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  • Family-Based Obesity Prevention: Perceptions of Canadian Parents of Preschool-Age Children
    Canadian Journal of Dietetic Practice and Research • Vol. 79 • No. 1 • pp. 13 - 17
    Our objectives were to explore the perspectives of a community-based sample of Canadian parents with 2–5-year-old children on: (i) strategies to support the development of healthful weight-related behaviours and (ii) assessment approaches to measure weight-related behaviours and outcomes among children and families. We conducted 4 focus groups with 28 parents (89% mothers and 68% identified as White). Transcripts were analyzed using conventional content analysis. Regarding parent’s perceptions of strategies to support healthful behaviours, we found that parents largely valued: home-based interventions, expert opinion, practical health behaviour strategies delivered in a nonjudgmental manner, and opportunities for social support. Regarding perceptions of assessment procedures, parents had mixed views on children providing blood samples, but looked upon it more favourably if it would contribute to research on child health. Our results suggest that to increase parental engagement interventions focused on improving weight-related behaviours among families with young children should be delivered within the home and include easy-to-implement behaviour change strategies communicated by experts, such as dietitians working in the clinical or public health setting. Using social media to share information and provide a platform for social support may also be an effective way to engage parents of young children.
  • Reproducing or Reducing Inequity? Considerations for School Food Programs
    Canadian Journal of Dietetic Practice and Research • Vol. 79 • No. 1 • pp. 18 - 22
    It is important to consider health inequities when exploring the extent to which school food programs may contribute to the stigmatization and social exclusion of families experiencing food insecurity. As part of a broader school-based project, this paper considers evidence derived from a secondary analysis of research in Nova Scotia (NS). In the original research, interviews were conducted with key stakeholders involved in supporting health promotion activities across NS elementary schools. For this article, data were re-examined using tenets of critical discourse analysis to evaluate if school practices were addressing the root social issues by identifying patterns in language and institutional norms. Our findings suggested that further illumination of programs may be needed to ensure that they do not contribute to the stigmatization and social exclusion of families experiencing food insecurity. Nutrition professionals are in a position to engage families experiencing food insecurity in policy action that will shift from a focus on individual determinants towards the social–structural conditions that underlie the complex issue of food insecurity.
  • Les caroténoïdes sériques comme biomarqueurs : une stratégie pour améliorer la validité de l’évaluation alimentaire
    Canadian Journal of Dietetic Practice and Research • Vol. 79 • No. 1 • pp. 23 - 27
    La marge d’erreur dans l’évaluation de la prise alimentaire au moyen des outils traditionnels comme le rappel de 24 h, le questionnaire de fréquence et le journal alimentaire est grande et peut conduire à l’interprétation erronée de résultats de recherche. La recherche sur des biomarqueurs associés à la consommation de fruits et de légumes a le potentiel d’améliorer sensiblement la validité de l’évaluation de la prise alimentaire ainsi que la mesure des associations entre la qualité nutritionnelle et la santé. Les caroténoïdes, des pigments issus presque exclusivement du monde végétal, présentent un intérêt grandissant dans ce domaine. Les caractéristiques des caroténoïdes ainsi que les avantages et les défis que pose leur utilisation dans l’évaluation nutritionnelle seront explorés dans la présente revue.
  • Gluten-Free Foods in Rural Maritime Provinces: Limited Availability, High Price, and Low Iron Content
    Canadian Journal of Dietetic Practice and Research • Vol. 78 • No. 4 • pp. 192 - 196
    We investigated the price difference between gluten-free (GF) and gluten-containing (GC) foods available in rural Maritime stores. GF foods and comparable GC items were sampled through random visits to 21 grocery stores in nonurban areas of Nova Scotia, New Brunswick, and Prince Edward Island, Canada. Wilcoxon rank tests were conducted on price per 100 g of product, and on the price relative to iron content; 2226 GF foods (27.2% staple items, defined as breads, cereals, flours, and pastas) and 1625 GC foods were sampled, with an average ± SD of 66 ± 2.7 GF items per store in rural areas and 331 ± 12 in towns. The median price of GF items ($1.76/100 g) was more expensive than GC counterparts ($1.05/100 g) and iron density was approximately 50% less. GF staple foods were priced 5% higher in rural stores than in town stores. Although the variety of GF products available to consumers has improved, higher cost and lower nutrient density remain issues in nonurban Maritime regions. Dietitians working in nonurban areas should consider the relative high price, difficult access, and low iron density of key GF items, and work together with clients to find alternatives and enhance their food literacy.
