Food Insecurity Is Linked to Dietary Intake but Not Growth of Children in the Caribbean

ABSTRACT Objective: To examine food insecurity and its relationship with children's nutritional health. Methods: The data for the 390 children, aged 7-12 years and their caregivers, recruited from eight schools in Trinidad and seven schools in St. Kitts in 2013-2014 from a study dealing with food and nutrition security were used for this study. Food insecurity was assessed using the USDA's Household Food Security Survey Module, and 24-hour dietary recall of the children was assessed in home interviews. The children's height and weight were measured, and a capillary blood sample was collected at their schools. Results: Overall, 41.5% of the caregivers reported household food insecurity, with 15% of the children living in households with very low food security. Daily intakes of protein and zinc were higher among the children from the 'food secure' vs the 'food insecure' households (protein, 59.6 ± 31.5 g vs 50.9 ± 24.4 g, p = 0.003; zinc, 7.33 ± 5.02 mg vs 6.20 ± 3.47 mg, p = 0.004, respectively). There were no other differences in their dietary intake. The children's body mass index z-score, weight status and height-for-age z-score were not associated with their food security status, and there was no evidence of stunting in either group. Anaemia, however, was prevalent (30%) and higher among the children from the food insecure households (39% vs 23%; p = 0.002). Conclusion: Household food insecurity was was associated with lower intakes of some nutrients, and anaemia rates were higher among the children living in food insecure households but food insecurity was not related to the indicators of growth or weight status.

School food environments associated with adiposity in Canadian children.

BACKGROUND/OBJECTIVES: Targeting obesogenic features of children's environment that are amenable to change represents a promising strategy for health promotion. The school food environment, defined as the services and policies regarding nutrition and the availability of food in the school and surrounding neighborhood, is particularly important given that students travel through the school neighborhood almost daily and that they consume a substantial proportion of their calories at school. SUBJECTS/METHODS: As part of the Quebec Adipose and Lifestyle Investigation in Youth (QUALITY) cohort study, we assessed features of school indoor dietary environment and the surrounding school neighborhoods, when children were aged 8-10 years (2005-2008). School principals reported on food practices and policies within the schools. The density of convenience stores and fast-food outlets surrounding the school was computed using a Geographical Information System. Indicators of school neighborhood deprivation were derived from census data. Adiposity outcomes were measured in a clinical setting 2 years later, when participants were aged 10-12 years (2008-2011). We conducted cluster analyses to identify school food environment types. Associations between school types and adiposity were estimated in linear regression models. RESULTS: Cluster analysis identified three school types with distinct food environments. Schools were characterized as: overall healthful (45%); a healthful food environment in the surrounding neighborhood, but an unhealthful indoor food environment (22%); or overall unhealthful (33%). Less healthful schools were located in more deprived neighborhoods and were associated with greater child adiposity. CONCLUSIONS: Despite regulatory efforts to improve school food environments, there is substantial inequity in dietary environments across schools. Ensuring healthful indoor and outdoor food environments across schools should be included in comprehensive efforts to reduce obesity-related health disparities.

Muscle Mass Index and Animal Source of Dietary Protein Are Positively Associated with Insulin Resistance in Participants of the NuAge Study.

OBJECTIVES: Contribute evidence towards the complex interrelationships of body composition, insulin sensitivity and protein intake independently from adiposity in an older population. DESIGN: This is a cross-sectional analysis of an existing dataset in which a literature-supported model linking together the variables of interest is tested using path analysis. SETTING: The loss of muscle mass has been implicated in the development of insulin resistance. We propose to test associations of muscle mass with insulin sensitivity and their respective associations with animal and vegetable sources of protein intake, independently from adiposity. PARTICIPANTS: Non-diabetic participants aged 68-82 years from the NuAge study with all available measures (n=441) were included. MEASUREMENTS: A model considering age, sex, chronic diseases, physical activity; smoking and sources of protein intake influencing body composition components and insulin sensitivity was created and tested with Path Analysis for their independent associations. Muscle mass index (MMI; kg/height in m2) and % body fat were derived from DXA and BIA. Insulin resistance was estimated by the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) score and physical activity by the Physical Activity Scale for the Elderly (PASE) questionnaire. Protein intakes were obtained from three non-consecutive 24h-diet recalls. RESULTS: In the final model, direct positive associations were observed between HOMA-IR score and MMI (ß=0.42; 95%CI: 0.24; 0.6) and % body fat (ß=0.094; 95%CI: 0.07; 0.11). There were no direct associations between animal protein intake and MMI or with HOMA-IR. There was a significant direct negative association between plant protein intake and MMI (ß= -0.068; 95%CI: -0.13; -0.003) and significant indirect associations mediated through MMI and % body fat between HOMA-IR and animal protein intake (ß=0.0321; 95%CI: 0.01; 0.05), as well as plant protein intake (ß= -0.07; 95%CI: -0.1; 0.0). CONCLUSIONS: Our final model indicated that MMI and HOMA score were significantly positively associated. Protein intake sources were related to HOMA-IR score differently through MMI and % body fat, respectively.

