CANADIAN JOURNAL OF DIETETIC PRACTICE AND RESEARCH

Exploring the Social Determinants of Health in Nutrition Care for South Asian Communities: A Narrative Review
Balakrishnan S., Benea C., Banerjee A. and Mahajan A.
The South Asian (SA) diasporic communities in Canada experience a greater burden of diabetes and cardiovascular disease (CVD) compared to white populations. Nutrition interventions often focus on individual behaviours and fail to consider that the social determinants of health (SDH) have a greater impact on chronic disease risk. A narrative review was conducted to identify the SDH in nutrition care interventions for the SA diaspora in Canada. The final analysis included fourteen articles from which SDH were identified and categorized based on the Social Ecological Model (SEM). The study analysis yielded the following needs in dietetic practice based on the SEM: (1) intrapersonal - need for language appropriate services, and representation of cultural foods and non-Western health perspectives in dietary guidelines, (2) interpersonal - understanding family and friends as social supports, (3) community - incorporating peer and community leader influences, (4) institution - importance of faith-based locations as community hubs, and client workplaces as a barrier to attending appointments, and (5) policy - advocacy for transportation and childcare access, adequate and secure income, and equitable care. These findings urge dietitians to move beyond cultural awareness, sensitivity, and competence to practicing cultural safety and humility in their practice, which is integral to providing equitable care.
Examination of the Feelings and Experiences of Postpartum Mothers Engaging with Social Media: A Qualitative Study
Tang L., Petresin T., Gruson-Wood J., Rice C. and Haines J.
This study examined how postpartum mothers experience social media within the context of mothering and their postpartum body. A subsample of 20 mothers (age 23-42) of infants aged 0-6 months who were exposed to body-focused social media posts as part of an experimental study designed to test social media's impact on body dissatisfaction took part in semi-structured interviews. We used thematic analysis to identify themes and subthemes generated from the data. We identified three themes in the study: () Social media provides a sense of connection with family and friends as a source of support, and connecting with others to gather information related to mothering and child-rearing; () social media led mothers to engage in comparison regarding their bodies, lifestyles, and baby's development; and: () mothers do not always recognize the influence of social media on their feelings. Findings can help guide prenatal and postpartum interventions and equip healthcare professionals with the information needed to support postpartum mothers in maintaining a positive body image and mothering experience when engaging online.
From Equity, Diversity, and Inclusion to Justice: Calling in for Collective Learning and Action on Racism in Dietetics
Brady J. and Ng E.
Equity, diversity, and inclusion (EDI) is the prevailing framework that has informed efforts in dietetics to redress racism. Although EDI has strengths, it has several weaknesses that ultimately hinder progress on racism in the profession. In this paper, we present racial justice as an alternative framework that, we assert, engenders more meaningful, purposive, and politically critical language, analysis, and action to redress racism and White supremacy.
Parent/Caregiver Perceptions of the Good Food for Learning Universal School Lunch Program in Canada
Michnik K., Basilan P., Cooke C., Lummerding D., McAuley R., Alaniz-Salinas N., Engler-Stringer R., Kang E. and Nasser R.
The universal school lunch program is a two-year population health intervention research study in two elementary schools in Saskatoon, Saskatchewan to implement and evaluate a promising model for school food programs (SFPs) in Canada. A survey was administered to understand parent/caregivers' perceptions of the free, universal school lunch program, participation, and willingness to pay for a future school lunch program ( = 113). A healthy and cost-free lunch were the top two benefits recognized by parents/caregivers. The survey estimated student participation in the program at 77%. For future program planning, universal and cost-free were favoured program aspects to continue. In addition, 68% of parents/caregivers demonstrated a willingness to pay $2.00 per child per lunch. Understanding parental/caregiver expectations and attitudes towards SFPs can inform the planning, decision-making, and sustainability for future models and a national school food policy in Canada.
Registered Dietitians' Experiences and Perceptions in Providing Prenatal Nutrition Care in Canada: A Cross-sectional Study
Wilding S., Francis J., Seabrook J.A. and Twynstra J.
