Food, Nutrients and Health: Interim Evidence Update 2018

Download the alternative format
(PDF format, 946 KB, 14 pages)

Organization: Health Canada

Date published: 2019-01-22

The Evidence Review Cycle for Dietary Guidance (ERC) is Health Canada's ongoing systematic approach to gathering, assessing, and analyzing scientific evidence relevant to dietary guidance. This process helps to ensure that dietary guidance from Health Canada on healthy eating, such as Canada's Food Guide, remains scientifically sound, current, relevant, and useful. The ERC examines evidence in three key input areas that inform dietary guidance: Scientific Basis; Relevance in the Canadian Context; and Use of Existing Dietary Guidance (Figure 1). The current Food, Nutrients and Health: Interim Evidence Update 2018 focuses specifically on one of the key areas of the ERC—the Scientific Basis. It aims to:

  1. ensure that dietary guidance from Health Canada is developed using the latest scientific evidence;
  2. maintain credibility in Health Canada's approach to gathering evidence on relationships between food, nutrients and health;
  3. provide an overview of evidence on convincing relationships between food, nutrients and health gathered between July 2015 and November 2018;
  4. summarize the state of the evidence on convincing relationships between food, nutrients and health gathered between January 2006 and November 2018.

Figure 1: Key input areas to inform decisions about dietary guidance

Figure 1: Key input areas to inform decisions about dietary guidance. Text description follows.
Figure 1: Key input areas to inform decisions about dietary guidance - Text Description

This figure describes the 3 key input areas that inform decisions about Health Canada’s dietary guidance and other actions. The 3 input areas are the following:

  1. Canadian context: demographics and health status, food skills, habits and behaviours, attitudes and beliefs about healthy eating, food and nutrient intakes, food supply, policy environment and nutrition information environment.
  2. Scientific basis: Nutrient standards and food and health.
  3. Use of existing dietary guidance: Awareness and understanding, confidence and acceptance, and integration and use.

A brief summary of the methodology for the evidence review process of the scientific basis is described in Annex 1. When developing dietary guidance, Health Canada uses convincing findings that are supported by a well-established evidence base and are unlikely to change in the foreseeable future as new scientific evidence emerges. Annex 2 provides an overview of evidence on convincing relationships between food, nutrients and health gathered between July 2015 and November 2018. Annex 3 summarizes the state of the evidence on convincing relationships between food, nutrients and health gathered between January 2006 and November 2018.

Annex 1: Summary of the Evidence Review Process Methodology

Health Canada used the methodology outlined in the 2015 Evidence Review for Dietary Guidance: Technical Report.Footnote 1 The outcomes of interest were chronic diseases/conditions of public health concern in Canada—as identified in the 2015 evidence review—specifically: cancer (various types), cardiovascular disease/coronary artery disease (including hypertension, dyslipidemia and stroke), obesity (including adiposity and weight gain), osteoporosis (including bone health and fractures), and type 2 diabetes. The following health outcomes were added to the evidence review process since 2015 based on expert reviewer suggestions:

  • All-cause mortality
  • Metabolic syndrome
  • Oral health

In addition, since 2015, there has been an increase in the overall amount of credible evidence. As a result, recent reports generally provide greater detail on food, nutrients and health relationships (for example, specificity of health outcomes, identification of thresholds in the level of exposure to a food or nutrient, stratification of exposures by demographic variables, etc.). Health Canada has refined its approach to gathering and assessing the evidence to accurately reflect the food, nutrients and health relationships provided in more recent reports.

Annex 2: How has Health Canada's General Understanding of Food, Nutrients and Health Relationships Changed Since 2015?

The 2015 Evidence Review for Dietary Guidance: Technical ReportFootnote 1 included a review of 27 reports Footnote 2,Footnote 3,Footnote 4,Footnote 5,Footnote 6,Footnote 7,Footnote 8,Footnote 9,Footnote 10,Footnote 11,Footnote 12,Footnote 13,Footnote 14,Footnote 15,Footnote 16,Footnote 17,Footnote 18,Footnote 19,Footnote 20,Footnote 21,Footnote 22,Footnote 23,Footnote 24,Footnote 25,Footnote 26,Footnote 27,Footnote 28 published between January 2006 and July 2015 by federal agencies and leading scientific organizations. Since 2015, an additional 33 reportsFootnote 29,Footnote 30,Footnote 31,Footnote 32,Footnote 33,Footnote 34,Footnote 35,Footnote 36,Footnote 37,Footnote 38,Footnote 39,Footnote 40,Footnote 41,Footnote 42,Footnote 43,Footnote 44,Footnote 45,Footnote 46,Footnote 47,Footnote 48,Footnote 49,Footnote 50,Footnote 51,Footnote 52,Footnote 53,Footnote 54,Footnote 55,Footnote 56,Footnote 57,Footnote 58,Footnote 59,Footnote 60,Footnote 61 were reviewed. A total of 47 reportsFootnote 2,Footnote 4,Footnote 5,Footnote 6,Footnote 7,Footnote 8,Footnote 9,Footnote 10,Footnote 11,Footnote 12,Footnote 13,Footnote 14,Footnote 15,Footnote 24,Footnote 25,Footnote 26,Footnote 27,Footnote 28,Footnote 29,Footnote 30,Footnote 31,Footnote 32,Footnote 33,Footnote 34,Footnote 35,Footnote 36,Footnote 37,Footnote 38,Footnote 39,Footnote 40,Footnote 41,Footnote 42,Footnote 43,Footnote 44,Footnote 45,Footnote 46,Footnote 47,Footnote 48,Footnote 49,Footnote 54,Footnote 55,Footnote 56,Footnote 57,Footnote 58,Footnote 59,Footnote 60,Footnote 61 were retained for this Interim Evidence Update as 13 reportsFootnote 3,Footnote 16,Footnote 17,Footnote 18,Footnote 19,Footnote 20,Footnote 21,Footnote 22,Footnote 23,Footnote 50,Footnote 51,Footnote 52,Footnote 53 published between 2006 and 2015 were superseded by updated reports published since 2015.

