Food environment research in Canada: a rapid review of methodologies and measures deployed between 2010 and 2021.

Numerous research methodologies have been used to examine food environments. Existing reviews synthesizing food environment measures have examined a limited number of domains or settings and none have specifically targeted Canada. This rapid review aimed to 1) map research methodologies and measures that have been used to assess food environments; 2) examine what food environment dimensions and equity related-factors have been assessed; and 3) identify research gaps and priorities to guide future research. A systematic search of primary articles evaluating the Canadian food environment in a real-world setting was conducted. Publications in English or French published in peer-reviewed journals between January 1 2010 and June 17 2021 and indexed in Web of Science, CAB Abstracts and Ovid MEDLINE were considered. The search strategy adapted an internationally-adopted food environment monitoring framework covering 7 domains (Food Marketing; Labelling; Prices; Provision; Composition; Retail; and Trade and Investment). The final sample included 220 articles. Overall, Trade and Investment (1%, n = 2), Labelling (7%, n = 15) and, to a lesser extent, Prices (14%, n = 30) were the least studied domains in Canada. Among Provision articles, healthcare (2%, n = 1) settings were underrepresented compared to school (67%, n = 28) and recreation and sport (24%, n = 10) settings, as was the food service industry (14%, n = 6) compared to grocery stores (86%, n = 36) in the Composition domain. The study identified a vast selection of measures employed in Canada overall and within single domains. Equity-related factors were only examined in half of articles (n = 108), mostly related to Retail (n = 81). A number of gaps remain that prevent a holistic and systems-level analysis of food environments in Canada. As Canada continues to implement policies to improve the quality of food environments in order to improve dietary patterns, targeted research to address identified gaps and harmonize methods across studies will help evaluate policy impact over time.

Cross-sectional comparisons of dietary indexes underlying nutrition labels: nutri-score, Canadian 'high in' labels and Diabetes Canada Clinical Practices (DCCP).

PURPOSE: To assess the cross-sectional association between dietary indexes (DI) that underlie, respectively, the Nutri-score (NS), the proposed Canadian 'High In' Symbol (CHIL) and the Diabetes Canada Clinical Practice Guidelines (DCCP) with food consumption, nutrient intakes and metabolic markers. METHODS: 1836 adults (18-74 years) participating in the representative ESTEBAN study, conducted in mainland France in 2014-2016, were included in the analysis. Food consumption was assessed with three repeated 24 h dietary recalls. Anthropometric measurements and biomarkers of metabolic risk (cholesterol-total, LDL (Low Density Lipoprotein), HDL (High Density Lipoprotein)-triglycerides, glucose) were obtained through a clinical examination and fasting blood draw. The DI were assessed for their association with food consumption, dietary intakes and metabolic biomarkers as quintiles and continuous variables using multi-adjusted linear regression. Heathier diets were assigned to lower scores. RESULTS: Correlations between scores ranged from + 0.62 between CHIL-DI and NS-DI to + 0.75 between NS-DI and DCCP-DI. All DIs discriminated individuals according to the nutritional quality of their diets through food consumption and nutrient intakes (healthier diets were associated with lower intakes of energy, added sugars and saturated fat; and with higher intakes of fiber, vitamins and minerals). NS-DI was associated with blood glucose (adjusted mean in Q1 = 5 vs. Q5 = 5.46 mmol/dl, ptrend = 0.001) and DCCP-DI was associated with BMI (Q1 = 24.8 kg/m2 vs. Q5 = 25.8 kg/m2, ptrend = 0.025), while CHIL showed no significant association with any anthropometric measures or biomarkers. CONCLUSIONS: This study provides elements supporting the validity of the nutrient profiling systems underlying front-of-package nutrition labellings (FOPLs) to characterize the healthiness of diets.

Evaluating the potential implications of canadian front-of-pack labelling regulations in generic and branded food composition databases.

