Assessing the nutritional quality of diets of Canadian children and adolescents using the 2014 Health Canada Surveillance Tool Tier System

Abstract

Background: Health Canada's Surveillance Tool (HCST) Tier System was developed in 2014 with the aim of assessing the adherence of dietary intakes with Eating Well with Canada's Food Guide (EWCFG). HCST uses a Tier system to categorize all foods into one of four Tiers based on thresholds for total fat, saturated fat, sodium, and sugar, with Tier 4 reflecting the unhealthiest and Tier 1 the healthiest foods. This study presents the first application of the HCST to examine (i) the dietary patterns of Canadian children, and (ii) the applicability and relevance of HCST as a measure of diet quality.

Methods: Data were from the nationally-representative, cross-sectional Canadian Community Health Survey 2.2. A total of 13,749 participants aged 2-18 years who had complete lifestyle and 24-hour dietary recall data were examined.

Results: Dietary patterns of Canadian children and adolescents demonstrated a high prevalence of Tier 4 foods within the sub-groups of processed meats and potatoes. On average, 23-31 % of daily calories were derived from "other" foods and beverages not recommended in EWCFG. However, the majority of food choices fell within the Tier 2 and 3 classifications due to lenient criteria used by the HCST for classifying foods. Adherence to the recommendations presented in the HCST was associated with closer compliance to meeting nutrient Dietary Reference Intake recommendations, however it did not relate to reduced obesity as assessed by body mass index (p > 0.05).

Conclusions: EWCFG recommendations are currently not being met by most children and adolescents. Future nutrient profiling systems need to incorporate both positive and negative nutrients and an overall score. In addition, a wider range of nutrient thresholds should be considered for HCST to better capture product differences, prevent categorization of most foods as Tiers 2-3 and provide incentives for product reformulation.

Keywords: 2014 Health Canada Surveillance Tool Tier system; Adolescents; Canadian; Children; Nutrient profiling.

Fig. 1

Weighted age-stratified analysis of classification of foods as a percentage of servings based on the 2014 Health Canada Surveillance Tool Tier system^a,b among Canadian population of Boys and Girls ages 2 to 8 years. ^aEnergy adjusted ^bTiers are based on Health Canada’s Surveillance Tool [19] and defined generally as follows: Tier 1–3 foods are compliant with EWCFG and Tier 4 foods are not recommended by the EWCFG. Tier 1 are foods that do not exceed lower thresholds for total fat, sugars, and sodium; Tier 2 foods do not exceed up to 2 lower thresholds for total fat, sugars or sodium, without exceeding any upper thresholds; for the Vegetables and Fruit and Grain Products food groups Tier 3 are foods that exceed all 3 lower thresholds without exceeding any upper thresholds or exceed only one upper threshold, while Tier 4 foods exceed at least 2 upper thresholds for total fat, saturated fat, sugars, or sodium. Within the Milk and Alternatives and Meat and Alternatives food groups, Tier 3 foods exceed all 3 lower thresholds without exceeding any upper thresholds for total fat, sugars, or sodium (irrespective of saturated fat) or exceed only one of these 3 thresholds or foods that only exceed the upper saturated fat threshold; within these 2 food groups foods that exceed at least 2 upper thresholds for total fat, sugars, or sodium were classified as Tier 4. Where lower thresholds entail: total fat ≤3 g/RA, sugars ≤6 g/RA, and sodium ≤140 mg/RA; and upper thresholds are: total fat >10 g/RA, sugars >19 g/RA, sodium >360 mg/RA, and saturated fat >2 g/RA

Fig. 2

Implementation of Health Canada Surveillance Tool Tier system applied to the dietary intakes of Canadians <19 years in a weighted analysis of Children (≥2 to <12 years) and Adolescents (≥12 to <19 years). Dietary profile of compliers (Quartile 1)^a, intermediates (Quartiles 2 and 3)^b, and non-compliers (Quartile 4)^c based on the serving from each of the Eating Well with Canada’s Food Guide subgroups per 1000 Kcal for a) Children (2–11 years), b) Adolescents (12–18 years)^{d,e a}The 25 % of individuals with the lowest number of Tier 4 and “other” food servings ^bThe individuals in the interquartile range for dietary intake of Tier 4 and “other” food servings ^cThe 25 % of individuals with the highest number of Tier 4 and “other” food servings ^dAdjusted for age, sex, and misreporting status (under-reporter, plausible-, and over-reporters) ^eQuartiles are based upon percentage of energy from all Tier 4 foods based on Health Canada’s Surveillance Tool Tier system 2014 plus “other” foods and beverages not recommended in the Eating Well with Canada’s Food Guide ^fSignificant p-value for trend for difference of quartiles (P-trend <0.05)