The objective of this work is to estimate the economic burden and premature death rate in Canada attributable to low serum 25-hydroxyvitamin D (25(OH)D) levels. Vitamin D deficiency has been linked to many diseases and conditions in addition to bone diseases, including many types of cancer, several bacterial and viral infections, autoimmune diseases, cardiovascular diseases, and adverse pregnancy outcomes. Canadians have mean serum 25(OH)D levels averaging 67 nmol/L. The journal literature was searched for papers reporting dose-response relationships for vitamin D indices and disease outcomes. The types of studies useful in this regard include randomized controlled trials, observational, cross-sectional, and ecological studies, and meta-analyses. The mortality rates for 2005 were obtained from Statistics Canada. The economic burden data were obtained from Health Canada. The estimated benefits in disease reduction were based on increasing the mean serum 25(OH)D level to 105 nmol/L. It is estimated that the death rate could fall by 37,000 deaths (22,300-52,300 deaths), representing 16.1% (9.7-22.7%) of annuals deaths and the economic burden by 6.9% (3.8-10.0%) or $14.4 billion ($8.0 billion-$20.1 billion) less the cost of the program. It is recommended that Canadian health policy leaders consider measures to increase serum 25(OH)D levels for all Canadians.
We investigated barriers to healthful eating and vitamin/mineral supplement use among groups at risk for low nutrient intakes, particularly those with low income.
Twelve focus groups (73 participants) and 11 key informant interviews were conducted in Saskatoon, Saskatchewan. Focus group participants represented a diverse population. Key informants included health professionals and personnel from community-based organizations who worked in a low-income area. Focus group meetings and key informant interviews were audiotaped and transcribed; thematic coding was used to identify key concepts.
The focus groups and interviews revealed five themes on barriers to healthful eating and to the use of vitamin/mineral supplements: knowledge, income, accessibility, health, and preferences. Key informants were aware of the barriers, and were able to see not only individual and family reasons but also societal influences.
The study results provide valuable information for focusing efforts on reducing barriers to healthful eating and to appropriate vitamin/mineral supplement use.
To investigate the beverage intake patterns of Canadian adults and explore characteristics of participants in different beverage clusters.
Analyses of nationally representative data with cross-sectional complex stratified design.
Canadian Community Health Survey, Cycle 2.2 (2004).
A total of 14 277 participants aged 19-65 years, in whom dietary intake was assessed using a single 24 h recall, were included in the study. After determining total intake and the contribution of beverages to total energy intake among age/sex groups, cluster analysis (K-means method) was used to classify males and females into distinct clusters based on the dominant pattern of beverage intakes. To test differences across clusters, ?2 tests and 95 % confidence intervals of the mean intakes were used.
Six beverage clusters in women and seven beverage clusters in men were identified. 'Sugar-sweetened' beverage clusters - regular soft drinks and fruit drinks - as well as a 'beer' cluster, appeared for both men and women. No 'milk' cluster appeared among women. The mean consumption of the dominant beverage in each cluster was higher among men than women. The 'soft drink' cluster in men had the lowest proportion of the higher levels of education, and in women the highest proportion of inactivity, compared with other beverage clusters.
Patterns of beverage intake in Canadian women indicate high consumption of sugar-sweetened beverages particularly fruit drinks, low intake of milk and high intake of beer. These patterns in women have implications for poor bone health, risk of obesity and other morbidities.
