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Healthy diet plays an important role in the prevention of cardiovascular disease (CVD), which is the second leading cause of death in Canada. In 2019, Health Canada released an updated Canada’s Food Guide (CFG) which is accompanied with supportive evidence of Canada’s Dietary Guidelines (CDG) to reflect the latest evidence of the relationship between diet and prevention of chronic diseases including CVD. The Canadian Cardiovascular Society recommends the use of the Framingham risk score (FRS) to estimate the 10-year CVD risk and heart age in individuals aged 30 and older, aiding in CVD prevention interventions such as lifestyle modifications. However, the relationship between the intake of dietary choices aligned with 2019 CFG/CDG and CVD risk among Canadians was not studied. This study aims to examine the association between dietary choices assessed by a Food Choices Assessment Score (FCAS) according to 2019 CFG/CDG and 10-year CVD risk and heart age among Canadian adults. This cross-sectional study was conducted using the national Canadian Health Measures Survey (CHMS) (2016–2019) and included Canadian adults (≥ 30 years) without heart disease (n = 5,111). The 2019 CFG/CDG FCAS was calculated using the CHMS food frequency questionnaire. Canadians in the highest quintile (healthiest) of the FCAS had 55% lower odds (OR) of having high risk (≥ 20%) of estimated 10-year CVD risk (OR: 0.45; 95%CI: 0.23, 0.90) ( P trend  = 0.011), and 47% lower odds of having unhealthy heart age difference (heart age > chronological age) (OR: 0.53; 95%CI: 0.30, 0.92) ( P trend  = 0.02), compared to those in the first quintile (unhealthy) of the FCAS. This study indicates a strong inverse association of dietary choices as measured by the 2019 CFG/CDG FCAS with high 10-year CVD risk (≥ 20%) and unhealthy heart age (older than chronological age), estimated with the FRS.

A pervasive and persistent finding is the health disadvantage experienced by those in food insecure households. While clear associations have been identified between food insecurity and diabetes risk factors, less is known about the relationship between food insecurity and incident type 2 diabetes. The objective of this study is to investigate the association between household food insecurity and the future development of type 2 diabetes. We used data from Ontario adult respondents to the 2004 Canadian Community Health Survey, linked to health administrative data (n = 4,739). Food insecurity was assessed with the Household Food Security Survey Module and incident type 2 diabetes cases were identified by the Ontario Diabetes Database. Multivariable adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for type 2 diabetes as a function of food insecurity. Canadians in food insecure households had more than 2 times the risk of developing type 2 diabetes compared to those in food secure households [HR = 2.40, 95% CI = 1.17-4.94]. Additional adjustment for BMI attenuated the association between food insecurity and type 2 diabetes [HR = 2.08, 95% CI = 0.99, 4.36]. Our findings indicate that food insecurity is independently associated with increased diabetes risk, even after adjustment for a broad set of measured confounders. Examining diabetes risk from a broader perspective, including a comprehensive understanding of socioeconomic and biological pathways is paramount for informing policies and interventions aimed at mitigating the future burden of type 2 diabetes.

Children are frequently exposed to marketing on food packaging. This study evaluated the presence, type and power of child-appealing marketing and compared the nutritional quality of child-appealing vs. non-child-appealing Canadian packaged foods and examined the relationship between nutrient composition and marketing power. Child-relevant packaged foods (n = 5,850) were sampled from the Food Label Information Program 2017 database. The presence and power (# of techniques displayed) of child-appealing marketing were identified. Fisher's Exact test compared the proportion of products exceeding Health Canada's nutrient thresholds for advertising restrictions and Mann Whitney U tests compared nutrient composition between products with child- /non-child-appealing packaging. Pearson's correlation analyzed the relationship between nutrient composition and marketing power. 13% (746/5850) of products displayed child-appealing marketing; the techniques used, and the power of the marketing varied ([Formula: see text] 2.2 techniques; range: 0-11). More products with child-appealing packaging than with non-child appealing packaging exceeded Health Canada's thresholds (98% vs. 94%; p < .001). Products with child-appealing packaging (vs. non-child-appealing) were higher in total sugars (median: 14.7 vs. 9 g/RA; p < .001) and free sugars (11.5 vs. 6.2 g/RA; p < .001), but lower in all other nutrients. There was weak overall correlation between marketing power and nutrient levels. Results varied by nutrient and food category. Unhealthy products with powerful child-appealing marketing displayed on package are prevalent in the food supply. Implementing marketing restrictions that protect children should be a priority.