To explore Canadian Registered Dietitians' (RDs) roles and experiences in prenatal care. This cross-sectional study utilized an online, anonymous, original survey. Eligible RDs, who are members of Dietitians of Canada (DC) and provide care for pregnancy, were invited to participate through their publicly available online profiles on the DC website. Of the 71 RDs who completed the survey, 97.1% provided nutrition care when requested by the client, 68.8% in times of complications, and 60.0% through referrals. RDs most frequently discussed topics on foods to avoid, supplementation, and healthy eating. Only 4.3% of RDs felt that other prenatal healthcare providers (HCPs) are providing adequate nutritional care, while all (100.0%) RDs believed that they should be the ones providing nutrition care for pregnancy, and most (88.6%) thought they should start providing nutrition counselling during preconception. Most (92.9%) respondents acknowledged that barriers exist in accessing RDs for nutrition advice. Recommendations for improving RD accessibility included increased government funding, involvement in standard care and referrals, awareness, and remote access. Canadian RDs would like to play a larger role in prenatal care through a more integrated approach with other prenatal HCPs and improved access to dietetic services for all pregnant people.
Identifying and Mapping Canadian Registered Dietitians' Perceptions and Knowledge of and Experiences with Weight-Related Evidence: A Scoping Review
Waugh R., Mireault A., Rothfus M.A., Gray M., Mannette J., Stoneman S., Lee-Baggley D., Lengyel C., Norris D., Snelgrove-Clarke E., Joy P. and Grant S.
In this scoping review, "weight-related evidence" is an umbrella for various terms, phrases, and ways in which weight, body size, fatness, and/or obesity present in research and dietetic practice. Canadian Registered Dietitians' perceptions of, experiences with, and/or knowledge of weight-related evidence in nutrition care was identified and mapped. Implementing JBI scoping review methodology, four databases were searched: () CINAHL (EBSCO); () Medline (Ovid); () Embase (Elsevier); and () Scopus (Elsevier). Google and Bing were searched for grey literature. Three JBI-trained independent reviewers completed screening to extraction. Community consultation was conducted using the Delphi Method. Of 2217 results, 67 were included in the review (29 peer-reviewed; 38 grey). Identified frequencies were 67 examples of perception, 54 of experience, and 51 of knowledge. This review identified diverse definitions/perspectives of weight-related evidence, highlighting the benefits of continuing to discuss and explore this topic within and beyond dietetics. Weight-related evidence was identified in nutrition care in various settings, representing nutrition assessment, diagnoses, interventions, monitoring, and evaluation. Focused on dietetic research and practice, this work provides a foundation for future evaluation of dietitian-led intervention fidelity, utility, and effectiveness, using systematic review or other research designs. These Canadian findings can serve as a foundation for a global/international review.
How Many Participants Are Needed? Strategies for Calculating Sample Size in Nutrition Research
Seabrook J.A.
Sample size estimation is a critical aspect of nutrition research methodology, yet it remains frequently overlooked, leading to underpowered studies and potentially inaccurate conclusions. This review addresses this gap by providing comprehensive guidance on how to calculate sample size in nutrition research. Emphasizing the importance of an a priori sample size calculation, the review outlines the key considerations, including the desired levels of significance and power, effect size estimation, and standard deviation assessment. Formulas for determining sample size for various comparisons, including two proportions, two means, three or more groups, and unevenly sized groups, are provided, along with strategies for addressing loss to follow-up. Hypothetical examples illustrate these formulas' application across different research scenarios, highlighting their practical value in ensuring study robustness. Additionally, the review discusses common pitfalls in sample size estimation, such as misjudging effect size or standard deviation, and emphasizes the need for transparent reporting of sample size calculations to enable accurate interpretation of study findings. This article is a resource for nutrition researchers, offering guidance on conducting appropriate sample size calculations to bolster methodological rigor and study reliability. By embracing the principles outlined herein, researchers can elevate the quality of nutrition research.
Nourishing Individuals So Our Communities Can Flourish
Cahill N.
