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  • Registered Dietitians’ Experiences and Perceptions in Providing Prenatal Nutrition Care in Canada: A Cross-sectional Study
    Canadian Journal of Dietetic Practice and Research • e-First • pp. 1 - 10
    Purpose: To explore Canadian Registered Dietitians’ (RDs) roles and experiences in prenatal care.Methods: This cross-sectional study utilized an online, anonymous, original survey. Eligible RDs, who are members of Dietitians of Canada (DC) and provide care for pregnancy, were invited to participate through their publicly available online profiles on the DC website.Results: Of the 71 RDs who completed the survey, 97.1% provided nutrition care when requested by the client, 68.8% in times of complications, and 60.0% through referrals. RDs most frequently discussed topics on foods to avoid, supplementation, and healthy eating. Only 4.3% of RDs felt that other prenatal healthcare providers (HCPs) are providing adequate nutritional care, while all (100.0%) RDs believed that they should be the ones providing nutrition care for pregnancy, and most (88.6%) thought they should start providing nutrition counselling during preconception. Most (92.9%) respondents acknowledged that barriers exist in accessing RDs for nutrition advice. Recommendations for improving RD accessibility included increased government funding, involvement in standard care and referrals, awareness, and remote access.Conclusions: Canadian RDs would like to play a larger role in prenatal care through a more integrated approach with other prenatal HCPs and improved access to dietetic services for all pregnant people.
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    Does Dietitian Involvement During Pregnancy Improve Birth Outcomes? A Systematic Review
    Canadian Journal of Dietetic Practice and Research • Vol. 85 • No. 1 • pp. 32 - 44
    Maternal diet during pregnancy can have a significant impact on maternal and offspring health. As nutrition counselling is an important component of prenatal care, registered dietitians (RDs) are uniquely trained professionals who can provide personalized nutrition counselling customized to an individual’s sociocultural needs. The objective of this systematic review was to determine if RD involvement during pregnancy is associated with a lower prevalence of adverse birth outcomes in the United States and Canada. The review was conducted through a search of four databases: PubMed, CINAHL, Embase, and Web of Science. A total of 14 studies were identified. Women had a lower prevalence of low birth weight and preterm infants when RDs were involved during prenatal care. While RD involvement during pregnancy was not associated with macrosomia, more research is needed to assess its relationship with small for gestational age, large for gestational age, and infant mortality. Future research should also investigate the specific dietary advice provided by RDs and the extent and timing of their involvement throughout pregnancy to better understand the mechanisms surrounding nutrition counselling, in utero development, and health outcomes.
  • Applicability of the Socioecological Model for Understanding and Reducing Consumption of Ultra-Processed Foods in Canada
    Canadian Journal of Dietetic Practice and Research • Vol. 84 • No. 1 • pp. 38 - 42
    Ultra-processed foods (UPFs) have become a major contributor to the diets of Canadians, with a recent report from Statistics Canada suggesting Canadians are consuming almost one-half of their calories from UPFs. Research has linked UPF consumption with increased risk for chronic diseases such as cardiovascular disease and type 2 diabetes, among others. This paper sought to investigate the popularity of UPFs, particularly among children and teens, utilizing the socioecological model as a framework to illustrate how influences at multiple levels (i.e., public policy, organizational, community, interpersonal, and individual) have played a role in the proliferation of UPFs. Evidence from previous studies is used to identify how factors at different levels may influence UPF consumption and discuss potential strategies for reducing UPF consumption. To meaningfully reduce UPF consumption among Canadians, all levels should be considered, with the goal of creating a healthier Canadian population.
  • Sixty Percent of Foods Advertised in Grocery Store Flyers are Not In-line with Canada’s Food Guide
    Canadian Journal of Dietetic Practice and Research • Vol. 83 • No. 2 • pp. 52 - 58
    Purpose: To evaluate foods advertised in discount and premium grocery flyers for their alignment with Canada’s 2007 Food Guide (CFG) and assess if alignment differed by food category, season, page location, and price.Methods: Weekly flyers (n = 192) were collected from discount and premium grocery chains from each of 4 seasons. Health Canada’s Surveillance Tool was used to assess food items as in-line or not in-line with CFG.Results: Of 35 576 food items, 39.7% were in-line with CFG. There were no differences in proportions of foods not in-line in discount versus premium flyers (60.9% and 60.0%, respectively). Other Foods and Meat & Alternatives were advertised most (28.0% and 26.3%, respectively; P < 0.001). Milk & Alternatives were the least advertised food group (10.3%). Vegetables & Fruit (19.6%), Grains (21.6%), Milk & Alternatives (20.6%), and Meat & Alternatives (20.2%) were promoted least in Fall (P < 0.001). A higher proportion of foods advertised on middle pages were not in-line (61.0%) compared with front (56.6%) and back (58.8%) pages (P < 0.001). Not in-line foods were more expensive ($3.49, IQR = $2.82) than in-line foods ($3.28, IQR = $2.81; P < 0.001).Conclusions: While there was no difference in healthfulness of foods advertised in discount versus premium flyers, grocers advertised more foods not in-line with CFG. Government policies to improve the food environment should consider grocery flyers.
