Adherence to Vitamin D Supplementation Recommendations for Breastfed Infants and Young Children: An Analysis of Canadian Community Health Survey Data Cycles From 2015 to 2018.

BACKGROUND: In Canada, nutrition policy, as outlined in the Nutrition for Healthy Term Infants recommendations, includes a daily vitamin D supplement of 10 µg (400 IU) for breastfed infants and young children to support adequate vitamin D status. OBJECTIVES: This study aimed to report on adherence to vitamin D supplementation recommendations for breastfed infants (≤12 months); and for children breastfed >12 mo. METHODS: Canadian Community Health Survey (paired-cycles 2015/2016 and 2017/2018) maternal experiences data for infants born 2012-2018 who received any breastmilk formed the sample (n = 7079). Whether the infant was given a vitamin D supplement (yes/no) and the frequency (daily/almost every day, 1-2/wk, or <1/wk) were surveyed. Weighted data (95% CI) were summarized according to breastfeeding history (exclusive to 6 mo and continuing; partial to 6 mo and continuing; and stopped ≤6 mo). Correlates of supplement adherence were explored using logistic regression. RESULTS: Overall, 87.1% (95% CI: 85.9%, 88.3%) of participants reported giving their infant (≤12 mo) a vitamin D supplement, and of these, 83.3% (95% CI: 81.9%, 84.7%) did so daily/almost every day, 12.4% (95% CI: 11.1%, 13.7%) did so 1-2/wk, and 4.3% (95% CI: 3.6%, 5.0%) did so <1/wk. Lower adjusted odds of adherence were observed among participants reporting: stopped breastfeeding ≤6 mo, lower education or income, recent immigration, and overweight prepregnancy body mass index; higher odds of adherence were observed in the western provinces. Regarding mothers of children >12 mo and breastfed (n = 2312), 58.0% (95% CI: 54.9%, 61.1%) gave a vitamin D supplement daily/almost every day. CONCLUSIONS: Adherence to providing a vitamin D supplement to breastfed infants is high in Canada. Nonetheless, we estimate that ∼27% of mothers are nonadherent to daily/almost every day administration of a vitamin D supplement and that adherence declines in children breastfed >12 mo. Further promotion to support uptake of the current guidance may be necessary, particularly for parents of recent immigration or lower socioeconomic status.

Population Iron Status in Canada: Results from the Canadian Health Measures Survey 2012-2019.

BACKGROUND: In Canada, population iron status estimates are dated (2009-2011) and did not consider the presence of inflammation. OBJECTIVES: This study aimed to update iron status estimates in Canada using serum ferrin (SF) and evaluate different correction methods for inflammation based on c-reactive protein (CRP). METHODS: Data from the Canadian Health Measures Survey cycles 3-6 (2012-2019) formed a multiyear, cross-sectional, nationally representative sample (3-79 y) (n = 21,453). WHO cutoffs for SF and hemoglobin were used to estimate iron deficiency (ID), iron deficiency anemia (IDA), anemia, and elevated iron stores. ID was first estimated without considering inflammation. Correction approaches evaluated were excluding individuals with CRP >5 mg/L, using modified SF cutoffs, and regression correction. RESULTS: Total population uncorrected prevalence estimates were 7% (95% CI: 6.2, 7.9) ID, 6.1% (95% CI: 5.2, 7.0) anemia, and 2.0% (95% CI: 1.6, 2.4) IDA. The uncorrected prevalence of ID was the highest among females of reproductive age with 21.3% (95% CI: 17.6, 25.0) and 18.2% (95% CI: 15.4, 21.1) in 14-18 y and 19-50 y, respectively. Corrected ID estimates were higher than the uncorrected values, independent of the correction approach. Regression correction led to a moderate increase in the prevalence to 10.5% for the total population, whereas applying the higher modified SF cutoffs (70 µg/L for those older than 5 y) led to the largest increases in the prevalence, to 12.6%. Applying modified cutoffs led to implausibly high ID estimates among those with inflammation. Elevated iron stores were identified in 17.2% (95% CI: 16.2, 18.2) of the population, mostly in adult males. CONCLUSIONS: Correction methods for estimating population iron status need further research. Considering the fundamental drawbacks of each method, uncorrected and regression-corrected estimates provide a reasonable range for ID in the Canadian population. Important sex-based differences in iron status and a public health ID problem of moderate magnitude among females of reproductive age are evident in Canada.

