Development of the Healthy Eating Food Index (HEFI)-2019 measuring adherence to Canada’s Food Guide 2019 recommendations on healthy food choices

Brassard, Didier; Munene, Lisa-Anne Elvidge; Pierre, Sylvie St; Guenther, Patricia M.; Kirkpatrick, Sharon I.; Slater, Joyce; Lemieux, Simone; Jessri, Mahsa; Haines, Jess; Prowse, Rachel; Olstad, Dana Lee; Garriguet, Didier; Vena, Jennifer E.; Vatanparast, Hassan; L’Abbé, Mary R.; Lamarche, Benoı̂t

doi:10.1139/apnm-2021-0415

Cited by 21 publications

(30 citation statements)

References 23 publications

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“…We will also examine the impact of excluding patients who were started on lipid-lowering or anti-hypertensive therapy from models assessing impact on blood lipids and blood pressure, respectively. Additional sensitivity analyses will consider the impact on findings when food insecurity is modelled as a continuous, rather than as a categorical outcome, 132 when diet quality is assessed via the new Healthy Eating Food Index-2019, 133 and when an indicator of energy intake misreporting (ie, the ratio of reported energy intake to estimated energy expenditure) is included in models assessing impact on diet quality.…”

Section: Discussionmentioning

confidence: 99%

Healthy food prescription incentive programme for adults with type 2 diabetes who are experiencing food insecurity: protocol for a randomised controlled trial, modelling and implementation studies

et al. 2022

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IntroductionThe high cost of many healthy foods poses a challenge to maintaining optimal blood glucose levels for adults with type 2 diabetes mellitus who are experiencing food insecurity, leading to diabetes complications and excess acute care usage and costs. Healthy food prescription programmes may reduce food insecurity and support patients to improve their diet quality, prevent diabetes complications and avoid acute care use. We will use a type 2 hybrid-effectiveness design to examine the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) of a healthy food prescription incentive programme for adults experiencing food insecurity and persistent hyperglycaemia. A randomised controlled trial (RCT) will investigate programme effectiveness via impact on glycosylated haemoglobin (primary outcome), food insecurity, diet quality and other clinical and patient-reported outcomes. A modelling study will estimate longer-term programme effectiveness in reducing diabetes-related complications, resource use and costs. An implementation study will examine all RE-AIM domains to understand determinants of effective implementation and reasons behind programme successes and failures.Methods and analysis594 adults who are experiencing food insecurity and persistent hyperglycaemia will be randomised to a healthy food prescription incentive (n=297) or a healthy food prescription comparison group (n=297). Both groups will receive a healthy food prescription. The incentive group will additionally receive a weekly incentive (CDN$10.50/household member) to purchase healthy foods in supermarkets for 6 months. Outcomes will be assessed at baseline and follow-up (6 months) in the RCT and analysed using mixed-effects regression. Longer-term outcomes will be modelled using the UK Prospective Diabetes Study outcomes simulation model-2. Implementation processes and outcomes will be continuously measured via quantitative and qualitative data.Ethics and disseminationEthical approval was obtained from the University of Calgary and the University of Alberta. Findings will be disseminated through reports, lay summaries, policy briefs, academic publications and conference presentations.Trial registration numberNCT04725630.Protocol versionVersion 1.1; February 2022

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Section: Discussionmentioning

confidence: 99%

Healthy food prescription incentive programme for adults with type 2 diabetes who are experiencing food insecurity: protocol for a randomised controlled trial, modelling and implementation studies

et al. 2022

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“…Key CFG recommendations on healthy food choices aim at increasing intake of vegetables, fruits, whole grains, plant-based protein foods, water and unsweetened beverages, and unsaturated fats, while decreasing the relative proportion of refined grains, sugary drinks, and processed meats, as well as saturated fats, free sugars, and sodium intakes ( 4 , 5 , 7 ). These recommendations are common to many other dietary guidelines around the world ( 34 ) and are also key features of well-established healthy patterns such as the Mediterranean diet ( 35 , 36 ).…”

Section: Discussionmentioning

confidence: 99%

“…The Oxford WebQ is not based on the Automated Multiple-Pass Method, but rather assesses intakes of ≤206 commonly consumed foods and ≤32 types of beverages ( 11 , 13 ). All foods and drinks were classified according to the HEFI-2019 food and beverage categories ( Supplemental Figure 1 ) ( 7 ). Total nutrient intakes were derived from the reported food and beverage intakes and food composition data corresponding to foods available at the time of questionnaire completion.…”

Section: Methodsmentioning

confidence: 99%

Greater adherence to the 2019 Canada’s Food Guide recommendations on healthy food choices reduces the risk of cardiovascular disease in adults: a prospective analysis of UK Biobank data