Dietetic Students' Perceived Anxiety towards Simulation Activities: A Mixed-methods Pilot Study
Rosa M., Bodnaruc A.M. and Giroux I.
To assess dietetic students' anxiety levels before and after a series of simulations and to document students' perceived sources of anxiety while completing simulation-based learning activities. A mixed-method convergent pilot study was conducted. Students enrolled in a Nutrition Assessment course that included a series of four simulations were invited to participate. Students completed an online pre-post simulation survey and engaged in individual interviews and a focus group discussion. The questionnaires included demographic questions and the French State-Trait Anxiety Inventory. Nonparametric tests and thematic analysis were used to examine data. Fourteen students participated in the study's quantitative component and seven in the qualitative component. There was a significant decrease in trait (44.5 ± 13.8 vs 32.0 ± 14.0,  = 0.01) and state (47.0 ± 11.2 vs 33.0 ± 18.0,  = 0.05) anxiety from pre- to post-simulations. Individual factors influencing students' anxiety levels were stress and self-confidence. External factors influencing students' anxiety levels were unknown situations, observers, patient profiles, observers' feedback, preparation level, and academic setting. Our findings suggest that ensuring the educator is not present during simulations, advance preparation, and reassurance that simulations are a learning and not an evaluation activity may be effective pedagogical strategies for dietetic educators to reduce learners' anxiety and facilitate competency development.
Exploring Dysphagia Assessment and Management in Canadian Primary Care: A Clinical Practice Survey
Lam P., Bailey E. and Steel C.
Oropharyngeal dysphagia (OD), or dysphagia, is associated with malnutrition, pneumonia, and hospital admissions, and affects up to 35% of older adults in the community. This study aimed to understand dysphagia assessment and management practices among registered dietitians (RDs), speech-language pathologists (SLPs), and occupational therapists (OTs) working with adults in Canadian primary care and to help identify gaps and opportunities to optimize dysphagia patient care.A 22-question online practice survey was administered to RDs, SLPs, and OTs recruited through professional associations and practice groups.A total of 126 respondents partially or fully completed the survey. Clinical swallowing evaluations/mealtime observations were the primary assessment method used by RDs (92%), SLPs (83%), and OTs (50%). Patient education, oral care, and diet modifications were indicated as the top three management strategies. Challenges identified in dysphagia care included patient adherence to management strategies and limited personnel for assessing and managing dysphagia. Inter-professional clinical care pathways, patient/caregiver resources, and professional training for dysphagia assessment were identified to be the most valued resources for providing care.Timely assessment and management are crucial for community-living individuals with dysphagia. Finding unique and sustainable ways to overcome challenges in managing dysphagia in primary care will help improve care for this vulnerable population.
Investigating Dietitians' Knowledge and Comfort in Supporting Muslim Clients and Communities Who Fast During Ramadan
Richmond M., Hillier K., Walker S., Anjum A., Desmarais M., Lubchenko K. and Souchotte J.
The purpose of this preliminary study was to explore Saskatchewan Registered Dietitians' perceived knowledge, comfort, and access to resources in supporting Muslims who choose to fast during Ramadan. An online anonymous survey was distributed to Saskatchewan dietitians from January 31 to February 22, 2022. Quantitative data analysis was employed using Microsoft Excel. A total of 93 dietitians completed the survey. Most participants understood that fasting involved abstaining from food and drink (90%, 80/90). Further, participants (71%, 65/92) reported they had never provided care during Ramadan to fasting Muslims, and some (55%, 48/88) felt they did not have access to nutrition guidelines to help Muslims choosing to fast during Ramadan. Yet, 97% (85/88) of participants believe understanding Ramadan is important to providing culturally safe care. Few registered dietitians in Saskatchewan had knowledge regarding Ramadan fasting practices. Some Saskatchewan dietitians may feel uncomfortable due to the limited experience reported providing care to Muslims during Ramadan. Future research should further investigate Canadian dietitians' knowledge, attitude, and practices providing culturally safe care to Muslims during Ramadan.