BACKGROUND: Canada proposed the implementation of mandatory front-of-pack (FOP) labelling regulations, whereby foods meeting or exceeding thresholds for nutrients-of-concern (i.e., total sugars, saturated fat, sodium) must display a 'high-in' FOP symbol (FOP). The objective of the study was to evaluate the potential implications of the proposed regulations using Canadian generic and branded food composition databases. METHODS: A generic food composition database of products consumed by Canadians, Canadian Nutrient File (CNF) 2015 (n = 3,677), and a branded food composition database of packaged foods and beverages, Food Label Information Program (FLIP) 2017 (n = 17,521), were used to evaluate the number and proportion of foods that would display a FOP symbol based on the details of the proposed FOP labelling regulations published in 2018. RESULTS: Overall, 35.5% (n = 1,306) of products in CNF 2015 and 63.9% (n = 11,193) of products in FLIP 2017 would display a FOP symbol for at least one nutrient-of-concern exceeding proposed thresholds. Soups, Combination Dishes, and Desserts categories in CNF 2015 and Combination dishes, Soups, and Meats categories in FLIP 2017 would have the highest proportion of products that would display a FOP symbol. Although displaying a FOP symbol for one nutrient was most common in both CNF 2015 (n = 992; 27.0%) and FLIP 2017 (n = 7,296, 41.6%), the number (i.e., 0-3) and type (i.e., saturated fat, sodium, total sugar) of nutrients displayed varied by food category. CONCLUSION: While the generic database, containing both packaged and unpackaged foods, revealed a low prevalence of foods that would display a FOP symbol, the branded database showed that the proposed FOP labelling regulations would identify over 60% of packaged foods with excess contents of nutrients-of-concern. Considering the high prevalence of packaged foods in Canada that would meet or exceed the thresholds of nutrients-of-concern, the proposed FOP labelling regulations should be implemented in a timely manner to help consumers easily identify foods high in nutrients-of-concern and encourage manufacturer-driven product reformulations.

The relationship between voluntary product (re) formulation commitments and changes in the nutritional quality of products offered by the top packaged food and beverage companies in Canada from 2013 to 2017.

BACKGROUND: Food companies shape Canada's food supply through voluntary actions and commitments concerning product (re)formulation; however, the extent that these initiatives translate into actual improvements in nutritional quality is unclear. This study examined changes in the nutritional quality of products offered by the top 22 packaged food and beverage companies in Canada from 2013 to 2017, in relation to the strength of their product (re) formulation actions and commitments. METHODS: The Food Company Reformulation (FCR) scoring tool was used to quantify the strength of companies' reported recent actions and commitments to reduce energy and nutrients of concern in their products, with higher scores signifying stronger voluntary actions/commitments. Nutritional information for products was sourced from the University of Toronto FLIP 2013 (n = 6490) and 2017 (n = 8277) databases (n = 4074 matched products). Changes in product healthfulness were assessed using the Health Star Rating (HSR) system (with higher HSRs denoting healthier products) and calories, sodium, saturated fat, trans fat, and total and free sugar levels per 100 g/mL. Generalized estimating equations examined changes in nutritional quality in relation to FCR scores. RESULTS: Overall, mean HSRs increased significantly for 5 companies' product portfolios and were reduced in 1 company's product portfolio. There were significant reductions in calories, sodium, saturated fat in 2 companies' portfolios and increases in 4, 3, and 8 companies' portfolios, respectively. Trans fats increased significantly in 2 companies' portfolios. Total and free sugars decreased significantly in 4 and 5 companies' portfolios, respectively, and increased in 1 company's portfolio. There was little change in the healthfulness of matched products. Higher FCR scores were not associated with greater increases in HSRs, or reductions in calories or nutrient amounts. FCR scores were negatively associated with HSRs and positively associated with total and free sugars. No relationship was observed between FCR scores and calories, sodium, saturated fat or trans fat. CONCLUSIONS: Reporting stronger voluntary product (re) formulation actions and commitments was not associated with greater improvements in the healthfulness of products offered by Canada's leading packaged food and beverage companies from 2013 to 2017, suggesting a need for stronger industry initiatives or mandatory government interventions to improve the healthfulness of the food supply.

The efficacy of 'high in' warning labels, health star and traffic light front-of-package labelling: an online randomised control trial.