Intakes of folate, vitamin B6 and B12 and risk of depression in community-dwelling older adults: the Quebec Longitudinal Study on Nutrition and Aging.

BACKGROUND/OBJECTIVES: Depression can decrease quality of life and affect health outcomes in older population. We investigated whether different intake levels of folate, vitamin B6 and B12 were associated with a 3-year depression incidence among generally healthy, community-dwelling older men and women. SUBJECTS/METHODS: Participants in the Québec Longitudinal Study on Nutrition and Aging (NuAge), free of depression (that is, 30-item Geriatric Depression Scale (GDS) <11) at baseline (N=1368; 74 ± 4 years old; 50.5% women), were screened annually for incident depression (GDS ⩾ 11) or antidepressant medication. Tertiles of intakes (food only and food+supplements) were obtained from the mean of three non-consecutive 24-h recalls at baseline. Sex-stratified multiple logistic regression models were adjusted for age, physical activity, physical functioning, stressful life events and total energy intake. RESULTS: Over 3 years, 170 participants were identified as depressed. Women in the highest tertile of B6 intake from food were 43% less likely to become depressed when adjusting for demographic and health factors (multivariate odds ratio (OR) 0.57, 95% confidence interval (CI) 0.39-0.96), but adjustment for energy intake attenuated the effect. Men in the highest tertile of dietary B12 intake had decreased risk of depression (energy-adjusted multivariate OR 0.42, 95% CI 0.20-0.90). No other association was observed. CONCLUSIONS: This study provides some evidence of decreased depression risk among women with higher intakes of vitamin B6 from food, which was dependent on total energy intake, and among men with higher intakes of B12 from food, independently of energy intake.

Dietary patterns and incidence of depression in a cohort of community-dwelling older Canadians.

OBJECTIVES: To investigate the association of dietary patterns with a 3-year incidence of depression among healthy older adults. DESIGN: Multiple logistic regression models adjusted for age, sex, marital status, smoking, education, total energy intake, physical activity, body mass index, hypertension, functional autonomy, cognitive functioning, social activities, and stressful life events. Energy and macronutrient intakes were also analyzed as potential predictors of depression. SETTING: Cities of Montréal, Laval, and Sherbrooke in Quebec, CA. PARTICIPANTS: Community-dwelling older adults, free of depression at baseline (N=1,358, 67-84 y), followed for 3y in the Québec Longitudinal Study on Nutrition and Aging (NuAge). MEASUREMENTS: Dietary patterns derived from principal components analysis of three 24 h-recalls at baseline, and depression incidence as measured by the 30-item Geriatric Depression Scale (≥11) and/or use of antidepressants at follow-up years. RESULTS: 170 people (63% women) became depressed over the 3 years. People in the highest tertile of adherence to the "varied diet" had lower risk of depression before adjustment (OR 0.58, 98% C.I. 0.38-0.86) but not significant once age and sex were controlled. No other dietary pattern was associated with the incidence of depression. The highest tertile of energy intake was associated with lower depression incidence after controlling for all confounders (OR 0.55, 95%CI 0.34-0.87). CONCLUSION: Among healthy older adults, dietary patterns do not appear to be related to depression. Those who eat less, however, possibly reflecting declining health, are at higher risk of becoming depressed.