Consistent convincing evidence

Most of the convincing evidence reviewed since 2015 re-affirmed Health Canada's understanding of food, nutrients and health relationships. For example the following convincing evidence is consistent with previous convincing evidence captured in the 2015 Evidence Review for Dietary Guidance: Technical ReportFootnote 1:

Alcohol:
Fats:
  • Replacement of saturated fat with carbohydrate and improved blood lipid levels.Footnote 56
  • Replacement of saturated fat or trans fat with unsaturated fat (polyunsaturated or monounsaturated) and improved blood lipid levels in adults.Footnote 56,Footnote 57
  • Replacement of trans fat with unsaturated fat (polyunsaturated or monounsaturated) and improved blood lipid levels in adults.Footnote 57
Fibre:
  • Dietary fibre and improved blood lipid levels.Footnote 34
Meat and meat alternatives:
  • Diets high in soy protein and lowered low-density lipoprotein (LDL) cholesterol.Footnote 32
  • Processed meat intake and increased risk of colorectal cancer.Footnote 29,Footnote 49
Patterns:
  • Healthy dietary patterns and lowered LDL cholesterol and cardiovascular disease risk.Footnote 32
Sugars:
  • Intake of sugar-sweetened drinks and increased risk of weight gain, overweight and obesity.Footnote 60

New convincing evidence

Some of the convincing evidence reviewed since 2015 added to our understanding of food, nutrients and health relationships. For example, there is new convincing evidence for the following food, nutrients and health relationships:

Carbohydrates:
  • Diets higher in carbohydrate and lower in fat and/or protein and improved blood lipid levels.Footnote 34
Fats:
  • Increased intake of polyunsaturated fat and improved blood lipid levels.Footnote 31,Footnote 33,Footnote 54
  • Replacement of saturated fat with unsaturated fat (polyunsaturated or monounsaturated) and improved blood lipid levels in children.Footnote 55
  • Decreased saturated fat intake in children and improved blood lipid levels, lower blood pressure and lower risk of obesity.Footnote 55
  • Replacement of trans fat with carbohydrate and improved blood lipid levels.Footnote 57
Fibre:
  • Dietary fibre and decreased risk of colon cancer, cardiovascular diseases and type 2 diabetes.Footnote 34
Glycemic Index/Load:
  • Higher glycemic index or glycemic load and increased risk of type 2 diabetes.Footnote 34
Meat and meat alternatives:
  • Diets high in nuts and lowered LDL cholesterol.Footnote 32
  • Processed meat intake and increased risk of cancer.Footnote 29
Sugars:
  • Intake of sugars-containing beverages, including 100% fruit juice, and increased risk of dental decay in children.Footnote 34
  • Increased intake of sugars and increased risk of excess energy intake leading to weight gain.Footnote 34

No longer convincing evidence

Occasionally, some relationships are no longer convincing, which also has important implications for dietary guidance. For example, since 2015, the evidence grade changed from 'convincing' to 'probable' for the following food, nutrients and health relationships:

Fibre:
  • Dietary fibre (total fibre and fibre found in fruits and vegetables as well as whole grains) and decreased risk of colorectal cancer.Footnote 49
Meat and meat alternatives:
  • Red meat intake and increased risk of colorectal cancer.Footnote 49
Annex 3: Summary of Convincing (strong) Food and Health Relationships and Changes Since 2015
PREDICTOR OUTCOME
(SPECIFIC OUTCOME OR RISK FACTOR)
DIRECTION OF
RISKTable 1 footnote ,Table 1 footnote ††
SOURCE
(# OF FINDINGS)
CHANGES IN CONVINCING EVIDENCE SINCE
2015Table 1 footnote *,Table 1 footnote **,Table 1 footnote ***
Alcohol
Alcohol Cancer (Colorectal; Breast - postmenopausal; Oesophageal - squamous cell carcinoma; Liver; Mouth, pharynx, larynx) Increased WCRF, 2018Table 1 footnote 49 (1); WCRF, 2018Table 1 footnote 36 (1); WCRF, 2018Table 1 footnote 44 (1); WCRF, 2018Table 1 footnote 43 (1);
WCRF, 2018Table 1 footnote 47 (1)
No change
Alcohol (Moderate drinking) CVD (CHD) Decreased DGAC, 2010Table 1 footnote 5 (1) No change
Carbohydrates
Diets higher in carbohydrate, lower fat CVD (Blood lipids: TC) Decreased SACN, 2015Table 1 footnote 34 (1) New finding
Diets higher in carbohydrates, lower fat & average protein CVD (Blood lipids: LDL; TC) Decreased SACN, 2015Table 1 footnote 34 (2) New finding
Diets higher in carbohydrate,  differing in the proportion of fat and proteinTable 1 footnote a CVD (BP: SBP; DBP); CVD (Blood lipids: CRP; NEFA; LDL; HDL) No effect SACN, 2015Table 1 footnote 34 (11) New finding
Diets higher in carbohydrate and/or lower fat and average proteinTable 1 footnote a Overweight/Obesity (Body weight; Energy intake) No effect SACN, 2015Table 1 footnote 34 (2) New finding
Diets higher in carbohydrate,  differing in the proportion of fat and proteinTable 1 footnote a T2D (A1c; Fasting insulin; FBG; OGTT) No effect SACN, 2015Table 1 footnote 34 (7) New finding
Total carbohydrate intake Cancer (Colorectal; Colon; Rectal) No association SACN, 2015Table 1 footnote 34 (3) New finding
Dietary Behaviours
Fast food Overweight/Obesity (Weight gain, overweight, obesity) Increased DGAC, 2010Table 1 footnote 5 (1) No change
Dietary patterns
DASH combined with independent lowered sodium intake CVD (BP: SBP & DBD) Decreased ACC/AHA, 2013Table 1 footnote 2 (1) No change
Dietary patternTable 1 footnote b CVD Decreased DGAC, 2015Table 1 footnote 4 (1) No change
Dietary pattern higher in vegetables, fruits, & whole grains; includes low-fat dairy products, poultry, fish, legumes, nontropical vegetable oils, & nuts; & limits intake of sweets, SSBs, & red meats CVD (Blood lipids: LDL); BP (SBP, DBP) Decreased ACC/AHA, 2013Table 1 footnote 2 (2) No change
Mediterranean CVD Decreased CCS, 2016Table 1 footnote 32 (1) No change
Macronutrient profiles that contain 5% to 6% saturated fat, 26% to 27% total fat, 15% to 18% protein, & 55% to 59% carbohydrate CVD (Blood lipids: LDL) Decreased ACC/AHA, 2013Table 1 footnote 2 (1) No change
Steps I and II diets from the US National Cholesterol Education Program CVD (Blood lipids: LDL) Decreased CCS, 2016Table 1 footnote 32 (1) No change
Fats
PUFA (EPA & DHA &/or DPA) All-cause mortality No association AHRQ, 2016Table 1 footnote 31 (1) New finding
PUFA (EPA & DHA &/or DPA) CVD (Blood lipids: TG; TC:HDL ratio) Decreased AHRQ, 2016Table 1 footnote 31 (2) New finding
PUFA (EPA &/or DHA) CVD (Blood lipids: TG) Decreased HC, 2016Table 1 footnote 33 (1) New finding
PUFA (EPA & DHA &/or DPA) CVD (Blood lipids: LDL; HDL) Increased AHRQ, 2016Table 1 footnote 31 (2) New finding
PUFA (EPA & DHA &/or DPA) CVD (Coronary revascularization; Major adverse CVD event; Sudden cardiac death) No association AHRQ, 2016Table 1 footnote 31 (3) New finding
PUFA (EPA & DHA &/or DPA) CVD (BP: SBP & DBP) No effect AHRQ, 2016Table 1 footnote 31 (1) New finding
PUFA (Long-chain omega-3) All-cause mortality No effect WHO, 2018Table 1 footnote 54 (1) New finding
PUFA (Long-chain omega-3) CVD (Blood lipids: HDL) No effect WHO, 2018Table 1 footnote 54 (1) New finding
PUFA (Long-chain omega-3) CVD (Blood lipids: TG) Decreased WHO, 2018Table 1 footnote 54 (1) New finding
PUFA (Long-chain omega-3) CVD (Cardiovascular events) No effect WHO, 2018Table 1 footnote 54 (1) New finding
PUFA (Long-chain omega-3) Overweight/Obesity (BMI; Body weight) No effect WHO, 2018Table 1 footnote 54 (2) New finding