OBJECTIVE: To examine the impact of front-of-package (FOP) labels on perceived healthfulness, purchasing intentions and understanding of common FOP systems. DESIGN: A parallel, open-label design randomised participants to different FOP labelling conditions: 'high in' warning labels (WL), multiple traffic light labelling (TLL), health star ratings (HSR) (all displayed per serving) or control with no interpretive FOP labelling. Participants completed a brief educational session via a smartphone application and two experimental tasks. In Task 1, participants viewed healthy or unhealthy versions of four products and rated healthiness and purchasing intention on a seven-point Likert-type scale. In Task 2, participants ranked three sets of five products from healthiest to least healthy. SETTING: Online commercial panel. PARTICIPANTS: Canadian residents ≥ 18 years who were involved in household grocery shopping, owned a smartphone and met minimum screen requirements. RESULTS: Data from 1997 participants (n 500/condition) were analysed. Task 1: across most product categories, the TLL and HSR increased perceived healthiness of healthier products. All FOP systems decreased perceived healthiness of less healthy products. Similar, albeit dampened, effects were seen regarding purchasing intentions. Task 2: participants performed best in the HSR, followed by the TLL, WL and control conditions. Lower health literacy was associated with higher perceived healthiness and purchasing intentions and poorer ranking task performance across all conditions. CONCLUSIONS: All FOP labelling systems, after a brief educational session, improved task performance across a wide spectrum of foods. This effect differed depending on the nutritional quality of the products and the information communicated on labels.Trial Registration: NCT03290118.

A randomized controlled trial examining consumers' perceptions and opinions on using different versions of a FoodFlip© smartphone application for delivery of nutrition information.

BACKGROUND: Food labelling is a common intervention to improve diets, where the back-of-pack Nutrition Information Panel (or Nutrition Facts table (NFt)) provides comprehensive nutrition information on food packages. However, many consumers find it difficult and time-consuming to identify healthier foods using the NFt. As a result, different interpretative nutrition rating systems (INRS) may enable healthier food choices and it is essential that consumers have the tools to allow for easily accessible nutrition information. The objective of this study was to examine consumers' perceptions of different (INRS) for delivery of nutrition information using different versions of a smartphone app, FoodFlip©. METHODS: This study was part of a larger randomized controlled trial examining consumer perceptions of different INRS on food products. A nationally representative commercial sample of 2008 Canadians were randomized to one of four INRS intervention groups: 1) traffic light, 2) health star rating, 3) 'high-in' warning labels or 4) no INRS (NFt only; control) and asked to scan or enter 20 products into FoodFlip© from a list of food products provided to them with varying levels of healthfulness. After completing the app task, participants were asked a series of 7-point Likert-scale and open-ended questions to provide opinions on the usability and functionality of the app. RESULTS: Of the survey sample of 1997 participants, 95% (n = 1907) completed the app task, with similar number of participants in each treatment group. The mean age was 40 ± 12 years with no differences in sociodemographic characteristics between treatment groups. The health star rating ranked significantly lower in comparison to the other treatment groups in terms of usefulness (OR, 95% CI -0.67, 0.52-0.85), believability (0.59, 0.46-0.75), and understanding (0.55, 0.44-0.71) (p < 0.001). The health star rating (1.20, 0.94-1.53) and control (NFt) (1,1,1) ranked significantly lower than the traffic light or the 'high-in' warning labels for their ability to compare the healthfulness of products (p < 0.001). CONCLUSION: This study demonstrated Canadian consumers' preference for a nutrient-specific system (i.e. traffic light or 'high-in' warning labels). The app, which was liked by majority of the participants for its functionality and usability, has the potential to support healthy dietary decision making and may also encourage reformulation. TRIAL REGISTRATION: NCT03290118 (Clinicaltrials.gov).

A comparison of the nutritional quality of products offered by the top packaged food and beverage companies in Canada.