Development and validation of a sodium AnaLysis tool (SALT).

BACKGROUND: Sodium is an essential nutrient; however, excess dietary sodium is associated with increased blood pressure levels. The 2004 Canadian Community Health Survey - Nutrition (CCHS 2.2) concluded that most Canadians exceeded the Tolerable Upper Intake Level (UL) of 2300 mg/day. The 2015 CCHS indicated that Canadians were still consuming above the UL. To assess population sodium intakes, a Sodium AnaLysis Tool (SALT) was developed. METHODS: We used data from CCHS 2.2 (2004) to group foods into types (e.g., popcorn, crackers) and general categories (e.g., snack foods) which formed the SALT questions. Portion sizes and sodium values were calculated for SALT questions. Over a one-month period, one hundred participants completed three, 24-h recalls (at beginning, middle, and end) and two SALT (SALT1 & SALT2) tools (at beginning and end). To assess both validity and reliability, statistical tests including Bland-Altman (B-A) plots, paired t-tests, differences between means, and correlations were conducted. The mean of the 3,24-h recalls (m24HR) was used for validation. RESULTS: Validity testing between SALT2 and the m24HR yielded variable results. A B-A plot between SALT2 and m24HR depicted a small bias of 7 mg/day of sodium. The sodium intake for m24HR (2742 ± 980 mg/day) (mean ± standard deviation) versus SALT2 (2735 ± 1174 mg/day) was not significantly different (p = 0.960). Pearson's correlation between methods, although significant (p = 0.02) was poor (r = 0.202; de-attenuated r = 0.400). There was a fair, significant agreement (κ = 0.236, p = 0.02) for the classification of sodium intake into two categories (above or below the UL). Test-retest reliability results were also variable. There was moderate, significant agreement (κ = 0.488, p = 0.001) for classification of sodium intake into two categories between SALT1 and SALT2, a significant correlation (Pearson's r = 0.785, p < 0.001), and the B-A plot depicted good agreement. However, the values for sodium intake for SALT1 (3185 ± 1424) vs SALT2 (2735 ± 1174) were significantly different (p = 0.005). CONCLUSIONS: Results indicate that the SALT has the potential to be a valid and reliable tool for assessing dietary sodium intake of Canadian adult populations. Despite some classification issues, there may be some value in using the SALT to categorize sodium intakes. Further refinement of the SALT may be required.

Food and Culinary Knowledge and Skills: Perceptions of Undergraduate Dietetic Students.

PURPOSE: The objective of the current study was to examine food and culinary skills and knowledge of dietetic students. METHODS: An online bilingual survey was created using Survey MonkeyTM to explore the skills, knowledge, and perceptions of undergraduate dietetic students regarding food and cooking. Chi-square and logistic regression analyses were used to compare skills and knowledge of food and culinary concepts. RESULTS: The final sample included second- (n = 22) and third-year (n = 22) students within the Baccalauréat specialisé en sciences de la nutrition program at the University of Ottawa. There were no significant differences (P > 0.05) on 3 of 4 skills (preparing a cake, whipping egg whites, or baking a yeast bread) or knowledge concepts (fold, baste, braise, grill, and poach) amongst second- and third-year students. Third-year students perceived more skill in preparing a béchamel sauce. There was a trend for third-year students (59%) to have higher food and cooking skills and knowledge compared with second-year students (32%). CONCLUSIONS: Perceived knowledge and confidence was proportional with the academic year, whereas overall knowledge and skills of food and culinary concepts were moderate among both groups of students. This research suggests that more dedicated time may need to be spent on food and cooking competencies in undergraduate dietetic education.

High-speed (20 kHz) digital in-line holography for transient particle tracking and sizing in multiphase flows.

