Sharon I Kirkpatrick

University of Waterloo | UWaterloo · School of Public Health and Health Systems

The objective of this study was to assess the construct validity and reliability of the Canadian Eating Practices Screener/Questionnaire court canadien sur les pratiques alimentaires, which was developed to measure eating practices based on the 2019 Canada’s Food Guide (2019-CFG). From July to December 2021, adults (n=154) aged 18-65 years complete...

In 2019, Health Canada released a new iteration of Canada's Food Guide (2019-CFG), which, for the first time, highlighted recommendations regarding eating practices, i.e., guidance on where, when, why and how to eat. The objective of this study was to develop a brief self-administered screener to assess eating practices recommended in the 2019-CFG...

Indigenous peoples and ethnic minority groups often experience poor diet quality and poor health outcomes. Such inequities may be partially due to nutrition interventions not meeting the unique cultural and linguistic needs of these population groups, which could be achieved using co-creation and/or personalised approaches. Cultural adaptation or t...

Purpose: Co-operative (co-op) education facilitates development of workplace competencies but may have unintended consequences for financial stability and food security. This study examined the association between co-op program enrolment and food security status among a sample of undergraduate students. Financial insufficiency and strategies to cop...

Background: Racism is a key determinant of perinatal health disparities. Poor diet may contribute to this effect, but research on racism and dietary patterns is limited. Objective: We aimed to describe the relation between experiences of racial discrimination and adherence to the 2015‒2020 Dietary Guidelines for Americans. Methods: We used dat...

Background: Diets dense in fruits and vegetables are associated with a reduced risk of preeclampsia, but pathways underlying this relationship are unclear. Dietary antioxidants may contribute to the protective effect. Objective: We determined the extent to which the effect of dietary fruit and vegetable density on preeclampsia is due to high int...

The Canadian Food Intake Screener/Questionnaire court canadien sur les apports alimentaires was developed to rapidly assess alignment of adults’ dietary intake over the past month with the 2019 Canada’s Food Guide’s healthy food choices recommendations. From July to December 2021, adults ( n = 154) aged 18–65 years completed the screener and up to...

The objective of this project was to develop a brief self-administered dietary screener, in English and French, to rapidly assess alignment of adults’ dietary intake with the 2019 Canada's Food Guide healthy food choices recommendations. In consultation with Health Canada and external advisors ( n = 15), guiding principles were defined. Existing sc...

Background Nutrition knowledge is an important determinant of diet-related behaviour; however, the use of disparate assessment tools creates challenges for comparing nutrition knowledge levels and correlates across studies, geographic contexts, and populations. Using the Food Processing Knowledge (FoodProK) score – a measure of nutrition knowledge...

Objective: Web-based dietary interventions could support healthy eating. The Advice, Ideas and Motivation for My Eating (Aim4Me) trial investigated the impact of three levels of personalised web-based dietary feedback on diet quality in young adults. Secondary aims were to investigate participant retention, engagement, and satisfaction. Design:...

Objective: This study examined psychometric properties, parent-youth agreement, and factors associated with agreement on the 12-item and 36-item versions of the World Health Organization Disability Assessment Schedule (WHODAS) 2.0. Methods: Data come from a clinical sample of 56 youth, aged 14-17 years, receiving mental health care at a pediatri...

Background: Disruptions from the coronavirus disease 2019 (COVID-19) pandemic potentially exacerbated food insecurity among adults and youth. Objectives: The objective was to examine changes in the prevalence and severity of food insecurity among adults and youth from before (2019) to during (2020) the pandemic in multiple countries. Methods:...

The Canadian Food Intake Screener/Questionnaire court canadien sur les apports alimentaires was developed to rapidly assess alignment of adults’ dietary intake over the past month with the 2019 Canada Food Guide’s healthy food choices recommendations. From July to December 2021, adults (n=154) aged 18-65 years completed the screener and up to two 2...