BACKGROUND: Canada's food supply is abundant in less healthy products, increasing Canadians' risk of obesity and non-communicable diseases. Food companies strongly influence the food supply; however, no studies have examined differences in the healthfulness of products offered by various companies in Canada. This study aimed to compare the nutritional quality of products offered by the top packaged food and beverage companies in Canada. METHODS: Twenty-two top packaged food and beverage manufacturing companies were selected, representing > 50% of the Canadian market share in 2018. Nutritional information for products (n = 8277) was sourced from the University of Toronto Food Label Information Program 2017 database. Descriptive analyses examined the nutritional quality of products based on: 1) the Health Star Rating (HSR) system; 2) calories, sodium, saturated fat and total sugars per 100 g (or mL) and per reference amounts (RAs) defined by Health Canada; and 3) "high in" thresholds for sodium, saturated fat and total sugars proposed by Health Canada for pending front-of-package labelling regulations. Kruskal-Wallis tests compared HSRs of products between companies. RESULTS: Mean HSRs of companies' total product offerings ranged from 1.9 to 3.6 (out of 5.0). Differences in HSRs of products between companies were significant overall and for 19 of 22 food categories (P < 0.05), particularly for fats/oils and beverages. Calories, sodium, saturated fat and total sugars contents varied widely between companies for several food categories, and depending on whether they were examined per 100 g (or mL) or RA. Additionally, 66.4% of all products exceeded ≥1 of Health Canada's "high in" thresholds for sodium (31.7%), saturated fat (28.3%) and/or sugars (28.4%). The proportion of products offered by a company that exceeded at least one of these thresholds ranged from 38.5 to 97.5%. CONCLUSIONS: The nutritional quality of products offered by leading packaged food and beverage manufacturers in Canada differs significantly overall and by food category, with many products considered less healthy according to multiple nutrient profiling methods. Variation within food categories illustrates the need and potential for companies to improve the healthfulness of their products. Identifying companies that offer less healthy products compared with others in Canada may help prompt reformulation.

Influence of front-of-pack labelling and regulated nutrition claims on consumers' perceptions of product healthfulness and purchase intentions: A randomized controlled trial.

Mandatory front-of-pack (FOP) labelling was proposed in Canada to highlight foods with high contents of sugars, sodium and/or saturated fats, which would be displayed on labels along with the mandatory Nutrition Facts table and voluntary nutrition claims. In an online survey, participants (n = 1997) were randomized to one of four FOP labelling conditions: 1) control, 2) warning label, 3) health star rating or 4) traffic light labelling. Participants were shown four drinks (a healthier drink with or without a disease risk reduction claim, a healthier drink with or without a nutrient content claim, a less healthy drink with or without a disease risk reduction claim and a less healthy drink with or without a nutrient content claim) in random order and one at a time. Participants rated perceived product healthfulness and purchase intentions using a 7-point Likert scale. Participants could access the Nutrition Facts table while viewing labels. Results showed less healthy drinks displaying any FOP labelling were perceived as less healthy compared to the control. In healthier drinks, health star rating and traffic light labelling created a 'halo' effect, which was not observed with warning labels. Similar results were observed with purchase intentions. Drinks displaying a disease risk reduction claim were perceived as healthier than those without (p < 0.001) regardless of product's healthfulness. The effect of a nutrient content claim was not significantly different. The effect of FOP labelling and claims was mitigated for those who used the Nutrition Facts table. FOP labelling was likely helpful for consumers with different levels of health literacy. Overall, FOP labelling had significantly stronger influence than nutrition claims on consumers' perceptions; however, the effect of each FOP label varied on healthier and less healthy drinks.

Comparison of nutrient profiling models for assessing the nutritional quality of foods: a validation study.

Nutrient profiling (NP) is a method for evaluating the healthfulness of foods. Although many NP models exist, most have not been validated. This study aimed to examine the content and construct/convergent validity of five models from different regions: Australia/New Zealand (FSANZ), France (Nutri-Score), Canada (HCST), Europe (EURO) and Americas (PAHO). Using data from the 2013 UofT Food Label Information Program (n15342 foods/beverages), construct/convergent validity was assessed by comparing the classifications of foods determined by each model to a previously validated model, which served as the reference (Ofcom). The parameters assessed included associations (Cochran-Armitage trend test), agreement (κ statistic) and discordant classifications (McNemar's test). Analyses were conducted across all foods and by food category. On the basis of the nutrients/components considered by each model, all models exhibited moderate content validity. Although positive associations were observed between each model and Ofcom (all P trend<0·001), agreement with Ofcom was 'near perfect' for FSANZ (κ=0·89) and Nutri-Score (κ=0·83), 'moderate' for EURO (κ=0·54) and 'fair' for PAHO (κ=0·28) and HCST (κ=0·26). There were discordant classifications with Ofcom for 5·3 % (FSANZ), 8·3 % (Nutri-Score), 22·0 % (EURO), 33·4 % (PAHO) and 37·0 % (HCST) of foods (all P<0·001). Construct/convergent validity was confirmed between FSANZ and Nutri-Score v. Ofcom, and to a lesser extent between EURO v. Ofcom. Numerous incongruencies with Ofcom were identified for HCST and PAHO, which highlights the importance of examining classifications across food categories, the level at which differences between models become apparent. These results may be informative for regulators seeking to adapt and validate existing models for use in country-specific applications.

