Canada's Food Guide Research Articles

The association between the cost and quality of diets of children in Canada.

To examine the association between the cost and quality of diets of grade 5 children in Alberta, Canada. We used survey data of 2731 grade 5 students (10-11 years of age), collected between March and June 2014. This survey included the Harvard Youth Adolescent Food Frequency Questionnaire which captures information on intake of 147 food items. On the basis of these food items, we calculated the diet quality, using the Diet Quality Index-International (DQI) and Canada's Food Guide, and costs by accessing prices from four Canadian grocery retailers. We applied linear regression to determine the association of diet quality with costs. We estimated the cost of a child's diet to be CAD $13.19 per day. For the 12% of children with a low diet quality, these costs were $12.12 and for the 66% of children with moderate and 22% with high diet quality, these costs were $13.27 and $13.51, respectively. For every one-unit increase in DQI, the cost of the diet increased by seven cents per day. Diets that met the recommendations for vegetables and fruit and for meat and alternatives were respectively 53 cents and $1.39 higher relative to diets not meeting these recommendations. Costs for unessential food items constituted $1.39 per day. We observed a gradient whereby diets of better quality are costlier. For low-income households, this may lead to a genuine barrier to healthy eating. Initiatives that target unhealthy unessential foods may create the financial space for households to purchase pricier healthier options. Such initiatives may also alleviate future health care costs.

Is the 2019 Canada's Food Guide Snapshot nutritionally adequate?

This analysis assessed the nutrient content of foods depicted in Canada's Food Guide Snapshot. Nutrient contents per 2000 kcal were initially assessed by comparison to Daily Values (DVs). For essential nutrients provided in amounts <DVs, the probability of inadequacy was determined. DVs were met for "nutrients to limit", dietary fibre, and most essential nutrients. However, the probability of calcium and vitamin D inadequacy for reference individuals in most age/sex groups exceeded 50% and ranged up to >90%. Novelty Canadians who consume foods as depicted in the Food Guide Snapshot are likely to fall below dietary requirements for calcium and vitamin D.

Maternal Impressions of the New 2019 Canadian Food Guide

Background: Canada’s new food guide was released on January 2019 followingits predecessor Eating Well with Canada’s Food Guide released in 2007. Major changes in the new food guide included a partitioned plate of realfoods, messages around healthy eating being more than the foods you eat, and no feature of the milk and alternatives group. There were also no recommended servings for age groups or developmental stages including pregnant women.&#x0D; Objective: The purpose of this qualitative study was to explore the perceptions of pregnant Canadian women toward the new Canada food guide.Methods: Eight pregnant women over the age of eighteen were recruited from facilities that offered prenatal fitness. Interviews included documenting impressions of the Canada food guide, dietary choices during pregnancy and planned dietary changes. The interviews were digitally recorded, and transcribed verbatim. Braun and Clarke thematic analysis was used to analyze the data.Results: All the participants were familiar with Canada food guides and all but three were aware of the newest version. Participants commented that the new food guide was appealing and healthy. Most participants had already madechanges to their daily diet that coincidentally corresponded to the new food guide. Many also followed the messages in the new food guide but reported that pregnancy was the main influence for food changes. Participants included more fruits and vegetables, and less meat than when they were not pregnant.The internet, family, physicians and previous knowledge were also used to inform food choices. Much of this information was however reported as too little and contradictory. Participants wanted information more specific to pregnant women which was not included in the new food guide.Conclusions: Canada’s new food guide reinforced actions that women were already taking to improve their diet during pregnancy. The new food guide offers broad recommendations for Canadians to follow but pregnant women prefer a guide that is specific with clear recommendations for pregnant women.

The validation of the Healthy and Unhealthy Eating Behavior Scale (HUEBS): Examining the interplay between stages of change and motivation and their association with healthy and unhealthy eating behaviors and physical health