Measuring changes in nutritional knowledge: a nutrition education intervention among primary school children in Trinidad and Tobago

OBJECTIVE: To measure changes in nutritional knowledge among primary school children aged 6-12 years in Trinidad and Tobago. DESIGN AND METHODS: This study utilized a randomized experimental design. Eight government primary schools from two geographical regions with students aged 6-12 years from varied socioeconomic status in Trinidad participated in the study. A paired design, matched on geographical region and school population size was used to randomly assign schools to one of the four groups, i.e., (1) menu modification plus and nutrition education (MM plus NE), (2) menu modification (MM) alone, (3) nutrition education (NE) alone, and (4) control group. RESULTS: An analysis of changes in nutrition knowledge score on the 15-item pre/post tests indicated higher scores for three groups: MM plus NE, NE alone, and the control. Specifically, a statistically significant mean increase from baseline of 1.47 points for MM plus NE group, 0.61 points for NE group, and 1.19 points for the control group was found. Statistically significant differences were observed in the treatment groups receiving NE when compared to the control for level of nutrition knowledge. At post-intervention, the highest score was in the MM plus NE (p < 0.01), which was significantly higher than the control or MM. Further, mean knowledge scores for NE and MM plus NE were significantly higher than MM (p < 0.01). CONCLUSION: The researchers concluded that both interventions together had greater improvements in knowledge scores than the MM alone group but not compared to the control group.

Insulin secretion and its association with physical activity, fitness and screen time in children.

OBJECTIVES: To determine the independent associations of moderate to vigorous physical activity (MVPA), fitness, screen time, and adiposity with insulin secretion in children. DESIGN AND METHODS: Caucasian youth (n = 423/630), 8-10 years old, with at least one obese biological parent, were studied (QUALITY cohort). Insulin secretion was measured using HOMA2-%B, area under the curve (AUC) of insulin to glucose over the first 30 minutes (AUC I/G(t30min)) of the OGTT and AUC I/G(t120min) over 2 hours. Fitness was measured by VO2peak ; percent fat mass (PFM) by DXA; 7-day MVPA by accelerometry; self-reported screen time included television, video game, or computer use. Models were adjusted for age, sex, season, puberty, PFM, and insulin sensitivity [IS] (HOMA2-IS, Matsuda-ISI). RESULTS: PFM was strongly associated with insulin secretion, even after adjustment for IS: for every 1% increase in PFM, insulin secretion increased from 0.3% to 0.8% across indices. MVPA was negatively associated with HOMA2-%B (P < 0.05), but not with OGTT-derived measures. Fitness was negatively associated with AUC I/G(t120min) (P < 0.05). Screen time showed a trend toward higher HOMA2-%B in girls (P = 0.060). CONCLUSIONS: In children with an obese parent, lower insulin secretion is associated with lower adiposity, higher MVPA, better fitness, and possibly reduced screen time.

Do implant overdentures improve dietary intake? A randomized clinical trial.

People wearing mandibular two-implant overdentures (IOD) chew food with less difficulty than those wearing conventional complete dentures (CD). However, there is still controversy over whether or not this results in better dietary intake. In this randomized clinical trials (RCT), the amounts of total dietary fiber (TDF), macronutrients, 9 micronutrients, and energy in diets consumed by persons with IOD and CD were compared. Male and female edentate patients ≥ 65 yrs (n = 255) were randomly divided into 2 groups and assigned to receive a maxillary CD and either a mandibular IOD or a CD. One year following prosthesis delivery, 217 participants (CD = 114, IOD = 103) reported the food and quantities they consumed to a registered dietician through a standard 24-hour dietary recall method. The mean and median values of TDF, macro- and micronutrients, and energy consumed by both groups were calculated and compared analytically. No significant between-group differences were found (ps > .05). Despite quality-of-life benefits from IODs, this adequately powered study reveals no evidence of nutritional advantages for independently living medically healthy edentate elders wearing two-implant mandibular overdentures over those wearing conventional complete dentures in their dietary intake at one year following prosthesis delivery.

Baseline determinants of global diet quality in older men and women from the NuAge cohort.

