Protocol for FLIP pilot study

This protocol includes a training guide to assist researchers in cataloguing food ingredients through use of the Food Label Information Program (FLIP) interface and database. It includes steps for downloading the “Food Collector App” which can scan information (including both text and image) on food labels. A step by step process is outlined for entering the data for compilation and analysis. Examples are provided for tinned food such as fruit and vegetables, and dry food packaging such as cereals

Protocol for FLIP study of project IDRC 108167 scaling-up and evaluating salt reduction policies and programs in Latin American countries

This guide assists researchers in cataloguing food ingredients by using the Food Label Information Program (FLIP) interface and database. It includes steps for downloading the “Food Collector App” which can scan information (including both text and image) on food labels. A step by step process is outlined for entering the data for compilation and analysis. Examples are provided for tinned food such as fruit and vegetables, and dry food packaging such as cereals

FLIP-LAC user guide

This is version 6.4 of the FLIP-LAC manual. The Food Labeling Information Program for Latin America (FLIP-LAC) for data collection and registration is a smartphone-based technology developed by the University of Toronto, Canada. The FLIP iPhone app is meant for quickly capturing a limited amount of information about a food product - most importantly the product barcode and photos of product. Once this information is captured, the data and the photos are later uploaded to the FLIP website where the rest of the data entry can be completed based on photos of the product

Canadian Initiatives to Prevent Hypertension by Reducing Dietary Sodium

Hypertension is the leading risk for premature death in the world. High dietary sodium is an important contributor to increased blood pressure and is strongly associated with other important diseases (e.g., gastric cancer, calcium containing kidney stones, osteoporosis, asthma and obesity). The average dietary sodium intake in Canada is approximately 3400 mg/day. It is estimated that 30% of hypertension, more than 10% of cardiovascular events and 1.4 billion dollars/year in health care expenses are caused by this high level of intake in Canada. Since 2006, Canada has had a focused and evolving effort to reduce dietary sodium based on actions from Non Governmental Organizations (NGO), and Federal and Provincial/Territorial Government actions. NGOs initiated Canadian sodium reduction programs by developing a policy statement outlining the health issue and calling for governmental, NGO and industry action, developing and disseminating an extensive health care professional education program including resources for patient education, developing a public awareness campaign through extensive media releases and publications in the lay press. The Federal Government responded by striking a Intersectoral Sodium Work Group to develop recommendations on how to implement Canada’s dietary reference intake values for dietary sodium and by developing timelines and targets for foods to be reduced in sodium, assessing key research gaps with funding for targeted dietary sodium based research, developing plans for public education and for conducting evaluation of the program to reduce dietary sodium. While food regulation is a Federal Government responsibility Provincial and Territorial governments indicated reducing dietary sodium needed to be a priority. Federal and Provincial Ministers of Health have endorsed a target to reduce the average consumption of sodium to 2300 mg/day by 2016 and the Deputy Ministers of Health have tasked a joint committee to review the recommendations of the Sodium Work Group and report back to them

Gaps and priorities in assessment of food environments for children and adolescents in low- and middle-income countries

School-aged children and adolescents have complex interactions with their food environments—the point of engagement of individuals with the food system—and are influenced by a diversity of individual, household and organizational factors. Although a wide range of methods have been proposed to define, monitor and evaluate food environments, few are tailored to school-aged children and adolescents. Here, we interrogate published literature on food metrics and methodologies for the characterization of food environments for school-aged children and adolescents living in low- and middle-income counties. We identify key priority actions and potential indicators for better monitoring and evaluation to galvanize policymaking to improve the healthiness of these interactions, which are so crucial to future adult well-being

Assessing the nutritional quality of diets of Canadian children and adolescents using the 2014 Health Canada Surveillance Tool Tier System

