Food Consumption and

Nutrition Surveys in Canada

Maya Villeneuve
Nutrition Research Division, Health Products
and Food Branch, Health Canada

What kind of investigations have

you done?

Nutrition Canada;

Provincial Nutrition Surveys;

Canadian Community Health Survey.

Nutrition Canada: General Information

Conducted in 1972;
Nutritional status of
Canadians;
Objectives of the
survey;
Population surveyed;
Regions surveyed;
Sample.

Nutrition Canada: Survey Procedure

Home visits;

Survey centre;

Central laboratory;

Data processing centre.

Nutrition Canada: Questionnaires

Household & Family

Profile;
List of household
members;
24-hour dietary recall;
Dietary form
frequency;

Dental examination;
Anthropometry;
Physical
assessment;
Health Review

Nutrition Canada: 3-D Models

Provincial Nutrition Surveys:

General Information

Canadian Heart Health Strategy;

Nutrition Canada Results;
Federal/Provincial Partnership:

Federal Partners

Provincial Partners

Financial

Responsibility

support
Questionnaire design & development
Training manual
Training of field personnel
Data entry & verification
Food & recipe database
Data analyses

of the survey
Printing of all material
Selection of field personnel
Training of field personnel
Field coordination & supervision
Preparation of the report

Provincial Surveys: Provinces

1999

1994
19931993-94

1998

1990

1996

&
19971997-98

1999*

1995
19961996-97

19891989-90

Provincial Surveys: Sample

Target Population: 2000 individuals
Inclusion

Exclusion Criteria

18-74 years old adults

(BC: seniors up to 84 years
old)
Non-institutionalized
people

Pregnant and lactating

women
Army personnel living on
military bases
Native people living on
reserves
People living in institutions

Survey Data Collection: Paper Flow

Initial Contact: letter sent to participants

Supervisor sent batches of

forms to Ottawa

Interviewer contacts and

arranges an interview date
Interviewer conducts the interview
in the participants home
Interviewer review all survey forms
before sending them to the facilitator

Nutrition Survey
reviews batches

OK?

Facilitator reviews the packages

OK?

Supervisor
reviews packages

Data entry
of forms

Provincial Surveys: Questionnaires

24-hour Dietary Recall

Supplements

Food Frequency Questionnaires

Demographic Profile

Measurements

Provincial Questionnaire

Provincial Surveys: 3-D Models

Canadian Community Health Survey

Cross-sectional survey
Operates on a 2-year collection cycle:
1st year of the survey (cycle .1):

large sample,
general population health survey,
provide reliable estimates at the health region level.

2nd year of the survey (cycle .2):

smaller sample,
focused health topic
provide provincial level results.

Overview of CCHS Cycles

Cycle 1.1 (2000-2001)
General health
130,000 participants
12 years and older

Cycle 1.2 (2002)

Cycle 2.1 (2003)

General health
130,000 participants
12 years and older

Mental health
30,000 participants
15 years and older

Cycle 3.1 (2005)

General health
130,000 participants

Cycle 2.2 (2004)

Nutrition
30,000 participants
0 and older

Cycle 4.1 (2007-2008)

12 years and older

General health
65,000 participants /year

CHMS (2006-2008)

over 2 years

Health Measures

12 years and older

5,000 participants

Cycle 4.2 (2008)

6 to 79 years of age

Healthy Aging?
30,000 participants
50 years and older?

http://www.statcan.ca/english/concepts/hs/index.htm

CCHS 2.2: Sample

30,000 respondents across the 10 provinces;

15 age-sex groups based on the DRI;

Sample buy-ins by HC and 3 provinces;

Final sample size: slightly over 35,000.

CCHS 2.2: Questionnaires

Administration

General Health

Household

Womens health

Income

Chronic conditions

Labour Force

Smoking

Socio-demographics

Alcohol

CCHS 2.2: Questionnaires contd

Physical activity;
Sedentary activity;
Height and weight:

Self-reported;
Measured;

Food Security;
Supplements;
24-hour recall;
Fruit and Vegetable
Consumption.

CCHS 2.2: 2-D Models

Why have you chosen a specific

assessment tool or tools?