UNLABELLED: Judicious food choices are of prime importance during aging. OBJECTIVES: This study was conducted to identify individual and collective attributes determining global diet quality (DQ). METHODOLOGY: Participants were 1,793 adults (52% women) from the NuAge study on nutrition and successful aging. Subjects aged 67 to 84 years in relatively good health were recruited from the Québec Medicare Database. Sociodemographic, affective, and cognitive data, health conditions, perceived physical health and functional status, dietary habits and dietary attributes and community resources were obtained using questionnaires. Body weight and height were measured and body mass index (BMI) was calculated. Three non-consecutive 24-hour diet recalls were collected at recruitment. DQ, assessed using the Canadian Healthy Eating Index (C-HEI, /100), was computed on the mean intakes from the diet recalls. Analyses were stratified by gender. Variables significantly related to DQ in bivariate analyses (p<.05) were entered into backward stepwise multiple regression analyses. RESULTS: Among men, the final model showed higher education (ß=0.23, p=.01), diet knowledge (ß=0.96, p<.0001), number of daily meals (ß=1.91, p=.02) and perceived physical health (ß=0.06, p=.01) to be positive determinants of DQ, whereas alcohol consumption (ß=-2.25, p=.05), wearing dentures (ß=-2.31, p=.01) and eating regularly in restaurants (ß=-1.65, p=.03) were negative determinants of DQ (adjusted R2 = 13.7%). Among women, higher education (ß=0.29, p=.002), diet knowledge (ß=0.54, p=.002), number of daily meals (ß=3.61, p<.0001), and hunger (ß=0.61, p<.0001) were positive determinants of global DQ; greater BMI (ß=-0.16, p=.03) and chewing problems (ß=-0.48, p=.03) were negative determinants of DQ (adjusted R2 = 7.8%). DISCUSSION: These results point to several key factors influencing global DQ in older adults and also show gender-based differences. More research must be done to better understand how these factors change with aging and exert their impact on diet, particularly since variance in DQ was largely unexplained. As diet knowledge was an independent predictor for both genders, targeted, sustainable interventions are needed to ensure good diet quality as people age.

Adiposity and glucose intolerance exacerbate components of metabolic syndrome in children consuming sugar-sweetened beverages: QUALITY cohort study.

BACKGROUND: Sugar-sweetened beverage (SSB) consumption is linked to weight gain and metabolic syndrome (MetS) components in children, but whether these associations are modified by excess weight and glucose tolerance status in children is not known. OBJECTIVE: The objective of this study was to examine the cross-sectional associations between SSB intake and MetS components among children above and below the 85th body mass index (BMI) percentile and those with and without impaired glucose tolerance (IGT). METHODS: Data were from the QUébec Adiposity and Lifestyle InvesTigation in Youth study (2005-2008). Caucasian children aged 8-10 years (n = 632) were recruited from 1040 primary schools in Québec, Canada. SSB consumption was assessed by three 24-h dietary recalls, body fat mass by dual-energy absorptiometry, physical activity by 7-d accelerometer. Multivariate linear regressions were used, with age, sex, fat mass index and physical activity as covariates, including waist circumference (WC), systolic blood pressure (SBP), concentrations of triglyceride and high-density lipoprotein cholesterol and homeostasis model assessment of insulin resistance (HOMA-IR) as outcome variables. RESULTS: Among overweight children, a 100-mL higher SSB consumption was associated with a 0.1-unit higher HOMA-IR (P = 0.009) and a 1.1-mm Hg higher SBP (P = 0.001). In children with IGT, a 100-mL higher SSB consumption was associated with a 1.4-mm Hg higher SBP and a 4.0-cm higher WC (P < 0.001). These associations were not observed among children <85th BMI percentile. CONCLUSIONS: Our results suggest that the association between higher SSB consumption and MetS components is more evident in overweight/obese and glucose-intolerant children.

Implant overdentures and nutrition: a randomized controlled trial.

We conducted a randomized clinical trial to determine whether providing simple mandibular implant overdentures (IODs) to elderly individuals would give them a significantly better nutritional profile than those who receive complete dentures (CDs). Two hundred fifty-five edentate patients > 65 yrs were randomly assigned to receive maxillary CDs and mandibular IODs (n = 128) or CDs (n = 127). Six-month and one-year post-treatment outcomes were blood plasma levels of homocysteine (tHcy), vitamin B12, vitamin B6, albumin, serum folate, and C-reactive protein concentrations, as well as dietary intake. The association between treatment and tHcy levels was not statistically significant. A decline of folate from baseline values in both study groups, as well as those of vitamins B6 and B12 and albumin, was observed. Significant between-group differences were detected in food preparation and in the individuals' ability to chew a variety of foods. This study suggests that implant overdentures do not have a more positive effect on the nutritional state of elderly edentate individuals at 6 and 12 mos post-treatment than new complete dentures. However, those wearing IODs are significantly more likely to take in their nutrients through fresh, whole fruits and vegetables.

Higher vitamin D intake is needed to achieve serum 25(OH)D levels greater than 50 nmol/l in Québec youth at high risk of obesity.

