Development of the Healthy Eating Food Index (HEFI)-2019 measuring adherence to Canada's Food Guide 2019 recommendations on healthy food choices.

The release of Canada's Food Guide (CFG) in 2019 by Health Canada prompted the development of indices to measure adherence to these updated dietary recommendations for Canadians. This study describes the development and scoring standards of the Healthy Eating Food Index (HEFI-2019), which is intended to measure alignment of eating patterns with CFG-2019 recommendations on food choices among Canadians aged 2 years and older. Alignment with the intent of each key recommendation in the CFG-2019 was the primary principle guiding the development of the HEFI-2019. Additional considerations included previously published indices, data on Canadians' dietary intakes from the 2015 Canadian Community Health Survey-Nutrition, and expert judgement. The HEFI-2019 includes 10 components: Vegetables and fruits (20 points), Whole-grain foods (5 points), Grain foods ratio (5 points), Protein foods (5 points), Plant-based protein foods (5 points), Beverages (10 points), Fatty acids ratio (5 points), Saturated fats (5 points), Free sugars (10 points), and Sodium (10 points). All components are expressed as ratios (e.g., proportions of total foods, total beverages, or total energy). The HEFI-2019 score has a maximum of 80 points. Potential uses of the HEFI-2019 include research as well as monitoring and surveillance of food choices in population-based surveys. Novelty: The Healthy Eating Food Index-2019 was developed to measure adherence to the 2019 Canada's Food Guide recommendations on healthy food choices. The HEFI-2019 includes 10 components, of which 5 are based on foods, 1 on beverages and 4 on nutrients, for a total of 80 points.

Evaluation of the Healthy Eating Food Index (HEFI)-2019 measuring adherence to Canada's Food Guide 2019 recommendations on healthy food choices.

The objective of this study was to evaluate the construct validity and reliability of the Healthy Eating Food Index-2019 (HEFI-2019), which was developed to measure adherence to Canada's Food Guide 2019 (CFG-2019) recommendations on healthy food choices. Dietary intake data from 24-hour dietary recalls in the 2015 Canadian Community Health Survey-Nutrition were used for that purpose. Multidimensionality was examined using principal component analysis. Mean scores were compared among subgroups of the population. The association between scores and energy intake was assessed using Pearson correlations. Cronbach's alpha was calculated to assess reliability. The estimated mean HEFI-2019 score (/80) was 43.1 (95% CI, 42.7 to 43.6) among Canadians aged 2 years and older. The first and 99th percentiles were 22.1 and 62.9 points. The mean HEFI-2019 score for smokers was 7.2 points lower than for non-smokers (95% CI, -8.5 to -5.9). The HEFI-2019 was weakly correlated with energy intake (r = -0.13; 95% CI, -0.20 to -0.06). The principal components analysis revealed at least 4 dimensions. Cronbach's alpha was 0.66 (95% CI, 0.63 to 0.69). Evidence of construct validity and internal consistency support the use of the HEFI-2019 to assess adherence to CFG-2019's recommendations on healthy food choices. Novelty: Examination of the HEFI-2019's psychometric properties is needed prior to implementation. Analyses support the construct validity and internal consistency of the HEFI-2019. Interpretation of the total HEFI-2019 score must be accompanied by its components' scores, considering it assesses multiple dimensions of food choices.

Free Sugars Consumption in Canada.

Free sugars (FS) are associated with a higher risk of dental decay in children and an increased risk of weight gain, overweight and obesity and type 2 diabetes. For this reason, Canada's Food Guide recommends limiting foods and beverages that contribute to excess free sugars consumption. Estimating FS intakes is needed to inform policies and interventions aimed at reducing Canadians' consumption of FS. The objective of this study was to estimate FS intake of Canadians using a new method that estimated the free sugars content of foods in the Canadian Nutrient File, the database used in national nutrition surveys. We define FS as sugars present in food products in which the structure has been broken down. We found that 12% of total energy (about 56 g) comes from FS in the diet of Canadians 1 year of age and older (≥1 year). The top four sources were: (1) sugars, syrups, preserves, confectionary, desserts; (2) soft drinks; (3) baked products and (4) juice (without added sugars), and accounted for 60% of total free sugars intake. The results show that efforts need to be sustained to help Canadians, particularly children and adolescents, to reduce their FS intake.

International approaches to developing healthy eating patterns for national dietary guidelines.

As part of the revision of the 2007 Eating Well with Canada's Food Guide, a literature scan on statistical modeling approaches used in developing healthy eating patterns for national food guides was conducted. The scan included relevant literature and online searches, primarily since the 2007 Canada's Food Guide was released. Eight countries were identified as utilizing a statistical model or analysis to help inform their healthy eating pattern, defined as the amounts and types of food recommended, with many common characteristics noted. Detail on international modeling approaches is presented, highlighting similarities and differences as well as strengths and challenges.

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.

A surveillance tool to assess diets according to Eating Well with Canada's Food Guide.

