Nutritional quality of the food choices of Canadian children | BMC Nutrition

Experimental design

The CCHS 2015 is a cross-sectional survey which sampled the Canadian inhabitants throughout January 2, 2015 to December 31, 2015 [11]. The survey design included sampling people in line with 12 age-sex Dietary Reference Intake (DRI) classes. CCHS 2015 was a voluntary 24-h dietary recall survey carried out utilizing a modified 5 – step automated multi-pass methodology (AMPM), tailored for the Canadian inhabitants, from the United States Department for Agriculture. Respondents accomplished a 24-h dietary recall, and supplied extra data on demographic and life-style traits. The whole pattern dimension of the survey was n = 20, 487 people with a 61.6% response charge [11]. Following the 24-h dietary recall, 35% of respondents have been requested to finish a second day recall over the telephone inside 3–10 days of the primary interview occurring on all days of the week.


Individuals sampled within the survey have been ages > 1 yr residing in Canada’s 10 provinces, excluding people dwelling in: territories, reserves, Aboriginal settlements, full-time members of the Canadian Armed Force, and institutionalized people [11]. Results from pregnant and breastfeeding girls, infants, and people with invalid dietary recollects (as outlined by Statistics Canada) have been excluded from this research. The dietary high quality of meals consumed from single 24-h dietary recollects for girls and boys between 2 to 18 years (n = 4642) have been investigated on this research.

Classifying meals within the 24-h dietary recall in line with HCST

Foods reported within the 24-h dietary recall have been categorized and the dietary composition was decided utilizing the 2015 Canadian Nutrient File (CNF) which contained data for 5690 distinctive Canadian meals generally consumed [11, 12]. Staff from Health Canada and Public Health Agency of Canada developed the CNF/CFG classification, enabling linkage of CNF meals codes to 4 CFG meals teams and 21 subgroups in line with Eating nicely with Canada’s meals information 2007 [12, 13]. Foods within the CCHS 2015 have been categorized in line with Canada’s Food Guide subgroups, and positioned into Tiers in line with established thresholds for sodium, saturated fat, whole fat, and sugars [8, 9, 13]. These thresholds have been derived from thresholds used for nutrient content material claims, DRI, and Nutrition Standards for Foods in Schools [8].

Exact strategies utilized by Health Canada to categorize meals into Tier teams are described elsewhere [8, 9]. Briefly, decrease thresholds for fat and sodium content material have been primarily based on nutrient content material claims for quantities generally consumed in a single sitting, termed the Reference Amount (RA) [8]. Foods categorized as Tier 1 should not exceed any of the decrease thresholds: ≤ 3 g/ RA fats, ≤140 mg/RA sodium and, ≤ 6 g/RA sugar [8]. As there is no such thing as a day by day worth (DV) for sugar, higher and decrease thresholds for sugar have been decided from the advice by the Institute of Medicine (IOM) [8]. The 15% DV of sodium (> 360 mg/RA), whole fat (> 10 g/RA) and saturated fat (> 2 g/RA) and for sugars (> 19 g) have been set because the higher thresholds [8]. Tier 2 meals might exceed one or two decrease thresholds however no higher thresholds. Tier 3 meals are meals with nutrient contents above all decrease thresholds (i.e., sodium, sugar, and whole fats), and should exceed one higher threshold. Tier 4 represents meals that exceed ≥2 higher thresholds, nonetheless particular consideration was given to meals belonging to the Meat and Alternative, and Milk and Alternative classes as they naturally have larger saturated fats content material [8]. Additional changes for meals primarily based on directional statements from CFG could be present in HCST [8].

Using the CNF/CFG classification system, 9 teams of meals couldn’t be labeled in line with Tiers 1–4 [8]. Of these teams, 5 classes of meals have been grouped as “different meals” representing meals not advisable within the 2007 Canada’s meals information. These teams are: 1) saturated and/or trans-fats and oils; 2) high-fat and excessive sugar meals akin to, candies, sweets, and syrups; 3) excessive calorie drinks ≥40 kcal/100 g; 4) low calorie drinks < 40 kcal/100 g (which exclude water); and 5) alcoholic drinks [8, 13].


Analyses have been accomplished utilizing Statistical Analysis Software (SAS) model 9.4 (SAS Institute Inc., Cary, NC, USA). Bootstrap balanced repeated replication with 500 repeats was used to estimate inhabitants parameters i.e., confidence intervals, normal errors, and coefficients of variation. Survey weights supplied with the grasp recordsdata have been used for all people 2 to 18 years, to make sure samples from CCHS 2015 remained nationally consultant [11]. Dietary intakes have been assessed in line with DRI age-sex groupings and adjusted for added life-style measures, which included smoking, bodily exercise and Body Mass Index (BMI). BMI was decided utilizing measured peak and weight, and cut-offs for BMI categorization have been derived primarily based on WHO BMI development curves [11]. PROC SURVEYREG and PROC SURVEYLOGISTIC have been used for steady (e.g., servings from fruit and greens) and for categorical (e.g., life-style measures) analyses, respectively, adjusting for vitality consumption, age, and intercourse the place acceptable. Results with two- tailed p-value ≤0.05 have been reported as statistically important.

Identification of implausible reporters

Studies utilizing the CCHS 2015 have acknowledged a big share of under-reporting [14, 15]. Under-reporting happens most frequently with many socially undesirable meals or these excessive in fats and sugars [14,15,16]. Following earlier publications, this research recognized people as under-reporters, believable reporters, and over-reporters, primarily based on the comparability of their estimated vitality requirement (EER) to whole vitality expenditure (EER: TEE) [11, 16, 17]. The Institute of Medicine (IOM) developed the EER equation which took into consideration age, intercourse, BMI and bodily exercise [18]. For youngsters < 12 years, under-reporters have been labeled as having a reported vitality consumption (EI) < 74% of the EER, and over-reporters > 135% of their EER [17]. For youngsters ≥12 years, under-reporters have been labeled as having an EER lower than 70% of what was reported and over-reporters have been having an EI over 142% of the EER [16]. If youngsters had no reported bodily exercise stage (PAL) they have been categorized as “low energetic” (< 14 years) and “sedentary” (> 14 years), primarily based on findings by Garriguet et al. [11, 15, 17].


All researchers obtained Reliability Status as outlined within the Policy on Government Security and accomplished a safety examine by the Royal Ontario Mounted Police, as required by the Statistics Canada Act. Data analyses have been accomplished on the Toronto, Ontario Research Data Centre (RDC) of Statistics Canada in accordance with survey pointers and procedures. To shield the confidentiality of respondents, RDC Analysts reviewed and launched the info offered on this manuscript, to make sure compliance with pointers developed by Statistics Canada. The information offered on this research was accomplished completely as secondary analyses and all data supplied was de-identified and didn’t require institutional REB approval.

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