Food Environment and Youth Intake May Influence Uptake of Gluten-Free Food Guide Recommendations in Celiac Disease
Publication: Canadian Journal of Dietetic Practice and Research
3 May 2022
Abstract
A gluten-free (GF) food guide for children and youth (4–18 years) living with celiac disease (CD) has been developed and extensively evaluated by stakeholders, including registered dietitians. A case study analysis was conducted on data from 16 households of youth with CD to examine how factors related to parental food literacy, the home food environment, and food purchasing patterns may influence food guide uptake by Canadian youth with CD and their families. Households were of higher socioeconomic status, parents had good food literacy, and the home food availability of fruits, vegetables and GF grains was diverse. However, households also had a diverse supply of convenience foods and snack options. Youth reported consuming a larger proportion of these foods (>35% dietary intake) and had suboptimal diet quality. Dietary intake of fruits and vegetables were below GF plate model recommendations by over 30%. Despite limited economical barriers, good parental food literacy, and diverse food availability, meeting fruit and vegetable recommendations based on the pediatric GF food guide remains a major challenge. Findings inform that effective strategies and healthy public policies to support the uptake of GF food guide recommendations are needed to improve the health outcomes of youth with CD.
Résumé
Un guide alimentaire sans gluten (SG) pour les enfants et les jeunes (4 à 18 ans) vivant avec la maladie cœliaque (MC) a été créé puis évalué en profondeur par des intervenants, dont des diététistes. Une analyse d’études de cas a été réalisée sur des données issues de 16 ménages de jeunes atteints de MC afin d’examiner comment des facteurs liés à la littératie alimentaire des parents, à l’environnement alimentaire à la maison et aux habitudes d’achat alimentaires peuvent influencer l’adoption du guide alimentaire par les jeunes Canadiens ayant la MC et leur famille. Les ménages avaient un statut socioéconomique élevé, les parents avaient une bonne littératie alimentaire et il y avait une bonne diversité de fruits, de légumes et de produits céréaliers SG à la maison. Cependant, les ménages avaient aussi une variété d’aliments prêts-à-servir et de collations. Les jeunes ont rapporté consommer une plus grande proportion de ces aliments (> 35 % de l’apport alimentaire), et la qualité de leur alimentation était sous-optimale. La consommation de fruits et légumes était de plus de 30 % inférieure aux recommandations de l’assiette modèle SG. Malgré des obstacles économiques limités, la bonne littératie alimentaire des parents et la disponibilité d’une variété d’aliments, respecter les recommandations du guide alimentaire SG pédiatrique quant aux fruits et légumes demeure une difficulté majeure. Les conclusions indiquent que des stratégies efficaces et des politiques publiques saines favorisant l’adoption des recommandations du guide alimentaire SG sont nécessaires pour améliorer la santé des jeunes vivant avec la MC.
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Financial support: This case study was generously supported by the WCHRI Graduate Studentship by the support of the Stollery Children’s Hospital Foundation through the Women and Children’s Health Research Institute (2020, S.C), the Sir Frederick Banting and Dr. Charles Best Canada Graduate Studentship – Master’s (CIHR CGSM) (2020, S.C), the Alberta Graduate Studentship (2020, S.C) and the Alberta Diabetes Institute Graduate Studentship by donation from the G. Woodrow Wirtanen Studentship (2019, S.C).
Conflicts of interest: The authors declare that they have no competing interests.
REFERENCES
1
Pinto-Sanchez MI, Verdu EF, Gordillo MC, Bai JC, Birch S, Moayyedi P, et al. Tax-deductible provisions for gluten-free diet in Canada compared with systems for gluten-free diet coverage available in various countries. Can J Gastroenterol Hepatol. 2015;29(2):104–10.
2
Green PH and Cellier C. Celiac disease. N Engl J Med. 2007;357(17):1731–43. Epub 2007/10/26.
3
Mager DR, Liu A, Marcon M, Harms K, Brill H, Mileski H, et al. Diet patterns in an ethnically diverse pediatric population with celiac disease and chronic gastrointestinal complaints. Clin Nutr ESPEN. 2019;30:73–80.
4
Cyrkot S, Anders S, Kamprath C, Liu A, Mileski H, Dowhaniuk J, et al. Folate content of gluten-free food purchases and dietary intake are low in children with coeliac disease. Int J Food Sci Nutr. 2020;71(7):863–74.
5
Mager DR, Cyrkot S, Lirette C, Brill H, Dowhaniuk J, Mileski H, et al. Nutritional considerations of a paediatric gluten-free food guide for coeliac disease. Br J Nutr. 2021;127(3):421–30.
6
Konsor M, Schneider KL, and Appelhans BM. Associations between weight loss attempts, food planning, and the home food environment. J Nutr Educ Behav. 2021;53(1):36–42.
7
Vereecken C, Haerens L, De Bourdeaudhuij I, and Maes L. The relationship between children’s home food environment and dietary patterns in childhood and adolescence. Public Health Nutr. 2010;13(10A):1729–35.