  • Creation of University Wellness Program Healthy Eating and Active Lifestyle Supports: A Knowledge-to-Action Process
    Canadian Journal of Dietetic Practice and Research • Vol. 79 • No. 1 • pp. 7 - 12
    With the burdens that preventable health conditions place on individuals, workplaces, and society, workplace wellness programs (WWP) are critical to ensuring employees have access to health promotion supports tailored to their work environments. Such programs are best guided by a knowledge-to-action (KTA) framework; a theoretically grounded, systematic process that considers the ongoing exchange of knowledge with employees to engage them in health behaviour change and to garner employers’ support for the interventions. Therefore the purpose of this project was to develop, implement, and evaluate WWP healthy eating and active lifestyle supports at a university. A KTA process guided the consultations with employees and stakeholders that led to the development and implementation of a range of resource effective supports and the incorporation of wellness in the organization culture. A key support was the Wellness Passport that encouraged participation in scheduled WWP activities, as well as allowing for self-identified ones. Quality assurance assessments demonstrated a desire for a continuation of these WWP supports and activities. Dietitians, as health promotion leaders, can play key roles in the emerging field of WWPs. University dietetic and internship programs should consider adding WWP and KTA training components.
  • Qualitative Assessment of Key Messages about Nutrition and Weight Gain in Pregnancy in Printed Educational Materials in Alberta
    Canadian Journal of Dietetic Practice and Research • Vol. 78 • No. 4 • pp. 182 - 186
    Printed educational materials are a common source of health information, although their effectiveness in improving women’s knowledge or self-care in pregnancy has been questioned. This study describes the information in printed educational materials that address healthy eating during pregnancy and gestational weight gain (GWG) that are currently used in Alberta, Canada. Content of 6 resources was analyzed using a constant comparison qualitative approach. Resources emphasized healthy eating, prenatal supplements, folate supplementation, and healthy weight gain. More resources discussed the importance of “eating enough” than provided guidance on avoiding excessive GWG. Themes identified were: “everything is important” meaning that all healthy behaviours are important, making prioritization difficult; “more is more” emphasized eating more over moderation; “everyone is individual” suggests women seek individualized care through the care provider; and “contradictions” describes differences in content and recommendations within and between resources. New or revised versions of resources should provide congruent information with up-to-date recommendations that are easily prioritized. Care providers should be aware of contradictory information or information that does not align with current recommendations within printed educational materials and be ready to help women address the areas important for her personal behaviour change.
  • Bringing Menu Labelling to Independent Restaurants: Findings from a Voluntary Pilot Project in Toronto
    Canadian Journal of Dietetic Practice and Research • Vol. 78 • No. 4 • pp. 177 - 181
    Toronto Public Health conducted a pilot project to assess the feasibility of menu labelling by independent restaurants. The pilot project was informed by consultations with the industry and other jurisdictions that have implemented a similar initiative. Public Health Dietitians worked closely with these restaurants to help them work toward posting calories and sodium on their menus. This paper reports on the findings of a feasibility assessment that took a mixed-methods approach resulting in a comprehensive process evaluation. Results showed that having highly motivated restaurants and early adopters of menu labelling is a necessary starting point. However, this alone is not sufficient to make voluntary menu labelling successful. It may be feasible only for select independent restaurants who: (i) are highly motivated and ready to make a substantial time commitment; (ii) value offering healthy food choices; (iii) have fairly standardized recipes to begin with; (iv) receive extensive specialized, individualized support; and (v) receive incentives, cost offsetting, and recognition. Full-scale implementation of a menu labelling program with Toronto independent restaurants was not justified given the current level of interest and capacity.
