Nu fs 377 Midterm 2

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Cards (215)

  • Sodium Requirements
    • Tolerable Upper Intake Level for individuals 14 years and older: 2300
    mg sodium per day
    • Intake above this level likely to pose a health risk for cardiovascular disease
    (high blood pressure, heart disease, stroke)
    • CVD is the second leading cause of death in Canada
  • Where do Canadians get their sodium?
    1. Bakery Products - 20%
    2. Mixed dishes - 20%, pizza, frozen entrees
    3. processed meat products - 11%
  • Sodium sources in processed foods
    • Sodium chloride (table salt)
    • Sodium bicarbonate (baking soda)
    • Sodium nitrate (e.g., preserved meats)
    • Monosodium glutamate (flavour enhancer)
    • Disodium guanylate and disodium inosinate (flavour enhancers)
  • Required actions to reduce sodium intake
    • Decreasing sodium intake requires changes in consumer eating
    behaviour and reductions in sodium levels in the food supply.
  • Between 2007 and 2010, Health Canada tasked a group of
    stakeholders (the Sodium Working Group) to develop strategies to
    bring the average daily sodium intake of Canadians down to 2,300 mg
    per day by the end of 2016.
  • Stakeholders that formed the Sodium Working Group
    • Stakeholders included representatives from:
    • scientific and health-organizations (e.g., Canadian Stroke Network, Dietitians
    of Canada, Heart and Stroke Foundation, Canadian Nutrition Society)
    • government representatives (e.g., Office of Nutrition Policy and Promotion,
    Public Health Agency of Canada, Agriculture and Agri-Food Canada)
    • food manufacturing and food service industry (e.g., Baking Council of Canada,
    Canadian Restaurant and Foodservices Association, Canadian Meat Council,
    Dairy Processors of Canada)
  • Tensions occurred among stakeholders
    • Health and nutrition stakeholders wanted regulatory measures to
    reduce sodium in the food supply by the food industry.
  • Food and beverage industry stakeholders
    • Food and beverage producers argued that not everyone responds the same way
    to sodium in the diet, and that sodium in table salt (sodium chloride) and other
    compounds (e.g., sodium benzoate, sodium nitrate) has important functional
    properties (e.g., food preservation, bread dough conditioner).
    • They wanted voluntary sodium reduction measures.
  • Government strategies to reduce sodium
    • In 2012, Health Canada set voluntary sodium reduction targets to guide food industry efforts to achieve product reformulation.
    • The food industry was asked to voluntarily reduce the amount of sodium in processed and prepared foods to levels that would lower
    sodium intakes of Canadians by at least 25% by 2016.
    • These targets were developed in conjunction with the food industry, health sector, and research experts and aimed to achieve gradual
    sodium reduction in processed foods while ensuring food product
    quality, food safety, and consumer acceptance.
  • Industry self-regulation failed
    • The goal to reduce the average daily sodium intake of Canadians to
    2300 mg by 2016 through product reformulation was not achieved.
    • Voluntary efforts by the food processing sector resulted in an 8%
    decrease in average sodium intake, not the 25% decrease that was
    required to achieve an intake of 2300 mg per day.
    • In 2017, most Canadians consumed too much sodium, on average,
    2760 mg per day.
  • What did this failure mean for the health of Canadians?
    • What if packaged foods had successfully been reformulated to reduce sodium
    intake to 2300 mg per day?
    • An estimated 2,176 deaths due to CVDs, mainly from ischemic heart disease,
    stroke, and hypertension could have been averted or delayed.
  • Mixture of ‘soft’ and ‘hard’ policies
    • Reducing sodium intake involves both soft and hard policies.
    • Soft policies include educational campaigns, healthy eating
    information and behavioural public policy approaches like ‘nudges’
    that change the default option on all entrees to a salad.