The objective of this project was to develop a brief self-administered dietary screener, in English and French, to rapidly assess alignment of adults’ dietary intake with the 2019 Canada’ s Food Guide healthy food choices recommendations. In consultation with Health Canada and external advisors (n=15), foundational principles were defined. Existing...

Objective This study aimed to identify correlates of nutrition label awareness and use, particularly subgroup differences among consumers. Two label types were assessed: 1) Nutrition Facts tables (NFt) in Australia, Canada, Mexico, United Kingdom (UK), United States (US); 2) Front-of-package (FOP) labels, including mandatory Guideline Daily Amounts...

Error in self-reported food and beverage intake affects the accuracy of dietary intake data. Systematically synthesizing available data on contributors to error within and between food groups has not been conducted but may help inform error mitigation strategies. This review aimed to systematically identify, quantify, and compare contributors to er...

Objectives The impact of the pandemic on the prevalence of food insecurity is unclear given the potentially contradictory effects of shocks such as lockdowns versus stabilizers such as income supplements. We examined changes in the prevalence of household food insecurity in five countries from before (2019) to during the pandemic (2020). Methods D...

Background Children ages 6 to 17 years can accurately assess their own food insecurity, whereas parents are inaccurate reporters of their children's experiences of food insecurity. No globally applicable scale to assess food insecurity of children has been developed and validated. Objective We aimed to develop a globally applicable experience-base...

Background Adherence to the Dietary Guidelines for Americans is often assessed using the Healthy Eating Index (HEI). The HEI total score reflects overall diet quality, with all aspects equally important. Using the traditional weighting scheme for the HEI, all components are generally weighted equally in the total score. However, there is limited em...

Background: Structural racism and economic marginalization shape dietary patterns in complex ways. Most research examining race and income inequities discount their interactions in shaping dietary intakes. An intersectional approach is needed to identify interconnected sources of social inequities and to more precisely locate dietary inequities....

Background: Diets that reduce reliance on animal-source foods are recommended in some contexts. Objectives: This study aimed to compare proportions of respondents who reported following meat-reduced dietary practices (i.e., vegetarian, vegan or pescatarian diets) and/or making efforts to reduce animal-source foods, and to examine sociodemographi...

Background Menu labelling, and more specifically calorie labelling, has been posited as an intervention to improve nutrition literacy and the healthfulness of consumers’ food purchases. However, there is some concern calorie labelling may unintentionally trigger or exacerbate disordered eating among vulnerable persons. The purpose of this research...

Objective To investigate associations between eating behavior constructs (social eating, perceived competence, habit automaticity, self-determined motivation) and diet quality among young adults. Design Cross-sectional analysis. Participants Young adults (n = 1,005; mean age, 21.7 ± 2.0 years; 85% female) enrolled in the Advice, Ideas, and Motiva...

Background Accurately estimating portion sizes remains a challenge in dietary assessment. Digital images used in online 24-hour dietary recalls may be conducive to accuracy. Objective The current analyses were conducted to examine the accuracy of portion size estimation by women with low incomes who completed 24-hour dietary recalls using the onli...

Background The public health benefits of sugar-sweetened beverage (SSB) taxes often rely on, among other things, changes to consumer purchases. Thus, perceived cost of SSBs and signalling effects—via awareness of the tax—may impact the effectiveness of SSB taxes on consumer purchases. Objective The study sought to examine perceived cost of SSBs, t...

The Dietary Guidelines rely on summaries of the effect of diet pattern on disease risk, independent of other population characteristics. We explored the modifying effect of prepregnancy body mass index (BMI) on the relation between fruit and vegetable density and preeclampsia using data from a pregnancy cohort study conducted in 8 US medical center...

Background: Nutrition labels on pre-packaged foods are an important source of nutrition information; however, differences in comprehension of varying label formats may limit their use and effectiveness. Objectives: This study examined levels and correlates of consumers' self-reported understanding of Nutrition Facts tables (NFt) and Front-of-Pac...