Effect of a Sodium-Restricted Diet on Intake of Other Nutrients in Heart Failure: Implications for Research and Clinical Practice.

BACKGROUND: Sodium restriction is the primary dietary therapy for heart failure (HF) patients. Currently, it is unknown if changing diets to reduce dietary sodium in HF causes secondary changes to the intake of other nutrients in this patient population already at nutritional risk. METHODS AND RESULTS: HF patients (n = 16; 52 ± 12 years old; 78% male) followed a sodium-restricted diet for 1 week. Nutritional changes were documented at baseline and after a <2,000 mg/d sodium-restricted diet, as measured by food records before baseline and each day during the study. After a 49% reduction in dietary sodium (3,626 ± 956 to 1,785 ± 696 mg/d), we observed a significant reduction in calorie (2,467 ± 748 to 1,931 ± 388 kcal/d; P < .016), carbohydrate (293 ± 108 to 232 ± 56 g/d; P = .013), calcium (995 ± 496 to 609 ± 208 mg/d; P < .004), thiamine (2.0 ± 0.8 to 1.5 ± 0.8 mg/d; P = .020), and folate (412 ± 192 to 331 ± 172 µg/d; P = .019) intakes. There was a decrease in saturated fat (32 ± 18 to 21 ± 6 g/d; P = .032) and a trend to lower total fat (89 ± 34 to 68 ± 19 g/d; P = .066) and higher potassium (1,262 ± 328 to 1,405 ± 268 mg/1,000 kcal; P = .055) intakes. CONCLUSIONS: We found multiple unintentional nutritional consequences with dietary sodium reduction in HF patients. These findings highlight the need to consider the whole diet when counseling HF patients to lower sodium intake.

Thiamin deficiency and heart failure: the current knowledge and gaps in literature.

The management of heart failure (HF) represents a significant challenge for both patients as well as the healthcare system in industrialized countries. Thiamin is a required coenzyme in the energy-producing reactions that fuel myocardial contraction. Therefore, thiamin deficiency (TD) may contribute to myocardial weakness by limiting the energy available for contraction. Previous studies have reported a wide range in the prevalence of TD in patients with HF (3-91 %). The impact of thiamin supplementation in patients with HF is inconclusive. Studies conducted to date are limited by their small sample size, indirect methods of assessing thiamin concentration, methodological inconsistencies, use of impractical means of thiamin supplementation, a focus on hospitalized patients, and lack a robust technique for the assessment of cardiac function. Future large prospective studies and randomized controlled trials are needed to improve our understanding of any change in nutritional requirements associated with chronic disease as well as the clinical benefit of supplementation.

Correction: Nutrient intakes and top food categories contributing to intakes of energy and nutrients-of-concern consumed by Canadian adults that would require a 'high-in' front-of-pack symbol according to Canadian labelling regulations.

[This corrects the article DOI: 10.1371/journal.pone.0285095.].

A systematic umbrella review and meta-meta-analysis of eHealth and mHealth interventions for improving lifestyle behaviours.