  • Feasibility and Tolerability of Daily Pulse Consumption in Individuals with Peripheral Artery Disease
    Canadian Journal of Dietetic Practice and Research • Vol. 78 • No. 4 • pp. 187 - 191
    The present study investigated the feasibility, tolerability, and adherence of daily consumption of whole pulses (dried beans, peas, lentils, chickpeas) by individuals with peripheral artery disease participating in an 8-week study. Study questionnaires and semi-structured interviews for 26 participants were used to determine prestudy pulse consumption and participants’ experiences with respect to adherence, positive and negative effects, bowel routine, satiety, and enjoyment of the foods. Although the majority of participants rarely consumed pulses prior to the study, there was a high rate of adherence to daily consumption of the study foods for 8 weeks despite comments regarding study fatigue during the latter part of the study. Participants had no gastrointestinal side effects (42%) or experienced flatulence that resolved by week 4 (23%), whereas 62% reported improvements in their bowel pattern. By week 8 greater satiety was noted by some participants (19%), with the categories “less afternoon snacking” and “not snacking” receiving more responses. The key finding of this study was that consumption of pulses is a viable approach for this population; however, the frequency of consumption that is tolerable in the long term should be integrated with the dose and timeframe required to achieve and maintain health benefits.
  • A Comparative Content Analysis of Vegetarian Food Blogs Written by Registered Dietitians and Non-Registered Dietitians
    Canadian Journal of Dietetic Practice and Research • Vol. 78 • No. 2 • pp. 86 - 91
    This purpose of this study was to compare the nutritional content of vegetarian recipes published in food blogs written by registered dietitians (RDs) and by non-registered dietitians (non-RDs). Twelve food blogs written by RDs and 12 written by non-RDs were selected using a systematic approach. For each food blog, 2 vegetarian entrée recipes per season were selected (n = 192 recipes). Descriptive analyses were performed using Fisher’s exact test. Median nutritional values per serving between RDs’ and non-RDs’ recipes were compared using Wilcoxon–Mann–Whitney tests. RDs’ recipes were significantly lower in energy, non-heme iron, vitamin C, and sodium, contained significantly more vitamin D and had a higher protein proportion than non-RDs’ recipes. Disparities were also observed across type of entrée and vegetarian dietary pattern. In conclusion, this study showed that RD and non-RD food bloggers provided vegetarian recipes with few nutritional differences. Whether expanding the comparative analysis between RDs and non-RDs’ blogs targeting different nutrition-related topics would yield different results remains to be investigated.
  • Food and Mood: Diet Quality is Inversely Associated with Depressive Symptoms in Female University Students
    Canadian Journal of Dietetic Practice and Research • Vol. 78 • No. 3 • pp. 124 - 128
    Researchers have found support for an inverse association between diet quality and depressive symptoms in middle-aged adults. This association has not been well examined among university students, a population at risk of developing both depression and unhealthy lifestyle habits. We sought to examine the cross-sectional association between depressive symptoms and diet quality in female university students. One hundred and forty-one females (19.1 ± 1.5 years, 22.3 ± 3.4 kg/m2) were recruited from a Canadian university in 2012 and 2013. Dietary intake data were collected using 3-day food records and analysed using the Canadian Healthy Eating Index. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. Results of a linear regression demonstrated an inverse association between depressive symptoms and diet quality score (β = −0.016, 95% CI = −0.029 to −0.003, P = 0.017). Elevated depressive symptoms were associated with consumption of diets of poor nutritional quality in our female university student sample. Thus, healthy eating may correspond with lower levels of depression in young adult females.
  • Aboriginal Cultural Competency in Dietetics: A National Survey of Canadian Registered Dietitians
    Canadian Journal of Dietetic Practice and Research • Vol. 78 • No. 4 • pp. 172 - 176
    Little has been published on cultural competency curriculum and dietetics considering the impact of food-related beliefs and behaviours on health. A 14-item online survey was administered in January 2016 to 145 participants (125 members of Dietitians of Canada Aboriginal Nutrition Network and 20 dietitians with an interest in Aboriginal nutrition). Questions included multiple choice and ranking responses and were pretested by 4 preceptors with the Northern Ontario Dietetic Internship Program (NODIP). Quantitative data analysis included frequencies, pivot tables, and averaging/grouping of ranking scores. A total of 42 individuals (29%) completed the survey. The majority rated the 5 health and cultural competencies and 6 food and nutrition competencies as “important” (90%–98% and 86%–100%, respectively). Overall, the competency related to identifying health status was ranked highest (78%), whereas developing culturally appropriate recipes was ranked lowest (83%). Most participants (95%) believed that all dietitians and graduating dietetic interns should be minimally competent in Aboriginal health and culture. The initial 11 draft competencies for dietetic interns were condensed to 6 minimum and 2 advanced competencies. Results will inform dietitians working with Aboriginal peoples and refinement of NODIP intern and preceptor tools, with the potential to integrate across Canadian dietetic internship programs.