BACKGROUND/OBJECTIVES: Vitamin D levels are often observed to be low in Canadian youth, despite the mandatory fortification of fluid milk. We identified modifiable correlates of plasma vitamin D concentrations to inform public health efforts to remediate low-vitamin D status. SUBJECTS/METHODS: We recruited 159 children aged 8-11 years, who were at at high risk of obesity, non-systematically during different seasons. Vitamin D status was assessed by measuring plasma 25-hydroxyvitamin D (25(OH)D) using a radioimmunoassay. Dietary intake, including vitamin supplements, was measured using three dietitian-administered 24 h diet recalls. Fat mass was measured by dual energy X-ray absorptiometry. Accelerometers were worn for 7 days to estimate physical activity. Independent correlates of plasma 25(OH)D concentrations were identified using multiple regression in an analysis controlling for season of measurement. RESULTS: Approximately, 7% of youth had hypovitaminosis D (25(OH)D ≤37.5 nmol/l) during winter and spring when vitamin D levels are at their nadir. Only 55% of participants had vitamin D levels, which the Institute of Medicine considers optimal (25(OH)D >50 nmol/l). The mean dietary vitamin D intake, 6.6 mcg, was well below current recommendations set at 15 mcg. A serving increase in milk consumption and a s.d. increase in physical activity were associated with only a 2.9 and 2.1 nmol/l increase in plasma 25(OH)D, respectively. There was no association between 25(OH)D and adiposity. CONCLUSIONS: Our results indicate the challenges of obtaining adequate vitamin D intake from the current food supply to support a level of 25(OD)D >50 nmol/l.

The physical functional capacity of frail elderly persons undergoing ambulatory rehabilitation is related to their nutritional status.

OBJECTIVES: To estimate the prevalence of malnutrition in frail elders undergoing rehabilitation and the association between their nutritional status and physical function. DESIGN: Observational study of new participants undergoing ambulatory rehabilitation. SETTING: Two Geriatric Day Hospitals (GDH) in Montreal, Quebec. PARTICIPANTS: 121 women and 61 men. INTERVENTION: Evaluation of nutritional status, body composition and physical function. MEASUREMENTS: The nutritional status was assessed with a composite index based on anthropometric measurements and serum albumin, as well as using the Mini Nutritional Assessment (MNA) questionnaire. Patients were classified as well-nourished, having mild/at risk of malnutrition or malnourished. Body composition was estimated by bioimpedance and handgrip strength and gait speed by standard methods. RESULTS: 13% of patients were found to be mildly malnourished, whereas 6% were malnourished. Malnourished patients were older and had worse cognition, lower BMI, and % body fat (all p<0.05). Malnourished patients and those with mild malnutrition had lower weight, triceps skinfold thickness, muscle and fat mass (all, p<0.003). Handgrip strength was different according to the nutritional status (p=0.034) and correlated with muscle mass (r=0.65, p<0.001). MNA classified 53% of patients as being at risk whereas 3% were malnourished and it correlated with gait speed (r=0.26, p=0.001). CONCLUSION: There is a high prevalence of patients in GDH at risk or with mild malnutrition. Being malnourished was associated with worse physical performance, which suggests that a nutritional intervention may be of benefit in improving their physical function.

Peanut-free guidelines reduce school lunch peanut contents.

BACKGROUND: Some schools implement peanut-free guidelines (PFG) requesting omission of peanut from lunches. Our study assessed parental awareness of, and adherence to, PFG by comparing the percentage of lunches containing peanut between primary school classes with and without PFG in Montreal, Québec. METHODS: Parents, school principals and teachers were queried concerning the school's PFG and children's lunches were inspected by a dietician for peanut-containing foods. RESULTS: When lunch peanut contents were compared in randomly selected classrooms, peanut was found in 5/861 lunches in classes with PFG (0.6%, 95% CI 0.2% to 1.4%) and in 84/845 lunches in classes without PFG (9.9%, 95% CI 8.0% to 12.2%), a 9.4% (95% CI 7.3% to 11.4%) difference. CONCLUSIONS: Our findings demonstrate that PFG are effective in reducing peanut in classrooms providing a basis for future research that should address whether or not the reduction in peanut achieved by restrictive lunch policies decreases the morbidity associated with peanut allergy in the school setting.

Increased body fat percentage and physical inactivity are independent predictors of gestational diabetes mellitus in South Asian women.