The aim of this meta-meta-analysis was to systematically review randomised controlled trial (RCT) evidence examining the effectiveness of e- and m-Health interventions designed to improve physical activity, sedentary behaviour, healthy eating and sleep. Nine electronic databases were searched for eligible studies published from inception to 1 June 2023. Systematic reviews with meta-analyses of RCTs that evaluate e- and m-Health interventions designed to improve physical activity, sedentary behaviour, sleep and healthy eating in any adult population were included. Forty-seven meta-analyses were included, comprising of 507 RCTs and 206,873 participants. Interventions involved mobile apps, web-based and SMS interventions, with 14 focused on physical activity, 3 for diet, 4 for sleep and 26 evaluating multiple behaviours. Meta-meta-analyses showed that e- and m-Health interventions resulted in improvements in steps/day (mean difference, MD = 1329 [95% CI = 593.9, 2065.7] steps/day), moderate-to-vigorous physical activity (MD = 55.1 [95% CI = 13.8, 96.4] min/week), total physical activity (MD = 44.8 [95% CI = 21.6, 67.9] min/week), sedentary behaviour (MD = -426.3 [95% CI = -850.2, -2.3] min/week), fruit and vegetable consumption (MD = 0.57 [95% CI = 0.11, 1.02] servings/day), energy intake (MD = -102.9 kcals/day), saturated fat consumption (MD = -5.5 grams/day), and bodyweight (MD = -1.89 [95% CI = -2.42, -1.36] kg). Analyses based on standardised mean differences (SMD) showed improvements in sleep quality (SMD = 0.56, 95% CI = 0.40, 0.72) and insomnia severity (SMD = -0.90, 95% CI = -1.14, -0.65). Most subgroup analyses were not significant, suggesting that a variety of e- and m-Health interventions are effective across diverse age and health populations. These interventions offer scalable and accessible approaches to help individuals adopt and sustain healthier behaviours, with implications for broader public health and healthcare challenges.

Natural language processing and machine learning approaches for food categorization and nutrition quality prediction compared with traditional methods.

BACKGROUND: Food categorization and nutrient profiling are labor intensive, time consuming, and costly tasks, given the number of products and labels in large food composition databases and the dynamic food supply. OBJECTIVES: This study used a pretrained language model and supervised machine learning to automate food category classification and nutrition quality score prediction based on manually coded and validated data, and compared prediction results with models using bag-of-words and structured nutrition facts as inputs for predictions. METHODS: Food product information from University of Toronto Food Label Information and Price Database 2017 (n = 17,448) and University of Toronto Food Label Information and Price Database 2020 (n = 74,445) databases were used. Health Canada's Table of Reference Amounts (TRA) (24 categories and 172 subcategories) was used for food categorization and the Food Standards of Australia and New Zealand (FSANZ) nutrient profiling system was used for nutrition quality score evaluation. TRA categories and FSANZ scores were manually coded and validated by trained nutrition researchers. A modified pretrained sentence-Bidirectional Encoder Representations from Transformers model was used to encode unstructured text from food labels into lower-dimensional vector representations, followed by supervised machine learning algorithms (i.e., elastic net, k-Nearest Neighbors, and XGBoost) for multiclass classification and regression tasks. RESULTS: Pretrained language model representations utilized by the XGBoost multiclass classification algorithm reached overall accuracy scores of 0.98 and 0.96 in predicting food TRA major and subcategories, outperforming bag-of-words methods. For FSANZ score prediction, our proposed method reached a similar prediction accuracy (R2: 0.87 and MSE: 14.4) compared with bag-of-words methods (R2: 0.72-0.84; MSE: 30.3-17.6), whereas structured nutrition facts machine learning model performed the best (R2: 0.98; MSE: 2.5). The pretrained language model had a higher generalizable ability on the external test datasets than bag-of-words methods. CONCLUSIONS: Our automation achieved high accuracy in classifying food categories and predicting nutrition quality scores using text information found on food labels. This approach is effective and generalizable in a dynamic food environment, where large amounts of food label data can be obtained from websites.

The Effects of Ontario Menu Labelling Regulations on Nutritional Quality of Chain Restaurant Menu Items-Cross-Sectional Examination.

