Report from: THE NINTH annual health and nutrition symposium

This is a report on a symposium that was held on October 5-8, 2009, The plate and beyond in edmonton, Toronto, Montreal and Moncton. New perspectives on food and nutrition

or the ninth consecutive year, Dairy Farmers of Canada Finvited a panel of respected researchers and nutrition experts to present the latest information related to nutrition practice and education at a series of meetings across Canada. The meetings, which were held in October in Edmonton, Toronto, Montreal and Moncton, drew hundreds of participants from the field of nutrition and related disciplines. Presenting thought-provoking data and ideas, the speakers delved into topics such as defining healthy food, the role of whole foods in the prevention of chronic disease, the importance of family meals, and the impact of technology on nutrition practice.

Food for thought Leslie Beck, RD Director of Nutrition, FIGURE 1 Tracking nutrition trends: More knowledge but less success Medcan Clinic Weekly columnist, The Globe and Mail • 8 out of 10 Canadians consider themselves very or somewhat Nutrition expert, knowledgeable about nutrition. CTV Canada AM, CFRB Toronto radio and • 50% of Canadians consider nutrition to be very important when CJAD Montreal radio deciding what to eat. • 57% of Canadians read food labels. There is no question that Canadians’ eating and lifestyle habits are • 6 out of 10 Canadians made an effort in the past year to adopt changing. Just a generation ago, a healthier diet—in particular, eating more fibre, more fruits and families regularly ate dinner together, vegetables, less sugar, less salt and fewer calories. dining out was a rare treat, children • 50% of adults and 70% of children age 5 to 9 do not eat the walked to school (after having recommended daily minimum of 5 servings of fruit and vegetables. This meeting breakfast), and “screen time” was • Only one third of children age 5 to 9 consume the recommended daily coverage from limited to a bit of television in the minimum of two servings of milk products. This trend worsens with Dairy Farmers of evening. Today, these behaviours are age: 61% of boys and 83% of girls age 10 to 16, and more than 75% Canada Symposium often the exception, not the norm. of seniors over age 71, do not consume enough milk products. is printed as a One positive change is that Canadians • 40% of Canadians skip breakfast at least once a week. are now more knowledgeable about service to health • 17% of Canadian adults are obese (up from 15% in 2003). professionals. For nutrition than ever. But, as this chart shows, although people know more • One quarter of Canadian children are overweight or obese. more information about healthy eating, they are failing on this Symposium, to apply that knowledge to daily living. please see As a result, more than half of all dairynutrition.ca. Canadians now carry excess weight. Food beyond nutrients in prevention of chronic disease G. Harvey Anderson, PhD There are a number of developments Professor, Departments that take advantage of the Canadian FIGURE 2 Mean (± SEM) energy intake at the lunch test meal of Nutritional Sciences and Physiology climate. Canola oil, for example, 2900 Director, Program in Food which was developed in Manitoba p = 0.04 Safety, Nutrition and Regulatory Affairs and Saskatchewan in the 1960s and 2800 70s, is a healthy oil, balanced in fatty University of Toronto 2700 acids, and healthier than olive oil. The nutritional quality and health 2600 benefits of food are the subjects of Potatoes are a low-cost, nutrient-dense an enormous amount of research. vegetable that is very high in dietary 2500 fiber. Canadian researchers were While we have come a long way in 2400 understanding how our diets can help responsible for the development of promote good health, it is clear that the very popular yellow-fleshed Yukon 2300 nutrient-based food guidance systems, Gold potato and are continuing to E nergy consumed (kJ) 2200 such as Canada’s Food Guide, study the health benefits of this often 2100 are inadequate for chronic disease misunderstood vegetable. prevention. If we look at food beyond Flax is another great Canadian food 0 Skim milk Fruit juice its nutrients, we may be able to reduce from the Prairies. It contains omega-3 healthcare costs. fatty acid, soluble and insoluble fiber Study beverage Many people attribute the cause of and lignans (compounds protective Adapted from Dove et al., Am J Clin Nutr 2009;90:1-6 chronic disease to the Western diet against certain kinds of cancer). Also (i.e., high fat, high sugar, and nutrient from the Prairies, pulses (lentils, beans, (Dove et al. Am J Clin Nutr 2009;90: consumed before a carbohydrate meal poor). Some think the solution is the peas and chickpeas) are considered by 1-6), which compared a toast-and-jam stimulates insulin and incretin hormone Mediterranean food pattern—which some to be the ideal food for satiety, breakfast with milk versus one with secretion, slows gastric emptying and emphasizes fruits, vegetables, grains, weight management and blood fruit juice (total 500 calories; 21 grams reduces postprandial glycemia in type 2 fish, seafood and olive oil—as it is glucose control. They are low calorie, protein provided by skim milk) in diabetes. overweight subjects, found that milk thought to reduce the incidence of low GI, high fiber, high protein and There are many other aspects of milk drinkers consumed fewer calories at cardiovascular disease (CVD). But a nutrient rich. A recent study found that functionality that go beyond nutrients. lunch (see Figure 2). closer examination of CVD death rates individuals who ate one serving of Among its properties, milk is: shows that Canada ranks sixth lowest pulse daily for two months lost weight Additionally, it was recently reported • Antimicrobial—including control out of 36 countries. In fact, CVD death and improved their blood lipid levels. that supplementing dairy products into of gut microflora rates are lower in Canada than in Another great whole food from Canada obese adults’ calorie-reduced weight • Antiviral Mediterranean countries such as Italy is milk. Unfortunately, negative loss diets enhances weight loss, and • Anticancer this effect is more effective than an and Greece. messaging about calories and saturated • Immunomodulation equivalent amount of supplemental Rather than importing food and eating fat has led to a significant decline in • Antioxidation calcium. It was therefore concluded patterns from other countries we should milk consumption over recent years. • Bone protective that there must be several components be looking closer to home for solutions; Contrary to this perception, research • Appetite suppressant in dairy products, including calcium, in particular, we should be developing now indicates that there is an inverse • Anti-hypertensive and marketing the Canadian Climate relationship between body weight contributing to this inverse relationship Advantage diet. From shore to shore, and milk consumption. One study, for between dairy products and weight loss. The Canadian food supply, combined we have wonderful foods that can example, found that the more servings Another study looked at the effect of with our healthcare system, has served promote good health. One of this of cereal that children eat per week, milk protein (whey) on food intake and us well. We need to continue to put country’s greatest advantage is winter; the less prevalence of overweight, metabolic control. Researchers found more research into understanding the the annual freeze means that there are suggesting that lower obesity rates can that as little as 10 grams of pre-meal health benefits of Canadian food fewer pests to control, fewer pesticides be attributed to milk consumed with whey markedly reduced blood glucose beyond their nutrients and to commu­ used on our food and less soil depletion. the cereal. Another recent study in healthy adults. As well, whey protein nicate those benefits to the public.