Abstract Background Health Canada’s Surveillance Tool (HCST) Tier System was developed in 2014 with the aim of assessing the adherence of dietary intakes with Eating Well with Canada’s Food Guide (EWCFG). HCST uses a Tier system to categorize all foods into one of four Tiers based on thresholds for total fat, saturated fat, sodium, and sugar, with Tier 4 reflecting the unhealthiest and Tier 1 the healthiest foods. This study presents the first application of the HCST to examine (i) the dietary patterns of Canadian children, and (ii) the applicability and relevance of HCST as a measure of diet quality. Methods Data were from the nationally-representative, cross-sectional Canadian Community Health Survey 2.2. A total of 13,749 participants aged 2–18 years who had complete lifestyle and 24-hour dietary recall data were examined. Results Dietary patterns of Canadian children and adolescents demonstrated a high prevalence of Tier 4 foods within the sub-groups of processed meats and potatoes. On average, 23–31 % of daily calories were derived from “other” foods and beverages not recommended in EWCFG. However, the majority of food choices fell within the Tier 2 and 3 classifications due to lenient criteria used by the HCST for classifying foods. Adherence to the recommendations presented in the HCST was associated with closer compliance to meeting nutrient Dietary Reference Intake recommendations, however it did not relate to reduced obesity as assessed by body mass index (p > 0.05). Conclusions EWCFG recommendations are currently not being met by most children and adolescents. Future nutrient profiling systems need to incorporate both positive and negative nutrients and an overall score. In addition, a wider range of nutrient thresholds should be considered for HCST to better capture product differences, prevent categorization of most foods as Tiers 2–3 and provide incentives for product reformulation

Assessing the nutritional quality of diets of Canadian children and adolescents using the 2014 Health Canada Surveillance Tool Tier System

Abstract Background Health Canada’s Surveillance Tool (HCST) Tier System was developed in 2014 with the aim of assessing the adherence of dietary intakes with Eating Well with Canada’s Food Guide (EWCFG). HCST uses a Tier system to categorize all foods into one of four Tiers based on thresholds for total fat, saturated fat, sodium, and sugar, with Tier 4 reflecting the unhealthiest and Tier 1 the healthiest foods. This study presents the first application of the HCST to examine (i) the dietary patterns of Canadian children, and (ii) the applicability and relevance of HCST as a measure of diet quality. Methods Data were from the nationally-representative, cross-sectional Canadian Community Health Survey 2.2. A total of 13,749 participants aged 2–18 years who had complete lifestyle and 24-hour dietary recall data were examined. Results Dietary patterns of Canadian children and adolescents demonstrated a high prevalence of Tier 4 foods within the sub-groups of processed meats and potatoes. On average, 23–31 % of daily calories were derived from “other” foods and beverages not recommended in EWCFG. However, the majority of food choices fell within the Tier 2 and 3 classifications due to lenient criteria used by the HCST for classifying foods. Adherence to the recommendations presented in the HCST was associated with closer compliance to meeting nutrient Dietary Reference Intake recommendations, however it did not relate to reduced obesity as assessed by body mass index (p > 0.05). Conclusions EWCFG recommendations are currently not being met by most children and adolescents. Future nutrient profiling systems need to incorporate both positive and negative nutrients and an overall score. In addition, a wider range of nutrient thresholds should be considered for HCST to better capture product differences, prevent categorization of most foods as Tiers 2–3 and provide incentives for product reformulation

Examining the Relationship between Free Sugars and Calorie Contents in Canadian Prepacked Foods and Beverages

To align with broader public health initiatives, reformulation of products to be lower in sugars requires interventions that also aim to reduce calorie contents. Currently available foods and beverages with a range of nutrient levels can be used to project successful reformulation opportunities. The objective of this study was to examine the relationship between free sugars and calorie levels in Canadian prepackaged foods and beverages. This study was a cross-sectional analysis of the University of Toronto’s 2013 Food Label Database, limited to major sources of total sugar intake in Canada (n = 6755). Penalized B-spline regression modelling was used to examine the relationship between free sugar levels (g/100 g or 100 mL) and caloric density (kcal/100 g or 10mL), by subcategory. Significant relationships were observed for only 3 of 5 beverage subcategories and for 14 of 32 food subcategories. Most subcategories demonstrated a positive trend with varying magnitude, however, results were not consistent across related subcategories (e.g., dairy-based products). Findings highlight potential areas of concern for reformulation, and the need for innovative solutions to ensure free sugars are reduced in products within the context of improving overall nutritional quality of the diet