Canada’s food guide

Appendix C: Process used for the selection of content in this report

Health Canada developed a multi-step decision-making process to select the content in this report. Our approach was adapted from established methods for developing guidelines. Schünemann HJ, Wiercioch W, Etxeandia I, Falavigna M, Santesso N, Mustafa R, et al. Guidelines 2.0: systematic development of a comprehensive checklist for a successful guideline enterprise. CMAJ. 2014;186(3):E123-42. Eccles MP, Grimshaw JM, Shekelle P, Schünemann HJ, Woolf S. Developing clinical practice guidelines: target audiences, identifying topics for guidelines, guideline group composition and functioning and conflicts of interest. Implemen Sci. 2012;7:60. Scottish Intercollegiate Guidelines Network (SIGN). SIGN 50: a guideline developer's handbook. Edinburgh: Scottish Intercollegiate Guidelines Network; 2015. National Institute for Health and Care Excellence (NICE). Developing NICE guidelines: the manual. London: National Institute for Health and Care Excellence; 2014. World Health Organization [Internet]. Geneva: World Health Organization [cited 2018 Sep 14]. Development of WHO nutrition guidelines. US Preventive Task Force. US Preventive Task Force: procedure manual. Rockville: U.S. Preventive Services Task Force; 2018. Canadian Task Force on Preventive Health Care. Canadian Task Force on Preventive Health Care: procedure manual [Internet]. Ottawa: Canadian Task Force on Preventive Health Care; 2016 [cited 2018 Sep 14]. Kredo T, Bernhardsson S, Machingaidze S, Young T, Louw Q, Ochodo E, et al. Guide to clinical practice guidelines: the current state of play. Int J Qual Health Care. 2016;28(1):122-8.

Step 1: Content Organization

A preliminary list of content was identified by examining relevant sources of information:

• Health Canada's Evidence Review for Dietary Guidance 2015.
• Relevant Health Canada nutrition-related inquiries (includes public inquiries, media inquiries, and trending nutrition topics on social media).
• Health Canada's reports on food skills in Canada^{Footnote i}.
• Dietary guidelines from other countries.

The preliminary list was organized into categories:

• Content was identified as a topic when it referred to modifiable, nutrition-related risk factors for chronic disease, or nutrients of public health concern.
• Content was identified as context when it referred to where, how, and when food choices are made, or current patterns of consumption and behaviours associated with food choices.
• Content was identified as a factor interrelated with nutrition when it referred to a health factor that has a mutual relationship or connection to food and nutrition, in which one factor affects or depends on another.
• Content related to factors and conditions that influence food choices and eating behaviours was considered broadly, reflecting Health Canada's population health approach to developing dietary guidance.

Step 2: Preliminary Scoping

In this step, the preliminary list of content was assessed as either "in scope" or "out of scope" of dietary guidelines. To be "in scope," the content had to be related to the prevention—not the management—of a nutrition-related chronic disease or condition (such as type 2 diabetes), or a nutrition-related risk factor (such as hypercholesterolemia). The content also had to be in line with Health Canada's federal role in nutrition, which includes promoting the nutritional health and well-being of the population. Health Canada [Internet]. Ottawa: Health Canada; 2018 [cited 2018 Sep 14]. Food and Nutrition.

Step 3: Detailed Scoping

The content was further scoped to determine whether it should be "retained" for the assessment of relevance in Step 4. In order for the content to be retained, it had to meet two conditions. First, it had to align with Health Canada's role in disseminating guidance on the topic. In some instances, retained content overlapped with current or in-process Government of Canada guidance (for example guidance on physical activity). In these cases, the content was referred to the relevant areas within the government to determine how best to address it in the report.

Second, there had to be a need for Health Canada to take a position on the content. This was assessed in terms of a perceived need for clarity or consistency in existing guidance as indicated by health stakeholders. To help determine whether there was a need for a Health Canada position, the following questions were considered:

• Are there concerns or uncertainties relative to the content?
• Is there a wide variation in knowledge, understanding or interpretation of the content that could negatively impact the implementation of guidance?
• Is there a public perception that a gap exists between evidence and public health policies and programs related to the content?
• Is there public or stakeholder interest in the content?
• Is the content of public health importance?
• Has the content area been a longstanding issue?

If the answer was "yes" to one or more of these questions, the content was retained for an assessment of relevance in Step 4.

Step 4: Assessment of Relevance

Relevance was primarily informed by concurrently considering the evidence base and stakeholder needs. Well-established associations with a convincing finding were considered highly relevant, as determined by Health Canada's Evidence Review for Dietary Guidance 2015 and Food, Nutrients and Health: Interim Evidence Update 2018. Health Canada. Evidence review for dietary guidance: technical report 2015. Ottawa: Health Canada; 2016. Health Canada. Food, Nutrients and Health: Interim Evidence Update 2018. Ottawa: Health Canada; 2019. Health Canada also considered:

• the potential to shift the distribution of risk of diet-related chronic diseases or conditions of public health concern, and
• whether health professionals and policy makers needed guidance on the content and whether they could implement the guidance.

When content did not have a strong evidence base, but had a high level of stakeholder interest, it was assessed as relevant. For example, although convincing findings on food skills were not identified, this topic was assessed as highly relevant because of a longstanding public health need, as well as broad stakeholder interest in Health Canada's position.

Additional evidence was gathered and assessed as needed to further assess relevance. Health Canada continued to consider only reports from leading scientific organizations and government agencies, as well as high-quality, peer-reviewed, systematic reviews that met the evidence review inclusion criteria. Inclusion and exclusion criteria for reports considered are summarized in Table C.1.

The content identified as highly relevant was grouped into four broad categories:

• healthy dietary patterns,
• foods to consume more,
• foods to consume less, and
• factors that support healthy eating.

The content from these categories form the basis of Canada's Dietary Guidelines. To confirm whether the content was appropriate, or whether additional content should be considered, Health Canada sought input through consultation and engagement. There were two open public consultations on the Food Guide and two rounds of expert reviews of draft versions of the report. Health Canada also sought input from key health professional organizations, health charities, and National Indigenous Organizations as well as members of the Federal Provincial Territorial Group on Nutrition. Final decisions on the scope of the guidelines rested with Health Canada.

Table C.1: Inclusion and exclusion criteria for identifying reports in the 2015 evidence review

Inclusion criteria

Exclusion criteria

Authored by a health organization with the involvement of an expert panel Includes an original systematic review of the evidence for a diet-health relationship and an assessment of the quality of primary studies Includes at least one food topic and its relationship to at least one outcome related to a chronic disease or condition that is of public health interest in Canada Includes a clear description of the systematic review methodology Provides an evidence grade for the overall quality of the evidence supporting the findings French or English language

Commissioned by industry or an organization with a business interest Presented or concurred with findings from other reports Later updated in another report by the same organization on the same topic Focused on an outcome outside the scope of this scan (for example management of a chronic disease, food safety)

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