8
Nepper MJ and Weiwen C. Validation of a checklist to assess the home food environment of school-aged children. Health Behav Policy Rev. 2016;3(4):348–60.
9
Couch SC, Glanz K, Zhou C, Sallis JF, and Saelens BE. Home food environment in relation to children’s diet quality and weight status. J Acad Nutr Diet. 2014;114(10):1569–79.e1.
10
Rosenkranz RR and Dzewaltowski DA. Model of the home food environment pertaining to childhood obesity. Nutr Rev. 2008;66(3):123–40.
11
Pearson N, Biddle SJ, and Gorely T. Family correlates of fruit and vegetable consumption in children and adolescents: a systematic review. Public Health Nutr. 2008;12(2):267–83.
12
Gebremariam MK, Vaque-Crusellas C, Andersen LF, Stok FM, Stelmach-Mardas M, Brug J, et al. Measurement of availability and accessibility of food among youth: a systematic review of methodological studies. Int J Behav Nutr Phys Act. 2017;14(1):22.
13
Thomas H, Perry EA, Slack J, Samra R, Manowiec E, Petermann L, et al. Complexities in conceptualizing and measuring food literacy. J Acad Nutr Diet 2018;116:1–11.
14
Kulai T and Rashid M. Assessment of nutritional adequacy of packaged Gluten-free food products. Can J Diet Pract Res. 2014;75(4):186–90.
15
Jamieson JA and Gougeon L. Gluten-free foods in rural maritime provinces: limited availability, high price, and low iron content. Can J Diet Pract Res. 2017;78(4):192–6.
16
Stevens L and Rashid M. Gluten-free and regular foods: a cost comparison. Can J Diet Pract Res. 2008;69(3):147–50.
17
Jegede O, Enns A, Kantounia M, Preun T, Vagianos K, Suh M, et al. Cost, nutritional content and number of Gluten-free staple foods available in Winnipeg, Manitoba, Canada. Plant Foods Hum Nutr. 2021.
18
Elliott C. The nutritional quality of Gluten-free products for children. Pediatrics 2018;142(2):2–8.
19
Lambert K and Ficken C. Cost and affordability of a nutritionally balanced gluten-free diet: is following a gluten-free diet affordable? Nutr Diet 2016;73:36–42.
20
Campbell KJ, Crawford DA, Salmon J, Carver A, Garnett SP, and Baur LA. Associations between the home food environment and obesity-promoting eating behaviors in adolescence. Obesity (Silver Spring) 2007;15(3):719–30.
21
Alzaben AS, Turner J, Shirton L, Samuel TM, Persad R, and Mager D. Assessing nutritional quality and adherence to the Gluten-free diet in children and adolescents with celiac disease. Can J Diet Pract Res. 2015;76(2):56–63.
22
Ferrar K and Golley R. Adolescent diet and time use clusters and associations with overweight and obesity and socioeconomic position. Health Educ Behav. 2015;42(3):361–9.
23
Sue A, Dehlsen K, and Ooi CY. Paediatric patients with coeliac disease on a Gluten-free diet: nutritional adequacy and macro- and micronutrient imbalances. Curr Gastroenterol Rep. 2018;20(1):2.
24
Deeks J, Verreault MF, and Cheung W. Canadian nutrient file (CNF): update on Canadian food composition activities. J Food Compos Anal. 2017;64:43–47.
25
Woodruff SJ and Hanning RM. Development and implications of a revised Canadian Healthy Eating Index (HEIC-2009). Public Health Nutr. 2010;13(6):820–5.
26
Gibbs HD, Kennett AR, Kerling EH, Yu Q, Gajewski B, Ptomey LT, et al. Assessing the nutrition literacy of parents and its relationship with child diet quality. J Nutr Educ Behav. 2016;48(7):505–9.e1.
27
Gibbs HD, Ellerbeck EF, Gajewski B, Zhang C, and Sullivan DK. The nutrition literacy assessment instrument is a valid and reliable measure of nutrition literacy in adults with chronic disease. J Nutr Educ Behav. 2018;50(3):247–57.e1.
28
Green SH and Glanz K. Development of the perceived nutrition environment measures survey. Am J of Preventative Med. 2015;49(1):50–61.
29
Fulkerson JA, Nelson MC, Lytle L, Moe S, Heitzler C, and Pasch KE. The validation of a home food inventory. Int J Behav Nutr Phys Act. 2008;5:55. Epub 2008/11/06.
30
Appelhans BM, French SA, Tangney CC, Powell LM, and Wang Y. To what extent do food purchases reflect shoppers’ diet quality and nutrient intake? Int J Behav Nutr Phys Act. 2017;14(46):1–10.
31
Nackers LM and Appelhans BM. Food insecurity is linked to a food environment promoting obesity in households with children. J Nutr Educ Behav. 2013;45(6):780–4.