PUFA (Type not specified) CVD (Blood lipids) Decreased DGAC, 2010Table 1 footnote 5 (1) No change
SFA CVD (Blood lipids: LDL, TC); T2D (Insulin resistance) Increased DGAC, 2010Table 1 footnote 5 (2) No change
SFATable 1 footnote c (Decreased) CVD (Blood lipids: HDL) – In children No effect WHO, 2017Table 1 footnote 55 (3) New finding
SFA (Decreased) CVD (Blood lipids: LDL) Decreased ACC/AHA, 2013Table 1 footnote 2 (1) No change
SFATable 1 footnote c (Decreased) CVD (Blood lipids: LDL; TC) – In children Decreased WHO, 2017Table 1 footnote 55 (6) New finding
SFATable 1 footnote c (Decreased) CVD (BP: DBP) – In children Decreased WHO, 2017Table 1 footnote 55 (2) New finding
SFATable 1 footnote c (Decreased) Overweight/Obesity (BMI; Body weight)  – In children Decreased WHO, 2017Table 1 footnote 55 (4) New finding
SFA (Reduction in diet for those with SFA intakes >10% of total energy) CVD (Blood lipids: Apo-B) – In children Decreased WHO, 2017Table 1 footnote 55 (1) New finding
TFA CVD (CHD risk factors & events) Increased FAO, 2010Table 1 footnote 6 (1) No change
TFA (Decreased) CVD (Blood lipids: LDL) Decreased ACC/AHA, 2013Table 1 footnote 2 (1) No change
Replacement of carbohydrate with:
MUFA CVD (Blood lipids: HDL) Increased FAO, 2010Table 1 footnote 6 (1) No change
Replacement of SFA with:
Carbohydrate CVD (Blood lipids: HDL, LDL)Table 1 footnote f Decreased FAO, 2010Table 1 footnote 6 (1) No change
CarbohydrateTable 1 footnote c CVD (Blood lipids: HDL; LDL;TC; LDL:HDL ratio; ApoA-1; Apo-B)Table 1 footnote l Decreased WHO, 2016Table 1 footnote 56 (24) New finding
CarbohydrateTable 1 footnote c CVD (Blood lipids: TG; TG:HDL ratio)Table 1 footnote l Increased WHO, 2016Table 1 footnote 56 (8) New finding
MUFATable 1 footnote d CVD (Blood lipids: HDL; LDL;TC; TG; TC:HDL ratio; LDL:HDL ratio; ApoA-1Table 1 footnote g; Apo-B)Table 1 footnote e Decreased WHO, 2016Table 1 footnote 56 (29) No change
MUFA CVD (Blood lipids: LDL, TC:HDL ratio) Decreased FAO, 2010Table 1 footnote 6 (1) No change
MUFATable 1 footnote c CVD (Blood lipids: LDL; TC; TG) – In children Decreased WHO, 2017Table 1 footnote 55 (3) New finding
MUFA CVD (Blood lipids); T2D (Blood lipids) Decreased DGAC, 2010Table 1 footnote 5 (2) No change
PUFATable 1 footnote d (LA & ALA) CVD (Blood lipids: HDL; LDL; TC; TG; TC:HDL ratio; LDL:HDL ratio; TG:HDL ratio; ApoA-1, Apo-B)Table 1 footnote e Decreased WHO, 2016Table 1 footnote 56 (36) No change
PUFATable 1 footnote c (Type not specified) CVD (Blood lipids: HDL) – In children No effect WHO, 2017Table 1 footnote 55 (1) New finding
PUFATable 1 footnote c (Type not specified) CVD (Blood lipids: LDL; TC) – In children Decreased WHO, 2017Table 1 footnote 55 (2) New finding
PUFA (Type not specified) CVD (CVD events, coronary mortality) Decreased DGAC, 2015Table 1 footnote 4 (1) No change
Unsaturated Fatty Acids (PUFA & MUFA from vegetable oils) CVD (Blood lipids: TC, LDL) Decreased HC, 2012Table 1 footnote 10 (1) No change
Unsaturated Fatty Acids, especially PUFA (Type not specified) CVD (Blood lipids: TC, LDL) Decreased DGAC, 2015Table 1 footnote 4 (1) No change
TFA CVD (Blood lipids: HDL)Table 1 footnote h Decreased FAO, 2010Table 1 footnote 6 (1) No change
TFA CVD (Blood lipids: HDL; LDL;TC; ApoA-1; Apo-B)Table 1 footnote i,Table 1 footnote j Decreased WHO, 2016Table 1 footnote 57 (35) New finding
TFATable 1 footnote k CVD (Blood lipids: TG; TC:HDL ratio; LDL:HDL ratio)Table 1 footnote i,Table 1 footnote j Increased WHO, 2016Table 1 footnote 57 (19) New finding
Replacement of TFA with:
CarbohydrateTable 1 footnote k CVD (Blood lipids: Apo-B)Table 1 footnote p Increased WHO, 2016Table 1 footnote 57 (6) New finding
CarbohydrateTable 1 footnote k CVD (Blood lipids: LDL;TC; TC:HDL ratio; LDL:HDL ratio; ApoA-1)Table 1 footnote p Decreased WHO, 2016Table 1 footnote 57 (35) New finding
MUFATable 1 footnote k CVD (Blood lipids: HDL)Table 1 footnote m,Table 1 footnote o Increased WHO, 2016Table 1 footnote 57 (7) New finding
MUFATable 1 footnote k CVD (Blood lipids: LDL; TC; TG; TC:HDL ratio; LDL:HDL ratio; Apo-BTable 1 footnote n)Table 1 footnote m Decreased WHO, 2016Table 1 footnote 57 (40) New finding
PUFATable 1 footnote k (Type not specified) CVD (Blood lipids: HDL)Table 1 footnote m,Table 1 footnote o Increased WHO, 2016Table 1 footnote 57 (7) New finding