  • Influence of a School-Based Cooking Course on Students’ Food Preferences, Cooking Skills, and Confidence
    Canadian Journal of Dietetic Practice and Research • Vol. 78 • No. 1 • pp. 37 - 41
    A quasi-experimental study was conducted to evaluate the influence of Project CHEF, a hands-on cooking and tasting program offered in Vancouver public schools, on students’ food preferences, cooking skills, and confidence. Grade 4 and 5 students in an intervention group (n = 68) and a comparison group (n = 32) completed a survey at baseline and 2 to 3 weeks later. Students who participated in Project CHEF reported an increased familiarity and preference for the foods introduced through the program. This was statistically significant (P ≤ 0.05) for broccoli, swiss chard, carrots, and quinoa. A higher percentage of students exposed to Project CHEF reported a statistically significant increase (P ≤ 0.05) in: cutting vegetables and fruit (97% vs 81%), measuring ingredients (67% vs 44%), using a knife (94% vs 82%), and making a balanced meal on their own (69% vs 34%). They also reported a statistically significant increase (P ≤ 0.05) in confidence making the recipes introduced in the program: fruit salad (85% vs 81%), minestrone soup (25% vs 10%), and vegetable tofu stir fry (39% vs 26%). Involving students in hands-on cooking and tasting programs can increase their preferences for unpopular or unfamiliar foods and provide them with the skills and cooking confidence they need to prepare balanced meals.
  • Evaluation of Dietitian Counselling Access Revealed Reduced Pediatrician-Reported Hospital Admissions and Increased Parental Knowledge and Confidence
    Canadian Journal of Dietetic Practice and Research • Vol. 78 • No. 2 • pp. 81 - 85
    Based on a 1999 needs assessment a pediatric community-based outpatient dietitian counselling service was created. By 2010 annual referrals had grown to almost 1500 (62% from physicians; 38% from public health nurses). An evaluation was undertaken to gather perspectives of practitioners and parents about access, satisfaction, referral practices, and changes in knowledge, attitudes, behaviour, and child well-being. Health professionals surveyed via email were 62 pediatricians (response rate 71%), 25 family physicians (21%), 87 public health nurses (31%), and 7 dietitian providers (100%). Parents (n = 93, response rate 75% of those contacted) were interviewed by telephone. Pediatricians reported a significantly lower rate of 7% (95% confidence interval (CI), 0.8%–23%) for admitting children to hospital to access a dietitian, compared to 1999 of 39% (95% CI, 22%–59%) (P = 0.005). Health professionals reported a high degree of agreement on benefits of the service to their practice and on child health problems and a high degree of satisfaction with the service. Parents reported gaining knowledge (76%), confidence (93%), and making behaviour changes in foods offered (77%). Our evaluation demonstrated health practitioners saw a need for access to dietitians for pediatric dietitian counselling and parents reported more confidence and improved child feeding practices after dietitian counselling.
  • Examining Diet-Related Care Practices Among Adults with Type 2 Diabetes: A Focus on Glycemic Index Choices
    Canadian Journal of Dietetic Practice and Research • Vol. 78 • No. 1 • pp. 26 - 31
    We examined self-care dietary practices and usual intakes among adults with Type 2 diabetes in Alberta, Canada, using data from the Healthy Eating and Active Living for Diabetes study. Participants completed a modified Fat/Sugar/Fruit/Vegetable Screener and answered questions about the number of days per week they followed specific diabetes self-care dietary recommendations. Capillary blood samples were collected to assess glycemic control measured by hemoglobin A1c (HbA1c). ANOVA was used to examine differences in dietary self-care, intakes, and glycemic control across categories of days/week of practicing recommended dietary behaviour. Participants (n = 196) were 51% women, mean ± SD age 59.6 ± 8.5 years, with BMI 33.6 ± 6.5 kg/m2, and diabetes duration of 5.1 ± 6.3 years. Sixteen percent of participants were unfamiliar with low-GI eating and 28% did not include low-GI foods in their diet. Overall, lower mean intake of saturated fat, trans fat, added sugars, higher fibre, and greater GI were each associated with meeting diabetes-related dietary behaviours including: eating ≥5 servings of vegetables and fruit; avoiding processed high fat foods; and replacing high with low-GI foods (P < 0.05). No clear pattern was observed for low-GI eating and HbA1c.
