Canadian Dietetic Association Research Articles

Supporting Dietitians in Practice: Professional Development Activities of Dietitians of Canada in the Past 30 Years

Dietitians of Canada (DC) was established in 1997 from the Canadian Dietetic Association and the provincial associations. This project is part of a larger program of work to document the recent history of Canadian dietetic practice, including the professional development (PD) initiatives DC has provided since its inception. The aims of the present study are to synthesize a timeline of PD events since 1993, understand the context that led to their development, and understand their impact on the profession. 13 key informants were recruited by email, of which 11 semi-structured interviews were conducted, and 8 participants provided written contributions. Interview transcripts and written contributions were analyzed thematically, and a final timeline of events was developed. Six themes were found: 1) the use of technology in PD tools, e.g. online courses, Learning on Demand; 2) conferences and workshops , e.g. national conference, Coast-to-Coast workshops; 3) initiatives that placed DC as a leader in health and nutrition, e.g. Practice-based Evidence in Nutrition (PEN); 4) informal discussion about emerging issues in dietetics, e.g. PEN Current Issues, Practice Blog; 5) DC actively sought member input to inform PD strategy, e.g. members issues forums; and, 6) DC PD events demonstrated their support for research and dietetic education, e.g. relationship with CFDR, public health online course. Key concerns for the future included: declining DC membership and funding, and dietetics not keeping pace with other professions on PD. The successes and failures of initiatives in this time period can inform the development of DC’s PD strategy for the coming decades.

Monounsaturated fatty acids and risk of cardiovascular disease: synopsis of the evidence available from systematic reviews and meta-analyses.

No dietary recommendations for monounsaturated fatty acids (MUFA) are given by the National Institute of Medicine, the United States Department of Agriculture, European Food and Safety Authority and the American Diabetes Association. In contrast, the Academy of Nutrition and Dietetics, and the Canadian Dietetic Association both promote <25% MUFA of daily total energy consumption, while the American Heart Association sets a limit of 20% MUFA in their respective guidelines. The present review summarizes systematic reviews and meta-analyses of randomized controlled trials and cohort studies investigating the effects of MUFA on cardiovascular and diabetic risk factors, cardiovascular events and cardiovascular death. Electronic database Medline was searched for systematic reviews and meta-analyses using “monounsaturated fatty acids”, “monounsaturated fat”, and “dietary fat” as search terms with no restriction to calendar date or language. Reference lists and clinical guidelines were searched as well. Sixteen relevant papers were identified. Several studies indicated an increase of HDL-cholesterol and a corresponding decrease in triacylglycerols following a MUFA-rich diet. The effects on total and LDL-cholesterol appeared not consistent, but no detrimental effects on blood lipids were observed. Values for systolic and diastolic blood pressure were found to be reduced both during short- and long-term protocols using high amounts of MUFA as compared to low-MUFA diets. In type 2 diabetic subjects, MUFA exerted a hypoglycemic effect and reduced glycosylated hemoglobin in the long term. Data from meta-analyses exploring evidence from long-term prospective cohort studies provide ambiguous results with respect to the effects of MUFA on risk of coronary heart disease (CHD). One meta-analysis reported an increase in CHD events, however, most meta-analyses observed a lesser number of cases in participants subjected to a high-MUFA protocol. Although no detrimental side effects of MUFA-rich diets were reported in the literature, there still is no unanimous rationale for MUFA recommendations in a therapeutic regimen. Additional long-term intervention studies are required to characterized efficacy and effectiveness of recommending MUFA-rich diet among general and clinical populations.

Dietary protein requirements and adaptive advantages in athletes

Dietary guidelines from a variety of sources are generally congruent that an adequate dietary protein intake for persons over the age of 19 is between 0·8-0·9 g protein/kg body weight/d. According to the US/Canadian Dietary Reference Intakes, the RDA for protein of 0·8 g protein/kg/d is "...the average daily intake level that is sufficient to meet the nutrient requirement of nearly all [~98 %]… healthy individuals..." The panel also states that "...no additional dietary protein is suggested for healthy adults undertaking resistance or endurance exercise." These recommendations are in contrast to recommendations from the US and Canadian Dietetic Association: "Protein recommendations for endurance and strength trained athletes range from 1·2 to 1·7 g/kg/d." The disparity between those setting dietary protein requirements and those who might be considered to be making practical recommendations for athletes is substantial. This may reflect a situation where an adaptive advantage of protein intakes higher than recommended protein requirements exists. That population protein requirements are still based on nitrogen balance may also be a point of contention since achieving balanced nitrogen intake and excretion likely means little to an athlete who has the primary goal of exercise performance. The goal of the present review is to critically analyse evidence from both acute and chronic dietary protein-based studies in which athletic performance, or correlates thereof, have been measured. An attempt will be made to distinguish between protein requirements set by data from nitrogen balance studies, and a potential adaptive 'advantage' for athletes of dietary protein in excess of the RDA.