Restaurant foods are associated with excessive energy intake and poor nutritional quality. In 2017, the Healthy Menu Choices Act mandated food service establishments with ≥20 outlets in Ontario to display the energy content on menus. To examine the potential impact of menu labelling, nutrition information for 18,760 menu items were collected from 88 regulated and 53 unregulated restaurants. Descriptive statistics were calculated for serving size, energy, saturated fat, sodium and total sugars. Quantile regression was used to determine the differences between regulated and unregulated restaurants. The energy content of menu items from regulated restaurants (median (95% CI): 320 kcal (310, 320)) was significantly lower than those from unregulated restaurants (470 kcal (460, 486), p < 0.001). Saturated fat, sodium and total sugars were significantly lower in regulated restaurants (4 g (4, 4), 480 mg (470, 490) and 7 g (6, 7), respectively) than in unregulated restaurants (6 g (6, 6), 830 mg (797, 862) and 8 g (8, 9), respectively, p < 0.001). This study showed that menu items from regulated restaurants had smaller serving size, lower levels of energy and nutrients of public health concern compared to those from the unregulated restaurants, suggesting potential downstream beneficial effects of menu labelling in lowering caloric content and nutrients of public health concern in foods.

Cross-Sectional Nutritional Information and Quality of Canadian Chain Restaurant Menu Items in 2020.

INTRODUCTION: More than 50% of Canadians report regularly eating foods prepared at restaurants. The literature shows poor nutritional quality of restaurant foods. No federal policy on improving the nutritional quality of restaurant food is available except for a provincial regulation that mandates Ontario chain restaurants to display the energy content of items on menus. There is limited information on the nutrition information reporting and nutritional quality of restaurant foods. This study aimed to examine the nutrition information reporting and nutritional quality of menu items of Canadian chain restaurants in 2020. METHODS: Nutrition information for menu items (n=18,760) was collected and analyzed from Canadian restaurants with ≥20 outlets nationally between 2020 and 2021. Menu items were categorized into 5 categories. Descriptive statistics were calculated for serving size, energy, and saturated fat, sodium, and sugar. Percentage daily values of energy and nutrient levels were calculated following the Canadian labeling guidelines. RESULTS: Of the 201 eligible chain restaurants, 141 (70%) provided some nutrition information, of which 70 (50%) voluntarily provided the complete nutrition information that is required on prepackaged foods. Overall, menu items were high per serving in energy (mean kcal=483; 95% CI=477, 489), saturated fat (mean=7.4 g; 95% CI=7.2, 7.5), sodium (mean=867 mg; 95% CI=853, 881), and total sugars (mean=17 g; 95% CI=17, 17), and all exceeded the recommended 15% percentage daily values threshold. CONCLUSIONS: Although most chain restaurants provided nutrition information, the lack of regulations regarding reporting format and provision of serving size and other nutrients challenges the assessment of the nutritional quality of menu items. Interventions to standardize nutrition information reporting and improve nutritional quality are needed in the restaurant sector.

A content and quality analysis of free, popular mHealth apps supporting 'plant-based' diets.

There has been an increased emphasis on plant-based foods and diets. Although mobile technology has the potential to be a convenient and innovative tool to help consumers adhere to dietary guidelines, little is known about the content and quality of free, popular mobile health (mHealth) plant-based diet apps. The objective of the study was to assess the content and quality of free, popular mHealth apps supporting plant-based diets for Canadians. Free mHealth apps with high user ratings, a high number of user ratings, available on both Apple App and GooglePlay stores, and primarily marketed to help users follow plant-based diet were included. Using pre-defined search terms, Apple App and GooglePlay App stores were searched on December 22, 2020; the top 100 returns for each search term were screened for eligibility. Included apps were downloaded and assessed for quality by three dietitians/nutrition research assistants using the Mobile App Rating Scale (MARS) and the App Quality Evaluation (AQEL) scale. Of the 998 apps screened, 16 apps (mean user ratings±SEM: 4.6±0.1) met the eligibility criteria, comprising 10 recipe managers and meal planners, 2 food scanners, 2 community builders, 1 restaurant identifier, and 1 sustainability assessor. All included apps targeted the general population and focused on changing behaviors using education (15 apps), skills training (9 apps), and/or goal setting (4 apps). Although MARS (scale: 1-5) revealed overall adequate app quality scores (3.8±0.1), domain-specific assessments revealed high functionality (4.0±0.1) and aesthetic (4.0±0.2), but low credibility scores (2.4±0.1). The AQEL (scale: 0-10) revealed overall low score in support of knowledge acquisition (4.5±0.4) and adequate scores in other nutrition-focused domains (6.1-7.6). Despite a variety of free plant-based apps available with different focuses to help Canadians follow plant-based diets, our findings suggest a need for increased credibility and additional resources to complement the low support of knowledge acquisition among currently available plant-based apps. This research received no specific grant from any funding agency.