The purpose of the present research was to examine how self-determined and non-self-determined motivation for eating was related to healthy and unhealthy eating behaviors at different stages of change. In Study 1 (n = 360), the structure of a new scale designed to measure healthy and unhealthy eating behaviors based on recent recommendations of the Canadian Food Guide was examined through Principal Component Analysis. Study 2 (n = 711) retested the structure of the scale and also examined whether women reported different patterns of motivation and eating behaviors depending on their stage of change for eating regulation. In Study 3 (n = 264), moderated mediation models were used to examine if eating behaviors served to mediate the relationship between motivation and waist circumference, and whether stages of change moderated the link from motivation to eating behaviors. Overall, the studies provided evidence for the 2-factor structure of the scale, where the first factor represents healthy eating and the second factor represents unhealthy eating behaviors. It was also demonstrated that as women moved along the stages of change for eating regulation, they reported higher levels of self-determined motivation and lower levels of non-self-determined motivation, as well as a higher consumption of healthy foods and a lower consumption of unhealthy foods. Finally, findings indicated that healthy eating fully mediated the relationship between self-determined motivation and waist circumference, and that the relationship between self-determined motivation and healthy eating was moderated by stages of change. Together, these studies highlight the interactive roles of motivation and stages of change in their association with healthy and unhealthy eating behaviors, as well as the importance of healthy eating for a lower waist circumference.

Development of a diet quality index to assess adherence to Canadian dietary recommendations in 3-year-old children.

Little is known about the diet quality of preschool children in Canada. We adapted an established diet quality index for European preschool children to align with the Canadian context and applied the index to dietary data of 3-year-old children to assess patterns of diet quality. Our diet quality index (DQI-C) consists of four components that align with Canada's Food Guide (Vegetables and Fruit, Grain Products, Milk and Alternatives and Meat and Alternatives) and two components that account for less healthy intakes (Candy/Snacks, and Sugar-Sweetened Beverages (SSB)). The ratio between consumption v. recommended intakes is calculated for each component and summed to give a total score from 0 to 6. Alberta, Canada. The DQI-C was applied to FFQ data from 1260 3-year-old children. Mean DQI-C was 3·69 (sd 0·6). Most children met recommendations for Vegetables and Fruit (73 %) and Meat and Alternatives (70 %); however, fewer met recommendations for Milk and Alternatives (38 %) and Grain Products (13 %). Children in the lowest quartile for DQI-C score consumed a mean of 82 g of Candy/Snacks and 193 g of SSB daily, whereas those in the highest quartile consumed 45 g/d and 17 g/d of Candy and Snacks and SSB, respectively. This DQI-C score is useful for ranking Canadian preschool children according to their overall diet quality. There is room for improvement for consumptions of Grain Products, Meat and Alternatives, Candy/Snacks and SSB, which could be a target for initiatives to improve diet quality of preschool children in Canada.

Consumption and Sources of Saturated Fatty Acids According to the 2019 Canada Food Guide: Data from the 2015 Canadian Community Health Survey.

The 2019 revised version of Canada’s Food Guide (CFG) recommends limiting the consumption of processed foods that are high in saturated fatty acids (SFA). Yet, the contributions of each CFG group to the total SFA intake of Canadians are not specifically known. The objectives of this study were to quantify the total SFA intake of Canadians, determine the sources of SFA consumed by Canadian adults, and identify potential differences in these sources. A nation representative sample from the Canadian Community Health Survey (CCHS – Nutrition 2015) was used for these analyses. Dietary intakes were measured using a single 24-h recall. Food sources of SFA were classified according to the revised 2019 CFG categories. We have also examined the contribution of foods not included in these three categories to total SFA intake. Among Canadian adults, total SFA contributed to 10.4 ± 0.1% (SE) of total energy intake (E). The “Protein foods” (47.7 ± 0.5% with 23.2 ± 0.4% from milk and alternatives and 24.5 ± 0.4% from meats and alternatives) and “All other foods” (44.2 ± 0.5%) categories were the main sources of total SFA intake. Few differences in SFA sources were identified between sexes, age groups, education levels, and body mass index (BMI) categories. These data show that the mean SFA consumption is greater than the 10% E cut-off previously proposed in Canada. Future studies should examine which food substitution is most likely to contribute to a greater reduction in SFA intake at the population level.

Association between Grain Intake, Nutrient Intake, and Diet Quality of Canadians: Evidence from the Canadian Community Health Survey-Nutrition 2015.

The new Canada’s Food Guide (CFG) recommends whole grains foods as the primary choice of grain products in the daily diet. This study examined whether higher shares of whole-grain consumption, beyond the recommended levels (i.e., above half) of the daily grain intake, are linked with optimal diet quality and intakes of some key nutrients, for both children and adolescents and adults in Canada. To meet the objective of this study, we used the Canadian Community Health Survey (CCHS)–Nutrition 2015, which is a nationally representative data. We employed the propensity score matching (PSM) method in this study. PSM estimates the exposure effect when a set of individuals are exposed to a specific treatment (food group intake in this study) in a non-experimental setting. The results of our analyses implied that a high consumption of whole grains is associated with a good diet quality. However, after a certain level of whole-grain consumption, no significant differences can be observed in diet quality scores of children and adolescents and adults. Moreover, it was observed that the proportion of obese and overweight individuals was significantly lower among adults that had balanced intakes of whole and non-whole grains. The results of logistic regression analyses also showed the probability of being obese and overweight is significantly lower in the case of adults with balanced intakes of grains. However, no significant differences were observed in the prevalence of obesity and overweight across whole grains consumption patterns for children and adolescents.