32
Health Canada. Canada’s Food Guide. Ottawa, ON, Canada: Health Canada; 2019. [cited 16 February 2022] Available from: https://food-guide.canada.ca/en/.
33
Garriguet D. Overview of Canadian’s eating habits. Nutrition: findings from the Canadian Community Health Survey. Ottawa: Statistics Canada;2006. [cited 16 February 2022] Available from: https://www150.statcan.gc.ca/n1/en/pub/82-620-m/82-620-m2006002-eng.pdf?st=8KKrKNx1.
34
Gutowski ED, Weiten D, Green KH, Rigaux LN, Bernstein CN, Graff LA, et al. Can individuals with celiac disease identify gluten-free foods correctly? Clin Nutr ESPEN 2020;36:82–90.
35
Rasmussen M, Krolner R, Klepp KI, Lytle L, Brug J, Bere E, et al. Determinants of fruit and vegetable consumption among children and adolescents: a review of the literature. Part I: quantitative studies. Int J Behav Nutr Phys Act. 2006;3:22. Epub 2006/08/15.
36
Krolner R, Rasmussen M, Brug J, Klepp KI, Wind M, and Due P. Determinants of fruit and vegetable consumption among children and adolescents: a review of the literature. Part II: qualitative studies. Int J Behav Nutr Phys Act. 2011;8:112.
37
do Amaral EMGR, Silva PO, Nakabayashi J, Bandeira MV, Toral N, and Monteiro R. Family meal frequency and its association with food consumption and nutritional status in adolescents: A systematic review. PLoS One. 2020;15(9):e0239274. Epub 2020/09/19.
38
Neumark-Sztainer D, Larson NI, Fulkerson JA, Eisenberg ME, and Story M. Family meals and adolescents: what have we learned from Project EAT (Eating Among Teens)? Public Health Nutr. 2010;13(7):1113–21.
39
O’Dea J A. Why do kids eat healthful food? Perceived benefits of and barriers to healthful eating and physical activity among children and adolescents. J Acad Nutr Diet 2003;103(4):497–501.
40
Berge JM, MacLehose RF, Larson N, Laska M, and Neumark-Sztainer D. Family food preparation and its effects on adolescent dietary quality and eating patterns. J Adolesc Health 2016;59(5):530–6. Epub 2016/10/25. Doi :.
41
Vanderlee L, Hobin EP, White CM, and Hammond D. Grocery shopping, dinner preparation, and dietary habits among adolescents and young adults in Canada. Can J Diet Pract Res. 2018;79(4):157–63.
42
Watts AW, Barr SI, Hanning RM, Lovato CY, and Masse LC. The home food environment and associations with dietary intake among adolescents presenting for a lifestyle modification intervention. BMC Nutr. 2018;4:3.
43
Raine KD, Atkey K, Olstad DL, Ferdinands AR, Beaulieu D, Buhler S, et al. Healthy food procurement and nutrition standards in public facilities: evidence synthesis and consensus policy recommendations. Health Promot Chron Dis Prev Can. 2018;38(1):6–17.
44
Buhler S, Raine KD, Arango M, Pellerin S, and Neary NE. Building a strategy for obesity prevention one piece at a time: the case of sugar-sweetened beverage taxation. Can J Diabetes 2013;37(2):97–102.
45
Pearson N, Ball K, and Crawford D. Predictors of changes in adolescents’ consumption of fruits, vegetables and energy-dense snacks. Br J Nutr. 2011;105(5):795–803.
46
Savoie-Roskos MR, Wengreen H, and Durward C. Increasing fruit and vegetable intake among children and youth through gardening-based interventions: a systematic review. J Acad Nutr Diet. 2017;117(2):240–50.
47
Iacovou M, Pattieson DC, Truby H, and Palermo C. Social health and nutrition impacts of community kitchens: a systematic review. Public Health Nutr. 2013;16(3):535–43. Epub 2012/06/01.
48
Dibsdall LA, Lambert N, Bobbin RF, and Frewer LJ. Low-income consumers’ attitudes and behaviour towards access, availability and motivation to eat fruit and vegetables. Public Health Nutr. 2003;6(2):159–68. Epub 2003/04/05.
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Published In
Canadian Journal of Dietetic Practice and Research
Volume 83 • Number 4 • December 2022
Pages: 186 - 192
Editor: Naomi Cahill
History
Received: 6 July 2021
Accepted: 16 February 2022
Version of record online: 3 May 2022
Copyright
© 2022.
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SamanthaCyrkotRD, DominicaGidrewiczMD, SvenAndersPhD, MargaretMarconMD, Justine M.TurnerPhD MD, and Diana R.MagerPhD MSc RD. 2022. Food Environment and Youth Intake May Influence Uptake of Gluten-Free Food Guide Recommendations in Celiac Disease. Canadian Journal of Dietetic Practice and Research.
83(4): 186-192. https://doi.org/10.3148/cjdpr-2022-011
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