OBJECTIVE: This study aims to identify lifestyle predictors of gestational diabetes mellitus (GDM) in South Asian women. Pre-gravid body mass index, body composition, rate of weight gain during pregnancy, physical activity (PA) and dietary intake were studied. DESIGN: Prospective cohort study (n=611) of South Asian women at Aga Khan University Hospital antenatal clinic in Karachi, Pakistan. Weight, height and body fat % were measured and data on PA, diet and socio-economic covariates were collected at baseline. A glucose screen was performed at 29.8+/-2.6 weeks. RESULTS: Using logistic regression analysis for the full cohort, the risk of GDM increased with older maternal age (odds ratio (OR) 1.13, confidence interval (CI) 1.06-1.21), increased body fat % (OR 1.07, CI 1.03-1.13) and the risk was inversely associated with PA (100 kcal) (OR 0.79-0.99, CI 0.89). Using a nested case (n=49) control (n=98) design to study dietary intake, the risk of GDM decreased with increasing protein (% energy) in the diet (OR 0.75, CI 0.60-0.95). CONCLUSIONS: Body fat %, physical inactivity and, possibly, diet quality are important modifiable risk factors for GDM. 2006.

Full-term, peri-urban South African infants under 6 months of age are at risk for early-onset anaemia.

OBJECTIVE: There is a paucity of data on the micronutrient status of low-income, lactating South African women and their infants under 6 months of age. The aim of this study was to elucidate the level of anaemia and vitamin A deficiency (VAD) in peri-urban breast-feeding women and their young infants. DESIGN: Cross-sectional study including anthropometric, biochemical and infant feeding data. SETTING: Peri-urban settlement in Cape Town, South Africa. SUBJECTS: Breast-feeding women (n=113) and their infants (aged 1-6 months) attending a peri-urban clinic. RESULTS: Mean (standard deviation (SD)) haemoglobin (Hb) of the lactating mothers was 12.4 (1.3) g dl(-1), with 32% found to be anaemic (Hb<12 g dl(-1)). Maternal serum retinol was 49.8 (SD 13.3) microg dl(-1), with 4.5% VAD. Using breast milk, mean (SD) retinol concentration was found to be 70.6 (24.6) microg dl(-1) and 15.7 (8.3) microg/g milk fat, with 13% below the cut-off level of <8 microg/g fat. There was no correlation found between breast milk retinol and infant serum retinol. Z-scores (SD) of height-for-age, weight-for-age and weight-for-height were -0.69 (0.81), 0.89 (1.01) and 1.78 (0.83), respectively. Mean (SD) infant Hb was 10.9 (1.1) g dl(-1), with the prevalence of anaemia being 50%, 33% and 12% using Hb cut-offs below 11 g dl(-1), 10.5 g dl(-1) and 9.5 g dl(-1), respectively. Mean (SD) infant serum retinol was 26.9 (7.2) microg dl(-1), with 10% being VAD. None of the infants was exclusively breast-fed, 22% were predominantly breast-fed and 78% received complementary (mixed) breast-feeding. Thirty-two per cent of infants received weaning foods at an exceptionally young age (< or =1 month old). CONCLUSION: A high rate of anaemia is present in lactating women residing in resource-poor settings. Moreover, their seemingly healthy infants under 6 months of age are at an elevated risk of developing early-onset anaemia and at lower risk of VAD.

Implications of day-to-day variability on measurements of usual food and nutrient intakes.

Day-to-day variability in dietary intake makes it difficult to measure accurately the "usual" intake of foods and nutrients. The objectives of the present study were to estimate within- and between-subject variability for foods and nutrients by adjusted and unadjusted models and to assess the number of days required to assess nutrient and food group intakes accurately by two different methods. Adult men and women aged 18-65 y (n = 1543) in the Food Habits of Canadians Study provided a 24-h recall. A repeat interview was conducted in a subsample to estimate components of variability. Within- and between-subject variability were determined by mixed model procedure (crude and adjusted for age, gender, education, smoking, family size and season). The number of days required to obtain various degrees of accuracy was ascertained by two methods, one that uses the variance ratio for groups and one that considers within-subject variability alone for individuals. Variance ratios were higher using the adjusted compared with the unadjusted method (e.g., for men, energy 1.07 vs. 0.49). More days were required to reflect usual intake with accuracy using the adjusted model (energy 5 vs. 2 d), indicating the need to control for confounders to obtain reliable estimates of intakes.

Food habits of Canadians: comparison of intakes in adults and adolescents to Canada's food guide to healthy eating.

