snacks with significantly more calories from sugar, and these snacks were consumed mostly in the evening. Total energy density of snacks was highest in the CC and CG genotypes compared to the GG genotype in TAS2R38, and also greater in the AA genotype in CD36 compared to G allele carriers, however this difference was not individually attributable to energy from fat, carbohydrates, sugar, or protein. Genetic variation in taste receptors may influence snacking patterns of preschoolers.

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.

Food parenting practices and their association with child nutrition risk status: comparing mothers and fathers.

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 = <0.001) were associated with higher nutrition risk. No associations were found between child nutrition status and parental emotion regulation, control, monitoring, or restriction for weight. In conclusion, both mothers' and fathers' food parenting practices are associated with their children's nutrition status. Fathers should be included in food parenting practices interventions.