Certain beverages contribute energy, protein, vitamins, and minerals. North American adolescents have shifted their beverage intake from predominantly milk to predominantly sugary beverages. Intake of these sugary beverages, in sufficient quantity, may increase the risk of bone fractures, may contribute to obesity, and may lead to tooth decay. This study evaluated the effectiveness of a school-nutrition education program (Fluids Used Effectively for Living) on nutrition knowledge, attitude, and self-reported behavior of grade 9 students in Saskatchewan, Canada. Two classes of grade 9 students, 1 (n = 33) in a high school in Saskatoon (n = 33) and 1 (n = 24) in a large high school in Prince Albert, Saskatchewan, received the peer educator intervention. Two other classes in the 2 cities (n = 24 and n = 24, respectively) were controls. Six sessions of Fluids Used Effectively for Living nutrition education were delivered by using 2 peer educator models (multiple and single), and the intervention was delivered in a 45-minute weekly class session over a 6-week period. After the intervention, students in these 2 peer educator classes decreased their sugary beverage intake significantly, which was sustained for 3 months. Students in the control self-taught class increased their juice intake at the end of the year. The significant decrease of juice and sugary beverage intakes in the single model peer educator class disappeared after Bonferroni correction. Carbonated sugary beverage intake of students in the control self-taught classes declined, but it was not sustainable at the 3-month follow-up. A peer educator school-based nutrition education approach can lead to a decrease in sugary beverage intake in high school children.
Little is known of the beverage intake patterns of Canadian children or of characteristics within these patterns. The objective was to determine beverage intake patterns among Canadian children and compare intakes of fourteen types of beverages, along with intakes of vitamin C and Ca, and sociodemographic factors across clusters.
Dietary information was collected using one 24 h recall. Sociodemographic data were collected by interview. Cluster analysis was used to determine beverage intake patterns. Pearson's ?2 and 95 % CI were used to test differences across clusters.
Data from the Canadian Community Health Survey Cycle 2·2.
Children aged 2-18 years with plausible energy intake and complete sociodemographic data (n 10 038) were grouped into the following categories: 2-5-year-old boys and girls, 6-11-year-old girls, 6-11-year-old boys, 12-18-year-old girls and 12-18-year-old boys.
Five beverage clusters emerged for children aged 2-5 years, six clusters for children aged 6-11 years (both sexes) and four clusters for those aged 12-18 years (both sexes). Sweetened beverage clusters appeared in all age-sex groups. Intakes of sweetened beverages ranged from 553 to 1059 g/d and contributed between 2 % and 18 % of total energy intake. Girls 6-11 years of age in the 'soft drink' cluster had lower Ca intake compared with other clusters in that age-sex group. Age and ethnicity differed across clusters for most age-sex groups. Differences for household food security status and income were found; however, no pattern emerged.
Patterns in beverage intake among Canadian children include beverages that are predominantly sugar sweetened. Public health nutrition professionals can use knowledge about beverage patterns among children, as well as the characteristics of these groups, in the development of nutritional programmes and policies.
Sweetened beverage intake has risen in past decades, along with a rise in prevalence of overweight and obesity among children. Our objective was to examine the relationship between beverage intake patterns and overweight and obesity among Canadian children. Beverage intake patterns were identified by cluster analysis of data from the cross-sectional Canadian Community Health Survey 2.2. Intake data were obtained from a single 24-hour recall, height and weight were measured, and sociodemographic data were obtained via interview. Data on children and adolescents aged 2-18 years who met inclusion criteria (n = 10?038) were grouped into the following categories: 2-5 years (male and female), 6-11 years (female), 6-11 years (male), 12-18 years (female), and 12-18 years (male). ?² test was used to compare rates of overweight and obesity across clusters. Logistic regression was used to determine the association between overweight and obesity and beverage intake patterns, adjusting for potential confounders. Clustering resulted in distinct groups of who drank mostly fruit drinks, soft drinks, 100% juice, milk, high-fat milk, or low-volume and varied beverages (termed "moderate"). Boys aged 6-11 years whose beverage pattern was characterized by soft drink intake (553 ± 29 g) had increased odds of overweight-obesity (odds ratio 2.3, 95% confidence interval 1.2-4.1) compared with a "moderate" beverage pattern (23 ± 4 g soft drink). No significant relationship emerged between beverage pattern and overweight and obesity among other age-sex groups. Using national cross-sectional dietary intake data, Canadian children do not show a beverage-weight association except among young boys who drink mostly soft drinks, and thus may be at increased risk for overweight or obesity.
To report bone mineral density (BMD) in young, reportedly healthy Canadian women and to determine whether lifestyle factors that have been associated with bone health in older women are also associated with BMD in young women.