The association of dietary exposures with health outcomes may be attenuated or reversed as a result of energy intake (EI) misreporting. This study evaluated several methods for dealing with implausible recalls when analysing the association between dietary factors and obesity. We examined data from 16 187 Canadians aged ≥12 years in the nationally representative Canadian Community Health Survey 2.2. Under- and over-reporting were defined as the ratio of EI:estimated energy requirement <0·7 and >1·42, respectively. Multinomial logistic regression-generalised logit model was conducted to test the utility of different methods for handling misreporting, including (a) adjusting for variables related to misreporting, (b) excluding misreported recalls, (c) adjusting for reporting groups (under-, plausible and over-reporters), (d) adjusting for propensity score and (e) stratifying the analyses by reporting groups. In the basic model, EI showed a negative association with overweight (OR 0·988; 95 % CI 0·979, 0·998) and obesity (OR 0·989; 95 % CI 0·977, 0·999). Similarly, the association between total energy density and overweight (OR 0·670; 95 % CI 0·487, 0·923) and obesity (OR 0·709; 95 % CI 0·495, 1·016) was inverse. Among all methods of handling misreporting, adjusting for the reporting status revealed the most satisfactory results, where a positive association between EI and overweight (OR 1·037; 95 % CI 1·019, 1·055) and obesity (OR 1·109; 95 % CI 1·082, 1·137) was observed (P<0·0001), as well as direct positive associations between energy density and percentage energy from solid fats and added sugars with obesity (P<0·05). The results of this study can help advance knowledge about the relationship between dietary variables and obesity and demonstrate to researchers and nutrition policy makers the importance of adjusting for recall plausibility in obesity research, which is highly relevant in light of global obesity epidemic.

Canada recently mandated front-of-pack (FOP) labelling regulations, where foods meeting and/or exceeding recommended thresholds for nutrients-of-concern (i.e., saturated fat, sodium, and sugars) must display a ‘high-in’ FOP nutrition symbol. However, there is limited research on the amounts and sources of foods consumed by Canadians that would require a FOP symbol. The objective was to examine the intakes of nutrients-of-concern from foods that would display a FOP symbol and to identify the top food categories contributing to intakes for each nutrient-of-concern. Using the first day 24-hour dietary recall from the nationally representative 2015 Canadian Community Health Survey-Nutrition (CCHS), Canadian adults’ intakes of nutrients-of-concern from foods that would display a FOP symbol was examined. Foods were assigned to 1 of 62 categories to identify the top food categories contributing to intakes of energy and nutrient-of-concern that would display a FOP symbol for each nutrient-of-concern. Canadian adults (n = 13,495) consumed approximately 24% of total calories from foods that would display a FOP symbol. Foods that would display a FOP symbol for exceeding thresholds for nutrients-of-concern accounted for 16% of saturated fat, 30% of sodium, 25% of total sugar, and 39% of free sugar intakes among Canadian adults. The top food category contributing intakes of each nutrient-of-concern that would display a FOP symbol were nutrient-specific: Processed meat and meat substitutes for saturated fat; Breads for sodium; and Fruit juices & drinks for total and free sugars. Our findings show that Canadian FOP labelling regulations have the potential to influence the intakes of nutrients-of-concern for Canadian adults. Using the findings as baseline data, future studies are warranted to evaluate the impact of FOP labelling regulations.

Excess dietary sodium is a global public health priority, particularly in low- and middle-income countries where rates of hypertension and cardiovascular disease are high. The International Development Research Centre funded a research consortium of five Latin American countries (LAC) to inform public health policy for dietary sodium reduction (2016–2020). The objective of this study was to determine the outcomes of this funding on short-term (e.g., research, capacity building) and intermediary outcomes (e.g., policies). A summative program evaluation was conducted, using a logic model and multiple data sources including document review, surveys and interviews. Researchers from Argentina, Costa Rica, Brazil, Peru and Paraguay produced a significant amount of scientific evidence to guide decision making on sodium policy related to its content in foods, consumer behaviors (social marketing), and the health and economic benefits of dietary reduction. A substantive number of knowledge translation products were produced. The funding enabled training opportunities for researchers who developed skills that can be scaled-up to other critical nutrients and health issues. It was unexpected that intermediary policy changes would occur, however several countries demonstrated early policy improvements derived from this research. A funded research consortium of LAC is a practical approach to invoke policy innovations.