  • Stronger Together: Use of Storytelling at a Dietetics Conference to Promote Professional Collaboration
    Canadian Journal of Dietetic Practice and Research • Vol. 78 • No. 1 • pp. 32 - 36
    During a Dietitians of Canada conference session (2015), 4 facilitators drew upon “Alice’s Adventures in Wonderland” (Alice) to engage participants in discussing the future of dietetic education. The aim was to feature Nova Scotia (NS) collaborative experiences as an example of dietetic education planning that could be implemented elsewhere. Three vignettes from the Alice story were chosen as metaphoric representations of dilemmas and assumptions commonly faced by dietetic educators. Story quotations and facilitator questions related to each vignette-guided discussion. The 3-part story-based arts approach of hearing stories, recognizing stories, and telling stories enabled participants to reflect on their own practice, relate to the challenges of others, and question conventional wisdom. Participants heard the Alice stories, recognized their experiences through the NS examples and had an opportunity to tell their own stories during discussions. Participants identified barriers to and strategies for collaborative planning in their own regions. Evaluation suggests most participants were positively engaged by the storytelling approach. Participants recommended that future offerings allow more time for orientation and for completion of planned activities. Bilingual programming should also be considered. Participants valued the unconventional approach to workshop engagement and planned to implement it in their own workplaces.
  • Participation in School Food and Nutrition Activities among Grade 6–8 Students in Vancouver
    Canadian Journal of Dietetic Practice and Research • Vol. 77 • No. 3 • pp. 148 - 153
    This study examined student-reported participation in school food and nutrition activities in Vancouver, British Columbia (BC), and whether engagement differed by gender and between elementary and secondary school students. A cross-sectional survey of grade 6–8 public school students (n = 937) from 20 elementary and 6 secondary schools assessed student-reported participation in a range of food and nutrition activities. Statistical analyses included descriptive statistics and multilevel logistic regression to examine associations between participation with gender and school type. Overall, <50% of students reported engaging in most of the food and nutrition activities examined in the 2011–2012 school year, including: food preparation (36%), choosing/tasting healthy foods (27%), learning about Canada’s Food Guide (CFG) (45%), learning about foods grown in BC (35%), gardening (21%), composting (32%), and recycling (51%). Females were more likely to report recycling and learning about CFG and BC-grown foods (P < 0.05). Secondary students were more likely to report activities focused on working with or learning about food/nutrition (P < 0.05). Despite local and provincial efforts to engage students in food and nutrition experiences, participation in most activities remains relatively low, with few students exposed to multiple activities. Continued advocacy is needed from the dietetics community to improve student engagement in food and nutrition activities.
  • Nutrient and Food Group Intakes of Manitoba Children and Youth: A Population-Based Analysis by Pulse and Soy Consumption Status
    Canadian Journal of Dietetic Practice and Research • Vol. 77 • No. 4 • pp. 189 - 194
    Poor eating habits among children are associated with negative health outcomes. The objective of this study was to use pulse/soy consumption as an indicator to evaluate the eating profile of young Manitobans. Data from the Canadian Community Health Survey Cycle 2.2 were used for analysis and restricted to Manitoba residents aged 2 to 18 years (n = 1840). Consumers were identified as individuals who reported eating at least 1 pulse/soy product during their recall. On any given day, 8.2% of Manitobans reported consumption of pulses/soy. Intakes of fibre, protein, magnesium, and zinc were higher in consumers only when expressed relative to total caloric intake. Consumers also reported increased intakes of meat and alternatives. Total intakes of vitamin D, fibre, and fruit and vegetable consumption were low among all groups. Sodium intakes in both groups were high when compared with levels recommended by health professionals. These results indicate that there are many dietary issues affecting Manitoba children, suggesting the need for more research targeting dietary habits of children and youth, the quality of the food supply, and effective strategies in nutrition education.