BACKGROUND: A surveillance tool was developed to assess dietary intake collected by surveys in relation to Eating Well with Canada's Food Guide (CFG). The tool classifies foods in the Canadian Nutrient File (CNF) according to how closely they reflect CFG. This paper describes the validation exercise conducted to ensure that CNF foods determined to be "in line with CFG" were appropriately classified. DATA AND METHODS: With statistical modelling, 8,000 simulated diets (500 for each of the 16 Dietary Reference Intake [DRI] age/sex groups) were generated using commonly consumed foods classified as "in line with CFG." Criteria for assessing the energy content and nutrient distributions of the simulated diets were based on factors considered in the development of CFG, including Estimated Energy Requirement (EER) and Dietary Reference Intake (DRI) values. RESULTS: The median energy content of the simulated diets was at or below reference EERs. Most age/sex group distributions had macronutrient profiles that met the assessment criterion of 80% of the distribution within the Acceptable Macronutrient Distribution Range, and almost all age/sex group distributions had a low prevalence (less than 10%) of micronutrient profiles below the Estimated Average Requirements. Overall, the findings indicate that diets consisting of foods that are commonly consumed by Canadians and that are "in line with CFG" have a low probability of energy excess and nutrient inadequacy. INTERPRETATION: The classification of foods in the CNF accurately reflects CFG recommendations and can be used to assess surveillance data.

After-school snack intake among Canadian children and adolescents.

OBJECTIVES: The article describes the after-school (AS) snacking pattern of young Canadians and its relationship with the amount of energy consumed daily and at dinner. METHODS: We analyzed cross-sectional dietary data, measured by 24h recall, from 9,131 children and adolescents aged 4 to 18 years from the Canadian Community Health Survey, cycle 2.2 (2004). We evaluated AS snack intake; i.e., foods consumed Monday to Friday between 3:00 and 6:00 pm, excluding lunch and dinner. We also assessed the consumption frequency of AS snack items, the energy provided by AS snacks and total daily energy intake (TDEI) by age group and sex. RESULTS: Approximately 63% of respondents consumed AS snacks. AS snacks provided on average 1212[95%CI,1157-1268] kJ (290[95%CI,276-303] kcal), representing 13[95%CI,12-13]% of TDEI. Youth who consumed AS snacks contributing 1-418 kJ (1-99 kcal) reported lower TDEI than those who consumed no snack. Among AS snack consumers, TDEI was higher in groups consuming the highest amount of energy from AS snacks. Fruits were among the most frequently consumed food categories. However, the largest energy contributors were mostly foods that may be energy-dense and nutrient-poor, such as cookies, sugar-sweetened beverages and sweets. CONCLUSION: Considering that the majority of children and adolescents consumed AS snacks, that these snacks provided about 13% of their TDEI, and that the majority of the most frequently consumed snacks were generally energy-dense, nutrient-poor foods, the AS time period presents an opportunity to promote healthy eating in order to improve diet quality and potentially influence TDEI among Canadian children and adolescents.

Relation between appetite ratings before and after a standard meal and estimates of daily energy intake in obese and reduced obese individuals.

The aim of the present study was to relate appetite ratings before and after a standard breakfast to estimates of daily energy intake, before and after weight loss obese men and women. Nineteen obese subjects (9 men and 10 women) took part in a 15-week drug-based weight-loss program coupled to energy intake restriction. Body weight and body composition were significantly decreased in men and women. Both before and after the weight loss program, desire to eat, hunger, fullness and prospective food consumption (PFC) were measured after an overnight fast and at 10-min intervals in the hour following the ingestion of a standardized breakfast. Energy intakes were also measured and reported before and after weight loss. Fasting desire to eat and postprandial area under the curve (AUC) for hunger were significantly increased (p<0.05) after the intervention. No association was observed between measured or reported energy intakes and appetite ratings before weight loss in either men or women. Reported energy intake was not associated with appetite sensations after weight loss either. In contrast, measured energy intake was significantly associated with postprandial AUC for fullness (r=-0.90, p<0.01) and PFC (r=0.80, p<0.01) in men at the end of the program. In stepwise multiple regression analysis, only postprandial AUC for PFC contributed independently to the variance of measured energy intake after weight loss (r(2)=0.60, p=0.01). This study did not show consistent associations between averaged appetite ratings after a meal and daily energy intake, either before or after weight loss.

Greater than predicted decrease in energy expenditure during exercise after body weight loss in obese men.

This study was performed retrospectively to investigate whether exercise energy expenditure (EE) measured during a standardized treadmill protocol (4.5 km/h at 0% grade) falls below predicted values after body weight loss in obese men. A reference equation was established to predict net exercise EE in a control sample of 83 obese individuals (27 kg/m(2)< or = body mass index <45 kg/m(2)), using age, fat mass and fat-free mass as independent variables. This equation was then used to predict net exercise EE in another group of 11 obese men before and after a 15-week drug-based weight loss programme that was coupled with energy restriction [-2929 kJ/day (-700 kcal/day)]. Body weight and body composition were determined by hydrodensitometry. Net exercise EE, insulin, leptin, 3,3',5-tri-iodothyronine and free thyroxine were measured after an overnight fast at baseline and 2-4 weeks after the end of the programme, when subjects were weight stable. Body weight was significantly reduced (-11%; P <0.01) at the end of the weight loss programme. At baseline, measured net exercise EE was similar to that predicted from the regression equation [19.6 and 19.8 kJ/min (4.69 and 4.74 kcal/min) respectively; not significant]. However, after the end of the intervention, measured net exercise EE was significantly below the predicted value [15.5 and 17.3 kJ/min (3.71 and 4.14 kcal/min) respectively; P <0.01]. The difference between the predicted and the measured fall in net exercise EE was significantly associated with changes in leptin concentration ( r =0.79, P <0.01), even after correction for changes in fat mass and insulin. These observations suggest that net exercise EE falls below predicted values after body weight loss. In addition, this greater than predicted decrease in net exercise EE was associated with changes in leptin.