We recruited a convenience sample of 52 female undergraduate students in the Applied Human Nutrition program at the University of Guelph, Ontario, Canada. BMD was measured at the femoral neck, lumbar spine (L1 to L4), and whole body using a Discovery Wi (Hologic Inc.) dual-energy x-ray absorptiometer. Subjects completed a questionnaire to collect demographics, medical history, physical activity levels, and dietary habits; in addition, a subset of subjects (n = 31) completed a food frequency questionnaire to collect data on calcium and vitamin D intake. BMD data were examined using T- and Z-score classifications established by the World Health Organization (WHO); multiple regression analysis was used to predict BMD with biological and lifestyle variables.
Mean BMD measured at the femoral neck, lumbar spine, and whole body was 0.863 ± 0.11, 1.019 ± 0.09, and 1.085 ± 0.07 g/cm(2), respectively. Body mass and body mass index were significantly positively correlated with BMD at all 3 sites. Television watching, lactose intolerance, number of alcoholic drinks consumed per week, and age were used to develop a linear regression model to predict whole-body BMD (r(2) = 0.727, p
Calcium and vitamin D are recommended for bone health, but there are concerns about adverse risks. Some clinical studies suggest that calcium intake may be cardioprotective, whereas others report increased risk associated with calcium supplements. Both low and high serum levels of 25-hydroxyvitamin D have been associated with increased mortality.
The purpose of this study was to determine the association between total calcium and vitamin D intake and mortality and heterogeneity by source of intake.
The Canadian Multicentre Osteoporosis Study cohort is a population-based longitudinal cohort with a 10-year follow-up (1995-2007).
This study included randomly selected community-dwelling men and women.
A total of 9033 participants with nonmissing calcium and vitamin D intake data and follow-up were studied.
Total calcium intake (dairy, nondairy food, and supplements) and total vitamin D intake (milk, yogurt, and supplements) were recorded.
The outcome variable was all-cause mortality.
There were 1160 deaths during the 10-year period. For women only, we found a possible benefit of higher total calcium intake, with a hazard ratio of 0.95 (95% confidence interval, 0.89-1.01) per 500-mg increase in daily calcium intake and no evidence of heterogeneity by source; use of calcium supplements was also associated with reduced mortality, with hazard ratio of 0.78 (95% confidence interval, 0.66-0.92) for users vs nonusers with statistically significant reductions remaining among those with doses up to 1000 mg/d. These associations were not modified by levels of concurrent vitamin D intake. No definitive associations were found among men.
Calcium supplements, up to 1000 mg/d, and increased dietary intake of calcium may be associated with reduced risk of mortality in women. We found no evidence of mortality benefit or harm associated with vitamin D intake.
Adequate dietary intake during the growth period is critical for bone mineral accretion. In 1997, an adequate intake (AI) of 1300 mg/d Ca was set for North American adolescents aged 9-18 years based on best available data. We determined bone Ca accrual values from age 9 to 18 years taking into account sex and maturity. Furthermore, we used the accrual data to estimate adolescents' Ca requirements. Total body bone mineral content (TBBMC) of eighty-five boys and sixty-seven girls participating in the Saskatchewan Paediatric Bone Mineral Accrual Study were used to determine annual TBBMC accumulation over the pubertal growth period. Using a similar factorial approach as the AI, we estimated Ca requirements of adolescent boys and girls for two age groups: 9-13 and 14-18 years. Between 9 and 18 years, boys accrued 198.8 (SD 74.5) g bone mineral content (BMC) per year, equivalent to 175.4 (SD 65.7) mg Ca per d with the maximum BMC accrual of 335.9 g from age 13 to 14 years. Girls had 138.1 (SD 64.2) g BMC per year, equalling121.8 (SD 56.6) mg Ca per d with the maximum annual BMC accrual of 266.0 g from age 12 to 13 years. Differences were observed between both sex and age groups with respect to Ca needs: boys and girls aged 9-13 years would require 1000-1100 mg/d Ca, and from age 14 to 18 years, the mean Ca requirements would be relatively stable at 1000 mg/d for girls but would rise to 1200 mg/d for boys.