High-speed (20 kHz) digital in-line holography (DIH) is applied for 3D quantification of the size and velocity of fragments formed from the impact of a single water drop onto a thin film of water and burning aluminum particles from the combustion of a solid rocket propellant. To address the depth-of-focus problem in DIH, a regression-based multiframe tracking algorithm is employed, and out-of-plane experimental displacement accuracy is shown to be improved by an order-of-magnitude. Comparison of the results with previous DIH measurements using low-speed recording shows improved positional accuracy with the added advantage of detailed resolution of transient dynamics from single experimental realizations. The method is shown to be particularly advantageous for quantification of particle mass flow rates. For the investigated particle fields, the mass flows rates, which have been automatically measured from single experimental realizations, are found to be within 8% of the expected values.

Vitamin C status of Canadian adults: Findings from the 2012/2013 Canadian Health Measures Survey.

BACKGROUND: Although vitamin C is not produced in the body, it is important for many biochemical and physiological functions. Little is known about the current vitamin C status of Canadians. This study describes the correlates of vitamin C status in a nationally representative sample of adults. DATA AND METHODS: Data are from the 2012/2013 Canadian Health Measures Survey. Plasma vitamin C (L-ascorbic acid) concentrations were measured among a fasting subsample of respondents aged 20 to 79 (n = 1,615). Vitamin C status, prevalence of deficiency (plasma vitamin C < 11 µmol/L), and use of vitamin C-containing supplements were estimated. Multivariate regression models were used to examine associations between vitamin C status and sociodemographic characteristics, smoking, body mass index, supplement use, and consumption of fruit juice and citrus fruit. RESULTS: The mean plasma vitamin C concentration of adults aged 20 to 79 was 53 µmol/L; fewer than 3% were vitamin C-deficient. Almost 22% took a vitamin C-containing supplement. Concentrations were lower among smokers and people who were obese, and higher among vitamin C supplement users and fruit juice and citrus fruit consumers. Multivariate models showed that supplement use was the strongest and most consistent predictor of vitamin C status; fruit juice and citrus fruit consumption were predictors only among populations with lower vitamin C concentrations (for example, smokers, obese). INTERPRETATION: Few Canadians were vitamin C-deficient. Smokers and people with a higher BMI were most at risk of lower vitamin C concentrations; concentrations were higher among supplement users and consumers of fruit juice and citrus fruit.

Improving the Patient Experience in the Urology Office: An Evidence-Based Tool Kit to Impact Staff Perception Of Patient Satisfaction.

Researchers evaluated the effectiveness of an educational intervention, which included use of an evidence-based tool kit for healthcare providers to improve patient satisfaction. Findings demonstrated improved staff perceptions of their actions influencing patient experiences, use of standardized patient care processes, and increased patient experience scores.

Optically recording velocity interferometer system configurations and impact of target surface reflectance properties [invited].

The utility of the optically recording velocity interferometer system (ORVIS) diagnostic to be configured to meet specific experimental needs in terms of line- and surface-imaging modes enabling direct control of the spatial, temporal, and velocity sensitivities is presented along with two case studies of gas gun testing with highly heterogeneous materials. These experiments have successfully coupled two and three ORVIS interferometers onto a single experiment. Light collection from the target reflector is of critical importance to successful test execution. By utilizing the established field of electromagnetic wave scattering from rough surfaces, the reflectance characteristics of several ORVIS reflectors are qualitatively and quantitatively analyzed in terms of the surface roughness statistics, power spectral density, and bidirectional reflectance distribution function. Insights into the impact of the surfaces on ORVIS image records are quantified. Through method development for quantitatively characterizing reflector surfaces, future experimentation can begin with an ability to tailor a reflector to a given test material and experimental arrangement.

Quantitative, three-dimensional imaging of aluminum drop combustion in solid propellant plumes via digital in-line holography.

Burning aluminized propellants eject reacting molten aluminum drops with a broad size distribution. Prior to this work, in situ measurement of the drop size statistics and other quantitative flow properties was complicated by the narrow depth-of-focus of microscopic videography. Here, digital in-line holography (DIH) is demonstrated for quantitative volumetric imaging of the propellant plume. For the first time, to the best of our knowledge, in-focus features, including burning surfaces, drop morphologies, and reaction zones, are automatically measured through a depth spanning many millimeters. By quantifying all drops within the line of sight, DIH provides an order of magnitude increase in the effective data rate compared to traditional imaging. This enables rapid quantification of the drop size distribution with limited experimental repetition.