Exploring Student Perspectives of the Dietetics Profession Using a Professional Socialization Lens
Riediger N.D., Waugh A., Parker B., Russell C. and Bombak A.E.
We aimed to explore student perspectives of the dietetics profession using a professional socialization lens. We conducted qualitative semi-structured interviews, virtually or by phone, with 25 dietetic undergraduate/graduate students or interns in 2020/21. Transcripts were thematically analyzed. All participants identified as female, averaged 25 years old at the time of the interviews, and were in different stages of their education. Two themes captured their perspectives of the profession: and . Technical expertise was focused on scientific understandings of how individuals consume and utilize food, and how (mostly Western) food should be prepared for safety and maximum nutrition. Participants perceived dietetics as a white, feminized profession with dietitians' role to aid in weight loss; participants actively sought to resist these stereotypes, notably through social media. While holding technical expertise continues to be embedded as a key component of dietetics identity, student professional socialization is also being shaped by social media, racial justice, and body positivity movements. This socialization process is likely to influence changes to the profession as students enter practice.
Informing Evidence-based Practice in Nutritional Genomics: An Educational Needs Assessment of Nutrition Care Providers in Canada
Morelli P., Garneau V., Miville-Deschênes L., Morin-Bernier J., Vohl M.-C., Desroches S. and Keathley J.
To investigate why Canadian nutrition care providers choose, or not, to integrate nutritional genomics into practice, and to evaluate the nutritional genomics training/education experiences and needs of nutrition providers in Canada, while comparing those of dietitians to non-dietitians. A cross-sectional online survey was distributed across Canada from June 2021 to April 2022. In total, 457 healthcare providers (HCPs) [ = 371 dietitians (81.2%)] met the inclusion criteria. The majority ( = 372; 82.1%) reported having no experience offering nutritional genomics to clients ( = 4 did not respond). Of the 81 respondents with experience (17.9%), the most common reason to integrate nutrigenetic testing into practice was the perception that clients would be more motivated to change their eating habits (70.4%), while the most common reason for not integrating such tests was the perception that the nutrigenetic testing process is too complicated ( = 313; 84.1%). Dietitians were more likely than non-dietitians to view existing scientific evidence as an important educational topic ( = 0.002). The most selected useful educational resource by all HCPs was clinical practice guidelines ( = 364; 85.4%). Both dietitians and non-dietitians express a desire for greater nutritional genomics training/education; specific educational needs differ by type of HCP. Low implementation of nutrigenetic testing may be partly attributed to other identified barriers.
Culinary Medicine and Teaching Kitchens: Dietitians Leading Innovative Nutrition Training for Physicians
Rysdale L. and Barohn J.
The objective of this evaluation was to determine the impact of a pop-up Teaching Kitchen (TK) at a national cardiovascular conference. The 60-minute session was hosted in a hotel conference room and led by two registered dietitians. Participants prepared 12 recipes, enjoyed a family-style meal, and explored nutrition behaviour change strategies for patients. Using Likert-scaled and open-ended questions, pre-/post-online surveys assessed change in perceived nutrition counselling skills, attitudes, and confidence; post-survey also assessed effectiveness of session components and further training needs. Pre-survey response was 72% (18/25). Twenty-one participants attended the event (14 pre-registrants, six from waitlist, and five drop-ins); 81% completed the post-survey. Positive shifts were reported in nutrition competence, particularly attitudes towards using recipes in nutrition counselling, and increased skills and confidence discussing eating on a budget and SMART (Specific, Measurable, Achievable, Relevant, and Time-Bound) goal setting with patients. Components of the TK session that enhanced nutrition competence were key patient messages and the shared meal. Preparing and eating together in a hands-on format was most enjoyable. Promoting healthy eating behaviours requires understanding the complexity of individual and societal food literacy. With high physician interest, dietitians are well positioned to deliver culinary medicine interventions and support physicians' confidence in health promotion and chronic disease prevention and management.