JOURNAL OF THE CANADIAN DIETETIC ASSOCIATION

JOURNAL OF THE CANADIAN DIETETIC ASSOCIATION

JOURNAL OF THE CANADIAN DIETETIC ASSOCIATION

JOURNAL OF THE CANADIAN DIETETIC ASSOCIATION

Canadian Dietitians’ Understanding of Food Security

The Canadian Dietetic Association (CDA) has identified food security as a key action issue for its members. Since any course of action depends on how an issue is understood, we undertook a telephone survey of 487 CDA members to assess their understanding of food security. Dietitians were asked which of the following list they include in their definition of food security: (1) food safety; (2) food as a basic human right; (3) adequate food to maintain health; (4) sustainable agricultural systems; (5) affordability; (6) charitable food distribution systems; and (7) individual choice of personally acceptable foods. Overall, there was a fairly high level of awareness and broad conceptualization of food security. Ninety-three percent included food safety; 87% included food as a human right, adequate food for health, and sustainable agriculture; and 81% included affordability of food. Fewer dietitians included charitable food sources (62%) and individual choice of personally acceptable foods (51%) in their definition. Understandings of the term differed by area of practice but not length of time in practice. Different understandings of food security may lead dietitians to take different, but equally important, courses of action.This may make dialogue confusing and collaboration difficult until the differences are clarified and appreciated.

Assessment of Community Development and Leadership Skills Required by Caribbean Nutritionists and Dietitians: Research and International Collaboration in Action

As part of a collaborative project between the Canadian Dietetic Association and the Caribbean Association of Nutritionists and Dietitians, Caribbean nutritionists and dietitians (N = 61) were surveyed via a mailed questionnaire to determine their self-perceived needs with respect to community development and leadership skills. Factors that would support or deter participation in a professional development program aimed at enhancing those skills were identified. The response rate to the questionnaire was 67.8%, representing nutritionists and dietitians from all but one Caribbean territory included in the survey. Analysis of the data revealed that respondents do perceive the need for professional development. This paper describes the specific needs identified and provides recommendations for addressing those needs through further collaboration between the two professional groups. It also calls for revisions to university curricula and practicum training programs so that new graduates will be better prepared to meet the challenges of future dietetic practice.