Brassard

Manikpurage

Thériault

et al. 2022

The American Journal of Clinical Nutrition

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Background The Canada's Food Guide (CFG) was profoundly revised in 2019, but the extent to which adherence to recommendations on healthy food choices reduces the risk of cardiovascular disease (CVD) is unknown Objectives The aim of this study was to examine how greater adherence to the 2019 CFG's recommendations on healthy food choices influences the risk of incident CVD. Design Participants were a sample of adults without history of CVD, diabetes or cancer from the UK Biobank prospective cohort study. Usual dietary intakes were estimated by modeling data from repeated web-based 24-h dietary recalls using the National Cancer Institute multivariate method. Adherence to key CFG's recommendations on healthy food choices was assessed using the Healthy Eating Food Index (HEFI)-2019. The CVD outcome was a composite of fatal and non-fatal myocardial infarction and ischemic stroke. Cox regression models adjusted via inverse probability weighting were used to estimate CVD risks. Counterfactual models were used to interpret risks of hypothetical changes in the HEFI-2019 score. Results A total of 136,698 participants met the eligibility criteria (55% females, mean age of 57.2 years, range 40–75 years). During the 11-year follow-up, there were 2,843 cases of incident CVD. Compared with no change in the HEFI-2019 score, increasing the HEFI-2019 score of all participants to the 90th percentile of the score distribution (58.1 points) would hypothetically reduce the risk of CVD by 24% (relative risk, 0.76; 95%CI: 0.58, 0.94; absolute risk difference, -0.58%). Conclusions These results suggest that greater adherence to the 2019 CFG recommendations on healthy food choices reduces the 11-year risk of CVD in middle-aged and older adults.

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“…Locavore-I-SF scores correlated weakly but significantly with the HEFI-2019 score, a measure of how dietary patterns align with recommendations on healthy food choices in the 2019 Canada's Food Guide, and hence a measure of diet quality ( 27 , 28 ). Interestingly, subscribing to a CSA box scheme was associated with overall high diet quality in a large Canadian cohort study, while purchasing local food products at farmers’ markets was not ( 12 ).…”

Section: Discussionmentioning

confidence: 99%

“…Participants also completed 24-h dietary recalls on 3 different days (2 weekdays and 1 weekend day) within a 2-wk period using a web-based 24-h recall (R24W) developed and validated by our group ( 23–26 ). Mean dietary intake data from the 3 d were used to calculate the Healthy Eating Food Index (HEFI)-2019, a diet quality index on an 80-point scale that measures adherence to recommendations on healthy food choices in the 2019 Canada's Food Guide ( 27 , 28 ).…”

Section: Methodsmentioning

confidence: 99%

Development and Validation of a Short Questionnaire Assessing the Behavior of Local Food Procurement in Quebec, Canada

Mercier

Rochefort

Fortier

et al. 2022

Current Developments in Nutrition

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Background Very few validated instruments, particularly screening tools applicable to large cohort studies, are available to assess the behavior of local food procurement. Objective To develop and validate a short questionnaire that measures local food procurement in a sample of French-speaking adults from Québec, Canada and to assess the association between local food procurement behavior and diet quality. Methods A comprehensive questionnaire developed previously to measure local food procurement (Locavore-Index [I]) was simplified through a series of steps that included face-validity, exploratory factor analysis and reliability testing (internal consistency). Construct validity of the resulting short Locavore-I-short form (Locavore-I-SF) was examined in a sample of 299 adults (85% women) from Québec City Metropolitan Community. Results The Locavore-I-SF comprises 12 questions that measure the frequency of short food supply chain use (self-production, farmers’ market and community supported agriculture box scheme) for three locally produced foods (carrot, tomato and lettuce) as well as the geographical origin of those three foods. The Locavore-I-SF, which is scored on a 12-point scale, had a high internal consistency (Cronbach alpha 0.74). The Locavore-I-SF scores were strongly correlated with the reference scores obtained from the Locavore-I from which it was developed (r = 0.84, p < 0.0001). Locavore-I-SF scores also correlated (r = 0.50, p < 0.0001) with the geographical origin of foods measured by pictures of food label taken by participants. Higher Locavore-I-SF scores were associated with behaviors consistent with eating local foods such as gardening (vs not gardening, mean (±SEM) difference 2.3 ± 0.4 points, p < 0.0001) and not being preoccupied by the foods’ appearance standards (vs being preoccupied, 1.4 ± 0.4 points, p = 0.0002). Finally, the Locavore-I-SF scores were weakly associated with the Healthy Eating Food Index-2019 score (Beta = 0.05 ± 0.02, p = 0.02). Conclusion The Locavore-I-SF, a short questionnaire based on three locally produced foods in Québec, measures the behavior local food procurement with good reliability and acceptable validity metrics.

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Development of the Healthy Eating Food Index (HEFI)-2019 measuring adherence to Canada’s Food Guide 2019 recommendations on healthy food choices

Cited by 21 publications

References 23 publications

Healthy food prescription incentive programme for adults with type 2 diabetes who are experiencing food insecurity: protocol for a randomised controlled trial, modelling and implementation studies

Healthy food prescription incentive programme for adults with type 2 diabetes who are experiencing food insecurity: protocol for a randomised controlled trial, modelling and implementation studies

Greater adherence to the 2019 Canada’s Food Guide recommendations on healthy food choices reduces the risk of cardiovascular disease in adults: a prospective analysis of UK Biobank data

Development and Validation of a Short Questionnaire Assessing the Behavior of Local Food Procurement in Quebec, Canada

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