Novel Guided Self-Help for the treatment of Binge Eating Disorder: Feasibility, Acceptability, and Preliminary Efficacy
Arbour G., Legendre M., Langlois M.-F. and Bégin C.
Binge eating disorder (BED) is a prevalent eating disorder. Many individuals with BED do not receive evidence-based care due to many barriers. This preliminary study evaluated the feasibility, acceptability, and potential efficacy of a manualized guided self-help (GSH) intervention with support in the form of a culturally adapted manual for a French-Canadian population. Twenty-two women with overweight or obesity meeting the BED diagnostic criteria participated in an 8-week open trial. The GSH programme combined a self-help book and weekly support phone calls. Participants were assessed at baseline, at week 4, postintervention, and 12 weeks following its end. Feasibility was measured by attrition rates, participation, and satisfaction. Acceptability was measured by a questionnaire based on the Theoretical Framework of Acceptability. Potential efficacy outcomes were objective binge eating days, eating disorder symptomatology, depressive symptoms, and propensity to eat intuitively. The GSH programme has proven feasible (4.5% attrition, 91% completion, 95.5% satisfaction) and acceptable. Potential efficacy results showed promising improvements on all outcomes (19% abstinence, 70.9% reduction in objective binge eating days). Although preliminary, this programme warrants further study as it may be an efficient and cost-effective way to deliver GSH for BED patients with accessibility barriers.
Canadian Dietary Intakes Assessed by Nutrient Profiling Models and Association with Mortality and Cardiovascular Disease
Jacobs A.C. and Jessri M.
Nutrient profiling (NP) ranks foods according to nutritional composition and underpins policies (e.g., front-of-package (FOP) labelling). This study aimed to evaluate Canadian adults' dietary intakes using proposed Canadian FOP "high-in" labelling thresholds and international NP models (i.e., Ofcom, FSANZ, and Nutri-Score) and examine the association between intakes using international NP models and all-cause mortality and cardiovascular disease (CVD). Intakes from the Canadian Community Health Survey-Nutrition (CCHS-Nutrition) 2004 and 2015 were given NP scores and assessed against FOP thresholds. CCHS-Nutrition 2004 was linked with death records (Canadian Vital Statistics Database, n = 6767) and CVD incidence and mortality (hospital Discharge Abstract Database, n = 6420) until December 2017. Foods that would require FOP labels, should there be such regulation in Canada, contributed 38% of calories. Association between NP scores and mortality was significant for Ofcom, FSANZ, and Nutri-Score (hazard ratio (HR) in highest quintile (lowest quality): 1.73, 95%CI [1.20-2.49], 1.59[1.15-2.21], and 1.75[1.18-2.59], respectively), and for CVD incidence, among males (HR in highest quintile: 2.11[1.15-3.89], 1.74[1.07-2.84], and 2.29[1.24-4.24], respectively). Canadians had moderately healthy intakes. NP systems could discriminate between low and high dietary quality such that adults with the lowest diet quality were more likely to experience all-cause mortality and CVD events (for males).
What Evidence?: Qualitative Publishing in the Canadian Journal for Dietetic Practice and Research
Brady J. and Bromley A.
Qualitative research involves the analysis of data in various forms (i.e., written text such as interview transcripts, literature, or a personal diary; visual media such as photographs, maps, or memes; and audio materials such as podcasts, music, or voice notes) to describe and/or interpret phenomena and humans' perceptions and experiences of the world, including of food, health, and well-being. Dietetic-scholars have raised concerns about the dearth and quality of qualitative dietetic research. To document the availability and quality of qualitative research published in Canadian dietetic literature. A manifest content analysis of articles published in the (CJDRP) between 2012 and 2021. In total, 340 articles were published between 2012 and 2021 of which 43 (12.6%) used qualitative methods. Overall, the quality of qualitative articles was poor; articles frequently failed to report the methodological approach or a theoretical framework. Methods of data collection, data analysis, and strategies to ensure rigor were seldom described in detail. Reported limitations were often inappropriate for qualitative research. Qualitative research is markedly underrepresented in the CJDPR. Efforts are needed to ensure that high-quality qualitative research evidence and publishing opportunities are available to Canadian dietetic practitioners and researchers. This study provides baseline data to evaluate the impact of future efforts.