Authors’ Reply

Lasslo-Meeks has correctly interpreted the title; greater weight loss does follow dietary modification without exercise, and surely this is a major issue arising from contemporary public health messages concerning weight control. The current view is that somatotype and, in particular, a predisposition toward overweight are inherited ((1)Bouchard C. Despres J-.P. Mauriege P. Genetic and non-genetic determinants of regional fat distribution.Endocr Rev. 1993; 14: 72-93Google Scholar) and that physical inactivity may be the key explanatory variable responsible for its expression. Thus, a sedentary lifestyle is responsible for the population trends toward increasing obesity and is at least as important as diet—possibly the dominant etiologic factor ((2)Prentice A.M. Jebb S.A. Obesity in Britain gluttony or sloth?.BMJ. 1995; 311: 437-439Google Scholar). The Heart Foundation of Australia identified sedentary lifestyle and reduction in regular exercise as associates of the per capita weight increase throughout the past decade, a pattern similarly described in reports of increasing overweight in other populations with technological advancement ((3)Paffenbarger R.S. Hyde R.T. Wing A.L. Lee I-.M. Jung D.L. Kampert J.B. The association of changes in physical-activity level and other lifestyle characteristics with mortality among men.N Engl J Med. 1993; 328: 538-545Google Scholar). These findings are the basis of the public health messages advocating exercise for weight control. The level of exercise prescribed for the subjects in our study was similar to that described in The American Dietetic Association's position statement for physical fitness and athletic performance in adults: 20 to 30minutes of aerobic exercise 3 times per week ((4)Position of The American Dietetic Association and The Canadian Dietetic Association: nutrition for physical fitness and athletic performance for adults.J Am Diet Assoc. 1993; 93: 691-696Google Scholar).Dietitians are better equipped to counsel patients if they are aware of the comparative efficacy of diet-induced and exercise-induced weight loss Because there are conflicting views on the effectiveness of prescribing 20 to 30minutes of exercise 3 times per week for weight control, our study set out to use contemporary technology to measure changes in body composition with weight loss to compare its efficacy with weight loss induced by prudent dietary modification. Despite excellent compliance, the exercising subjects in our study felt cheated and defeated by the meager weight loss success. This level of success could have been anticipated ((5)Zelasko C.J. Exercise for weight loss what are the facts?.J Am Diet Assoc. 1995; 95: 1414-1417Google Scholar). However, we believe dietitians are better equipped to counsel patients in weight control if they are aware of the comparative efficacy of diet-induced and exercise-induced weight loss provided by this randomized, controlled study, and of the difficulties in achieving weight loss with exercise as the sole weight-controlling strategy. We agree with Lasslo-Meeks that in our study exercise appears to conserve lean mass but this is the situation in a weight loss of only 2.6kg. Whether or not lean mass can be maintained in the situation of a 6.3-kg weight loss has not been determined by this study. It may be that some loss of lean tissue is inevitable with larger weight loss with exercise of longer duration or greater frequency.

New Dietary Reference Intakes Proposed to Replace the Recommended Dietary Allowances

Among the valuable papers presented a few months ago at the joint conference of The American Dietetic Association (ADA) and The Canadian Dietetic Association (CDA) was a report from the newly formed Committee on the Scientific Evaluation of Dietary Reference Intakes (DRI Committee) of the Food and Nutrition Board of the Institute of Medicine, National Academy of Sciences ( (1) Allen L. Fischer P. Nutrition recommendations in North America. Presented at Food and Nutrition Beyond Borders. 1996; (Banff, Alberta, Canada.) Google Scholar ). The presentation gave an overview of the Committee's progress toward revising the Recommended Dietary Allowances (RDAs) ( (2) Food and Nutrition Board.Recommended Dietary Allowances. 10th ed. National Academy Press, Washington, DC1989 Google Scholar ).

Celebrating the Pleasure of Healthy Eating

To show Canadians that good nutrition and good taste go hand in hand, the Canadian Dietetic Association (CDA) launched its 1995 National Nutrition Month (NNM 95) campaign theme “Celebrating the Pleasure of Healthy Eating” by partnering with the Canadian Federation of Chefs and Cooks (CCFQ inviting consumers to enjoy the pleasure of healthy eating through exploring the diversity of our food supply and our multicultural, ethnic and regional cuisines.A comprehensive Resource Manual was developed for health professionals to provide background information for programs and activities developed on the theme and provided information on: exploring the pleasure of food, taste and taste preferences, dietitian and chef partnerships, food service and healthy choices, ethnic light, food traditions across Canada, vegetarianism and a look at how well Canadians are eating. Valuable marketing tips were provided for promotion at local and national levels along with campaign art, posters, brochures and fact sheets.A special recipe brochure featuring regional recipes created by Chef and RD teams was produced as an insert for a national magazine. An additional one million brochures were distributed to the public via community activities by dietitians and by partner groups such as Health Canada, the Heart and Stroke Foundation of Canada, the Canadian Cancer Society, the Canadian Home Economics Association and food retailers. Interactive consumer facts sheets and a colourful theme poster were also developed for use in high traffic areas in the community. An extensive public relations program exposed Canadians to the theme including a major kick-off campaign, covered by local and national media.To illustrate how one province (Ontario) promoted the NNM 95 theme, the Ontario Dietetic Association (ODA) and the CDA received a government grant to sponsor a “Travelling Road Show” featuring two Chef and RD teams who demonstrated great tasting, healthy and easy-to-prepare recipes based on Canada's Guidelines for Healthy Eating and emphasizing our diverse food supply and multicultural cuisines. The success of the NNM 95 theme “Celebrating the Pleasure of Healthy Eating” was overwhelmingly positive and dietitians and chef partnerships were highly publicized as health and taste experts in print and electronic media. The strong alliance between CDA and CFCC promises to expand in the future offering new business opportunities as well as a heightened awareness by the public that nutritious is delicious! An exciting off-shoot of the campaign theme is the creation of a cookbook featuring over 200 recipes developed by chef and dietitian partners across Canada.