  • Energy Intake and Food Habits between Weight Maintainers and Regainers, Five Years after Roux-en-Y Gastric Bypass
    Canadian Journal of Dietetic Practice and Research • Vol. 77 • No. 4 • pp. 195 - 198
    We explored differences in dietary behaviours, energy, and macronutrient intake among individuals who had regained or maintained weight loss 5 or more years after Roux-en-Y gastric bypass (RYGB). This study assessed 27 adults who underwent RYGB an average of 12.1 ± 3.7 years before this study was conducted. Dietary assessment was performed using 3-day food records. Daily energy intake (kcal), protein (g), carbohydrate (g), fat (g), and alcohol intake (g) were computed using the ESHA’s Food Processor®. Participants were classified by percent weight loss, maintainers (≥38 %), and regainers (≤30 %). Daily carbohydrate consumption was greater in regainers (222 ± 84.3 g) compared with maintainers (162 ± 67.5 g), (P < 0.05). Thirty-seven percent of participants were not consuming the recommended amount of protein and 26% reported never taking vitamin supplements after surgery. Alcohol consumption was higher among regainers (18.5 ± 30.9 g) compared with maintainers (2.6 ± 6.5 g), (P < 0.05). Finally, 74% of the participants reported no contact with a Registered Dietitian, whereas 78 % were in contact with a health care professional once a year post-surgery. Differences were seen in carbohydrate intake and alcohol consumption between weight maintainers and regainers. These data suggest dietitians need to play a more active role in the long-term care of this medically complex population.
  • The Effects of Glucose Therapy Agents—Apple Juice, Orange Juice, and Cola—on Enteral Tube Flow and Patency
    Canadian Journal of Dietetic Practice and Research • Vol. 77 • No. 2 • pp. 93 - 97
    To develop evidence-based hypoglycemia treatment protocols in patients receiving total enteral nutrition, this study determined the effect on enteral tube flow of glucose therapy agents: apple juice, orange juice, and cola, and it also examined the effects of tube type and feed type with these glucose therapy agents. For this study, 12 gastrostomy tubes (6 polyethylene and 6 silicone) were set at 50 mL/h. Each feeding set was filled with Isosource HN with fibre or Novasource Renal. Each tube was irrigated with 1 glucose therapy agent, providing approximately 20 g of carbohydrate every 4 h. Flow-rate measurements were collected at 2 h intervals. The results showed that the glucose therapy agent choice affected flow rates: apple juice and cola had higher average flow rates than orange juice (P = 0.01). A significant difference was found between tube type and enteral formula: polyethylene tubes had higher average flow rates than silicone tubes (P < 0.0001), and Isosource HN with fibre had higher flow rates than Novasource Renal (P = 0.01). We concluded that apple juice and cola have less tube clogging potential than orange juice, and thus may be considered as primary treatment options for hypoglycemia in enterally fed patients. Polyethylene tubes and Isosource HN with fibre were less likely to clog than silicone tubes and Novasource Renal.
  • Content Validity for a Child Care Self-assessment Tool: Creating Healthy Eating Environments Scale (CHEERS)
    Canadian Journal of Dietetic Practice and Research • Vol. 77 • No. 2 • pp. 89 - 92
    The purpose of this project was to develop and content validate both a formative and summative self-assessment scale designed to measure the nutrition and physical activity environment in community-based child care programs. The study followed a mixed-method modified Ebel procedure. An expert group with qualifications in nutrition, physical activity, and child care were recruited for content validation. The survey was subjected to expert review through digital communication followed by a face-to-face validation meeting. To establish consensus for content validity beyond the standard error of proportion (P < 0.05) the content validity index (CVI) required was ≥0.78. Of the initial 64 items, 44 scored an acceptable CVI for inclusion. The remaining items were discussed, missing concepts identified, and a final CVI employed to determine inclusion. The final tool included 62 items with 5 subscales: food served, healthy eating program planning, healthy eating environment, physical activity environment, and healthy body image environment. Content validation is an integral step in scale development that is often overlooked or poorly carried out. Initial content validity of this scale has been established and will be of value to researchers and practitioners interested in conducting healthy eating interventions in child care.
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