Nutritional Quality of the Food Choices of Canadian Children | BMC Nutrition



Experimental design

The 2015 CCHS is a cross-sectional survey that sampled the Canadian population from January 2, 2015 to December 31, 2015. [11]. The survey design included sampling of individuals according to 12 age-sex categories of Dietary Reference Intakes (RDAs). The 2015 CCHS was a voluntary 24-hour dietary recall survey conducted using a modified five-step automated multiple-pass (AMPM) method, adapted for the Canadian population, from the State Department of Agriculture. -United. Respondents completed a 24-hour dietary recall and provided additional information on demographic and lifestyle characteristics. The total survey sample size was m= 20, 487 people with a response rate of 61.6% [11]. After the 24-hour dietary reminder, 35% of respondents were asked to do a second-day reminder by phone within 3 to 10 days of the first interview, every day of the week.


The people sampled in the survey were over one year old and resided in the 10 provinces of Canada, excluding people living in the territories, reserves, Indigenous settlements, full-time members of the Armed Forces Canadians and people living in institutions [11]. Results of pregnant and lactating women, infants, and people with invalid food recalls (as defined by Statistics Canada) were excluded from this study. The nutritional quality of foods consumed from unique 24-hour dietary recalls for boys and girls ages 2-18 (m = 4642) were studied in this study.

Classification of foods in the 24-hour food recall according to the HCST

Foods reported in the 24-hour dietary recall were categorized and nutritional composition determined using the 2015 Canadian Nutrient File (CNF), which contained information on 5,690 unique Canadian foods commonly consumed. [11, 12]. Health Canada and Public Health Agency of Canada staff developed the CNF / CFG classification, linking the CNF food codes to four CFG food groups and 21 subgroups according to Eating Well with the Food Guide. Canadian 2007 [12, 13]. Foods in the 2015 CCHS were categorized according to Canada’s Food Guide subgroups and placed in levels according to the thresholds established for sodium, saturated fat, total fat and sugars. [8, 9, 13]. These cutoffs were derived from cutoffs used for nutrient content claims, DRIs and nutritional standards for school foods. [8].

The exact methods used by Health Canada to categorize foods into level groups are described elsewhere. [8, 9]. In short, the lower thresholds for fat and sodium content were based on nutrient content claims for the amounts commonly consumed at one time, known as the Reference Amount (RA). [8]. Foods classified as level 1 must not exceed any of the lower thresholds: ≤ 3 g / RA of fat, ≤140 mg / RA of sodium and ≤ 6 g / RA of sugar [8]. Since there is no Daily Value (DV) for sugar, the upper and lower cutoffs for sugar were determined from the recommendation of the Institute of Medicine (IOM) [8]. The 15% DV of sodium (> 360 mg / AR), total fat (> 10 g / AR) and saturated fat (> 2 g / AR) and sugars (> 19 g) were set as upper thresholds [8]. Level 2 foods could exceed one or two lower thresholds but no upper thresholds. Level 3 foods are foods whose nutrient content exceeds all lower thresholds (i.e. sodium, sugar, and total fat) and may exceed an upper threshold. Level 4 represents foods that exceed the upper thresholds ≥2, but special attention has been paid to foods belonging to the Meat and Alternatives and Milk and Alternatives categories, as they naturally have a higher saturated fat content. [8]. Additional adjustments for foods based on directional statements from CFG can be found in HCST [8].

Using the CNF / CFG classification system, 9 food groups could not be classified according to levels 1 to 4 [8]. Among these groups, 5 food categories have been grouped under “other foods” representing foods not recommended in Canada’s Food Guide 2007. These groups are: 1) saturated and / or trans fats and oils; 2) foods high in fat and sugar such as candies, chocolates and syrups; 3) high-calorie drinks ≥ 40 kcal / 100 g; 4) low-calorie drinks alcoholic beverages [8, 13].


Analyzes were performed using Statistical Analysis (SAS) software version 9.4 (SAS Institute Inc., Cary, North Carolina, USA). Bootstrap balanced repeated replication with 500 replicates was used to estimate the population parameters, i.e., confidence intervals, standard errors and coefficients of variation. The survey weights provided with the master files were used for all persons 2 to 18 years of age, to ensure that the samples from the 2015 CCHS remain nationally representative. [11]. Dietary intakes were assessed based on DRI age-sex groups and adjusted for additional lifestyle measures including smoking, physical activity, and body mass index (BMI). BMI was determined using measured height and weight, and cutoffs for BMI categorization were derived based on WHO BMI growth charts [11]. PROC SURVEYREG and PROC SURVEYLOGISTIC were used for continuous analyzes (eg, servings of fruits and vegetables) and for categorical analyzes (eg, lifestyle measures), respectively, by adjusting energy intake, age and gender if applicable. Results with p-value ≤ 0.05 were reported as statistically significant.

Identification of implausible declarants

Studies using the 2015 CCHS recognized a high percentage of underreporting [14, 15]. Underreporting most often occurs with many foods that are socially unwanted or high in fat and sugars [14,15,16]. Following previous publications, this study identified individuals as under-reporters, plausible reporters and over-reporters, based on the comparison of their estimated energy requirements (EER) to total energy expenditure (EER: TEE) [11, 16, 17]. The Institute of Medicine (IOM) developed the EER equation which takes into account age, gender, BMI and physical activity [18]. For children 135% of their EER [17]. For children ≥ 12 years old, under-reporters were classified as having an EER less than 70% of what was reported and over-reporters had an EIA greater than 142% of the ERA [16]. If the children did not have a reported physical activity level (PAL), they were classified as “low active” ( 14 years), according to the results of Garriguet et al. [11, 15, 17].


All researchers have been given Reliability Status as described in the Government Security Policy and have performed a Royal Ontario Mounted Police security check as required by the Statistics Canada Act.Data analyzes were performed at Statistics Canada’s Research Data Center (RDC) in Toronto, Ontario in accordance with survey guidelines and procedures. To protect the confidentiality of respondents, RDC analysts have reviewed and published the data presented in this manuscript, to ensure compliance with guidelines developed by Statistics Canada. The data presented in this study were completed exclusively as secondary analyzes and all the information provided was anonymized and did not require the approval of the institutional REB.



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