The influence of menu labeling on calories selected or consumed: a systematic review and meta-analysis.

Recent menu labeling initiatives in North America involve posting the calorie content of standard menu items, sometimes with other nutrients of public health concern, with or without contextual information (such as the recommended daily caloric intake for an average adult) or interpretive information (such as traffic light symbols). It is not clear whether this is an effective method to convey nutrition information to consumers wanting to make more-informed food choices. Of particular concern are those consumers who may be limited in their food and health literacy skills to make informed food choices to meet their dietary needs or goals. The purpose of this systematic review was to determine whether the provision of menu-based nutrition information affects the selection and consumption of calories in restaurants and other foodservice establishments. A secondary objective was to determine whether the format of the nutrition information (informative vs contextual or interpretive) influences calorie selection or consumption. Several bibliographic databases were searched for experimental or quasiexperimental studies that tested the effect of providing nutrition information in a restaurant or other foodservice setting on calories selected or consumed. Studies that recruited generally healthy, noninstitutionalized adolescents or adults were included. When two or more studies reported similar outcomes and sufficient data were available, meta-analysis was performed. Menu labeling with calories alone did not have the intended effect of decreasing calories selected or consumed (-31 kcal [P=0.35] and -13 kcal [P=0.61], respectively). The addition of contextual or interpretive nutrition information on menus appeared to assist consumers in the selection and consumption of fewer calories (-67 kcal [P=0.008] and -81 kcal [P=0.007], respectively). Sex influenced the effect of menu labeling on selection and consumption of calories, with women using the information to select and consume fewer calories. The findings of this review support the inclusion of contextual or interpretive nutrition information with calories on restaurant menus to help consumers select and consume fewer calories when eating outside the home. Further exploration is needed to determine the optimal approach for providing this menu-based nutrition information, particularly for those consumers who may be limited in their food and health literacy skills.

ADL ORVIS: an air-delay-leg, line-imaging optically recording velocity interferometer system.

An interferometry system that enables acquisition of spatially resolved velocity-time profiles with very high velocity sensitivity has been designed and applied to two diverse, instructive experimental problems: (1) measurement of low-amplitude reverberations in laser-driven flyer plates and (2) measurement of ramp-wave profiles in symmetric impact studies of fused silica. The delay leg in this version of a line-imaging optically recording velocity interferometer system (ORVIS) consists of a long air path that includes relay optics to transmit the optical signal through the interferometer cavity. Target image quality from the delay path at the image recombination plane is preserved by means of a compact and flexible optical design utilizing two parabolic reflectors (serving as the relay optics) in a folded path. With an instrument tuned to a velocity per fringe constant of 22.4 m s(-1) fringe(-1), differences of 1-2 m s(-1) across the probe line segment can be readily distinguished. Measurements that capture small spatial variations in flyer velocity are presented and briefly discussed. In the fused silica impact experiments, the ramp-wave profile observed by this air-delay instrument compares favorably to the profile recorded simultaneously by a conventional line-imaging ORVIS.

Calcium, Vitamin D, Iron, and Folate Messages in Three Canadian Magazines.

PURPOSE: Data from the Canadian Community Health Survey showed that calcium, vitamin D, iron, and folate are nutrients of concern for females 19-50 years of age. The study objectives were to assess the quantity, format, and accuracy of messages related to these nutrients in selected Canadian magazines and to examine their congruency with Canadian nutrition policies. METHODS: Using content analysis methodology, messages were coded using a stratified sample of a constructed year for Canadian Living, Chatelaine, and Homemakers magazines (n = 33) from 2003-2008. Pilot research was conducted to assess inter-coder agreement and to develop the study coding sheet and codebook. RESULTS: The messages identified (n = 595) averaged 18 messages per magazine issue. The most messages were found for calcium, followed by folate, iron, and vitamin D, and the messages were found primarily in articles (46%) and advertisements (37%). Overall, most messages were coded as accurate (82%) and congruent with Canadian nutrition policies (90%). CONCLUSIONS: This research demonstrated that the majority of messages in 3 Canadian magazines between 2003 and 2008 were accurate and reflected Canadian nutrition policies. Because Canadian women continue to receive much nutrition information via print media, this research provides important insights for dietitians into media messaging.