Dietary Intakes From Ad Libitum Consumption of Canadian Armed Forces Field Rations Compared With Usual Home Dietary Intakes and Military Dietary Reference Intakes.

INTRODUCTION: Diet has an impact on weight status, health, and physical performance. Assessing the usual at-home dietary intakes of military personnel can help ascertain their nutritional status before field training or operations. Preference for foods consumed on a routine basis can also impact the military's preference for and consumption of field rations. Military personnel are limited by the inherent nature of the field rations and availability of calories and food types; and despite previous studies indicating a high acceptability of the field rations, it is unknown whether military personnel self-select the same number of calories when faced with a restricted list of field ration options as they would from their usual foods. Although field rations are intended to be nutritionally sufficient for standard military operations, there are limited data on the ad libitum intake of nutrients of Canadian Armed Forces (CAF) personnel from field rations in comparison to the military dietary reference intake (MDRI) recommendations, which establishes standards intended to meet the nutritional requirements of military personnel on duty. Thus, assessing the adequacy of their usual diets at home and longer-term sustenance on field rations in relation to MDRIs can provide insight on CAF personnel's operational readiness. The objectives of this study were to describe and compare, in a convenience sample of CAF, their ad libitum nutrient intakes from the consumption of self-selected field rations at home with their usual home intakes and to compare both with MDRI recommendations. MATERIALS AND METHODS: Eighteen CAF participants weighed and recorded their dietary intake from the ad libitum consumption of field rations at home and their usual at-home diets. Both MDRIs and the Institute of Medicine's dietary reference intake recommendations were used to assess the adequacy of intakes for each individual. Paired Student's t-test or Wilcoxon-matched paired tests were used to compare nutrient intake levels between usual at-home diets and field rations consumed at home. RESULTS: Mean daily energy intakes were similar between ad libitum intakes from field rations (2,688 ± 619 kcal) and usual home diets (2,657 ± 580 kcal), although participants had significantly higher intakes of protein and fat from their home diets and higher intakes of carbohydrates from the field rations (P ≤ 0.05). Participants had less than the recommended intakes of some micronutrients (vitamins A and D, folate, calcium, magnesium, and potassium), from both their home diets and field rations, but adequate intakes of vitamin C and iron. CONCLUSIONS: The results of this study showed no difference in energy intake between the consumption of field rations and home diets, with levels consistent with recommendations for individuals with average physical activity levels. The results also demonstrated less than the recommended intakes (in comparison with MDRIs) of some nutrients from both home diets and self-selected consumption of field rations, warranting further research into nutritional adequacy for operational readiness.

Top Sodium Food Sources in the American Diet-Using National Health and Nutrition Examination Survey.

Reducing population-level sodium intake can reduce hypertension, an important preventative strategy to lower the risk of cardiovascular diseases, the leading cause of death in the United States. Considering that most dietary sodium is derived from prepackaged foods, this study quantitatively estimates the proportion contribution and mean sodium intake from key food category contributors to total sodium intake in the US population. Data from the 2017-2018 National Health and Nutrition Examination Survey, which collected interviewer-administered 24 h dietary recalls from Americans (n = 7081), were analyzed. Based on the average proportion contributed, the top 15 sources of sodium were identified overall and by age/sex, poverty-income and race/ethnicity. More than 50% of US population-level dietary sodium intake was contributed by: pizza (5.3%); breads, rolls and buns (4.7%); cold cuts and cured meats (4.6%); soups (4.4%); burritos and tacos (4.3%); savoury snacks (4.1%); poultry (4.0%); cheese (3.1%); pasta mixed dishes (2.9%); burgers (2.5%); meat mixed dishes (2.5%); cookies, brownies and cakes (2.4%); bacon, frankfurters and sausages (2.4%); vegetables (2.2%); and chicken nuggets (1.5%), with the results remaining consistent among population subgroups. The results identified the top sources of sodium in the American population overall, as well as in key population subgroups, which can inform policies and programs aimed at reducing sodium intake.