24-hour dietary recall

Advantages:

Expertise
Large population
Lower burden than other tools;
Lower costs than other tools;
Do not require participant to have a high literacy level;
Participants will not alter their eating.

Disadvantages:

Knowledge of statistics - usual intakes;

Relies heavily on memory.

What are your experience with the

specific assessment tool or tools?

Manual Data collection (pen & paper)

Nutrition Canada Survey

Provincial Nutrition Surveys

Automated Data Collection

Canadian Community Health Survey

Nutrition (CCHS 2.2)

Manual Data Collection (pen & paper)

Modified 3-step approach with the help of 3-D models

Advantages:

Level of details;
Easy to make corrections;

Disadvantages:

Readability;
Interviewer differences;
Requires trained professionals:
Requires lots of training;
Need lots of storage space;
Cannot automate the data coding/processing.

Automated Data Collection

USDA Automated Multiple-Pass Method:
5-step method;
Developed by the USDA ARS;
BLAISE;
Memory cues.

New USDA Multiple-Pass Method

Step 1

Quick List
Step 2

Forgotten
Foods List
Step 3

Time and
Occasion
Step 4
Adapted from:
Moshfegh, A., Borrud, L., Perloff, B. and
LaComb, R. 1999.
Improved Method for the 24-hour Dietary
Recall for Use in National Surveys.
FASEB Journal 13(4):A603.

Detail Cycle
Step 5

Final Review
Probe

USDA AMPM: Quick List

New USDA Multiple-Pass Method

Step 1

Quick List
Step 2

Forgotten
Foods List
Step 3

Time and
Occasion
Step 4
Adapted from:
Moshfegh, A., Borrud, L., Perloff, B. and
LaComb, R. 1999.
Improved Method for the 24-hour Dietary
Recall for Use in National Surveys.
FASEB Journal 13(4):A603.

Detail Cycle
Step 5

Final Review
Probe

USDA AMPM: Quick List

New USDA Multiple-Pass Method

Step 1

Quick List
Step 2

Forgotten
Foods List
Step 3

Time and
Occasion
Step 4
Adapted from:
Moshfegh, A., Borrud, L., Perloff, B. and
LaComb, R. 1999.
Improved Method for the 24-hour Dietary
Recall for Use in National Surveys.
FASEB Journal 13(4):A603.

Detail Cycle
Step 5

Final Review
Probe

USDA AMPM: Forgotten Foods List

New USDA Multiple-Pass Method

Step 1

Quick List
Step 2

Forgotten
Foods List
Step 3

Time and
Occasion
Step 4
Adapted from:
Moshfegh, A., Borrud, L., Perloff, B. and
LaComb, R. 1999.
Improved Method for the 24-hour Dietary
Recall for Use in National Surveys.
FASEB Journal 13(4):A603.

Detail Cycle
Step 5

Final Review
Probe

USDA AMPM: Time and Occasion

New USDA Multiple-Pass Method

Step 1

Quick List
Step 2

Forgotten
Foods List
Step 3

Time and
Occasion
Step 4
Adapted from:
Moshfegh, A., Borrud, L., Perloff, B. and
LaComb, R. 1999.
Improved Method for the 24-hour Dietary
Recall for Use in National Surveys.
FASEB Journal 13(4):A603.

Detail Cycle
Step 5

Final Review
Probe

USDA AMPM: Detail Cycle

New USDA Multiple-Pass Method

Step 1

Quick List
Step 2

Forgotten
Foods List
Step 3

Time and
Occasion
Step 4
Adapted from:
Moshfegh, A., Borrud, L., Perloff, B. and
LaComb, R. 1999.
Improved Method for the 24-hour Dietary
Recall for Use in National Surveys.
FASEB Journal 13(4):A603.

Detail Cycle
Step 5

Final Review
Probe

USDA AMPM: Final Review Probe

Automatic Data collection

Advantages:

Can be used with a large sample (Quicker interview);

Standardized method of collection;
Already used in the field (NHANES);
Existing resources at Statistics Canada:
Interviewers;
Programmers;

Lower cost to adapt that to create our own;

Similar food supply & food composition database;
Can automate the data coding/processing;
Readability.

Automatic Data collection contd

Disadvantages:

Level of details is limited by the program;

Difficult to navigate through the system;

Requires lots of training;

Requires large memory capacity (laptops)

and server space;

Required some modifications.