  • Examining Elementary School Children’s Knowledge about Food and Nutrition in Southwestern Ontario, Canada
    Canadian Journal of Dietetic Practice and Research • Vol. 83 • No. 2 • pp. 59 - 67
    Purpose: Knowledge is fundamental to helping children make nutritional choices that support lifelong healthy behaviours. This study (i) investigates elementary school children’s knowledge about food and nutrition and (ii) identifies sociodemographic factors influencing children’s reported knowledge.Methods: In 2017–2019, a survey was administered to 2443 students (grades 5–8) at 60 schools across southwestern Ontario, Canada, and a parent survey was used to validate self-reported sociodemographics. Multiple regression was used to analyse children’s knowledge scores and related sociodemographic factors. A total knowledge score was calculated by summing correct responses derived from 46 individual questions in the student survey.Results: Mean total knowledge score was 29.2 out of a possible 46 points (63.5% correct). Students demonstrated some knowledge and awareness of strategies to encourage fruit and vegetable consumption, healthy food selection, nutrition, and food preparation skills, although knowledge of food guide recommendations and locally sourced produce were limited. Female sex, family income, and rurality were associated with higher knowledge scores.Conclusions: Results provide insight regarding strengths and gaps in elementary-school children’s food and nutrition knowledge. Poor performance of students on specific food guide-related questions suggests that the general guidance of the 2019 Canada’s Food Guide might be better understood by children and adolescents.
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    Identifiable Dietary Patterns of Pregnant Women: A Canadian Sample
    Canadian Journal of Dietetic Practice and Research • Vol. 83 • No. 3 • pp. 104 - 111
    Purpose: To estimate the percentage of a sample of pregnant women in Canada following a vegetarian, vegan, low-carbohydrate, gluten-free, Mediterranean, or well-balanced diet, before and during pregnancy and to explore if pregnant women received and were satisfied with nutrition information received from health care providers (HCPs).Methods: Participants were conveniently sampled through Facebook and Twitter. An online survey collected data on sociodemographic characteristics, maternal diet, and whether women received and were satisfied with nutrition information from their HCPs. The McNemar test assessed changes in the proportion of diets followed before and during pregnancy.Results: Of 226 women, most followed a well-balanced diet before (76.9%) and during (72.9%) pregnancy (p = 0.26). Vegetarian, gluten-free, vegan, and low-carbohydrate diets were the least followed diets before and during pregnancy (vegetarian: 7.6% vs 5.3%; gluten-free: 4.9% vs 4.0%; vegan: 2.7% vs 2.2%; low-carbohydrate:4.0% vs 0.4%). Overall, the number of women following restrictive diets before pregnancy was significantly reduced throughout pregnancy (19.1% vs 12.0%, p < 0.001). Only 52.0% of women received nutrition information from their primary HCP, and 35.6% were satisfied with the nutrition information received.Conclusions: Most women followed a well-balanced diet before and during pregnancy and approximately one-third were satisfied with the information received from HCPs.
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    A Review of Statistical Reporting in Dietetics Research (2010–2019): How is a Canadian Journal Doing?
    Canadian Journal of Dietetic Practice and Research • Vol. 82 • No. 2 • pp. 59 - 67
    Despite the widespread use of statistical techniques in quantitative research, methodological flaws and inadequate statistical reporting persist. The objective of this study is to evaluate the quality of statistical reporting and procedures in all original, quantitative articles published in the Canadian Journal of Dietetic Practice and Research (CJDPR) from 2010 to 2019 using a checklist created by our research team. In total, 107 articles were independently evaluated by 2 raters. The hypothesis or objective(s) was clearly stated in 97.2% of the studies. Over half (51.4%) of the articles reported the study design and 57.9% adequately described the statistical techniques used. Only 21.2% of the studies that required a prestudy sample size calculation reported one. Of the 281 statistical tests conducted, 88.3% of them were correct. P values >0.05–0.10 were reported as “statistically significant” and/or a “trend” in 11.4% of studies. While this evaluation reveals both strengths and areas for improvement in the quality of statistical reporting in CJDPR, we encourage dietitians to pursue additional statistical training and/or seek the assistance of a statistician. Future research should consider validating this new checklist and using it to evaluate the statistical quality of studies published in other nutrition journals and disciplines.
  • Using the Food Skills Questionnaire (FSQ) to Evaluate a Cooking Intervention for University Students: A Pilot Study
    Canadian Journal of Dietetic Practice and Research • Vol. 82 • No. 1 • pp. 41 - 44
    Purpose: To pilot test the Food Skills Questionnaire (FSQ) to evaluate a cooking intervention.Methods: Students attending Western University were invited to participate in 3 cooking classes over a 3-month period. All participants were asked to complete the FSQ pre- and post-intervention. The FSQ evaluated food skills in 3 domains—Food Selection and Planning, Food Preparation, and Food Safety and Storage—with a maximum score of 100 per domain. Domain scores were then computed as a weighted average for the Total Food Skills Score out of 100. Open-ended questions assessed participants’ perceptions of the classes.Results: Forty-four students participated. There was a significant increase in food planning (70.6 ± 13.5–77.6 ± 14.3, P < 0.01), food preparation (67.5 ± 14.0–74.9 ± 12.9, P < 0.01), food safety (78.0 ± 9.9–80.8 ± 13.0, P = 0.04), and total food skills (71.9 ± 8.9–77.8 ± 10.6, P < 0.01) post-intervention. Content analysis of open-ended questions indicated that participants enjoyed healthy recipes, supportive Peer Educators, discussions, the cooking experience, socializing, and the safe environment.Conclusions: The FSQ shows strong potential for evaluating basic (e.g., peeling, chopping, slicing) to intermediate (e.g., meal planning) food skills in an effective and feasible manner. It can also capture changes in specific domains, allowing the development of more focused nutrition education and skills-based interventions.