    • Initiatives that are part of the strategy to improve healthy eating
    information
    • Hard policies restrict choice
    • Initiatives that are part of strategies to improve nutrition quality of
    foods and protect vulnerable populations
  • Soft = consumers get to decide whether they eat healthy
    or not
    Nudge- entrees came with salads, you had to ask for
    fries
  • Improve healthy eating information
    • Increasing awareness and education of Canadians about sodium
  • Protect vulnerable populations
    • Health Canada is developing regulations to restrict the advertising of
    food and beverages high in sodium, sugars and saturated fat to
    children.
  • Improve food nutrition quality:
    1. Prohibit industrial trans fats (done) • Introduced a ban on partially hydrogenated oils, the main source of industrially produced trans fats in Canadian food
    2. Reduce sodium in food (done) • Published new sodium reduction targets for processed foods to be achieved by the food processing sector by 2025
  • Ban on Trans Fats
    • It is illegal for manufacturers to add partially hydrogenated oils to foods sold in
    Canada.
    • The ban includes both Canadian and imported foods, as well as those prepared in
    all food service establishments.
    • Evidence based policy
    • Eating too much trans fats increases the risk of heart disease, which is one of
    the leading causes of death in Canada.
    • Banning trans fats in New York City led to fewer heart attacks and strokes.
  • Voluntary sodium reduction targets for processed food
    • In 2020, Health Canada updated voluntary sodium reduction targets
    for processed foods to achieve the intake goal of 2300 mg of sodium
    per day by 2025; however, the revised targets and categories for
    processed foods are like those established in 2012.
  • What more needs to be done?
    • Regulate maximum sodium levels in key food categories.
    • Sodium targets for restaurant food (including fast foods) would support sodium reduction.
    • Manufactures can substitute potassium chloride for sodium chloride in foods since Canadians are
    consuming too much sodium and not enough potassium.
    • Government-mandated, healthy food procurement policies for all public settings (e.g., hospitals,
    schools) could ensure public funds are spent on lower sodium foods.
    • Legislation to prohibit the marketing of unhealthy food (including high-sodium foods) to children
  • Potassium chloride?
    • Potassium chloride is an important ingredient in reformulating foods to be lower in sodium.
    • Potassium chloride offers consumers flavor without increasing their daily sodium intake.
    • Low sodium salt (in which potassium chloride mostly replaces sodium chloride) is a strategy
    to reduce sodium intake, increase potassium intake, and thereby lowering blood pressure
    and preventing the adverse consequences of high blood pressure.
  • Mandatory sodium reduction is possible
    • In 2016, South Africa was one of the first countries that passed legislation
    for mandatory maximum sodium levels for different processed food
    categories.
    • Black South Africans and people in lower status socio-economic groups had
    the greatest reductions in sodium intake, likely reducing unnecessary CVD
    and death in these groups, suggesting the program reduced health
    inequalities.
    • The results from South Africa demonstrate the greater effectiveness of
    mandatory targets compared to voluntary targets in improving diets.
  • Household food insecurity refers to when a household has inadequate or insecure access to food due to financial
    constraints.
  • The18 question Household Food Security Survey Module (HFSSM) about experiences of food
    deprivation over the past 12 months is included on two national cross-sectional surveys
    administered by Statistics Canada.
    • Canadian Community Health Survey (CCHS) as a health indicator
    • Canadian Income Survey (CIS) as an indicator of poverty
    • These surveys omit individuals on First Nation reserves, in institutions, in the Canadian Armed
    forces, and in some remote areas.
  • HOUSEHOLD FOOD INSECURITY?
    Every question asks about
    money factor, ex. Skipping
    meals bc of dieting is not the
    same as skipping meals bc
    no money
  • CANADIAN COMMUNITY HEALTH SURVEY?
    CCHS is a cross-sectional national survey that collects information related to
    health status, health care utilization and health determinants for the Canadian
    population.
    • The primary use of the CCHS data is for health surveillance and population
    health research.
    • Public health surveillance is the ongoing, systematic collection, analysis and
    interpretation of health-related data essential to planning, implementation and
    evaluation of public health practice.
  • Surveillance- we need to know what problems
    exist before we can address it
    Data is very confidential and the use of it has
    strict guidelines
  • The Canadian Income Survey (CIS) is a cross-sectional survey
    developed to provide a portrait of the income and income sources of
    Canadians, with their individual and household characteristics.