PUFATable 1 footnote k (Type not specified) CVD (Blood lipids: LDL; TC; TG; TC:HDL ratio; LDL:HDL ratio; ApoA-1; Apo-B)Table 1 footnote m,Table 1 footnote o Decreased WHO, 2016Table 1 footnote 57 (49) New finding
Fibre
Cereal fibre CVD (Coronary events); T2D Decreased SACN, 2015Table 1 footnote 34 (2) New finding
Dietary fibre Cancer (Colon) Decreased SACN, 2015Table 1 footnote 34 (1) New finding
Dietary fibre CVD (Coronary events; Stroke); T2D Decreased SACN, 2015Table 1 footnote 34 (3) New finding
Dietary fibre (From mixed sources) CVD (Blood lipids: HDL, LDL, TC, TG) No association SACN, 2015Table 1 footnote 34 (1) New finding
Diets high in viscous soluble fibre, such as oats CVD (Blood lipids: LDL) Decreased CCS, 2016Table 1 footnote 32 (1) No change
Oat bran or beta-glucan supplementation CVD (Blood lipids: HDL) No effect SACN, 2015Table 1 footnote 34 (1) New finding
Oat bran or beta-glucan supplementation CVD (Blood lipids: LDL) Decreased SACN, 2015Table 1 footnote 34 (1) No change
Oat fibre, barley fibre or β-glucan supplements Overweight/Obesity (Energy intake) No effect SACN, 2015Table 1 footnote 34 (1) New finding
Oat bran or beta-glucan supplementation T2D (FBG) No effect SACN, 2015Table 1 footnote 34 (1) New finding
Single grains (i.e. Beta-glucan oat fibre; Barley grain products; Psyllium fibre); Ground whole flaxseed CVD (Blood lipids: LDL, TC) Decreased HC, 2010Table 1 footnote 14 (1); HC, 2012Table 1 footnote 11 (1); HC, 2011Table 1 footnote 13 (1); HC 2014Table 1 footnote 9 (1) No change
Vegetable or fruit fibre Cancer (Colorectal); T2D No association SACN, 2015Table 1 footnote 34 (4) New finding
Glycemic Index/Load
Glycemic index or glycemic load Overweight/Obesity (Body weight); Cancer No association DGAC, 2010Table 1 footnote 5 (2) No change
Glycemic index or glycemic load (Higher) T2D Increased SACN, 2015Table 1 footnote 34 (2) New finding
Glycemic load T2D No association DGAC, 2010Table 1 footnote 5 (1) No change
Grain Products
Whole grains CVD (Blood lipids: TC, TG); T2D (FBG; Fasting insulin concentration; Insulin sensitivity) No effect SACN, 2015Table 1 footnote 34 (4) New finding
Meat and meat alternatives
Diets high in nuts CVD (Blood lipids: LDL) Decreased CCS, 2016Table 1 footnote 32 (1) New finding
Diets high in soy protein CVD (Blood lipids: LDL) Decreased CCS, 2016Table 1 footnote 32 (1) No change
Processed meat Cancer (General)Table 1 footnote q Increased IARC, 2018Table 1 footnote 29 (1) New finding
Processed meat Cancer (Colorectal) Increased WCRF, 2018Table 1 footnote 49 (1) No change
Soy protein CVD (Blood lipids: TC, LDL) Decreased HC, 2015Table 1 footnote 8 (1) No change
Milk and milk alternatives
Milk & milk products Overweight/Obesity (Weight control) No association DGAC, 2010Table 1 footnote 5 (1) No change
Minerals
PotassiumTable 1 footnote r,Table 1 footnote s CVD (Blood lipids: TC) No effect WHO, 2012Table 1 footnote 27 (2) No change
PotassiumTable 1 footnote s CVD (BP: Resting SBP) Decreased WHO, 2012Table 1 footnote 27 (1) No change
Sodium & saltTable 1 footnote t (Decreased) CVD (Blood lipids: TC) No effect WHO, 2012Table 1 footnote 28 (2) No change
Sodium & saltTable 1 footnote t (Decreased) CVD (BP: Resting SBP) Decreased WHO, 2012Table 1 footnote 28 (2); No change
Sodium & salt (Decreased) CVD (BP: SBP & DBP) Decreased ACC/AHA, 2013Table 1 footnote 2 (1); DGAC, 2010Table 1 footnote 5 (1);  NHMRC, 2011Table 1 footnote 15 (1) No change
Sugars
Added sugars (Food &/or SSBs) Overweight/Obesity (Obesity); T2D Increased DGAC, 2015Table 1 footnote 4 (2) No change
Sugar sweetened drinks Overweight/Obesity (Weight gain, overweight, obesity) Increased WCRF, 2018Table 1 footnote 60 (1) No change
Sugar-sweetened beverages Overweight/Obesity (Adiposity) — In children Increased DGAC, 2010Table 1 footnote 5 (1) No change
Sugars Overweight/Obesity (Excess energy intake) Increased SACN, 2015Table 1 footnote 34 (1) New finding
Sugars-containing beverages (Amount and frequency) Oral health (Dental caries in deciduous dentition) — In children Increased SACN, 2015Table 1 footnote 34 (1) New finding
Sugars-sweetened beverages Cancer (Colon) No association SACN, 2015Table 1 footnote 34 (1) New finding
Supplements
PUFA (Omega-3) CVD (CVD events) No effect CCS, 2016Table 1 footnote 32 (1) New finding
Vegetables and Fruit
Fruit and vegetables CVD (CHD) Decreased HC, 2016Table 1 footnote 7 (1) No change

