Healthfulness of Food Choices As Recommended in Canada’s Food Guide 2019 and Cardiometabolic Health in Canadians: Evidence From the National Canadian Health Measures Survey

In 2019, Health Canada released an updated Canada's Food Guide (CFG), supported by Canada's Dietary Guidelines (CDG) to reflect the updated evidence that link the regular consumption of healthy food choices with diet-related chronic disease prevention and overall health. This study aims to compare the association between healthy food choices consistent with the new CFG/CDG and cardiometabolic biomarkers in Canadians. A Food Choices Assessment Score (FCAS) was developed to assess dietary choices in Canadian adults relative to 2019 CFG/CDG using a semi-quantitative food frequency questionnaire from the national Canadian Health Measures Survey cycles 5 & 6 (from 2016 to 2019). FCAS ranged from 0 to 80 and consisted of 8 components: protein foods, whole grains, fruits, vegetables, as recommended to be consumed regularly; in addition to 4 sub-groups of highly processed foods: red processed meat, processed dairy, sugary drinks, and savory snacks, which are recommended not to be consumed regularly. Comparisons between FCAS and cardiometabolic biomarkers were made using the independent t-test and ANOVA. FCAS (mean ± SEM) was estimated at (29.4 ± 0.4 over 80) in Canadian adults (n ∼ 6500). Measured body mass index, total cholesterol to high density lipoprotein cholesterol (HDL-C) ratio, non-HDL-C (mmol/L), and high sensitivity C-reactive protein (mg/L) were higher in Canadians in the lowest FCAS quintile relative to the highest (27.7 ± 0.4 vs. 26.5 ± 0.3; 3.92 ± 0.1 vs. 3.49 ± 0.07; 3.48 ± 0.08 vs. 3.36 ± 0.1; 2.8 ± 0.2 vs. 2.2 ± 0.17, respectively; P < 0.001). Measured waist circumference (cm) was higher, and HDL-C (mmol/L) was lower in Canadian females in the lowest FCAS quintile relative to the highest (93.8 ± 2.1 vs. 88.3 ± 1.1; 1.47 ± 0.04 vs.1.62 ± 0.03 respectively; P < 0.001). Lower FCAS was observed in Canadians with diastolic blood pressure (DBP) ≥85 mmHg relative to lower DBP, and with glycated hemoglobin (HbA1C) ≥6.5% (adjusting for self-reported diabetes) relative to normal HbA1C (28.4 ± 0.3 vs. 29.7 ± 0.2; 25.8 ± 2.6 vs. 29.3 ± 0.4, respectively; P < 0.001). These associations may indicate a potential relationship between healthy food choices based on 2019 CFG/CDG and reduced cardiometabolic risk factors in the Canadian population. Canadian Institutes of Health Research.