  • HOW CCHS AND CIS DATA IS USED?
    Academic researchers can access the data for research purposes.
    • PROOF is an interdisciplinary research team at the University of
    Toronto investigating household food insecurity using CCHS and CIS
    data.
    • The goal of this research program is to identify effective policy approaches to
    reduce household food insecurity.
  • In households that are food insecure, they are more likely to experience health disparities
    -weak sense of community belonging = social isolation
    • important to feel a member of community
    • Don’t trust and don’t feel you can reach out
    -stress
    -poor health
    -dissatisfied with life
    Reminder health is not just the absense of disease, it is physical, mental, social
  • -Surveys collected on ethnicity so we learn about which groups experience it the most
    People who where indigenous were more likely to be food insecure
    Reported in 2009, since it takes a lot of time to go through data and then making it confidential
    Then analyzing data and publishing it
    -which takes a long time
  • 18 question Household Food Security Survey Module (HFSSM) is a validated
    household-level self-report about experiences of food deprivation over the past 12
    months.
    • These experiences range in severity from worrying about running out of food to
    going whole days without eating, all due to financial constraints.
    • It assesses the food insecurity situation of adults and children within a household
    over the previous 12 months, but not the food insecurity status of individuals in the
    household.
  • HFSSM?
    Doesn’t identify how many households are insecure, data tells us how
    many people live food insecure (not everyone in family may be food
    insecure)
  • HFSSM?
    • Ten questions are specific to the food insecurity status of the adults in a household
    • Eight are specific to the food insecurity status of children in the household
  • STAGES OF HOUSEHOLD FOOD INSECURITY
    (CANADIAN INTERPRETATION)
    • Food insecure, marginal –These households report some concerns about running
    out of food or limiting food selection due to a lack of money for food.
    • Food insecure, moderate - These households compromise the quality and/or
    quantity of food consumed due to a lack of money for food.
    • Food insecure, severe - These households miss meals, reduce food intake or go days
    without food due to a lack of money for food.
  • HFSSM ADULT SCALE
    • You and other household members worried food would run out before you
    got money to buy more. (marginal)
    • Food you and other household members bought didn't last and there wasn't
    any money to get more. (moderate)
    • You or other adults in your household ever did not eat for a whole day
    because there wasn’t enough money for food. (severe)
  • HFSSM CHILD SCALE
    • You or other adults in your household relied on only a few kinds of low-cost
    food to feed child(ren) because you were running out of money to buy food.
    (marginal)
    • Child(ren) were not eating enough because you and other adult members of
    the household just couldn’t afford enough food. (moderate)
    • Child(ren) did not eat for a whole day because there wasn’t enough money
    for food. (severe)
  • Why does the HFSSM have separate questions for adult and child food
    insecurity?
    Kids eat before parents
    may not realize child is experiencing food insecure
    B. Adults try to spare children food insecure
    2. Experience food insecurity differently
    physiologically
    B. Since theyre still growing
    C. Increased suicidal ideation
    3. Adult intervention different policies
    school interventions work for children
    B. Minimum wage increase for adult
    4. Also if children are food insecure
    then its really bad since parents cant spare them
    B. And adults are probably even worse
  • Why don’t we just focus on determining the prevalence of households
    with hunger?
    5. We can work on ways to prevent food insecurity, harder to address severe food insecure
    1. also different strategies to address
    What if parents lie?
    • If social services take them
    • Parents who dont trust authority wont be honest
    • So under-reported of child insecurity
    • Even if you promise anonymity
    ◦you have a duty to report
  • 5% of households are food
    insecure
    1/5 households by province
    New brunswick and other
    resource rich provinces, but
    alberta is doing as bad and
    we have a lot of resources
    -so they’re not being shared
    18% (rounded) of households in the ten
    provinces experienced food insecurity
    in the previous 12 months.
  • Quebec has lowest food insecurity, has not even increased in pandemic bc they have anti poverty
    legistlation