Changes in beverage consumption in Canada.

Beverage consumption, especially water, is critical to a healthy diet. The 2007 Canada's Food Guide (CFG) makes specific recommendations regarding the intake of water, fruit juice, milk and energy-dense beverages. Earlier comparisons of 2004 and 2015 dietary data show that changing patterns in beverage intake can explain some of the changes in energy and sugar intake observed in the Canadian population. The objective of this study is to describe any changes in beverage consumption between 2004 and 2015, and how these changes relate to existing recommendations in the 2007 CFG. Data are from the Canadian Community Health Survey - Nutrition for 2004 and 2015. To estimate any change in the proportion of Canadians consuming a beverage the day before and the quantity consumed, 19 beverage categories were derived using the Bureau of Nutritional Science categories. The CFG classification was used to estimate the relative share of juice intake from total servings of vegetables and fruit, and the intake of milk from milk subcategories. The National Cancer Institute method was used to estimate usual intake. Water intake was higher in 2015 than in 2004. Consumption of milk, fruit juice, and energy-dense beverages such as fruit drinks and soft drinks was lower in 2015. Changes in water, soft drink and fruit drink consumption mostly reflect changes in the proportion of Canadians consuming these specific beverages the day before reporting, while changes in milk and fruit juice mostly reflect a change in the quantity consumed. In 2015, the majority of the population was consuming more whole vegetables and fruit than juice, which is in line with 2007 CFG recommendations. Beverage consumption patterns in Canada changed between 2004 and 2015. Some of these changes are in line with recommendations from the 2007 CFG, the food guide that was available at the time of the 2015 survey.

Which food literacy dimensions are associated with diet quality among Canadian parents?

PurposeThe purpose of this paper is to explore associations between different food literacy dimensions and diet quality among a sample of Canadian parents and examine differences in the prevalence of food literacy items between mothers and fathers.Design/methodology/approachParents responsible for food preparation (n=767) completed an online survey including dietary intakes and 22 items across five dimensions of food literacy (knowledge, planning, cooking, food conceptualisation and social aspects). Differences between genders for each item were analysed with χ2 tests. The healthy eating index (HEI) adapted to the Canadian Food Guide (CFG) was computed from a food frequency questionnaire. Associations between HEI scores and each item were analysed with linear regression models, controlling for sociodemographic variables and multiple testing.FindingsOf parents responsible for food preparation, 81 per cent were mothers. The mean HEI score was 76.6 (SD: 10.6) and mothers reported healthier diets in comparison to fathers (p=0.01). More mothers than fathers used CFG recommendations, selected foods based on nutrition labels, made soups, stews, muffins and cakes from scratch and added fruits and vegetables to recipes (p<0.05). More fathers reduced the salt content of recipes than mothers (p=0.03). Two knowledge items and seven food conceptualisation items were significantly associated with better HEI, after controlling for covariates and multiple testing. Planning items, cooking skills and social aspects were not significantly associated with HEI.Originality/valueThis study investigates multiple dimensions of food literacy and identifies knowledge and food conceptualisation as potential targets for future interventions involving parents responsible for household meal preparation. This study highlights the importance of considering gender differences in food literacy.

What’s Cooking? A Content and Quality Analysis of Food Preparation Mobile Applications (P16-050-19)