An unhealthy diet is among the leading global causes of death and disability. Globally, a range of policies are being implemented to support healthy food choices at a population level, including novel polices in the areas of food marketing, nutrition labelling, and taxation of less healthy foods. There is a need to evaluate and inform the implement...

Many research questions focused on characterizing usual, or long-term average, dietary intake of populations and subpopulations rely on short-term intake data. The objective of this paper is to review key assumptions, statistical techniques, and considerations underpinning the use of short-term dietary intake data to make inference about usual diet...

Few biomarker-based validation studies have examined error in online self-report dietary assessment instruments, and food records (FRs) have been considered less than food frequency questionnaires (FFQs) and 24-hour recalls (24HRs). We investigated measurement error in online and paper-based FFQs, online 24HRs, and paper-based FRs in three samples...

The objective of this study was to evaluate the construct validity and reliability of the Healthy Eating Food Index-2019 (HEFI-2019), which was developed to measure adherence to Canada’s Food Guide 2019 (CFG-2019) recommendations on healthy food choices. Dietary intake data from 24-hour dietary recalls in the 2015 Canadian Community Health Survey-N...

The release of Canada’s Food Guide (CFG) in 2019 by Health Canada prompted the development of indices to measure adherence to these updated dietary recommendations for Canadians. This study describes the development and scoring standards of the Healthy Eating Food Index (HEFI-2019), which is intended to measure alignment of eating patterns with CFG...

Background Psychosocial stress and diet quality individually mediate associations between socioeconomic position (SEP) and health, however it is not known whether they jointly mediate these associations. This is an important question as stress-related unhealthy eating is often invoked as an explanation for diet-related health inequities, particular...

Background Dietary inequities in childhood may shape dietary and health inequities across the life course. Quantifying the magnitude and direction of trends in absolute and relative gaps and gradients in diet quality according to multiple indicators of socioeconomic position (SEP) can inform strategies to narrow these inequities. Objectives We exa...

Background: Socioeconomic inequities in diet quality are stable or widening in the United States; however, these trends have not been well characterized in other nations. Moreover, purpose-developed indices of inequities that can provide a more comprehensive and precise perspective of trends in absolute and relative dietary gaps and gradients usin...

Background Front-of-package (FOP) nutrition labeling systems differ in how they rate food and beverage products. There is a need to examine the implications of these differences, including their focus on nutrients of public health concern. Objective Our aim was to examine the impacts of 4 common FOP labels on consumers’ purchases of products that...

Background The assessment of dietary intake underpins population nutrition surveillance and nutritional epidemiology and is essential to inform effective public health policies and programs. Technological advances in dietary assessment that use images and automated methods have the potential to improve accuracy, respondent burden, and cost; however...

BACKGROUND The assessment of dietary intake underpins population nutrition surveillance and nutritional epidemiology and is essential to inform effective public health policies and programs. Technological advances in dietary assessment that use images and automated methods have the potential to improve accuracy, respondent burden, and cost; however...

Background The construct and predictive validity of the Healthy Eating Index (HEI) have been demonstrated, but how error in reported dietary intake may affect scores is unclear. Objective These analyses examined concordance between HEI-2015 scores based on observed vs reported intake among adults. Design Data were from two feeding studies (Food a...

Objectives Individuals with a lower socioeconomic position (SEP) have poorer health than their more advantaged counterparts. Psychosocial stress and diet quality have been shown to individually mediate associations between SEP and health, however studies have not yet investigated whether psychosocial stress and diet quality jointly mediate these as...

Objectives Diet quality is a key determinant of chronic disease and shares a similar socioeconomic patterning. Inequities in diet quality are stable or widening in the US, however these trends have not been examined in other nations. Moreover, prior US studies only examined differences in diet quality between the most and least disadvantaged groups...

Aim To inform future training and professional development for individuals who measure, analyse and interpret dietary intake data. Methods A cross-sectional online survey was distributed via e-newsletter to members of Dietitians Australia, Dietitian Connection and Nutrition Society Australia. The survey included 37 questions on three key areas of...