Use of technology in practice: Are we ready to let our kids teach us? Alejandro R. Jadad, MD, simple calls. Email, which is a primary using structures designed more than and work in a meaningful way DPhil, FRCPC, FCAHS means of communication for many of 100 years ago. In order to convey our with today’s young people, they will Chief Innovator and Founder, Centre for Global us, is already old hat for young people. messages, we have to be creative and become obsolete. Our children are eHealth Innovation Online social networking sites, such combine education with entertainment ready to embrace new technology; Canada Research Chair in eHealth Innovation a Facebook, MySpace, YouTube (“edutainment”). the question is, are we ready? Rose Family Chair in and Twitter, are reshaping how we Supportive Care communicate, learn and live. LESSON 3 We gain by playing together. University of Toronto We, as healthcare professionals, do not Consider that Facebook now has more use the same technology in the same At the dawn of the 21st century, the than 300 million users, equivalent to way as our clients, how are we going rapid evolution of the Internet and the fourth largest country in the world. to teach this generation how to eat mobile telecommunication devices is That is a tremendously powerful Family, friends, students, well? Perhaps we need to let this FIGURE 3 giving humans the speed and efficiency resource, worth millions of dollars in patients... together generation teach us and let them work they need to connect with each other, infrastructure, offered without charge. to learn from each other and to transmit with us as partners. Here are a few lessons we should learn from them. and disseminate knowledge across the LESSON 4 world. This technological renaissance Today’s generation lives “glocal” lives. There are no experts anymore. could transform nutrition practice and LESSON 1 The Internet has no boundaries; education, but we need to understand If you Google “dairy”, 46 million sites borders, geography, institutions, how today’s generation uses online will appear in less than one second. education are all invisible online. tools. Take, for example, mobile People have literally instant access to telephones and email. Cell phones are unlimited information, some of it Consider that a mobile web device used most often by young people for accurate, some of it not. can now offer consumers grocery gaming, listening to music, texting lists, nutritional information and

