Options for basing Dietary Reference Intakes (DRIs) on chronic disease endpoints: report from a joint US-/Canadian-sponsored working group.

Dietary Reference Intakes (DRIs) are used in Canada and the United States in planning and assessing diets of apparently healthy individuals and population groups. The approaches used to establish DRIs on the basis of classical nutrient deficiencies and/or toxicities have worked well. However, it has proved to be more challenging to base DRI values on chronic disease endpoints; deviations from the traditional framework were often required, and in some cases, DRI values were not established for intakes that affected chronic disease outcomes despite evidence that supported a relation. The increasing proportions of elderly citizens, the growing prevalence of chronic diseases, and the persistently high prevalence of overweight and obesity, which predispose to chronic disease, highlight the importance of understanding the impact of nutrition on chronic disease prevention and control. A multidisciplinary working group sponsored by the Canadian and US government DRI steering committees met from November 2014 to April 2016 to identify options for addressing key scientific challenges encountered in the use of chronic disease endpoints to establish reference values. The working group focused on 3 key questions: 1) What are the important evidentiary challenges for selecting and using chronic disease endpoints in future DRI reviews, 2) what intake-response models can future DRI committees consider when using chronic disease endpoints, and 3) what are the arguments for and against continuing to include chronic disease endpoints in future DRI reviews? This report outlines the range of options identified by the working group for answering these key questions, as well as the strengths and weaknesses of each option

Examining the diversity of ultra-processed food consumption and associated factors in Canadian adults

Ultra-processed food (UPF) consumption is increasing globally at an unprecedented rate. We investigated UPF consumption among Canadian adults and associated sociodemographic and health-related factors. This study was a secondary analysis of the Foodbook study (2014–2015), which collected self-reported data on foods consumed by Canadians during a 7-day period. UPF diversity was assessed by summing the different types of UPFs consumed in the previous week to produce a diversity score. Descriptive statistics summarized UPF diversity among subgroups in Canada. Regression models identified significant associations between UPF diversity, body mass index (BMI), and sociodemographic variables. This study included 6062 participants, aged 18 years and older, representing 24.7 million Canadian adults. Almost all Canadian adults (99.0%) consumed UPFs at least once weekly. The most common UPFs consumed were chocolate, chips/pretzels, cold breakfast cereal, and fast foods. UPF diversity was greatest among men, young respondents, those with high income, and those with obesity. When controlling for potential confounders, UPF diversity for men and women was significantly associated with younger age and higher BMI; it was also associated with region for women. This study suggests UPF consumption in Canada varies across sociodemographic subgroups, but ultimately is pervasive. Further research examining potential health risks associated with UPF consumption is encouraged to inform Canadian interventions. Novelty: Almost all Canadians consume at least one type of ultra-processed food weekly. Nearly half or more Canadians consume chocolate, chips/pretzels, cold breakfast cereal, or fast food at least once weekly. Gender, age, and BMI are consistently associated with ultra-processed food diversity.The accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author

High-dose compared with low-dose vitamin B-12 supplement use is not associated with higher vitamin B-12 status in children, adolescents, and older adults

Over-the-counter vitamin supplements on the Canadian market are permitted to contain a daily vitamin B-12 dose of up to 1000 μg. Our objective was to determine the association between total daily vitamin B-12 supplement dose and markers of vitamin B-12 status in Canadians. Blood collected from a nationally representative sample aged 6-79 y (n = ∼5600) in the Canadian Health Measures Survey (2007-2009) was analyzed for serum vitamin B-12 and plasma total homocysteine (tHcy). Total daily intake of vitamin B-12 from single and multivitamin supplements was calculated. Individuals that indicated proton pump inhibitor or vitamin B-12 injection treatment were excluded from the supplement dose and tHcy analyses; folate-deficient individuals were also excluded from the tHcy analysis. Twenty-three percent of children, 12.3% of adolescents, and 25.5% of adults consumed a vitamin B-12-containing supplement. Supplement users had 33% higher serum vitamin B-12 and 4.2% higher prevalence of adequacy than did non-supplement users. Children and adolescents consuming >10 μg/d supplemental vitamin B-12 did not demonstrate higher serum vitamin B-12, higher prevalence of serumvitamin B-12 adequacy, or lower tHcy than did those consuming >0-10 μg/d. The association between serumvitamin B-12 reached a plateau at doses of >25 and >10-25 μg/d in adults aged 46-59 and 60-79 y, respectively. The prevalences of serum vitamin B-12 adequacy and normal tHcy, and tHcy did not differ by vitamin B-12 supplement dose in adults >45 y. In this cross-sectional study, vitamin B-12 supplement doses >10-25 μg/d were not associated with higher vitamin B-12 status in children, adolescents, or older adults compared with lower doses

Risk of bias in cross-sectional studies: Protocol for a scoping review of concepts and tools

Cross-sectional studies are commonly used to study human health and disease, but are especially susceptible to bias. This scoping review aims to identify and describe available tools to assess the risk of bias (RoB) in cross-sectional studies and to compile the key bias concepts relevant to cross-sectional studies into an item bank. Using the JBI scoping review methodology, the strategy to locate relevant RoB concepts and tools is a combination of database searches, prospective review of PROSPERO registry records; and consultation with knowledge users and content experts. English language records will be included if they describe tools, checklists, or instruments which describe or permit assessment of RoB for cross-sectional studies. Systematic reviews will be included if they consider eligible RoB tools or use RoB tools for RoB of cross-sectional studies. All records will be independently screened, selected, and extracted by one researcher and checked by a second. An analytic framework will be used to structure the extraction of data. Results for the scoping review are pending. Results from this scoping review will be used to inform future selection of RoB tools and to consider whether development of a new RoB tool for cross-sectional studies is needed

Options for basing Dietary Reference Intakes (DRIs) on chronic disease endpoints: report from a joint US-/Canadian-sponsored working group.

Dietary Reference Intakes (DRIs) are used in Canada and the United States in planning and assessing diets of apparently healthy individuals and population groups. The approaches used to establish DRIs on the basis of classical nutrient deficiencies and/or toxicities have worked well. However, it has proved to be more challenging to base DRI values on chronic disease endpoints; deviations from the traditional framework were often required, and in some cases, DRI values were not established for intakes that affected chronic disease outcomes despite evidence that supported a relation. The increasing proportions of elderly citizens, the growing prevalence of chronic diseases, and the persistently high prevalence of overweight and obesity, which predispose to chronic disease, highlight the importance of understanding the impact of nutrition on chronic disease prevention and control. A multidisciplinary working group sponsored by the Canadian and US government DRI steering committees met from November 2014 to April 2016 to identify options for addressing key scientific challenges encountered in the use of chronic disease endpoints to establish reference values. The working group focused on 3 key questions: 1) What are the important evidentiary challenges for selecting and using chronic disease endpoints in future DRI reviews, 2) what intake-response models can future DRI committees consider when using chronic disease endpoints, and 3) what are the arguments for and against continuing to include chronic disease endpoints in future DRI reviews? This report outlines the range of options identified by the working group for answering these key questions, as well as the strengths and weaknesses of each option