The consumption and availability of ultra-processed foods (UPFs), which are associated with an increased risk of noncommunicable diseases, have increased in most countries. While many countries have or are planning to incorporate UPF recommendations in their national dietary guidelines, the classification of food processing levels relies on expertise-based manual categorization, which is labor-intensive and time-consuming. Our study utilized transformer-based language models to automate the classification of food processing levels according to the NOVA classification system in the Canada, Argentina, and US national food databases. We showed that fine-tuned language models using the ingredient list text found on food labels as inputs achieved a high overall accuracy (F1 score of 0.979) in predicting the food processing levels of Canadian food products, outperforming traditional machine learning models using structured nutrient data and bag-of-words. Most of the food categories reached a prediction accuracy of 0.98 using a fined-tuned language model, especially for predicting processed foods and ultra-processed foods. Our automation strategy was also effective and generalizable for classifying food products in the Argentina and US databases, providing a cost-effective approach for policymakers to monitor and regulate the UPFs in the global food supply.

This study examined the relationship between reformulation and food price in Canadian packaged foods and beverages between 2017 and 2020. Matched foods and beverages in the University of Toronto Food Label Information and Price 2017 and 2020 databases were analysed ( 5774). Price change by food category and by retailer were compared using Wilcoxon signed-rank tests. The proportion of products with changes in calories and nutrient levels were determined, and mixed-effects models were used to examine the relationship between reformulation and price changes. The Food Standards Australia New Zealand (FSANZ) nutrient profiling model was applied to calculate nutritional quality scores, and mixed-effects models were used to assess if changes in nutritional quality score were associated with price changes. Large grocery retailers by market share in Canada. Foods and beverages available in 2017 and 2020. Food price changes differed by retailer and by food category (e.g. increased in Bakery, Snacks, etc; decreased in Beverages, Miscellaneous, etc.). Nutrient reformulation was minimal and bidirectional with the highest proportion of products changing in sodium (17·8 %; 8·4 % increased and 9·4 % decreased). The relationship between nutrient reformulation and price change was insignificant for all nutrients overall and was not consistent across food categories. Average FSANZ score did not change (7·5 in both years). For Legumes and Combination dishes, improvements in nutritional quality were associated with a price decrease and increase, respectively. Stronger policies are required to incentivise reformulation in Canada. Results do not provide evidence of reformulation impacting food prices.

Understanding the foods and beverages that children consume at school can help inform the development of school food programs, which has become a priority in Canada following the announcement of federal funding commitments and release of Canada's first National School Food Policy in 2024. Therefore, the objective was to identify top sources of energy, nutrients to limit (sodium, sugars, and saturated fat), and nutrients to encourage (potassium, calcium, fibre, iron, and vitamin A) consumed by Canadian children at school. Intake data from the first day 24-hour recall of the 2015 Canadian Community Health Survey - Nutrition was examined for children 4-18 y (n = 1,690) who consumed food at school. Foods and beverages were grouped into 28 categories (e.g., baked goods, fruit and vegetable juice and drinks etc.). Top categories were identified by frequency of consumption and percent contribution to total population-level intakes. Top sources of nutrients to limit often overlapped with top sources of nutrients to encourage. Handheld entrées was the top source of energy, sodium, saturated fat, calcium, and iron intakes at school. Fruits was the top source of sugars, potassium, and fibre and vegetables was the top source of vitamin A. By age group and sex, top sources were mostly similar with some differences in rankings and percent contributions. Results identified the top sources of energy, nutrients to limit, and nutrients to encourage consumed by Canadian children at school. Knowledge of these sources can inform the development of school food programs that aim to improve the diet quality of Canadian children at school.

To evaluate the application of front-of-package (FOP) labelling regulations to menu labelling in the Canadian restaurant sector by assessing the proportion of menu items that would be required to display the 'high-in' FOP symbol if the policy were extended to the restaurant sector. Nutrition information of 18 760 menu items was collected from 141 chain restaurants in Canada. Menu items were evaluated using the mandatory FOP labelling regulations promulgated in Canada Gazette II by Health Canada in July of 2022. Chain restaurants with ≥20 establishments in Canada. Canadian chain restaurant menu items including beverages, desserts, entrées, sides and starters. Overall, 77 % of menu items in the Canadian restaurant sector would display a 'high-in' FOP symbol. Among these menu items, 43 % would display 'high-in' one nutrient, 54 % would display 'high-in' two and 3 % would display 'high-in' all three nutrients-of-concern. By nutrient, 52 % were 'high-in' sodium, and 24 and 47 % were 'high-in' total sugars and saturated fat, respectively. Given the poor nutritional quality of restaurant foods, the current regulations, if applied to restaurant foods, would result in most menu items displaying a FOP symbol. Therefore, expanding the Canadian FOP labelling regulations to the restaurant sector can be key to ensuring a healthy food environment for Canadians. Furthermore, menu labelling along with other multi-faceted approaches such as reformulation targets are necessary to improve the dietary intake of Canadians from restaurant foods.