ObjectivesTo assess the nutrition content and overall quality of mobile apps for children that focus on food preparation. These apps are games that require the user to cook, prepare and decorate virtual foods. MethodsA systematic search of the Canadian Apple App and Google Play Stores was conducted using 16 unique search terms related to nutrition, education, and children. Apps were included for analysis if they were rated appropriate for children, if the app had been updated since January 2016 and was in English. App titles, developers and descriptions were screened to identify apps eligible for analysis. App content was assessed by classifying foods according to the Canadian Food Guide categorizations. App quality was evaluated using the Mobile Application Rating Scale (MARS), which ranges from 1 (lowest quality) to 5 (highest quality). All screening and analysis were conducted by two independent reviewers with a third reviewer to resolve disagreements. ResultsA total of 2575 unique apps were identified. After screening, 142 were included in the analysis. Apps were most likely to contain the following foods: Dairy products (73%), candy/frozen desserts (71%), refined grains (68%) fruits (61%), lean meats (52%), desserts/baked goods (49%), vegetables (44%), sugar-sweetened beverages (38%) and processed meats (33%). Apps were least likely to include fish (14%), plant-based proteins (10%), and whole grains (4%). Although the appearance of fruits in apps was high, in 55% of apps fruit was shown in combination with desserts, chocolate and candy, and rarely on their own (7%). Apps were more likely to include sweet, high-sugar foods and/or sugar-sweetened beverages (86%) over savoury, high-sodium foods (40%). No app directly provided nutrition information and only 3% of apps included healthy eating messages. The mean MARS score was 3.6 (range 2.5–4.8), indicating moderate quality overall. ConclusionsChildren’s food preparation games were moderate quality and include many foods that are not recommended by dietary guidelines. Given the popularity of these games, collaborations between app developers and nutritionists could enhance the quality and content of food preparation apps by incorporating a variety of foods recommended by current guidelines and healthy eating messages. Funding SourcesOntario Research Excellence Fund. Supporting Tables, Images and/or Graphs▪

Catherine Carstairs, Bethany Philpott & Sarah Wilmshurst. Be Wise! Be Healthy! Morality and Citizenship in Canadian Public Health Campaigns

The recent unveiling of the new Canada Food Guide reminds us that the Canadian government has a vested interest in keeping its citizens healthy. One has to wonder: has it always been this way? In this important new book, historians Catherine Carstairs, Bethany Philpott, and Sara Wilmshurst show us that over the last century, health has become inexplicably tied up with notions of responsible citizenship. In the initial absence of a comprehensive public health department in Canada, non-governmental organizations had a critical role in shaping contemporary views on health. These efforts have received little historical attention. This book starts to fill this gap by examining one such organization. Between 1920 and 1970, the Health League of Canada, under the leadership of Dr. Gordon Bates, played an important role in educating the public about new health initiatives. Underlying the league’s mandate was a belief that individuals needed to take more responsibility for their health. Utilizing an impressive array of primary sources, the authors trace the rise and decline of the league’s influence on public health.

Exploring Food Guidance Approaches for Seniors in Antigonish, NS: Is There Still Gold at the End of the Rainbow?

Purpose: As Canada rethinks approaches to food guidance, insights into the needs of seniors in rural communities are important to ensure their nutrition issues are addressed. This study aimed to explore the food guidance needs and wants of a group of seniors living in Antigonish, Nova Scotia. Methods: Three focus groups were held with a total of 12 participants over the age of 65 years, living independently in the community. Seniors were asked about their views on Canada's Food Guide (CFG) and the Brazilian Dietary Guidelines (BDG). Results: Participants identified CFG as a trusted source of information and related well to the food groups and directive statements. Portion sizes were confusing and advice on food choices was not seen as being realistic in terms of cost and availability. The holistic nature of the BDG was appealing but guidance on processed food and social eating was not seen as relevant. Neither guidance tool addressed concerns about sustainability and environmental issues. Point of purchase nutrition information was preferable to receiving it from health professionals. Conclusion: CFG was seen as a trusted source of advice; however, locally accessible guidance on affordability and environmental issues related to food choice is needed for this group.

Healthy Eating and Active Living for Diabetes-Glycemic Index (HEALD-GI): Protocol for a Pragmatic Randomized Controlled Trial.

