2. Introduction

In response to consumer demand for information on diet and health, interest in dietary guidelines and nutrition recommendations has blossomed in the last decade. As a result of this interest, there have been many versions of dietary guidelines in Canada since the release in 1977 of Health Canada's Nutrition Recommendations for Canadians (Murray and Rae, 1979).

The proliferation of dietary guidelines from a wide array of government and
non-governmental organizations was but one example of the lack of
coordination in the design and delivery of nutrition messages, programs and
materials in Canada. These conflicting messages caused confusion about diet and health among consumers and health professionals alike.

A meeting convened by the National Institute of Nutrition in 1986 identified the need for one common set of nutrition recommendations as a first step in developing a coordinated national policy on nutrition. During the course of the meeting, representatives of 12 organizations, including government, voluntary health organizations and professional associations, discussed the need for cooperation in producing nutrition recommendations that would be acceptable to all.

In 1987, the Minister of National Health and Welfare appointed two
committees - the Scientific Review Committee (SRC) and the
Communications / Implementation Committee (CIC). These committees were charged with reviewing and revising the Nutrition Recommendations for the healthy Canadian population. The aim was to provide up-to-date nutrition recommendations for professionals and the public which would promote and maintain health while reducing the risk of nutrition-related diseases.

The Scientific Review Committee reviewed the scientific evidence, from a public health perspective, for revising the Nutrition Recommendations. The Report of the Scientific Review Committee presents the updated Nutrition
Recommendations and their scientific rationale.

The Communications/Implementation Committee translated the updated
Nutrition Recommendations for the public and recommended ways to
communicate and implement them in the Report of the Communications / Implementation Committee. Together, the reports of these two committees are an important first step in the establishment of a national nutrition policy.

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3. Purpose of the Report

The Report of the Communications / Implementation Committee presents comprehensive strategies for communicating and implementing the Nutrition Recommendations suggested in the Report of the Scientific Review Committee, including a translation of the updated Nutrition Recommendations for communication to the public. It emphasizes nutrition as an important component in efforts to promote and maintain health.

The Report contains:

• Canada's Guidelines for Healthy Eating, which represent the translation of the updated Nutrition Recommendations into dietary advice for the public;
• a description of current nutrition practices of the population and gaps between current and recommended practices;
• an analysis of existing nutrition activities, programs, methods and materials, including Canada's Food Guide, that are directed to the public;
• a description of opportunities and challenges for implementation;
• a description of the existing infrastructure for implementing Canada's Guidelines for Healthy Eating;
• a description of key examples of current nutrition intervention programs;
• and recommendations for action to nutrition and other health professionals, governments, food and related industries, non-governmental health organizations and the public.

If the Guidelines are to be implemented successfully, each of these sectors must accept to act on the Recommendations for Action. Ultimately, the Canadian population will consume a more healthful diet and, as a result, enjoy a healthier life.

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4. Members of the Communications / Implementation Committee

• Dr. Donna Woolcott
  Chair, Communications/Implementation Committee
  Associate Professor
  Division of Applied Human Nutrition
  University of Guelph
  Guelph, Ontario
  
  
• Lise Bertrand
  Agente de planification et de programmation
  Département de santé communautaire
  Hôpital du Sacré-Coeur
  Montréal, Québec
  
  
• Karen Cooper
  Provincial Nutritionist
  Community Health Services Branch
  Saskatchewan Health
  Regina, Saskatchewan
  
  
• John Garcia
  Supervisor
  Community Health Promotion and Advocacy Section
  City of Toronto Department of Public Health
  Toronto, Ontario
  
  
• Shelagh Kerr
  Vice President, Technical
  Grocery Products Manufacturers of Canada
  Don Mills, Ontario
  
  
• François Lagarde
  Executive Director, National Projects
  PARTICIPaction
  Montreal, Quebec
  
  
• Marsha Sharp
  Executive Director
  The Canadian Dietetic Association
  Toronto, Ontario
  