Abbreviations

ACC/AHA: American College of Cardiologists/American Heart Association; AHRQ: Agency for Healthcare Research and Quality;  ALA: Alpha-linolenic acid; ApoA-1: Apolipoprotein A-1; Apo-B: Apolipoprotein B; BMI: Body mass index; BP: Blood pressure; CCS: Canadian Cardiovascular Society; CRP: C-Reactive Protein; CVD: Cardiovascular disease; CHD: Coronary heart disease; DASH: Dietary Approaches to Stop Hypertension;  DBP: Diastolic blood pressure; DGAC: Dietary Guidelines Advisory Committee (US); DHA: Docosahexaenoic acid; DPA: Docosapentaenoic acid; EPA: Eicosapentaenoic acid; FAO: Food and Agriculture Organization of the United Nations; FBG: Fasting blood glucose; HC: Health Canada; HDL: High Density Lipoprotein; IARC: International Agency for Research on Cancer; LA: Linoleic acid; LDL: Low density lipoprotein; MUFA: Monounsaturated fatty acid; NEFA: Non-esterified fatty acid; OGTT: Oral glucose tolerance test; PUFA: Polyunsaturated fatty acid; RCT: Randomized controlled trial; SACN: Scientific Advisory Council on Nutrition (UK); SFA: Saturated Fatty Acid; SSB: Sugar-Sweetened Beverage; SBP: Systolic blood pressure; T2D: Type 2 Diabetes; TC: Total cholesterol; TFA: Trans Fatty Acid; TG: Triglyceride; WCRF: World Cancer Research Fund/American Institute of Cancer Research; WHO: World Health Organization.

Footnotes

References

Reference 1

Health Canada. Evidence review for dietary guidance: technical report, 2015. Ottawa: Health Canada; 2016.

Return to first footnote 1 referrer

Reference 2

Eckel RH, Jakicic JM, Ard JD, de Jesus JM, Miller NH, Hubbard VS, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. Circulation. 2014;129(25 Suppl 2):S76-99.

Return to first footnote 2 referrer

Reference 3

Anderson TJ, Gregoire J, Hegele RA, Couture P, Mancini GB, McPherson R, et al. 2012 Update of the Canadian Cardiovascular Society guidelines for the diagnosis and treatment of dyslipidemia for the prevention of cardiovascular disease in the adult. Can J Cardiol. 2013;29(2):151-67.

Return to first footnote 3 referrer

Reference 4

Dietary Guidelines Advisory Committee. Scientific report of the 2015 Dietary Guidelines Advisory Committee: advisory report to the Secretary of Health and Human Services and the Secretary of Agriculture. Washington: U.S. Department of Agriculture, Agricultural Research Service; 2015.

Return to first footnote 4 referrer

Reference 5

Dietary Guidelines Advisory Committee. Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2010: to the Secretary of Health and Human Services. Washington: U.S. Department of Agriculture, Agricultural Research Service; 2010.

Return to first footnote 5 referrer

Reference 6

Food and Agriculture Organization of the United Nations. Fats and fatty acids in Human Nutrition: Report of an Expert Consultation. Rome: Food and Agriculture Organization of the United Nations; 2010.

Return to first footnote 6 referrer

Reference 7

Health Canada. Summary of Health Canada's assessment of a health claim about vegetables and fruit and heart disease [Internet]. Ottawa: Health Canada; 2016 [cited 2018 Sep 14].

Return to first footnote 7 referrer

Reference 8

Health Canada. Summary of Health Canada's assessment of a health claim about soy protein and cholesterol lowering [Internet]. Ottawa: Health Canada; 2015 [cited 2018 Sep 14].

Return to first footnote 8 referrer

Reference 9

Health Canada. Summary of Health Canada's assessment of a health claim about ground whole flaxseed and blood cholesterol lowering [Internet]. Ottawa: Health Canada; 2014 [cited 2018 Sep 14].

Return to first footnote 9 referrer

Reference 10

Health Canada. Summary of Health Canada's assessment of a health claim about the replacement of saturated fat with mono and polyunsaturated fat and blood cholesterol lowering [Internet]. Ottawa: Health Canada; 2012 [cited 2018 Sep 14].

Return to first footnote 10 referrer

Reference 11

Health Canada. Summary of Health Canada's assessment of a health claim about barley products and blood cholesterol lowering [Internet]. Ottawa: Health Canada; 2012 [cited 2018 Sep 14].

Return to first footnote 11 referrer

Reference 12

Health Canada. Summary of Health Canada's assessment of a health claim about whole grains and coronary heart disease [Internet]. Ottawa: Health Canada; 2012 [cited 2018 Sep 14].

Return to first footnote 12 referrer

Reference 13

Health Canada. Summary of Health Canada's assessment of a health claim about food products containing psyllium and blood cholesterol lowering [Internet]. Ottawa: Health Canada; 2011 [cited 2018 Sep 14].

Return to first footnote 13 referrer

Reference 14

Health Canada. Summary of assessment of a health claim about oat products and blood cholesterol lowering [Internet]. Ottawa: Health Canada; 2010 [cited 2018 Sep 14].

Return to first footnote 14 referrer

Reference 15

National Health and Medical Research Council. A review of the evidence to address targeted questions to inform the revisions of the Australian Dietary Guidelines. Canberra: National Health and Medical Research Council; 2011.

Return to first footnote 15 referrer

Reference 16

World Cancer Research Fund/American Institute for Cancer Research. Continuous Update Project Expert Report: Diet, nutrition, physical activity and liver cancer. Washington: American Institute for Cancer Research; 2015.

Return to first footnote 16 referrer

Reference 17

World Cancer Research Fund/American Institute for Cancer Research. Continuous Update Project Expert Report: Diet, nutrition, physical activity and gallbladder cancer. Washington: American Institute for Cancer Research; 2014.

Return to footnote 17 referrer

Reference 18

World Cancer Research Fund/American Institute for Cancer Research. Continuous Update Project Expert Report: Diet, nutrition, physical activity and ovarian cancer. Washington: American Institute for Cancer Research; 2014.