BackgroundRigorous evidence is needed regarding the best approach for increasing the uptake of Diabetes Canada’s evidence-based recommendations to include low-glycemic index (GI) foods in daily meal planning as an effective dietary self-care strategy for glycemic control among people with type 2 diabetes (T2D).ObjectiveThis study aims to present the study design and baseline data from the Healthy Eating and Active Living for Diabetes-Glycemic Index (HEALD-GI) trial, which was designed to evaluate the effectiveness of an enhanced GI-targeted nutrition education on GI-related knowledge and mean daily GI among adults with T2D in Edmonton, Alberta. MethodsWe used a pragmatic randomized controlled trial design and allocated 67 adults (aged ≥18 years) with T2D living in Edmonton, Alberta, Canada, to a control group that received standard printed copies of Canada’s Food Guide and Diabetes Canada’s GI resources or to an intervention group that received the same materials, plus a customized Web-based platform with 6 self-directed learning modules and print material. Each module included videos, links to reliable websites, chat rooms, and quizzes. Evidence-based GI concept information included GI values of foods and low-GI shopping, recipes, and cooking tips by a registered dietitian. In addition, support through email, text messaging (short message service), phone calls, or postal mail was provided to reinforce participants’ learning. The primary outcome, average dietary GI, was assessed using 3-day food records. Additional measures including GI knowledge and self-efficacy, glycated hemoglobin (HbA1c), lipids, systolic blood pressure, body mass index (BMI; weight, height), waist circumference, and computer proficiency were assessed at baseline and at 3-month postintervention.ResultsBetween November 2017 and February 2018, we contacted adults (aged ≥18 years) with T2D living in Edmonton, Alberta, screened and recruited eligible participants into the study. All data collection ended in June 2018. Overall, 64% (43/67) participants were males; mean age was 69.5 (SD 9.3) years, with a mean diabetes duration of 19.0 (SD 13.7) years. Mean BMI was 30.1 (SD 5.7) kg/m2, and mean HbA1c value was 7.1% (SD 1.2%). Data analysis was completed in December 2018.ConclusionsThe GI concept is often difficult to teach. The HEALD-GI study aims to provide evidence in support of an alternative approach to translating the GI concept to adults with T2D. Findings from this study may help registered dietitians to better disseminate low-GI dietary recommendations using efficient and cost-effective, patient-centered approaches. Furthermore, evidence generated will contribute to addressing some of the controversies regarding the clinical usefulness of the GI concept.International Registered Report Identifier (IRRID)DERR1-10.2196/11707

Assessment of Packaged Foods and Beverages Carrying Nutrition Marketing against Canada's Food Guide Recommendations.

Canadians’ food purchases consist largely of packaged processed and ultra-processed products, which typically fall outside the “core” foods recommended by Canada’s Food Guide (CFG). Almost half of packaged products in Canada carry nutrition marketing (i.e., nutrient content and health claims). This study assessed whether packaged foods carrying nutrition marketing align with recommendations outlined in the 2007 CFG. Label data (n = 9376) were extracted from the 2013 Food Label Information Program (FLIP). Label components (including nutrition marketing) were classified using the International Network for Food and Obesity/NCDs Research, Monitoring and Action Support (INFORMAS) labelling taxonomy. The Health Canada Surveillance Tool (HCST) was used to assess the alignment of products to CFG. Each food or beverage was classified into one of five groups (i.e., Tier 1, Tier 2, Tier 3, Tier 4, “Others”). Products in Tier 1, 2 or water were considered “in line with CFG”. Most products in the analyzed sample were classified as Tier 2 (35%) and Tier 3 (27%). Although foods with nutrition marketing were significantly more likely to align to CFG recommendations (p < 0.001), many products not “in line with CFG” still carried nutrition marketing. This study provides important baseline data that could be used upon the implementation of the new CFG.

Digesting Data: Tracing the Chromosomal Imprint of Scientific Evidence Through the Development and Use of Canadian Dietary Guidelines

The Eating Well With Canada’s Food Guide (CFG), which represents Canada’s official dietary guidelines, is designed to address high rates of obesity and diet-related chronic disease in Canada. This article presents a qualitative study of the social and ideological actions that the CFG performs. The study draws on the concepts of antecedent genres and uptake from rhetorical genre studies, applying them in a multimodal analysis of the CFG and interviews with the CFG’s producers and registered dietitians (RDs) who work with vulnerable populations. Findings reveal that scientific representations play a profound role in the social and ideological actions that the CFG performs. The author demonstrates how representations of scientific evidence from nutrition science, as exemplified in the concept of the Food Guide Serving, are taken up by the CFG and, in turn, how these scientific representations influence RDs’ use of the CFG and dominate, rather than facilitate, discussions about healthy eating. The study suggests that the CFG, instead of being an enabling resource, is a limiting document: It limits who can make healthier food choices and how such choices can be made.

