Development of the Healthy Eating Food Index (HEFI)-2019 measuring adherence to Canada's Food Guide 2019 recommendations on healthy food choices

The release of Canada’s Food Guide (CFG) in 2019 by Health Canada prompted the development of indices to measure adherence to these updated dietary recommendations for Canadians. This study describes the development and scoring standards of the Healthy Eating Food Index (HEFI)-2019, which is intended to measure alignment of eating patterns with CFG-2019 recommendations on food choices among Canadians aged 2 years and older. Alignment with the intent of each key recommendation in the CFG-2019 was the primary principle guiding the development of the HEFI-2019. Additional considerations included previously published indices, data on Canadians’ dietary intakes from the 2015 Canadian Community Health Survey (CCHS) – Nutrition, and expert judgement. The HEFI-2019 includes 10 components: Vegetables and fruits (20 points), Whole-grain foods (5 points), Grain foods ratio (5 points), Protein foods (5 points), Plant-based protein foods (5 points), Beverages (10 points), Fatty acids ratio (5 points), Saturated fats (5 points), Free sugars (10 points), and Sodium (10 points). All components are expressed as ratios (e.g., proportions of total foods, total beverages, or total energy). The HEFI-2019 score has a maximum of 80 points. Potential uses of the HEFI-2019 include research as well as monitoring and surveillance of food choices in population-based surveys. Novelty: ● The Healthy Eating Food Index-2019 was developed to measure adherence to the 2019 Canada's Food Guide recommendations on healthy food choices. ● The HEFI-2019 includes 10 components, of which 5 are based on foods, 1 on beverages and 4 on nutrients, for a total of 80 points.

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Evaluating Diet Quality of Canadian Adults Using Health Canada’s Surveillance Tool Tier System: Findings from the 2015 Canadian Community Health Survey-Nutrition

Nutrients ◽

10.3390/nu12041113 ◽

2020 ◽

Vol 12 (4) ◽

pp. 1113

Author(s):

Salma Hack ◽

Mahsa Jessri ◽

Mary R. L’Abbé

Keyword(s):

Food Choices ◽

Canadian Community Health Survey ◽

Dietary Intakes ◽

Tier 2 ◽

Dietary Recommendations ◽

Tier System ◽

Tier 1 ◽

Community Health Survey ◽

Tier 3

The 2014 Health Canada’s Surveillance Tool, Tier System (HCST) is a nutrient profiling model developed to evaluate adherence of food choices to dietary recommendations. With the recent release of the nationally representative Canadian Community Health Survey-Nutrition (CCHS-N) 2015, this study used HCST to evaluate nutritional quality of the dietary intakes of Canadians in the CCHS-N. Dietary intakes were ascertained using 24-hour dietary recalls from Canadians adults ≥19 years (N = 13,605). Foods were categorized into four Tiers based on degree of adherence to dietary recommendations according to thresholds for sodium, total fat, saturated fats, and sugars. Tier 1 and Tier 2 represented “recommended foods”, Tier 3 represents foods to “choose less often”, and Tier 4 represented foods “not recommended”. Across all dietary reference intakes (DRI) groups, most foods were categorized as Tier 1 for Vegetable and Fruits (2.2–3.8 servings/day), Tier 2 for Grain Products (2.9–3.4 servings/day), Tier 3 for Milk and Alternatives (0.7–1 serving/day) or for Meat and Alternatives (1.1–1.6 servings/day). Consumption of foods from Tier 4 and “other foods” such as high fat/sugary foods, sugar-sweetened beverages, and alcohol, represented 24–26% and 21–23% kcal/day, for males and females, respectively. Canadians are eating more foods categorized as Tier 1–3, rather than Tier 4. Adults with the highest intakes of Tier 4 and “other foods” had lower intakes of macronutrients and increased body mass index. These findings can be used by policy makers to assist in identifying targets for food reformulation at the nutrient level and quantitative guidance to support healthy food choices.

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Skipping Breakfast Is Associated with Diet Quality and the Distribution of Food Intake Throughout the Day: NHANES 2005–20016

Current Developments in Nutrition ◽

10.1093/cdn/nzaa046_034 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 534-534

Author(s):

Owen Kelly ◽

Stephanie Fanelli ◽

Sara Thomas ◽

Jessica Krok-Schoen ◽

Satya Jonnalagadda ◽

...