Anthropometrics, Eating Attitudes, and Body Image in Asians and Caucasians

Anthropometries, eating attitudes, fear of fat, and body image were assessed in 25 Asian and 91 Caucasian college women between the ages of 18 and 29. Height and weight were measured and body mass index (BMI) was calculated. Waist-to-hip ratio (WHR) was calculated by dividing waist circumference (measured 1 inch above the umbilicus) by hip circumference (measured at the maximum girth over the buttocks). Percent body fat was estimated from the sum of 3 skinfolds using Lange calipers. Eating disorder tendencies were assessed using the Eating Attitudes Test (EAT) for which a score of 30 or higher indicates weight preoccupation and an increased risk for developing an eating disorder. Goldbarb's Fear of Fat Scale was used to determine fear of fatness. Subjects were asked to identify the silhouette on the Canadian Dietetic Association's BMI Silhouette drawings (with BMI values deleted) that most closely represented their body as well as the ideal body. Weight and height were significantly higher in Caucasian women compared to Asian women (p<.0001). There were no significant differences between the two groups in BMI, percent body fat, or WHR. There was no difference in EAT scores between Asians and Caucasians. EAT scores for Asians and Caucasians were 17±10 and 17±13, respectively. Eleven percent of the Asians and 18 percent of the Caucasians scored above 30 on the EAT test. The range of EAT scores for all subjects was 1 to 59. Fear of fat scores were significantly higher for Asians than Caucasians (p<.01). Asians and Caucasians both picked the silhouette representing a BMI of 18 as the ideal and 20 as their perceived BMI, whereas actual BMIs for Asians and Caucasians were 22.1±8.9 and 23.0±2.9, respectively. In conclusion, Asian and Caucasian subjects had similar body composition and EAT scores. Both Caucasians and Asians chose an ideal BMI silhouette that is classified as underweight and associated with increased mortality risk. In addition, both groups tended to underestimate their actual BMI. This study demonstrated that Asians exhibit a greater fear of fat and a similar tendency for eating disorders compared to Caucasians.

Position of the American Dietetic Association and the Canadian Dietetic Association: Women's Health and Nutrition

As we approach the year 2000, women's health has emerged as both a powerful political platform and a dynamic public health issue. It has long been recognized that women have worse health than men, despite the fact that women live longer. Overall, women have more acute symptoms, chronic conditions, and short- and long-term disabilities resulting from health problems. Some diseases are unique to women—ovarian or uterine cancers, for example—whereas other diseases and conditions, such as osteoporosis, affect women disproportionately ( (1) Report of the NIH: Opportunities for Research on Women's Health Summary Report. Sept. 1992. Google Scholar ).

Journal of the Canadian dietetic association

Journal of the Canadian dietetic association

Dignified food security for all

Four important and influential policy statements on hunger that have served as national and international standards and guides for action have been reprinted here as a resource. They are (1) the Bellagio Declaration, which was produced by 24 international experts meeting to address the problem of world hunger in 1989 at the Rockefeller Foundation Conference Center in Bellagio, Italy; (2) the Medford Declaration to End Hunger in the U. S., which was designed to be a domestic equivalent of the Bellagio Declaration, was produced in April of 1990 at Tufts University by U. S. organizations concerned with domestic hunger; (3) the position statement of the American Dietetic Association (ADA) that was approved by the House of Delegates in 1990; and (4) the position statement of the Canadian Dietetic Association (CDA) that was approved by the executive of the CDA in 1991. Aiken's brief introduction to these four statements critically examines them to draw attention to some of their strengths and weaknesses and to help clarify some of their implicit normative assumptions and implications.

Hunger and food security in Canada: Official position of the Canadian Dietetic Association

Hunger and food security in Canada: Official position of the Canadian Dietetic Association

Journal of the Canadian dietetic association

Journal of the Canadian dietetic association

Journal of the Canadian dietetic association

Journal of the Canadian dietetic association

The Canadian Dietetic Association: Change of Address

The Canadian Dietetic Association: Change of Address