and surfing the Internet, yet many LESSON 2 We are really boring. recipe books in the palm of their healthcare professionals are still trying When reading and writing for medical hand. If dietitians do not take to learn how to use them to make journals, healthcare professionals are these lessons and learn to innovate

2 Defining healthy food: Using science to create healthier diets Adam Drewnowski, PhD Professor, Epidemiology FIGURE 5 Nutrient density (NRF) and energy density (kcal/100 g) Director, Center for Public Health Nutrition and Nutritional Sciences Program University of Washington 900

oil The Nutrient-Rich Foods 800

Index does not delineate “good” 700 foods from “bad.” Rather, the index represents a continuum, 600 nuts offering consumers plenty of 500 good choices to be made within 400 and among the food groups. sugar cheese The North American diet is energy 300 fortified cereals E nergy density (kcal/100 g) rich but nutrient poor. Skyrocketing ice cream rates of obesity can be associated 200 with this unfavourable ratio of calories to nutrients. 100 spinach Consumers need to spend less time soft drinks skim milk counting calories and instead focus on 0 yogurt making sure that every calorie counts. -200 -100 0 100 200 300 The development of the Nutrient-Rich NRF 9.3 per 100 kcal Foods (NRF) Index aims to enable Adapted from USDA FNDDS 1.0 people to build and enjoy healthier diets by getting the most nutrition objective, based on accepted nutrition includes: saturated fat, added sugars in calories. These results have important from their calories. This science-based, science and labeling practices. It is and sodium. implications for body mass index, blood consumer-driven system of food simple, based on published daily pressure and plasma lipid profiles. Nutrient density can be based on guidance was born from the 2005 values, algorithms and open-source 100 gram (as in Britain), 100 calorie It is important to note that the creation Dietary Guidelines for Americans, data (much of which is available online (as in France), or serving sizes (the of NRF is intended to be far more than which identified nutrient density as a through the USDA and Health Canada). FDA’s Reference Amounts Customarily the simple assigning of a number or key concept in diet quality. The NRF The NRF system is balanced, capturing Consumed [RACC]). NRF is based on rank to foods. The Index is the corner- Index uses the science of ranking or both nutrients to encourage and RACC values. Figure 5 illustrates food stone of creating positive nutrition classifying foods based on their nutrient nutrients to limit. Validation is also scores based on NRF and energy education and food guidance. It composition. Each food is assigned a extremely important, and the NRF has density. While foods to the right of the provides a bridge between the regula- unitary score that best reflects its total been tested against the USDA’s Healthy graph are more nutrient-rich than those tory components of the nutrition facts nutrient quality. Eating Index. Most importantly, this on the left, it is important to note that panel and the educational purpose The goal in nutrient profiling is to system is designed to be consumer there is no one point that delineates of the Food Pyramid. This shift away provide “nutrition at a glance.” friendly, accessible and easy to “good” foods from “bad.” Nor is any from the climate of fear engendered Current nutrition facts panels are too understand, guiding people to make one food group better than another. by negative nutrition messaging creates complicated for average consumers, better food choices. Rather, the NRF represents a conti- a positive focus for consumers. In telling who often feel like they need a calculator The choice of nutrients to encourage nuum, offering consumers plenty of people what to eat, rather than what to determine whether a particular food was based on the U.S. 2005 Dietary good choices to be made within and to avoid, the NRF helps consumers offers optimal amounts of calories, Guidelines, which identified “nutrients among the food groups. Even within build healthier diets and achieve total fat, saturated fat, sodium, etc. of concern,” i.e., those nutrients that one category of food, such as fruits and better health. The other problem with nutrient facts are not consumed in recommended vegetables, there is a range of values, panels is that they create an environment amounts in the American diet. A variety from highly nutrient-rich spinach to of fear by stressing the avoidance of of nutrient profiling models, which lower scoring syrup-packed canned “bad” nutrients (an approach known were based on a range of 5 to 23 peaches. To make the NRF more as “nutrients to limit” or LIM). A far nutrients to encourage, were reviewed, consumer friendly, a 5-point scale is Key learning points