The Evolving Landscape of Scholarly Publishing
Cahill N.
Improving Malnutrition Screening among Hemodialysis Patients
Sharma Parpia A., Valenzano T.J., Bosma R., Bavota B., Deveaux G., Wald R. and Bradley K.
Individuals receiving hemodialysis are at increased risk of malnutrition; however, regular diagnosis of malnutrition using subjective global assessment (SGA) is time-consuming. This study aimed to determine whether the Canadian Nutrition Screening Tool (CNST) or the Geriatric Nutrition Risk Index (GNRI) screening tools could accurately identify hemodialysis patients at risk for malnutrition. A retrospective medical chart review was conducted for in-centre day shift hemodialysis patients (n = 95) to obtain the results of the SGA assessment and the CNST screener and to calculate the GNRI score. Sensitivity and specificity analyses showed only a fair agreement between the SGA and CNST (sensitivity = 20%; specificity 96%; κ = .210 (95% CI, -0.015 to .435),  < .05) and between the SGA and GNRI (sensitivity = 35%; specificity = 88%; κ = .248 (95% CI, .017 to .479),  < .05). There was no significant statistical difference between the accuracy of either tool in identifying patients at risk of malnutrition ( = .50). The CNST and GNRI do not accurately screen for risk of malnutrition in the hemodialysis population; therefore, further studies are needed to determine an effective malnutrition screening tool in this population.
CELEBRATE Feeding: A Responsive Approach to Food and Feeding in Early Learning Settings
Rossiter M.D., Young M., Dickson E., Campbell J.E., Caldwell S. and Mcisaac J.-L.
Early learning and child care (ELCC) settings in Canada follow nutrition standards that outline food provisions, with many also encouraging responsive feeding practices that help to create a supportive environment for children. Caregivers who lack confidence in children's ability to regulate their own intake, or those who feel stressed about mealtime, may unknowingly engage in less responsive feeding practices. The CELEBRATE Feeding Approach is a flexible framework, driven by behaviour change theory, that builds on previous definitions and concepts of responsive feeding in ELCC environments. Through this approach, there is an intentional focus on supporting early childhood educators to implement feeding practices that are more responsive. The approach incorporates 13 target educator behaviours related to the three overlapping categories of CELEBRATE language, CELEBRATE Mealtime, and CELEBRATE Play. These practices recognize and support the development of a child's sense of autonomy, confidence, and self-regulation not only at mealtimes but also through play-based exploration and language that is used throughout the day around food and feeding. The goal is that children will be open to a wide variety of food, develop their self-regulation skills, and build the foundation for a positive relationship with food throughout their lifetime.
Vitamin D, Folate, Vitamin B, and Iron Status in Pregnant/Postpartum Old Order Anabaptist Women in Southwestern Ontario
Randall Simpson J.A., Miller N., Hartwig T., Leach J., Purdy M., Roth E., Mok Siu V., Soulliere C., Tam J. and Watt A.
To assess vitamin D, folate, vitamin B, and iron status in Old Order Anabaptist (OOA) pregnant/postpartum women. Blood was analyzed for plasma 25 hydroxy vitamin D (25(OH)D), red blood cell (RBC) folate, serum vitamin B, and iron status indicators. Dietary intakes (food and supplements) from 3-day estimated records were compared to Dietary Reference Intakes and Canada's Food Guide (2007). Fifty women participated in this descriptive cross-sectional study. Concentrations of 25(OH)D were low (<50 nmol/L for 20% and < 75 nmol/L for 63%); 42% had total vitamin D intakes < estimated average requirement (EAR). All women had RBC folate above the 1360 mmol/L cut-off. Nineteen percent had folate intakes upper limit. One woman had low serum vitamin B (<148 pmol/L); serum vitamin B was high (>652 pmol/L) for 24%. None had vitamin B intakes