  • Participating in Faculty-Supervised Extracurricular Experiential Learning Activities Contributes to Dietetic Competency Development
    Canadian Journal of Dietetic Practice and Research • Vol. 81 • No. 1 • pp. 37 - 43
    Purpose: To examine the relationship between Food and Nutrition graduates’ involvement in faculty-supervised extracurricular experiential learning activities (FEEs) and the development of dietetic competencies.Methods: An original web-based survey, assessing involvement in FEEs and self-perceived level of Canadian dietetic competencies, was administered to Brescia University College Food and Nutrition graduates for graduation years 2011–2017. Competency scores were calculated for each respondent in 4 practice areas (Professional Practice, Communication and Collaboration, Population and Public Health, and Management), and summed for a Total Competency Score. Multiple linear regressions were used to assess predictors of competency scores.Results: The final sample consisted of 233 respondents who participated in 1.9 ± 1.1 FEEs. The highest average competency score (out of 100) was Communication and Collaboration (59.7 ± 31.7); the lowest was Management (40.3 ± 30.9). Total hours spent and breadth of experiences in FEEs were significant predictors of all scores (P < 0.05). Depth of experiences was a significant predictor of all competency scores (P < 0.05) except for Management (P = 0.27).Conclusions: Participation in FEEs contributes to Food and Nutrition students’ development of entry-level dietetic competencies; therefore, counting some FEEs as curricular credits may be warranted. Given the prominence of competency-based learning assessments, these results also have implications for faculty resources, budgets, and collective agreements.
  • Point-of-Purchase Labels and Reward Cards Improve Sales of Healthy Foods in University Dining Halls
    Canadian Journal of Dietetic Practice and Research • Vol. 79 • No. 3 • pp. 92 - 98
    Purpose: To compare sales of Food Resources and Education for Student Health (FRESH) Approved versus non-FRESH Approved menu cycle items pre- and postimplementation of the FRESH program.Methods: Sales data from 2011–2015 of FRESH Approved versus non-FRESH Approved menu items were analyzed. Fruit and milk items sold, net sales, and the cost of free fruit and milk redeemed through the FRESH Reward Card (FRC) program, were also analyzed.Results: FRESH Approved items sold more often than non-FRESH Approved items in the latter 2 years (P = 0.01). Prices of FRESH Approved menu items were significantly lower than non-FRESH Approved items for all years (e.g., $1.52 ± $0.94 vs $2.21 ± $1.02 per serving in 2014–2015; P < 0.001). Across all FRESH implementation years, FRESH Approved menu items were found more often on the 6-week menu (P < 0.05). The number of fruit items sold increased from a baseline of 143 052 to 170 954, and net sales increased from $135 450 to $154 248 after 3 years of the FRC implementation.Conclusions: FRESH Approved items were less expensive, available more often, and had higher sales. The FRC increased net fruit sales despite the cost of free fruit. Highlighting and reducing the cost of healthy foods are promising practices to improve campus food environments.
  • Parental Reports of Lunch-Packing Behaviours Lack Accuracy: Reported Barriers and Facilitators to Packing School Lunches
    Canadian Journal of Dietetic Practice and Research • Vol. 79 • No. 3 • pp. 99 - 105
    Purpose: Parents influence the foods their children consume and often provide proxy reports of this intake. One way parents exert this influence is by providing home-packed lunches. This study compared parental reports of foods packed in children’s lunches with what was actually packed and identified parental barriers and facilitators to packing lunches.Methods: Grade 3 and 4 student–parent dyads (n = 321) in 19 elementary schools in Ontario participated. Parental reports and actual packed lunch contents were collected via self-administered surveys and direct observation, respectively. Parental barriers and facilitators were obtained through open and closed survey questions.Results: Median portions packed were significantly higher for sugar-sweetened beverages and snacks and significantly lower for fruits, fruit juice, vegetables, milk/alternatives, and meat/alternatives than parents reported. Packing a healthy lunch was “important/very important/of the utmost importance” for 95.9% of respondents, and 97.5% perceived their nutrition knowledge as “adequate/good/very good”. Barriers to packing a lunch included: child’s food preferences, time, finances, allergy policies, and food safety. Nutrition resources, observing other children’s lunches, child’s input, and planning ahead were identified as facilitators.Conclusions: Strategies to improve packed lunches should move beyond parental nutrition knowledge and importance of lunch packing to address parental barriers and facilitators.
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