better approach to nutrition is to tested and evaluated (see Figure 4). being developed. provide more positive messages that The final nine nutrients included in In addition to nutrients per calorie, • The Nutrient-Rich Foods encourage consumers to choose good the NRF 9.3 index are: protein, fiber, a new study is now examining the Index is a scientifically and better foods. vitamins A, C and E, calcium, iron, economic aspect of the NRF, looking valid definition of nutrient density of foods that meets Because this nutrient profiling system potassium and magnesium. The choice at dollars per calorie and nutrients per the criteria for nutrient is science driven, it follows science- of nutrients to limit was similarly guided dollar. While some nutrient-rich foods profiling. driven rules. The NRF system is by the U.S. Dietary Guidelines and are very expensive, the best sources of nutrients per dollar are: eggs, milk, • It is validated against pulses, pasta and potatoes. objective diet quality FIGURE 4 The validation process Recent research suggests that a positive measures. • A formal process was used to decide among alternative algorithms approach to food guidance, such as the • Higher NRF scores mean NRF, is more effective in promoting • Tested a family of NRF Indices: healthier diets that are – Range of positive nutrients (5-15) healthy diets than the negative, “foods- richer in nutrients and food – With and without nutrients to limit (3-4) to-avoid” approach. In one study groups to encourage. – Calculated per 100 kcal and per RACC that contrasted NRF with negative • Approaches that focus approaches (i.e., avoidance of • Used diet quality measures (e.g., Healthy Eating Index- HEI-2005) on nutrients to avoid (e.g., and health-related variables saturated fat, added sugar and sodium), saturated fat, added sugar researchers found that the NRF partici- • Used regression analyses with dependent variables: and sodium) do not – Measure of diet quality (HEI-2005) pant’s diets were not only higher in appear to translate into – Selected health outcomes (BMI, blood pressure, lipids) calcium, vitamins A, C and B12 and healthier diets. in fruits and vegetables, but also lower

3 On the menu: The future of family meals Mary Sue Waisman, benefits to eating together. When hand down food traditions and teach children learn about food and cooking MSc, RD, FDC children and parents eat together, their life skills to children. Better nutrition skills. The establishment of chef/ Dietitian, Professional Chef, Nutrition Consultant diets tend to include more vegetables, also results from home cooking: one nutritionist teams, such as the American and Cookbook Author fruits, grains and calcium-rich foods, study showed that meals prepared by Culinary Federation Chef and Child All About Food Nutrition Consulting and less fried foods, soft drinks, sweets young adults are more likely to meet Foundation Program, get children Halifax, Nova Scotia and fast foods. These benefits may be dietary objectives for fat, calcium, fruit, involved in cooking and learning about long-lasting, as teens are likely to vegetables and whole grains. Not food and health in a fun environment. Compared to past generations, today’s carry these positive eating habits into surprisingly, the most commonly cited Summer camp programs and school families are eating fewer meals together. adulthood. In addition, children who barriers to home meal preparation garden projects similarly help promote Several studies estimate that about 50 to eat dinner at home with their family are are lack of time and cooking skills. good food and healthy eating less likely to be overweight or obese. among children. 60 percent of Canadians regularly share Dietitians play an important role in a daily family meal (defined as a child The benefits of family meals go beyond helping to ensure that family meals Most importantly, dietitians can use and at least one parent or two family nutrition. One study found that teens continue. Some dietitians are their skills to tell and show people how members eating together). According to who have frequent family dinners advocating for a return to Home they can get healthy, tasty, inexpensive a Unicef survey that asked 15-year- (five to seven times per week) are half Economics in schools to ensure that family meals on the table. olds how routinely they ate dinner with as likely to smoke cigarettes and a parent, Canada ranks a poor 18 out marijuana and one third less likely to of 25 countries. Nutritional benefits—Eat together and eat better drink alcohol compared to teens with Figure 6 Although almost all parents (98%) and two or fewer family dinners per week. (children and adolescents) a majority of teens (74%) report that Increased conversation time and • More vegetables and fruit; less fried foods and soft drinks—Gillman, 2000