Keyword(s):

Food Intake ◽

Healthy Eating ◽

Diet Quality ◽

Diabetes Management ◽

Population Based ◽

Healthy Eating Index ◽

Dietary Intakes ◽

Nutrient Intakes ◽

Diabetes Status ◽

Skipping Breakfast

Abstract Objectives Distribution of carbohydrate intakes (carb choices) throughout the day are an important aspect to diabetes management and reducing blood glucose spikes. Skipping breakfast represents a behavior of concern, providing an extension of the overnight fast and may result in elevated sugar levels later in the day. Therefore, the purpose of this study was to evaluate dietary intake differences, including carbohydrates, based on consuming breakfast or not, and by diabetes status. Methods Adults over 30 years from NHANES 2005–2016 were classified into nondiabetes (HbA1c <5.7%, n = 14,701), prediabetes (HbA1c 5.7–6.4%, n = 5855) and diabetes (HbA1c (≥6.5%, n = 2881). Dietary intakes were assessed using a multiple pass 24-hour recall to estimate intakes from the foods and beverages reported as consumed on the day prior to the NHANES visit. Breakfast was self-defined by participants. Total population-based means (95% CI) of nutrient intakes, MyPlate equivalents, and Healthy Eating Index 2015 scores from the day of intake were calculated across levels of glycemic control and skipping breakfast status. Results Across all groups, adults who reported breakfast consumption had a significantly better overall diet quality, while total intakes of whole grains and fiber were significantly lower in those who skipped breakfast. Intakes of added sugars were not significantly different between those who skipped versus consumed breakfast. Conclusions The absence of breakfast on the day of intake was related to differential intakes of several nutrients related to healthy eating and glycemic management, resulting in a poorer overall diet quality. Healthcare professionals could evaluate meal skipping patterns and its impact on overall nutrient intakes, and the distribution of food intake throughout the day, in people with diabetes, to help improve disease management. Funding Sources Abbott Nutrition.

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Comparison of Evidence Review Methodologies Used to inform Nutrition Recommendations

Current Developments in Nutrition ◽

10.1093/cdn/nzaa064_022 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1732-1732

Author(s):

Huma Rana ◽

Kaylyn Dixon ◽

Sylvie St-Pierre ◽

Bryony Sinclair

Keyword(s):

Healthy Eating ◽

Systematic Reviews ◽

Review Process ◽

Food Choices ◽

The Public ◽

Rigorous Approach ◽

Funding Sources ◽

Disease Rates ◽

Evidence Review ◽

Health Canada

Abstract Objectives In an era of rising chronic disease rates and conflicting healthy eating messages, the public needs evidence-informed, credible healthy eating information to help guide their food choices. This is why credible scientific bodies have developed systematic approaches to reviewing evidence in order to inform nutrition recommendations. Health Canada compared the latest evidence review processes and grading methodologies that are used by credible scientific bodies to develop nutrition recommendations. Methods An environmental scan of evidence review approaches used by credible scientific bodies was conducted. Websites of scientific bodies were searched, and flowcharts and summaries of each scientific body's evidence review process were developed. The evidence review processes were then assessed and compared between scientific bodies, and with their own previous approaches. Results Evidence review processes of 11 scientific bodies were included in the comparison. All scientific bodies use a systematic approach to gather and review evidence, including the use of systematic reviews, and involve experts in the review of evidence to determine its strength. However, expert groups use varying criteria to grade the evidence. Interesting similarities also exist in how the evidence review processes have evolved over time to strengthen scientific rigour and credibility. For efficiency, scientific bodies are increasingly using ‘review of systematic reviews’ in their evidence review as more systematic reviews have become available. In addition, there is improved transparency in evidence review methods and scientific bodies have increased efforts to engage the public. Conclusions Overall, the methodologies of the scientific bodies are similar in their rigorous approach to reviewing evidence to inform the development of nutrition recommendations. However, they differ in how they engage experts and grade the strength of the evidence. Another difference is the transparency of their evidence review methods, which is important to allow for meaningful comparison and understanding of conclusions across scientific bodies. Funding Sources The authors received no specific funds for this work. The authors have no conflict of interest to declare.

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Association between energy-dense food consumption at 2 years of age and diet quality at 4 years of age

British Journal Of Nutrition ◽

10.1017/s0007114513003620 ◽

2013 ◽

Vol 111 (7) ◽

pp. 1275-1282 ◽

Cited By ~ 8

Author(s):

Sofia Vilela ◽

Andreia Oliveira ◽

Elisabete Ramos ◽

Pedro Moreira ◽

Henrique Barros ◽

...