The author responds to “Canada Food Guide’s focus on reducing saturated fat contradicts evidence”

I thank Drs. Bradshaw and Loffelmann[1][1] for their contribution to the discussion of plant versus animal product–based nutrition and response to the commentary in CMAJ .[2][2] They suggested that the National Academies of Sciences, Engineering and Medicine in the United States have criticized

Canada Food Guide’s focus on reducing saturated fat contradicts evidence

We read the article by Drs. Grant and Jenkins with interest.[1][1] We represent a growing group of Canadian physicians and health professionals called the Canadian Clinicians for Therapeutic Nutrition, who use whole food nutritional strategies to prevent and often reverse the burden of chronic

Diet Choices at 3 and 12 Months for Women and Their Partners after Recent Gestational Diabetes (GDM)—Results of the Families Defeating Diabetes (FDD) Study

Objectives: FDD was a 12 month, multi-centre, Canadian, randomized study translating diabetes-protective messages after GDM. Male partner participation was encouraged. We compared paternal vs. maternal food choices for interventional (INT) and control (CON) participants before and after FDD. Methods: INT maternal and paternal participants received information promoting high fibre/low fat foods; portion control; healthy restaurant choices via postpartum seminar, access to branded FDD website and twice-monthly email contact. CON maternal subjects received a postpartum healthy living handout. One-day food records at 3 and 12 months were analyzed for fast food intake (FF) and Canada’s Food Guide (CFG) servings. Results: 15 INT and 16 CON maternal/paternal pairs provided food records at 3 and 12 months. Considering INT and CON cohorts together: paternal and maternal grain products, milk/alternatives and meat/alternatives consumption met CFG guidelines at 3 and 12 months. Paternal and maternal vegetables and fruit (V and F) intakes were similar but lower than recommended (paternal: goal 8-10 servings/day; baseline 3.8±2.2; 12 months 4.6±2.9; maternal: goal 7-8 servings/day; baseline 4.1±2.8; 12 months 5.4±3.2). Paternal FF intake was higher than maternal at baseline: (0.41±0.61 vs. 0.12±0.34; p=0.03) but not at 12 months (0.44±0.62 vs. 0.34±0.40, p=0.6). Paternal and maternal V and F intakes were modestly correlated by 12 months (r=0.35, p=0.05). Conclusions: Notable paternal and maternal postpartum diet choices were: servings of V and F did not meet CFG recommendations at 3 and 12 months for men or women; paternal FF intake was higher than maternal soon after delivery, but not at 12 months as maternal servings increased; paternal and maternal V and F intakes were correlated at 12 months postpartum. Therefore, it may be helpful to target both paternal and maternal food choices when promoting healthy living after GDM. Disclosure A. Vezina: None. R.M. McManus: None. L.E. Donovan: None. D.B. Miller: None. I.T. Giroux: None.

Adherence to Canada's Food Guide recommendations among Alberta's multi-ethnic youths is a major concern: findings from the WHY ACT NOW project.

Dietary habits formed during youth may result in the development of obesity and chronic diseases in adulthood. We aimed to determine the frequency of the consumption of foods and beverages and the degree of adherence to Canada's Food Guide recommendations among multi-ethnic youths. Participants were recruited from 12 schools in the Edmonton, Alberta area by use of posters, school newsletters and advertisements. A 30-item food frequency questionnaire was administered by a trained interviewer to assess dietary intake in a convenience sample of 557 (328 females and 229 males) youths aged 11-23years; for the purpose of the present study, only the 14-18years age group was considered in the analysis. Participants were divided by sex and self-identified ethnicity into four groups [Indigenous, African & Middle Eastern (AME), Asian, and European]. Statistical analysis of the data was undertaken using t-tests, Welch's analysis of variance and Games-Howell tests. P<0.05 was considered statistically significant. Vegetables and Fruit recommendations were the least likely to be followed, with 90.7-96.8% of participants in all groups not consuming the recommended number of servingsday-1 . The mean frequency of fruit consumption was lower among Indigenous youths compared to Asian youths (0.90 versus 1.37 timesday-1 ). A greater proportion of males than females (55.9% versus 44.3%) did not meet the minimum recommendations for Meat and Alternatives (P=0.016). The percentage of youths not adhering to recommendations for Milk and Alternatives was 81.7% for Indigenous, 73.3% for AME, 78.6% for Asian and 63.5% for European youths. Indigenous youths more frequently consumed potato chips and soft drinks compared to other ethnic youths. The most frequently consumed beverage was milk (1.25 timesday-1 ). The majority of youths did not consume minimum daily recommended servings of Vegetables and Fruit, Milk and Alternatives, and/or Meat and Alternatives food groups. Evidence-based dietary interventions and public health strategies are needed.

Type 1 Diabetes in Children and Adolescents.

Type 1 Diabetes in Children and Adolescents.