they enjoy and value eating as a family. improved family relationships have • Fewer sweets and fast foods—Haapalahti, 2003 Mealtime togetherness is often thwarted also been reported among families • More fruits and vegetables, grains, calcium-rich foods and less soft by busy adolescent and parent schedules, that eat together. drinks—Neumark-Sztainer, 2003 teens’ desire for autonomy and Preparing meals at home is also • Canadian students (grades 6-8) who infrequently eat meals with their easy access to food outside beneficial. Home-cooked meals not families had poorer diet quality—Woodruff, 2007 the home. only ensure control over taste, quality • As the number of meals increased, so did the nutritional benefits— Family meals are worth saving, however. and quantity of ingredients, but the act Videon, 2003 Studies show significant nutritional of food preparation is an opportunity to

Question and Answer session The thought-provoking presentations from this knowledgeable panel of speakers prompted a dynamic question and answer session with the audience following the talks.

What advice do you have for health What is your vision for the future Our grocery stores are filled with How do we reconcile food professionals who want to learn of the Nutrient-Rich Foods (NRF) so many imports—grapes from guidance on nutrients, such about social media and use it in Index and how do you see this Chile, tomatoes from California, as DRIs, and chronic disease their practices? system being applied? etc. Is it a problem to have more prevention? foreign foods than local? Dr. Jadad: It is so important to have Dr. Drewnowski: We are looking at Dr. Drewnowski: Nutrient-based a presence on social networks. That using the NRF as more than just a Dr. Anderson: The environmental costs systems have been used in their is where the young people are, and labelling system. It is the centrepiece of moving foods around the world just extreme form to disqualify whole foods if we don’t join them, we will lose of a broader system of nutrition aren’t sustainable. We have to get out based on a single nutrient. But a food “mind share.” education and food guidance. Also, of the trap of thinking that we need to shouldn’t be considered “bad” just import foods from across the globe. I have some very practical suggestions. we need to move towards more because it has, for example, three The solution is to focus on eating First, create a Facebook account; positive nutrition messaging, away grams of fat or one gram of saturated fat locally within the region of Canada young people communicate through from “bad nutrients to avoid” and per serving. The whole point of nutrient and recognize that it is possible to have Facebook and text messaging more towards good and better foods to profiling is to find out what else foods a very healthy home-grown diet. For often than email. Next, develop your encourage. contain and look at the totality of their example, it is perfectly acceptable to own collection of websites that offer nutrient package. eat frozen or canned fruits and valuable information. Ask everyone vegetables when locally grown fresh you know for their favourite sites, Ms. Waisman: We need nutrients to produce is not available in the winter. then create links that you can share survive, and we get nutrients by eating with your clients as an “information food. We don’t eat nutrients; we eat prescription.” food. We need to be more positive in our messaging, and focus on the positive benefits of food and savouring meals.

PRESENTED BY DAIRY FARMERS OF CANADA

PRESENTED BY DAIRY FARMERS OF CANADA FPOXXX-XXX-000

4 BNU-1512—February 2010