  
• Dr. Nancy Schwartz
  President
  National Institute of Nutrition
  Ottawa, Ontario
  
  
• Heather Nielsen
  Coordinator,
  Communications/Implementation Committee
  (July 1987 to February 1988) Chief, Nutrition Programs Unit
  Health Services and Promotion Branch
  Health Canada
  Ottawa, Ontario
  
  
• Dr. Dawn Palin
  Coordinator,
  Communications/Implementation Committee
  (March 1988 to July 1989)
  Nutrition Programs Officer
  Health Services and Promotion Branch
  Health Canada
  Ottawa, Ontario
  
  
• Carmen Connolly
  Coordinator,
  Communications/Implementation
  Committee (August to September 1989)
  Nutrition Programs Officer
  Health Services and Promotion Branch
  Health Canada
  Ottawa, Ontario
  
  
• Dr. Joyce Beare-Rogers
  Coordinator, Scientific Review Committee
  Chief, Nutrition Research Division
  Health Protection Branch
  Health Canada
  Ottawa, Ontario
  

Details of the mandate and procedures used by the CIC are contained in Appendix A.

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5. Recommendations by the Scientific Review Committee

Recommendations by the SRC are the result of an in-depth review of the literature on nutrient requirements and the relationships between diet, nutrition and health. "They are intended to provide guidance in the selection of a dietary pattern that will supply recommended amounts of all essential nutrients while reducing the risk of chronic diseases. Although the recommendations are presented as individual entities, it is stressed that they will be fully effective only when applied as a unit. It is also important to appreciate that the recommendations are not a prescription and they can be satisfied by many combinations of available foods without any general need for supplements."

The Scientific Review Committee adopted the following key statements as Recommendations:

Nutrition Recommendations for Canadians

• The Canadian diet should provide energy consistent with the maintenance of body weight within the recommended range.
• The Canadian diet should include essential nutrients in amounts specified in the Recommended Nutrient Intakes.
• The Canadian diet should include no more than 30% of energy as fat (33 g/1000 kcal or 39 g/5000 kJ) and no more than 10% as saturated fat (11 g/1000 kcal or 13 g/5000 kJ).
• The Canadian diet should provide 55% of energy as carbohydrates (138 g/1000 kcal or 165 g/5000 kJ) from a variety of sources.
• The sodium content of the Canadian diet should be reduced.
• The Canadian diet should include no more than 5% of total energy as alcohol, or two drinks daily, whichever is less.
• The Canadian diet should contain no more caffeine than the equivalent of four cups of regular coffee per day.
• Community water supplies containing less than 1 mg/litre should be fluoridated to that level.

The Recommendations are directed at the healthy population over two years of age. The Executive Summary of the Report of the Scientific Review Committee is contained in Appendix B.

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6. Canada's Guidelines For Healthy Eating: A Translation of the SRC Recommendations

The goal of the Nutrition Recommendations is to give guidance to professionals and the public about what constitutes a healthful diet. In order for these recommendations to be acted upon and implemented, they must first be understood by the public.

Based on several sources of information, including expert advice and a thorough review of the literature and focus group research of Canadian consumers, the Communications/Implementation Committee suggests that the Nutrition Recommendations of the Scientific Review Committee be communicated to the public as follows:

Canada's Guidelines for Healthy Eating

• Enjoy a VARIETY of foods.
• Emphasize cereals, breads, other grain products, vegetables and fruits.
• Choose low-fat dairy products, lean meats, and foods prepared with little or no fat.
• Achieve and maintain a healthy body weight be enjoying regular physical activity and healthy eating.
• Limit salt, alcohol and caffeine.

Several principles guided the translation of the SRC Recommendations. Among these are scientific accuracy, a positive tone, an action-oriented approach, and a level of language understood by the majority of Canadians.

A2 - The Communications/Implementation Committee recommends that all sectors adopt and promote Canada's Guidelines for Healthy Eating as
the single set of nutrition recommendations for communication to and
implementation by the healthy public over two years of age.

