Evaluating Diet Quality of Canadian Adults Using Health Canada's Surveillance Tool Tier System: Findings from the 2015 Canadian Community Health Survey-Nutrition.

The 2014 Health Canada's Surveillance Tool, Tier System (HCST) is a nutrient profiling model developed to evaluate adherence of food choices to dietary recommendations. With the recent release of the nationally representative Canadian Community Health Survey-Nutrition (CCHS-N) 2015, this study used HCST to evaluate nutritional quality of the dietary intakes of Canadians in the CCHS-N. Dietary intakes were ascertained using 24-hour dietary recalls from Canadians adults ≥19 years (N = 13,605). Foods were categorized into four Tiers based on degree of adherence to dietary recommendations according to thresholds for sodium, total fat, saturated fats, and sugars. Tier 1 and Tier 2 represented "recommended foods", Tier 3 represents foods to "choose less often", and Tier 4 represented foods "not recommended". Across all dietary reference intakes (DRI) groups, most foods were categorized as Tier 1 for Vegetable and Fruits (2.2-3.8 servings/day), Tier 2 for Grain Products (2.9-3.4 servings/day), Tier 3 for Milk and Alternatives (0.7-1 serving/day) or for Meat and Alternatives (1.1-1.6 servings/day). Consumption of foods from Tier 4 and "other foods" such as high fat/sugary foods, sugar-sweetened beverages, and alcohol, represented 24-26% and 21-23% kcal/day, for males and females, respectively. Canadians are eating more foods categorized as Tier 1-3, rather than Tier 4. Adults with the highest intakes of Tier 4 and "other foods" had lower intakes of macronutrients and increased body mass index. These findings can be used by policy makers to assist in identifying targets for food reformulation at the nutrient level and quantitative guidance to support healthy food choices.