Keyword(s):

Healthy Eating ◽

Diet Quality ◽

Population Based ◽

Healthy Eating Index ◽

Soft Drinks ◽

Inverse Association ◽

Food Groups ◽

Dietary Recommendations ◽

Daily Consumption ◽

Energy Dense Food

The present study aimed to evaluate the association between the consumption of energy-dense foods at 2 years of age and the consumption of foods and diet quality at 4 years of age. The sample included 705 children evaluated at 2 and 4 years of age, as part of the population-based birth cohort Generation XXI (Porto, Portugal). Data on sociodemographic and lifestyle factors of both children and mothers were collected by face-to-face interviews. The weight and height of children were measured by trained professionals. Based on FFQ, four energy-dense food groups were defined: soft drinks; sweets; cakes; salty snacks. A healthy eating index was developed using the WHO dietary recommendations for children (2006) aged 4 years. The associations were evaluated through Poisson regression models. After adjustment for maternal age and education, child's carer, child's siblings and child's BMI, higher consumption of energy-dense foods at 2 years of age was found to be associated with higher consumption of the same foods 2 years later. An inverse association was found between the intake ( ≥ median) of soft drinks (incidence rate ratio (IRR) = 0·74, 95 % CI 0·58, 0·95), salty snacks (IRR = 0·80, 95 % CI 0·65, 1·00) and sweets (IRR = 0·73, 95 % CI 0·58, 0·91) at 2 years of age and the consumption of fruit and vegetables at 4 years of age ( ≥ 5 times/d). Weekly and daily consumption of energy-dense foods at 2 years of age was associated with a lower healthy eating score at 4 years of age (IRR = 0·75, 95 % CI 0·58, 0·96; IRR = 0·56, 95 % CI 0·41, 0·77, respectively). The consumption of energy-dense foods at young ages is negatively associated with the diet quality of children a few years later.

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Improving the nutritional status of food-insecure women: first, let them eat what they like

Public Health Nutrition ◽

10.1017/s1368980007702902 ◽

2007 ◽

Vol 10 (11) ◽

pp. 1288-1298 ◽

Cited By ~ 19

Author(s):

Lynn McIntyre ◽

Valerie Tarasuk ◽

Tony Jinguang Li

Keyword(s):

Nutritional Status ◽

Dietary Intake ◽

Food Insecurity ◽

Food Preferences ◽

Food Choices ◽

Healthy Food ◽

Dietary Intakes ◽

Healthy Foods ◽

Food Bank ◽

Diverse Community

AbstractObjectiveTo determine the extent to which identified nutrient inadequacies in the dietary intakes of a sample of food-insecure women could be ameliorated by increasing their access to the ‘healthy’ foods they typically eat.DesignMerged datasets of 226 food-insecure women who provided at least three 24-hour dietary intake recalls over the course of a month. Dietary modelling, with energy adjustment for severe food insecurity, explored the effect of adding a serving of the woman's own, and the group's typically chosen, nutrient-rich foods on the estimated prevalence of nutrient inadequacy.Setting and subjectsOne study included participants residing in 22 diverse community clusters from the Atlantic Provinces of Canada, and the second study included food bank attendees in Toronto, Ontario, Canada. Of the 226 participants, 78% lived alone with their children.ResultsWhile nutritional vulnerability remained after modelling, adding a single serving of either typically chosen ‘healthy’ foods from women's own diets or healthy food choices normative to the population reduced the prevalence of inadequacy by at least half for most nutrients. Correction for energy deficits resulting from severe food insecurity contributed a mean additional 20% improvement in nutrient intakes.ConclusionsFood-insecure women would sustain substantive nutritional gains if they had greater access to their personal healthy food preferences and if the dietary compromises associated with severe food insecurity were abated. Increased resources to access such choices should be a priority.

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Benefits of Family Meals

EDIS ◽

10.32473/edis-fy1362-2013 ◽

2013 ◽

Vol 2013 (5) ◽

Author(s):

Varnessa McCray ◽

Victor W. Harris ◽

Martie Gillen

Keyword(s):

Healthy Eating ◽

Food Choices ◽

Healthy Food ◽

Family Meals ◽

Fact Sheet ◽

Important Family ◽

The Past ◽

At Home

Over the past 30 years obesity among children has increased. One way to help youth make healthy food choices is by creating healthy eating choices and habits at home, starting with family meals. When parents value family dinners, children are likely to view family dinners as important. Family meals can provide important examples to show children what foods are good to eat and how much of the good foods they should eat. This 5-page fact sheet was written by Varnessa McCray, Victor W. Harris, and Martie Gillen, and published by the UF Department of Family Youth and Community Sciences, April 2013. http://edis.ifas.ufl.edu/fy1362