Return to footnote 18 referrer

Reference 19

World Cancer Research Fund/American Institute for Cancer Research. Continuous Update Project Expert Report: Diet, nutrition, physical activity and prostate cancer. Washington: American Institute for Cancer Research; 2014.

Return to footnote 19 referrer

Reference 20

World Cancer Research Fund/American Institute for Cancer Research. Continuous Update Project Expert Report: Diet, nutrition, physical activity and endometrial cancer. Washington: American Institute for Cancer Research; 2013.

Return to footnote 20 referrer

Reference 21

World Cancer Research Fund/American Institute for Cancer Research. Continuous Update Project Expert Report: Diet, nutrition, physical activity and pancreatic cancer. Washington: American Institute for Cancer Research; 2012.

Return to footnote 21 referrer

Reference 22

World Cancer Research Fund/American Institute for Cancer Research. Continuous Update Project Expert Report: Diet, nutrition, physical activity and colorectal cancer. Washington: American Institute for Cancer Research; 2011.

Return to footnote 22 referrer

Reference 23

World Cancer Research Fund/American Institute for Cancer Research. Continuous Update Project Expert Report: Diet, nutrition, physical activity and breast cancer. Washington: American Institute for Cancer Research; 2010.

Return to footnote 23 referrer

Reference 24

World Cancer Research Fund/American Institute for Cancer Research. Food, nutrition, physical activity, and the prevention of cancer: a global perspective. London: World Cancer Research Fund; 2007.

Return to footnote 24 referrer

Reference 25

Hooper L, Martin N, Abdelhamid A, Smith GD. Reduction in saturated fat intake for cardiovascular disease (Review). Cochrane Database Syst Rev. 2015;11(6):CD011737.

Return to footnote 25 referrer

Reference 26

Te Morenga L, Montez JM. Health effects of saturated and trans-fatty acid intake in children and adolescents: Systematic review and meta-analysis. Plos one. 2017;12(11):e0186672.

Return to footnote 26 referrer

Reference 27

World Health Organization. Guideline: Potassium for adults and children. Geneva: World Health Organization; 2012.

Return to footnote 27 referrer

Reference 28

World Health Organization. Guideline: Sodium for adults and children. Geneva: World Health Organization; 2012.

Return to footnote 28 referrer

Reference 29

International Agency for Research on Cancer. Monographs on the Evaluation of Carcinogenic Risks to Humans – Red Meat and Processed Meat. Lyon: International Agency for Research on Cancer; 2018.

Return to footnote 29 referrer

Reference 30

Newberry SJ, Chung M, Anderson C, Fu W, Chen C, Tang A, et al. Effects of Dietary Sodium and Potassium Intake on Chronic Disease Outcomes and Related Risk Factors. Rockville: Agency for Healthcare Research and Quality. 2018. Systematic Review No. 206. AHRQ Publication No. 18-EHC009-EF.

Return to footnote 30 referrer

Reference 31

Balk EM, Adam GP, Langberg V, Halladay C, Chung M, Lin L, et al. Omega-3 Fatty Acids and Cardiovascular Disease: An Updated Systematic Review. Rockville: Agency for Healthcare Research and Quality. 2016. Evidence Report/Technology Assessment No. 223. AHRQ Publication No. 16-E002-EF.

Return to footnote 31 referrer

Reference 32

Anderson TJ, Gregoire J, Pearson GJ, Barry AR, Couture P, Dawes M, et al. 2016 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease in the Adult. Can J Cardiol. 2016;32(11):1263-1282.

Return to footnote 32 referrer

Reference 33

Health Canada. Summary of Health Canada's assessment of a health claim about eicosapentaenoic acid, docosahexaenoic acid and triglyceride lowering [Internet]. Ottawa: Health Canada; 2016 [cited 2018 Sep 14].

Return to footnote 33 referrer

Reference 34

Scientific Advisory Committee on Nutrition. SACN Carbohydrates and health report. Norwich: Public Health England; 2015.

Return to footnote 34 referrer

Reference 35

World Cancer Research Fund/American Institute for Cancer Research. Food, nutrition, physical activity and the prevention of cancer: a global perspective. Continuous Update Project Expert Report 2018. Washington: American Institute for Cancer Research; 2018.

Return to footnote 35 referrer

Reference 36

World Cancer Research Fund/American Institute for Cancer Research. Continuous Update Project Expert Report 2018. Diet, nutrition, physical activity and breast cancer. Washington: American Institute for Cancer Research; 2018.

Return to footnote 36 referrer

Reference 37

World Cancer Research Fund/American Institute for Cancer Research. Continuous Update Project Expert Report 2018. Diet, nutrition, physical activity and pancreatic cancer. Washington: American Institute for Cancer Research; 2018.

Return to footnote 37 referrer

Reference 38

World Cancer Research Fund/American Institute for Cancer Research Continuous Update Project Expert Report 2018. Diet, nutrition, physical activity and endometrial cancer. Washington: American Institute for Cancer Research; 2018.

Return to footnote 38 referrer

Reference 39

World Cancer Research Fund/American Institute for Cancer Research. Continuous Update Project Expert Report 2018. Diet, nutrition, physical activity and ovarian cancer. Washington: American Institute for Cancer Research; 2018.

Return to footnote 39 referrer

Reference 40

World Cancer Research Fund/American Institute for Cancer Research. Continuous Update Project Expert Report 2018. Diet, nutrition, physical activity and bladder cancer. Washington: American Institute for Cancer Research; 2018.