The Guidelines are directed at healthy Canadians over two years of age.
Collectively, these statements make up the key nutrition message for healthy Canadians. While the above Guidelines are the key translation of the SRC Nutrition Recommendations, the CIC recommends further market testing on nutrition messages for specific target groups, such as low-literacy groups and ethnic sub-populations. In addition, specially targeted campaigns will be needed to reach particular segments of the Canadian population. The CIC recommends further research aimed at refining nutrition messages for these segments and determining consumer awareness and understanding of the Guidelines.

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7. Review of Canada's Food Guide

The CIC was asked specifically to review Canada's Food Guide (originally known as Canada's Food Rules), which has been the cornerstone of nutrition education in Canada for nearly 50 years. Canada's Food Guide was developed to translate nutrient requirements into foods and to provide a simple guide for consumers in selecting foods that are likely to ensure nutritional adequacy, that is, to prevent diseases caused by nutrient deficiency. (Health and Welfare, 1982a). The major t-related chronic diseases such as heart disease and cancer, in which excessive food and nutrient intake is the issue. This shift from nutrient deficiency diseases to nutrition-related health problems has prompted the need to re-evaluate nutrition education tools and programs.

In its review of Canada's Food Guide, the CIC received assistance from the Task Group on Canada's Food Guide and the Technical Group on Canada's Food Guide. (The recommendations of these two groups are contained in Appendix C and D, respectively.) The Report of the Task Group on Canada's Food Guide contains a comprehensive discussion of the literature and information provided by a wide range of groups and individual nutritionists and other educators. A thorough analysis of these sources of information led the reviewers to conclude that a key nutrition education tool like Canada's Food Guide is still necessary, but that significant revisions should be made to the Guide to reflect the nutrition concerns of Canadians today. Canada's Food Guide was designed as a guide for a foundation diet; that is, a diet that contained the minimum amount of foods required to ensure that nutrient requirements for most people would be met. It did not consider the need for people to limit certain nutrients or foods, nor did it take into account the wide variety of manufactured, processed or combination food dishes that characterize the contemporary Canadian diet. Many nutrition educators have called for revisions to the Guide, such as integrating the Nutrition Recommendations into the Guide, including foods that do not fit into any of the four food groups, and changing the name and visual presentation of the Guide. The Communications / Implementation Committee accepted the Recommendations of the Task Group on Canada's Food Guide, which call for a revised guide to be based on a total diet approach. This approach allows the Nutrition Recommendations to be incorporated into the Guide, thus making it meaningful not only as a tool for lowering the risk of nutrient deficiencies but also for promoting a diet that reduces the risk of chronic disease. This approach also permits the wide array of foods consumed by Canadians to be addressed in the Guide, and not just those basic foods that fit into the four food groups.

The Report of the Technical Group on Canada's Food Guide contains a detailed analysis of the changes required for a total diet approach to the revised Guide. The Report examines types and numbers of food groups, with nutrient analyses, to ensure that the updated SRC Nutrition Recommendations and the updated Recommended Nutrient Intakes for Canadians are reflected.

The Recommendations of the Technical Group on Canada's Food Guide were accepted by the CIC. These recommendations, together with the background report, provide detailed information on developing a revised Food Guide for Canadians.

Because of the widespread use of Canada's Food Guide in virtually all nutrition education programs across Canada, the recommendations for changes to the Guide require urgent attention. A revised guide, based on the total diet approach, will be a major tool for communicating and translating the SRC Nutrition Recommendations into terms that can be acted upon.

B16 - In summary, the CIC recommends that the Department of National Health and Welfare revise Canada's Food Guide, incorporating the recommendations of the Task Group and the Technical Group on Canada's Food Guide. The revised Food Guide should be based on a total diet approach which incorporates Canada's Guidelines for Healthy Eating and reflects the Nutrition Recommendations.