Zinc supplementation does not alter sensitive biomarkers of copper status in healthy boys.

The tolerable upper intake levels (UL) for zinc for children were based on limited data and there is concern that the UL may be set too low. The first effect of excessive zinc intake is a reduction in copper status. The primary objective of this study was to examine the effect of zinc supplementation on copper status in children. Healthy, 6- to 8-y-old boys from Ontario, Canada were assigned to take a placebo (n = 10) or 5 mg (n = 10), 10 mg (n = 9), or 15 mg (n = 8) of zinc supplement daily for 4 mo in a double-blinded, placebo-controlled, randomized trial. Biochemical measures were evaluated at baseline and after 2 and 4 mo of supplementation. Food records were completed near the baseline and 4-mo visits. Age and anthropometric measurements did not differ (P > 0.05) between treatment groups at baseline. Mean zinc intakes from food alone (10.9-14.8 mg zinc/d) approached or exceeded the UL of 12 mg/d. Compared with the placebo group, the zinc groups had a greater change in the urine zinc:creatinine ratio at 4 mo (P = 0.02). Traditional (plasma copper and ceruloplasmin activity) and more sensitive biomarkers of copper status, including erythrocyte SOD1 activity and the erythrocyte CCS:SOD1 protein ratio, were unchanged in zinc-supplemented boys, demonstrating that copper status was not depressed. Serum lipid measures and hemoglobin concentrations were also unaffected and gastrointestinal symptoms were not reported. These data provide evidence in support of the need for reexamining the current UL for zinc for children.

Iron sufficiency of Canadians.

BACKGROUND: Iron deficiency is the most common nutritional deficiency in the world, but little is known about the iron status of people in Canada, where the last estimates are from 1970-1972. DATA AND METHODS: The data are from cycle 2 (2009 to 2011) of the Canadian Health Measures Survey, which collected blood samples from a nationally representative sample of Canadians aged 3 to 79. Descriptive statistics (percentages, arithmetic means, geometric means) were used to estimate hemoglobin and serum ferritin concentrations, and other markers of iron status. Analyses were performed by age/sex group, household income, self-perceived health, diet, and use of iron supplements. World Health Organization reference values (2001) were used to estimate the prevalence of iron sufficiency and anemia. RESULTS: The overall prevalence of anemia was low in the 2009-to-2011 period--97% of Canadians had sufficient hemoglobin levels. Generally, hemoglobin concentration increased compared with 1970-1972; however, at ages 65 to 79, rates of anemia were higher than in 1970-1972. Depleted iron stores were found in 13% of females aged 12 to 19 and 9% of females aged 20 to 49. Lower household income was associated with a lower prevalence of hemoglobin sufficiency, but was not related to lower serum ferritin sufficiency. Self-perceived health and diet were not significantly associated with hemoglobin and serum ferritin levels. INTERPRETATION: The lack of a relationship between iron status and diet may be attributable to the use of questions about food consumption frequency that were not specifically designed to estimate dietary iron intake. Factors other than iron intake might have contributed to the increase in the prevalence of anemia among seniors.

Canadians continue to consume too much sodium and not enough potassium.

OBJECTIVES: Excessive sodium (Na) intakes and insufficient potassium (K) intakes are known contributors to hypertension. In July 2010, the Health Canada-led multi-stakeholder Sodium Working Group issued recommendations to lower Na intakes of Canadians. Baseline data and ongoing monitoring are needed. METHODS: Na and K content based on recently analyzed food composite samples from the Canadian marketplace were matched with over 35,000 dietary recalls from the Canadian Community Health Survey (CCHS 2.2). The distributions of usual intakes for Na and K were constructed using SIDE software and estimates by age and sex for the 5th, 10th, 25th, mean, median, 75th, 90th and 95th percentiles were determined. RESULTS: Based on recent analyses of Canadian foods, the majority of Canadians exceeded the Tolerable Upper Intake Level (UL) for Na for their age and sex group, including infants, children, adolescents and adults. In sharp contrast, few had Adequate Intakes (AI) of K. CONCLUSION: Canadians of all ages need to decrease Na intakes below the UL. At the same time, increased consumption of dairy products, fruits and vegetables must be promoted to increase K intakes to current recommendations. Both dietary interventions are required to help lower hypertension in the Canadian population. We provide the first report based on direct analysts of Canadian foods, confirming the high Na and low K intakes of the Canadian population. With its annual sampling program of foods commonly consumed in Canada, the Total Diet Study provides an important sentinel system for monitoring these dietary risk factors for hypertension.