Modified AMPM
French translation
Reflect Canadian food supply

Foods, mixed dishes & beverages

Brand Names

Metric system

Example of Canadian adaptation

to probe-type question
AMPM 2.1

Modified AMPM 2.1

Did you get the information you expected

with the chosen assessment tool?

24-hour recall- Manual collection

Collected information for 10 provinces:

Same tool;
Over 20,372 participants;

Representative sample;
Information on children;
Combined data challenges:

10 years span;
Different databases;
Different data entry system.

Did you get the information you expected

with the chosen assessment tool?

24-hour recall Automatic collection

Over 716,00 foods and recipes were collected

58% were automatically coded to a food/recipe code.
Confusion with metric and imperial measurements.
Estimating serving sizes: some participants had
difficulty describing serving sizes or estimating
dimensions of foods, particularly chicken parts and
sausages.
Reversals: units and amounts were sometimes
reversed during collection.

Example of a reversal

What are the limitation of the

assessment tool?

Manual data collection:

Interviewer difference level of details:

Need to set defaults:

AC Nielsen
Survey specific defaults

Need good quality control procedures

Facilitator
Supervisor

What are the limitation of the

assessment tool?

Automatic data collection:

Both languages appeared jointly in the MFL

& LUT;
Too many options in the MFL & LUT;
Navigation difficulties;
Lack of built-in quality controls
mechanisms for portion sizes.

What you or others do with the

assessed data?

Identification of nutrition-related health

issues;
Nutrition Policies;
Food Safety;
Evaluation of submissions
Nutrition Programs.

Identification of nutrition-related
health issues

Nutrition Canada:

Overweight;
Calcium and Vitamin D;
Vitamin C;
Thyroid.

Provincial Nutrition Surveys:

Overweight and obesity;

Folate;
Calcium;
Iron.

Identification of nutrition-related
health issues contd

CCHS 2.2

Adult obesity in Canada: Measured height & weight

23.1% of adult (18 & +) were obese;

36.1% (8.6 million) were overweight;
Obesity figure was up from 1978/79 (13.8%).

Overweight Canadian children & adolescents

26% of children & adolescents (2 to 17) were

overweight or obese;
8% were obese;
For adolescents (12 to 17), the overweight/obesity
rate more than doubled, & the obesity rate tripled,
over the past 25 years.

Published reports

Nutrition Canada:

Provincial Nutrition Surveys:

16 reports available
9 reports available: Nova Scotia,
Quebec (adults & children), Prince
Edward Island, Saskatchewan, Ontario,
British Columbia, Newfoundland and
Labrador & New Brunswick

CCHS 2.2:

Compendium of tables
Set of reports to be released

Nutrition Policies

Food fortification

Insufficient amounts in the diet Mandatory:

Iodine Salt (1949)

Vitamin A & D Milk (1975) & Margarine (1977)

Loses during food Processing Mandatory:

B Vitamin Complex Flour:

B1 & B2, Niacin & Iron (1976)

Folic acid (1998)

Canadas Food Guide to Healthy

Eating (CFGHE) 1992

Currently under
revision;
Related CFGHE to
food consumption
& nutrition
surveys;
Used in the
modelling exercise

Food Safety

Food recalls;
Risk assessments:

BSE
Mercury in fish
Furans
Farmed salmon

How did you handle the different:

Language

Provincial Nutrition Surveys

Mostly conducted in English, except:

Qubec & New Brunswick French

British Columbia Chinese and Punjabi

CCHS 2.2

Conducted in both official languages

Translation of the dietary assessment tool

How did you handle the different:

Dietary habits:

Data collection;
Food composition database;

Canadian Nutrient File;

Survey specific foods;
Recipe database;

Reference material;
Connections in the community.

How did you handle the different:

Size of the country (isolated area)- Territories

If you could start again, what would you

change in your present study design?

Would use the automated 24-hour recall tool

Redesign some aspects of the tool:

Separate the French & English from MFL & LUT

Re-establish the Tri-gram search
Reduce the number of food choices in the lists
Simplify the portion size screens
Built-in quality control mechanisms
+++ testing

More in-depth training & re-training

Adapt the data entry system