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Nutritional quality of the food choices of Canadian children

BMC Nutrition ◽

10.1186/s40795-021-00422-6 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Salma Hack ◽

Mahsa Jessri ◽

Mary R. L’Abbé

Keyword(s):

Children And Adolescents ◽

Nutritional Quality ◽

National Level ◽

Food Choices ◽

Canadian Community Health Survey ◽

Calorie Intake ◽

Dietary Intakes ◽

Nutrition Survey ◽

Tier System

Abstract Background The release of the Canadian Community Health Survey (CCHS), Nutrition 2015 provides a unique opportunity since CCHS 2004 to investigate food choices of Canadian children and adolescents at a national level. Objective This study examined the quality and quantity of food choices of children ages 2–8 years and adolescents 9–18 years, using Health Canada’s Surveillance Tool Tier System 2014. It is hypothesized that Canadian children and adolescents are consuming diets poor in nutritional quality based on evidence from the last national nutrition survey in 2004. Design Intakes from CCHS 2015, 24-h dietary recall were categorized into Health Canada’s Tiers 1–4, based on CNF/CFG classification system and thresholds for nutrients to limit i.e., total fat, saturated fats, sugars, and sodium to assess quality of food choices. Additionally, dietary intakes were grouped according to Canada’s 2007 food guide servings as the 2019 food guide was not available. Results Majority of foods reported by children 2–18 years were categorized as Tier 2 and Tier 3 foods. Investigation of energy contributions from the Tier 4 and “other foods” represented 21–25% of daily calorie intake and of these foods, high fat and/or high sugar foods contributed majority of daily calories to these categories. Conclusions This study showed Canadian children 2–18 years are consuming diets high in nutrients recommended to limit. Evidence from this study provides a unique opportunity to improve the nutritional quality of foods, and the food choices of children.

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Transiting out of Full-time National Service: A Qualitative Study of Barriers and Motivators of Weight Change in Young Adult Men

10.21203/rs.3.rs-108688/v1 ◽

2020 ◽

Author(s):

Mary Foong-Fong Chong ◽

Hui Xian Lim ◽

Beverly Wen Xin Wong ◽

Zi Han Chi ◽

JK Inthujaa ◽

...

Keyword(s):

Physical Activity ◽

Weight Gain ◽

Healthy Eating ◽

Weight Change ◽

Young Men ◽

Food Choices ◽

Healthy Food ◽

Full Time ◽

National Service ◽

Barriers And Motivators

Abstract Background A higher prevalence of obesity in men compared to women, particularly amongst those 18 to 40 years of age, has been observed in Singapore. We hypothesised that poor adaptation during the transition out of full-time National Service (NS) among young men may have contributed to weight gain and we sought to understand these underlying drivers. Methods In-depth interviews were conducted with young men (n=26; aged 19-25 years), 12 months after they had completed full-time NS. The interviews were guided by the health belief model to elicit perceived factors influencing weight change during the transition period, as well as barriers and motivators in weight management. Data was collected and cross-checked by two researchers, and analysed using the thematic analysis approach. Results The participants generally perceived themselves to be less fit and less healthy one year later, as compared to during full-time NS. They felt that reduced physical activity levels and unhealthy eating behaviours contributed to their perceived weight gain. However, they did not have immediate concerns about their perceived change in weight. While most were aware of the benefits of regular physical activity, benefits of healthy eating were rarely mentioned. Many did not view healthy lifestyle behaviours as a current priority, citing reasons which included: Time pressures, incongruence with current lifestyle, or poor self-motivation. Other barriers included a lack of access to healthy food choices and insufficient common leisure time to exercise with peers. Motivators for these lifestyle behaviours were mostly intrinsic, including interest in a particular sport, having personal fitness goals and personal preferences for healthy food options. Participants also described healthy eating as a means to compensate for inactivity or unhealthy food choices. Extrinsic motivators included peer influence, access to sports facilities, healthy food options and monetary incentives.ConclusionThere remains a need to educate young men transiting out of full-time NS on lifestyle, weight and health, and address their misconceptions in particular. Creating a healthy environment and providing appropriate incentives would be important to facilitate a smooth transition out of full-time NS, minimising the risk of unhealthy weight gain in young men.