The iron status of Canadian adolescents and adults: current knowledge and practical implications.

OVERVIEW: Iron is an essential nutrient, playing a central role in oxygen transport and cellular energy metabolism. The importance of ensuring adequate bioavailable dietary iron stems from the severe consequences associated with iron deficiency (ID) and anemia, including reduced immune function and resistance to infection, developmental delays and irreversible cognitive deficits in young children, impaired physical work performance, and adverse pregnancy outcomes. SPECIFIC POPULATIONS: Poor dietary iron intake and ID exist in Canada, particularly in women of reproductive age. Data from the provincial nutrition surveys suggest that the prevalence of inadequate iron intakes (and low intakes of absorbable iron) among women under 50 years of age is over 10%, which may reflect poor iron status. Teenage girls are at risk for low iron stores because of the adolescent growth spurt and the onset of menstruation; those who are vegetarian are at even greater risk. CONCLUSIONS: The Canadian diet has changed so that grain products are now the main source of dietary iron for all age groups. The public must be educated to ensure the consumption of adequate quantities of bioavailable iron and enhancing factors such as vitamin C. Industry, government, and health professionals must work together to promote healthy eating patterns and the selection of appropriate foods.

An assessment of inter-rater agreement of the literature filtering process in the development of evidence-based dietary guidelines.

OBJECTIVE: To determine whether the literature filtering process, a vital initial component of a systematic literature review, could be successfully completed by nutrition professionals or non-professionals. DESIGN: Using a diet-disease relationship as the guideline topic, inter-rater agreement for the title and abstract filtering processes between and among professionals and non-professionals was assessed and compared with an expert reference standard. Predetermined eligibility criteria were applied by all raters to 185 titles and 90 abstracts. Filtering decisions were initially made independently and then revised after a within-pair consensus meeting. SUBJECTS: The raters were six dietitians (RD) and six nutrition graduate students (Grad). To assess inter-rater agreement (reliability), each group was divided into three pairs. RESULTS: Weighted and unweighted kappa statistics and percentage agreement were calculated to determine the inter-rater agreement within pairs. Sensitivity and specificity estimates were determined by comparing responses with those of an expert reference standard. Overall, Grad pairs demonstrated greater inter-rater agreement than RD pairs for title filtering (P<0.05); no differences were observed for abstract filtering. Compared with the expert reference standard, every rater and pair had false-negative responses for both title and abstract filtering. CONCLUSIONS: After consensus meetings, both RDs and Grads were comparable in their agreement on title and abstract filtering, although important differences remained compared with the expert reference standard. This study provides preliminary findings on the value of utilising a non-expert pair in developing guidelines, and suggests that the literature filtering process is complex and quite subjective.

An evidence-based approach to the development of national dietary guidelines.

It has become apparent that confusing and conflicted nutritional advice from the media in combination with a quick reversal of policymakers' national nutrition recommendations have the potential to lead to public disbelief and cynicism for both the process and the conclusions. Consequently, poor design of policy can lead to ineffective communications with health professionals and the public. The ultimate result is that the public will ignore the recommendations with potentially adverse outcomes. Formal evidence-based clinical practice guidelines are being used regularly in the medical community. The methodology used to develop these guidelines includes a systematic review of the literature, filtering the literature for relevant articles, assessing the scientific quality of the available evidence, and rating the strength or weakness of the final recommendation. This article suggests that national dietary guidelines may be improved if they are based on a more formal evidence-based approach. Current research that is being conducted to test components of a generic, standardized methodology for developing evidence-based population targeted dietary guidelines is described.