Table of Contents

Purpose: Patient dissatisfaction with hospital food is an important driver of poor food intake in hospitals. The objective of this study was to examine patient satisfaction with current menu offerings and explore patient preferences and values, in order to inform a patient-centred menu redesign.Methods: Between July and September 2021, a cross-sectional survey was distributed to inpatients receiving a lunch tray at Vancouver General Hospital, a large tertiary care centre in Vancouver, Canada. The survey was based on the Acute Care Hospital Foodservice Patient Satisfaction Questionnaire, with additional questions on food experience, factors impacting preferences for hospital meals, interest in plant-rich diets, and demographics.Results: The response rate was 5.5%, with 271 patients completing at least part of the survey. On a 5-point Likert scale, (5 – highest score; 1 – lowest score) satisfaction with food quality (mean = 3.09, p < 0.001) and the overall experience (mean = 3.54, p < 0.001) was lower than industry benchmark of 4, and qualitative feedback was generally negative. Open-ended responses indicated patients were interested in expanded cultural diversity in food provision, more fresh produce and better flavours, and were generally open to trying plant-rich foods.Conclusions: A number of opportunities for improvement were identified in this survey, which will inform an upcoming menu redesign in this institution.

Purpose: Our understanding of the influence of sugar intake on anthropometrics among young children is limited. Most existing research is cross-sectional and has focused on sugar-sweetened beverages. The study objective was to investigate longitudinal associations between young children’s total, free, and added sugar intake from all food sources at baseline with anthropometric measures at baseline and 18 months.Methods: The Guelph Family Health Study (GFHS) is an ongoing randomized controlled trial and a family-based health promotion study. Food records and anthropometric data were collected at baseline (n = 109, 55 males; 3.7 ± 1.1 y, mean ± SD) and 18 months (n = 109, 55 males; 5.1 ± 1.1 y) of the GFHS pilots. Associations between sugar intakes and anthropometrics were estimated using linear regression models with generalized estimating equations adjusted for age, sex, household income, and intervention status.Results: Total sugar intake was inversely associated with body weight at 18 months (P = 0.01). There was no effect of time on any other associations between total, free, and added sugar intakes and anthropometrics.Conclusions: Early life dietary sugar intakes may not relate to anthropometric measures in the short term. Further investigation into potential associations between dietary sugar intakes and anthropometric variables over longer time periods is warranted.

Purpose: The Food and Nutrition for Manitoba Youth (FANS) study examined dietary intakes, food behaviours, food security status, health indicators, and body mass index of a cohort of grade 9 students. This paper describes regional differences and similarities in dietary intake (food and nutrients) and quality of youth participants in the FANS study.Methods: Grade 9 students completed a web-based survey on dietary intakes (24-hour recall), food behaviours, self-reported health indicators, and sociodemographic variables. Nutrient intakes were compared with national guidelines and diet quality was assessed using a modified Healthy Eating Index.Results: A total of 1587 students participated from northern, rural, and urban regions in Manitoba. Northern and rural students had higher intakes of sugar, sodium, and saturated fat compared with urban. Northern students consumed fewer grain products compared to urban, and more servings of “other” foods compared with rural and urban. While most participants were classified into the “needs improvement” or “poor” Healthy Eating Index categories, significantly more northern participants were in the “poor” category.Conclusions: Most adolescents in the study are at nutritional risk; however, there are additional vulnerabilities for those in rural and northern communities. Dietitians can use results to advocate for and plan interventions to improve adolescent nutrition.

Purpose: To assess vitamin D, folate, vitamin B₁₂, and iron status in Old Order Anabaptist (OOA) pregnant/postpartum women.Methods: Blood was analyzed for plasma 25 hydroxy vitamin D (25(OH)D), red blood cell (RBC) folate, serum vitamin B₁₂, and iron status indicators. Dietary intakes (food and supplements) from 3-day estimated records were compared to Dietary Reference Intakes and Canada’s Food Guide (2007).Results: Fifty women participated in this descriptive cross-sectional study. Concentrations of 25(OH)D were low (<50 nmol/L for 20% and < 75 nmol/L for 63%); 42% had total vitamin D intakes < estimated average requirement (EAR). All women had RBC folate above the 1360 mmol/L cut-off. Nineteen percent had folate intakes <EAR; 80% had folic acid supplement intakes >upper limit. One woman had low serum vitamin B₁₂ (<148 pmol/L); serum vitamin B₁₂ was high (>652 pmol/L) for 24%. None had vitamin B₁₂ intakes <EAR; intakes were high compared to the recommended dietary intake. One woman had low hemoglobin; 13% had ferritin <15 μg/L. Thirteen percent had total iron intake <EAR.Conclusions: Overall, dietary intake and serum micronutrient status of OOA pregnant and postpartum women in our study were similar to those reported in previous studies of Canadian women. While some women had low intakes of vitamin D and iron, most had high intakes of folate and vitamin B₁₂. These findings provide guidance to ensure appropriate dietary and supplement intakes in this potentially vulnerable and rarely studied population.

Literature on dietary behaviours of the pediatric Crohn’s Disease (CD) population and the relationship between dietary intake and CD activity is limited. Three dietary indices were developed and tested to conduct dietary pattern analysis in pediatric patients with CD consuming a free diet following remission induction via exclusive enteral nutrition (n = 11). Index scores underwent descriptive and inferential analysis. The mean adjusted scores (out of 100) for the Pediatric Western Diet Index, Pediatric Prudent Diet Index, and Pediatric-Adapted 2010 Alternate Healthy Eating Index (PA2010-AHEI) were 29.82 ± 15.22, 34.25 ± 15.18, and 51.50 ± 11.69, respectively. The mean Western-to-Prudent ratio was 0.94 ± 0.55. A significant correlation (r = −0.71) and relationship (F_{[1, 9]} = 9.04, P < 0.05, R² = 0.501) between the Western-to-Prudent ratio and PA2010-AHEI was found. The results suggest participants were not following a Western or Prudent diet, and were consuming foods not captured by the indices. More research is needed to describe dietary intake of individuals with CD, validate dietary indices in diverse samples, and explore the utility of these indices in CD assessment and treatment. The co-authors hope this work will stimulate/inspire subsequent interprofessional, dietitian-led research on this topic.

Early learning and child care (ELCC) settings in Canada follow nutrition standards that outline food provisions, with many also encouraging responsive feeding practices that help to create a supportive environment for children. Caregivers who lack confidence in children’s ability to regulate their own intake, or those who feel stressed about mealtime, may unknowingly engage in less responsive feeding practices. The CELEBRATE Feeding Approach is a flexible framework, driven by behaviour change theory, that builds on previous definitions and concepts of responsive feeding in ELCC environments. Through this approach, there is an intentional focus on supporting early childhood educators to implement feeding practices that are more responsive. The approach incorporates 13 target educator behaviours related to the three overlapping categories of CELEBRATE language, CELEBRATE Mealtime, and CELEBRATE Play. These practices recognize and support the development of a child’s sense of autonomy, confidence, and self-regulation not only at mealtimes but also through play-based exploration and language that is used throughout the day around food and feeding. The goal is that children will be open to a wide variety of food, develop their self-regulation skills, and build the foundation for a positive relationship with food throughout their lifetime.