Return to footnote 40 referrer

Reference 41

World Cancer Research Fund/American Institute for Cancer Research. Continuous Update Project Expert Report 2018. Diet, nutrition, physical activity and prostate cancer. Washington: American Institute for Cancer Research; 2018.

Return to footnote 41 referrer

Reference 42

World Cancer Research Fund/American Institute for Cancer Research. Continuous Update Project Expert Report 2018. Diet, nutrition, physical activity and gallbladder cancer. Washington: American Institute for Cancer Research; 2018.

Return to footnote 42 referrer

Reference 43

World Cancer Research Fund/American Institute for Cancer Research. Continuous Update Project Expert Report 2018. Diet, nutrition, physical activity and liver cancer. Washington: American Institute for Cancer Research; 2018.

Return to footnote 43 referrer

Reference 44

World Cancer Research Fund/American Institute for Cancer Research. Continuous Update Project Expert Report 2018. Diet, nutrition, physical activity and oesophageal cancer. Washington: American Institute for Cancer Research; 2018.

Return to footnote 44 referrer

Reference 45

World Cancer Research Fund/American Institute for Cancer Research. Continuous Update Project Expert Report 2018. Diet, nutrition, physical activity and kidney cancer. Washington: American Institute for Cancer Research; 2018.

Return to footnote 45 referrer

Reference 46

World Cancer Research Fund/American Institute for Cancer Research. Continuous Update Project Expert Report 2018. Diet, nutrition, physical activity and stomach cancer. Washington: American Institute for Cancer Research; 2018.

Return to footnote 46 referrer

Reference 47

World Cancer Research Fund/American Institute for Cancer Research. Continuous Update Project Expert Report 2018. Diet, nutrition, physical activity and cancers of the mouth, pharynx, and larynx. Washington: American Institute for Cancer Research; 2018.

Return to footnote 47 referrer

Reference 48

World Cancer Research Fund/American Institute for Cancer Research. Continuous Update Project Expert Report 2018. Diet, nutrition, physical activity and lung cancer. Washington: American Institute for Cancer Research; 2018.

Return to footnote 48 referrer

Reference 49

World Cancer Research Fund/American Institute for Cancer Research. Continuous Update Project Expert Report 2018. Diet, nutrition, physical activity and colorectal cancer. Washington: American Institute for Cancer Research; 2018.

Return to footnote 49 referrer

Reference 50

World Cancer Research Fund/American Institute for Cancer Research. Continuous Update Project Expert Report: Diet, nutrition, physical activity and breast cancer. Washington: American Institute for Cancer Research; 2017.

Return to footnote 50 referrer

Reference 51

World Cancer Research Fund/American Institute for Cancer Research. Continuous Update Project Expert Report: Diet, nutrition, physical activity and colorectal cancer. Washington: American Institute for Cancer Research; 2017.

Return to footnote 51 referrer

Reference 52

World Cancer Research Fund/American Institute for Cancer Research. Continuous Update Project Expert Report: Diet, nutrition, physical activity and oesophageal cancer. Washington: American Institute for Cancer Research; 2016.

Return to footnote 52 referrer

Reference 53

World Cancer Research Fund/American Institute for Cancer Research. Continuous Update Project Expert Report: Diet, nutrition, physical activity and stomach cancer. Washington: American Institute for Cancer Research; 2016.

Return to footnote 53 referrer

Reference 54

Abdelhamid AS, Brown TJ, Brainard JS, Biswas P, Thorpe GC, Moore HJ, et al. Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2018;11:CD003177.

Return to footnote 54 referrer

Reference 55

Te Morenga L, Montez JM. Health effects of saturated and trans-fatty acid intake in children and adolescents: Systematic review and meta-analysis. Plos one. 2017;12(11):e0186672.

Return to footnote 55 referrer

Reference 56

Mensink RP. Effects of saturated fatty acids on serum lipids and lipoproteins: a systematic review and regression analysis. Geneva: World Health Organization; 2016.

Return to footnote 56 referrer

Reference 57

Brouwer IA. Effect of trans-fatty acid intake on blood lipids and lipoproteins: a systematic review and meta-regression analysis. Geneva: World Health Organization; 2016.

Return to footnote 57 referrer

Reference 58

Souza RJ, Mente A, Maroleanu A, Cozma A I, Ha V, Kishibe T, et al. Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies. BMJ. 2015;351:h3978.

Return to footnote 58 referrer

Reference 59

Moynihan PJ, Kelly SA. Effect on caries of restricting sugars intake. J Dent Res. 2014;93(1):8-18.

Return to footnote 59 referrer

Reference 60

World Cancer Research Fund/American Institute for Cancer Research. Continuous Update Project Expert Report 2018. Diet, nutrition and physical activity: energy balance and body fatness. Washington: American Institute for Cancer Research; 2018.

Return to footnote 60 referrer

Reference 61

International Agency for Research on Cancer. Monographs on the Evaluation of Carcinogenic Risks to Humans – Drinking Coffee, Mate, and Very Hot Beverages. Lyon: International Agency for Research on Cancer; 2018.

Return to footnote 61 referrer

Report a problem or mistake on this page
Please select all that apply:

Thank you for your help!

You will not receive a reply. For enquiries, contact us.

Date modified: