WHAT COULD A CANADIAN DIET LOOK LIKE? Catherine B. Chan, PhD University of Alberta cbchan@ualberta.ca
DISCLOSURES All profits to diabetes research
WHAT COULD A CANADIAN DIET LOOK LIKE? The forces that determine what we eat Personal Environmental The PANDA Project A Canadian Diet for all Canadians
THE FORCES THAT DETERMINE WHAT WE EAT Personal Factors Nutrition knowledge Taste preferences Time Cooking ability Influence of family & friends
THE FORCES THAT DETERMINE WHAT WE EAT
THE FORCES THAT DETERMINE WHAT WE EAT
Public policy: The price of food has increased because of diversion of some crops to biofuel production. Community: The city I live in has more liquor stores than grocery stores. The nearest store to me only has snack food and bananas, no fresh vegetables. Organizational: Our workplace promotes healthy eating by providing vegetables but still serves French fries. Interpersonal: If Joe has fries, then it s OK if I do, too. Faced with all this choice, what should I have for lunch?
A Framework for Assessing Effects of the Food System www/iom.edu/foodsystem IOM (Institute of Medicine). 2015. A framework for assessing effects of the food system. Washington, DC: The National Academies Press.
Individual food choices are complex and not just dependent on nutrition knowledge or taste preferences.
Adequate Accessible Available Acceptable The 4-A Framework: Food for All
THE PANDA PROJECT For people with T2D, what is a dietary pattern that Embodies the 4A Framework? Helps manage diabetes? Is sustainable?
THE MEDITERRANEAN DIET & THE 4A FRAMEWORK Nutritionally Adequate Accessible Geographically ± Financially ± Available ± Acceptable ±
THE PANDA PROJECT: GUIDING PRINCIPLES Healthy foods are abundant on the Prairies Choosing local foods supports health eating and a healthy economy Foods emphasized are: For all people, at all life stages Consistent with Eating Well with Canada s Food Guide Meet evidence-based guidelines to reduce risk and/or treat chronic diseases Foods included should be: Grown on the Prairies whenever possible Have significant value-added component to processing and/or production
PANDA INTERVENTION: 6 MONTH FOLLOW-UP BIOLOGICAL OUTCOMES Mean Change 95% CI A1c (%) -0.5-0.9, -0.1 Weight (kg) -1.4-2.1, -0.8 BMI (kg/m 2 ) -0.5-0.7, -0.3 Waist (cm) -2.4-3.0, -1.8 Total cholesterol (mg/dl) -86.2-107, -65 HDL cholesterol (mg/dl) 44.6 37, 52 LDL cholesterol (mg/dl) -128-149, -108 Triglycerides (mg/dl) -3.8-21, 13 Asaad et al 2016
PANDA INTERVENTION: 3 MONTH FOLLOW-UP NUTRITIONAL OUTCOMES Mean Change 95% CI Energy (kcal) -178-304, -51 Total fat (g) -10-18, -3 Saturated fat (g) -3.5-6, -1 Protein (g) -6-11, -0.4 Added sugar (g) -9-16, -2 Sodium (mg) -570-870, -280 Healthy Eating Index 2.1 0.1, 4.1 Perceived Dietary Adherence 8.5 6.1, 10.8 Asaad et al 2016
FOOD ACCEPTABILITY MATTERS A1c A1c a PDAQ score a Dietary Adherence score -0.239** (n=195) -0.175* (n=195) -- Food Acceptability score -0.173* (n=200) -0.161* (n=200) 0.240** a Controlled for age, years with T2D, waist circumference and BMI Dapilos et al. Unpublished
A CANADIAN DIET FOR ALL CANADIANS FFH Pre-Workshop Survey Encourage consumption of foods grown and readily available in Canada 51% definitely, 42% somewhat Canadian agriculture should be considered 39% definitely, 39% somewhat Social and lifestyle factors should be a component 88% yes Convenience Cultural practices & preferences Vegan/vegetarian Whole/local/minimally processed foods
A CANADIAN DIET FOR ALL CANADIANS FFH Pre-Workshop Survey A Canadian Diet looks like Evolving palette of regional preferences Seasonal, whole foods Pulses, dairy, seafood, nuts, whole grains, V&F, lean meat, balance of animals and plant protein Cultural preferences Minimally processed
A CANADIAN DIET FOR ALL CANADIANS FFH Pre-Workshop Survey Opportunities for the Canadian Diet Improved health of Canadians Connect consumers to their food Improve sustainability Opportunity for agri-food innovation Reduce cost of food and improve accessibility
A CANADIAN DIET FOR ALL CANADIANS FFH Pre-Workshop Survey Barriers for the Canadian Diet Healthy Food Lack of alignment of health and agricultural priorities Ontario Food & Nutrition Access in government Food Strategy research Literacy priorities & Healthy Skills Food and industry priorities Systems Gaps in knowledge, more evidence needed Roblin et al Can J Diet Pract Res 2018;79:28-34
A CANADIAN DIET FOR ALL CANADIANS
CONSTRUCTING A CANADIAN DIET
CONSTRUCTING A CANADIAN DIET Who can we learn from? Mediterranean Diet Adaptations eg. Switzerland New Nordic Diet more calories from plant foods and fewer from meat more foods from the sea and lakes more foods from the wild countryside Traditional non-european diets Vormund et al. Eur J Nutr, 2015 Mithril et al. Publ Health Nutr, 2012
Adequate Accessible Available Acceptable The 4-A Framework: Food for All
Adequate Accessible Available Acceptable
A CANADIAN DIET FOR ALL CANADIANS Canola oil Modified from www.oldwayspt.org
A CANADIAN DIET FOR ALL CANADIANS Canola oil Modified from www.oldwayspt.org
早餐 Breakfast 菜單 Menu 食物的原料 Ingredients 加拿大食品指南份數 雜糧粥 (2 份 ) ( 見食譜, 第 15 頁 ) 薏米 1 / 12 杯 (20 毫升 ) 小黃米 1 / 12 杯 (20 毫升 ) 黑米 1 / 12 杯 (20 毫升 ) 糙米 1 / 12 杯 (20 毫升 ) 原味腰果原味腰果 4 湯匙 (60 毫升 2 份 糧食類 1 份 水果 1 份 肉類替代品 木瓜 木瓜 ½ 個 鷹嘴豆泥和梳打餅 低鹽 / 無鹽梳打餅乾 30 克 1 份 糧食類 上午零食 Morning snack 乾 鷹嘴豆泥 3 湯匙 ¼ 份 肉類替代品 強化豆奶強化豆奶 1 杯 1 份奶類替代品華人二型糖尿病菜單計劃主料 (2 份的量 ): 四季豆炒雞肉 (2 份 A ) Chinese 雞肉 Menu Plan ½ 杯 for (90 克 ) 午餐 Lunch ( 見食譜, 第 40 頁 ) Type 四季豆 2 Diabetes1 杯 1 份糧食類主料 : 1¼ 份肉類和替代品番茄炒蛋 (1 份 ) 番茄 1 杯 (1 個 ) 4 份蔬菜 ( 見食譜, 第 34 頁 ) 雞蛋 ½ 個 1 份奶類替代品混合米飯混合米飯 ½ 杯 ( 熟的 ) ( 白米 : 糙米 =1:1) 優酪乳 2% 低脂優酪乳 175 克 下午零食 Afternoon snack 蘋果中等大的蘋果阿爾伯塔大學 1 個 1 份水果 University of Alberta 蒸蘆筍 (1 份 ) 蘆筍 6 根 PANDA (Physical Activity and 青椒炒肉片 (1 Nutrition 份主料 for Diabetes : in Alberta) 2 份糧食類食品晚餐 Dinner ( 見食譜, 第 62 頁 ) 青椒課題組 ½ 個 2 份蔬菜 2015 豬裡脊年編印 ¼ 杯 (45 克 ) ½ 份肉類 混合米飯 混合米飯 1 杯 ( 熟的 ) 晚上零食 Evening snack 全麥麵包 全麥麵包 ½ 片 ( 每片 35 克 ½ 份 糧食類食品 1% 低脂牛奶 1% 低脂牛奶 1 杯 1 份 奶類 6½ 份 糧食類食品 一天攝入的總份數 8 份 蔬菜和水果 Total food servings today 3 份 肉類和替代品 3 份 奶類和替代品
A CANADIAN DIET FOR ALL CANADIANS Canola oil Modified from www.oldwayspt.org
ACKNOWLEDGEMENTS All of our participants PANDA team: R. Bell, L. McCargar, C. Field, T. Berry, S. Anders, S. Cash, R. Weselake, J. Ozga, R. Plotnikoff, R. Sigal, N. Boule Other help along the way: H. Vallianatos, R. Leung, P. Robson, H. Loeppky, N. Willows, K. Raine PCN staff: R. Anderson, J. MacLaren, E. St. Laurent J. Schaub (Southside); J. DeRoose (Edmonton West); K. Watkins, C. Sakowsky, G. Lavigne (Sherwood Park) PDF: F. Subhan Graduate students: D. Maxwell, G. Duri Raj, D. Soria Contreras, G. Asaad, C. Archundia Herrera, L. Yareni Zuniga Technical support: J. Glassford, S. Iqbal Undergraduate students: J. Leal, J. Frohlich, V. Friesen, C. Barber, H. MacDonald, S. Shoi, K. Ruby, B. Almberg, C. Prion-Frank, S. Babwik, J. Brown, M. Sadegian, R. Lau, Y. Xu, L. Gervais, L. Phan, A. Zhang, N. Dapilos High school student: K. Li AHS, ADF, ALMA, ACIDF, Alberta Canola Commission, Alberta Barley Commission, Alberta Milk, Alberta Pulse, Alberta Wheat Commission, Canada Beef, Potato Growers of Alberta