Over 25 years have elapsed since national food and nutrient intake data became available in Canada. Our goal was to describe present dietary intakes based on sociodemographic and 24-hour recall dietary interviews with adults and adolescents from households across the country. Within a multistage, stratified random sample of 80 enumeration areas, 1,543 randomly selected adults (aged 18-65) were enrolled in the study; 178 adolescents within the sampled households also participated. A comparison of food intake with Canada's Food Guide to Healthy Eating indicated that only males aged 13-34 met the minimum recommended intake levels for all four food groups. Mean milk products intake was below the minimum recommended level for all age groups of females and for men aged 35-65 years. Adolescent girls had low intakes of meat and alternatives. Daily grain product intakes were below five servings for women aged 50-65, as were vegetable and fruit intakes for women aged 18-40. Food choices from the "other foods" group contributed over 25% of energy and fat intake for all age and gender groups. These up-to-date data will be useful to dietitians, nutrition researchers, industry, and government in their efforts to promote Canadians' continued progress toward meeting food intake recommendations.

Fruit and vegetable consumption is lower and saturated fat intake is higher among Canadians reporting smoking.

Understanding differences in dietary patterns by smoking status is important for nutritionists and health educators involved in helping individuals to make healthy dietary and lifestyle choices. Although smokers have a poor quality diet compared with nonsmokers, no study has examined nutritional adequacy and variability in the nutrient intake of smokers. The aim of this study was to compare dietary habits of smokers with nonsmokers in terms of nutrient intake, food groups contributing to nutrient intake, nutritional adequacy and day-to-day variation in nutrient intake. Noninstitutionalized adults aged 18--65 y (n = 1543) who participated in the Food Habits of Canadians Survey (1997--1998) were studied. Subjects, selected from across Canada using a multistage, random-sampling strategy, completed an in-home 24-h dietary recall. Repeat interviews were conducted in a subsample to estimate variability in nutrient intake. Smokers had higher intakes of total and saturated fat, and lower intakes of folate, vitamin C and fiber than nonsmokers. There were no significant differences in calcium, zinc and vitamin A intakes or day-to-day variation in nutrient intake by smoking status. Smokers consumed significantly fewer fruits and vegetables than nonsmokers, leading to lower intakes of folate and vitamin C. In conclusion, smokers have a less healthy diet than nonsmokers, placing them at higher risk for chronic disease as a result of both dietary and smoking habits. Diet may act as a confounder in smoking-disease relationships.

Intervening to reduce weight gain in pregnancy and gestational diabetes mellitus in Cree communities: an evaluation.

BACKGROUND: A high prevalence of gestational diabetes mellitus and type 2 diabetes has been observed among the Cree of James Bay, Quebec. To address this problem, a diet and activity intervention during pregnancy, which was based on social learning theory, was initiated in 4 Cree communities. METHODS: A prospective intervention compared dietary, weight and glycemic indicators for 107 control subjects and for 112 women who received the intervention during the course of their pregnancy. A control period in 4 communities (July 1995-March 1996) was followed by an intervention period (April 1996-January 1997) when subjects were offered regular, individual diet counselling, physical activity sessions and other activities related to nutrition. RESULTS: The intervention and control groups did not differ at baseline regarding their mean age (24.3 years [SD 6.29] v. 23.8 years [SD 5.86]), mean prepregnancy weight (81.0 kg [SD 19.46] v. 78.9 kg [SD 17.54]) and mean gestational age at recruitment (17.1 weeks [SD 7.06] v. 18.5 weeks [SD 6.92]). The intervention did not result in differences in diet measured at 24-30 weeks' gestation, rate of weight gain over the second half of pregnancy (0.53 kg per week [SD 0.32] v. 0.53 kg per week [SD 0.27]) or plasma glucose level (50 g oral glucose screen) between 24 and 30 weeks (7.21 mmol/L [SD 2.09] v. 7.43 mmol/L [SD 2.10]). Mean birth weights were similar (3741 g [SD 523] v. 3686 g [SD 686]), as was maternal weight at 6 weeks post partum (88.1 kg [SD 16.8] v. 86.4 kg [SD 19.0]). The only changes in dietary intake were a reduction in caffeine (pregnancy) and an increase in folate (post partum). INTERPRETATION: This intervention had only a minor impact on diet; finding ways of encouraging appropriate body weight and activity levels remains a challenge.