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Clustering of adherence to personalised dietary recommendations and changes in healthy eating index within the Food4Me study

Public Health Nutrition ◽

10.1017/s1368980016001932 ◽

2016 ◽

Vol 19 (18) ◽

pp. 3296-3305 ◽

Cited By ~ 6

Author(s):

Katherine M Livingstone ◽

Carlos Celis-Morales ◽

Jose Lara ◽

Clara Woolhead ◽

Clare B O’Donovan ◽

...

Keyword(s):

Healthy Eating ◽

Dietary Intervention ◽

Controlled Trial ◽

Healthy Eating Index ◽

Lower Percentage ◽

Dietary Intakes ◽

Dietary Recommendations ◽

Physically Active ◽

Fried Foods ◽

Randomised Controlled

AbstractObjectiveTo characterise clusters of individuals based on adherence to dietary recommendations and to determine whether changes in Healthy Eating Index (HEI) scores in response to a personalised nutrition (PN) intervention varied between clusters.DesignFood4Me study participants were clustered according to whether their baseline dietary intakes met European dietary recommendations. Changes in HEI scores between baseline and month 6 were compared between clusters and stratified by whether individuals received generalised or PN advice.SettingPan-European, Internet-based, 6-month randomised controlled trial.SubjectsAdults aged 18–79 years (n 1480).ResultsIndividuals in cluster 1 (C1) met all recommended intakes except for red meat, those in cluster 2 (C2) met two recommendations, and those in cluster 3 (C3) and cluster 4 (C4) met one recommendation each. C1 had higher intakes of white fish, beans and lentils and low-fat dairy products and lower percentage energy intake from SFA (P<0·05). C2 consumed less chips and pizza and fried foods than C3 and C4 (P<0·05). C1 were lighter, had lower BMI and waist circumference than C3 and were more physically active than C4 (P<0·05). More individuals in C4 were smokers and wanted to lose weight than in C1 (P<0·05). Individuals who received PN advice in C4 reported greater improvements in HEI compared with C3 and C1 (P<0·05).ConclusionsThe cluster where the fewest recommendations were met (C4) reported greater improvements in HEI following a 6-month trial of PN whereas there was no difference between clusters for those randomised to the Control, non-personalised dietary intervention.

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Evaluation of the Healthy Eating Food Index (HEFI)-2019 measuring adherence to Canada's Food Guide 2019 recommendations on healthy food choices

Applied Physiology Nutrition and Metabolism ◽

10.1139/apnm-2021-0416 ◽

2022 ◽

Author(s):

Didier Brassard ◽

Lisa-Anne Elvidge Munene ◽

Sylvie St Pierre ◽

Alejandro Gonzalez ◽

Patricia M. Guenther ◽

...

Keyword(s):

Construct Validity ◽

Energy Intake ◽

Internal Consistency ◽

Healthy Eating ◽

Principal Component ◽

Food Choices ◽

Healthy Food ◽

Validity And Reliability ◽

Cronbach’S Alpha ◽

Cronbach's Alpha

The objective of this study was to evaluate the construct validity and reliability of the Healthy Eating Food Index-2019 (HEFI-2019), which was developed to measure adherence to Canada’s Food Guide 2019 (CFG) recommendations on healthy food choices. Dietary intake data from 24-hour dietary recalls in the 2015 Canadian Community Health Survey - Nutrition were used for that purpose. Multidimensionality was examined using principal component analysis. Mean scores were compared among subgroups of the population. The association between scores and energy intake was assessed using Pearson correlations. Cronbach’s alpha was calculated to assess reliability. The estimated mean HEFI-2019 score (/80) was 43.1 (95%CI, 42.7 to 43.6) among Canadians 2 years and older. The first and 99th percentiles were 22.1 and 62.9 points. The mean HEFI-2019 score for smokers was 7.1 points lower than for non-smokers (95%CI, -8.4 to -5.8). The HEFI-2019 was weakly correlated with energy intake (r=-0.13; 95%CI, -0.20 to -0.06). The principal components analysis revealed at least 4 dimensions. Cronbach’s alpha was 0.66 (95%CI, 0.63 to 0.69). Evidence of construct validity and internal consistency support the use of the HEFI-2019 to assess adherence to CFG-2019’s recommendations on healthy food choices. Novelty: • Examination of the Health Eating Food Index (HEFI)-2019’s psychometric properties is needed prior to implementation • Analyses support the construct validity and internal consistency of the HEFI-2019 • Interpretation of the total HEFI-2019 score must be accompanied by its components’ scores, considering it assesses multiple dimensions of food choices

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