Aim The aim of this study was to compare food and nutrient intakes of young Australian adults (18-24 years) to national recommendations as per the Australian Guide to Healthy Eating and Nutrient Reference Values. Methods Dietary intake of 18 to 24 year olds (n = 1005) participating in the Advice, Ideas, and Motivation for My Eating (Aim4Me) study...

Background All self-reported dietary intake data are characterized by measurement error, and validation studies indicate that the estimation of energy intake (EI) is particularly affected. Methods Using self-reported food frequency and physical activity data from Alberta’s Tomorrow Project participants ( n = 9847 men 16,241 women), we compared the...

Interventions are urgently needed to transform the food system and shift population eating patterns toward those consistent with human health and environmental sustainability. Postsecondary campuses offer a naturalistic setting to trial interventions to improve the health of students and provide insight into interventions that could be scaled up in...

InterventionThis study examined whether the impacts of sugar taxes and front-of-pack (FOP) nutrition labels differ across socio-demographic subgroups.Research questionWhat are the main and moderating effects of individual-level characteristics on the nutrient content of participants’ purchases in response to varying taxation levels and FOP labels?M...

Language focused on individual dietary behaviors, or alternatively, lifestyle choices or decisions, suggests that what people eat and drink is primarily a choice that comes down to free will. Referring to and intervening upon food consumption as though it were a freely chosen behavior has an inherently logical appeal due to its simplicity and easil...

Objective: To assess associations between household food security status and indicators of food skills, health literacy, and home meal preparation, among young Canadian adults. Design: Cross-sectional data were analyzed using logistic regression and general linear models to assess associations between food security status and food skills, health...

Objective This study explored associations between socio-demographic characteristics, self-reported health, and household food security among young adults.Methods National cohort study participants from Toronto, Montreal, Vancouver, Edmonton, and Halifax, Canada, aged 16–30 years (n = 2149) completed online surveys. Multinomial logistic regression,...

Background Existing nutrition knowledge measures tend to be lengthy or tailored for specific contexts, making them unsuitable for population-based surveys. Given the growing emphasis within country-specific dietary guidelines on reducing consumption of highly processed foods, consumers’ ability to understand and apply principles related to level of...

Background Evidence suggests that combining tools that gather short- and long-term dietary data may be the optimal approach for the assessment of diet–disease associations in epidemiologic studies. Online technology can reduce the associated burdens for researchers and participants, but feasibility must be demonstrated in real-world settings before...

When causal inference is of primary interest, a range of target parameters can be chosen to define the causal effect, such as average treatment effects (ATEs). However, ATEs may not always align with the research question at hand. Furthermore, the assumptions needed to interpret estimates as ATEs, such as exchangeability, consistency, and positivit...

Background Despite considerable public health interest in sugary drink consumption, there has been little comparison of intake across countries. Objectives This study aimed to compare the consumption frequency and amounts of commonly consumed beverages among adults in 5 upper-middle- and high-income countries, and examine differences in consumptio...

Introduction Low-calorie sweeteners are increasingly prevalent in the food supply and their consumption has increased in recent decades. Although low-calorie sweeteners approved for use are considered safe from a toxicological perspective, their short- and long-term impacts on chronic disease risk remain uncertain. The aim of this review was to sum...

Background Efforts to lose, gain, or maintain weight are prevalent among youth and young adults, but little is known about the relationship between weight management efforts and dietary quality. Attempts to manage weight are typically driven by weight perceptions, which may also uniquely affect overall diet. Objective The objective was to explore...

Objective: Sugar-sweetened beverage taxes are increasingly used to discourage sugar intake; however, the impact on consumer preferences for particular products is largely unknown. This study explored the impact of two tax structures (tiered vs. nontiered and inclusive vs. exclusive of 100% fruit juice) on participants' probability of purchasing mo...

Background Automated Self-Administered 24-Hour Dietary Assessment Tool (ASA24) is a self-administered web-based tool designed to collect detailed dietary data at low cost in observational studies. Objective The objectives of this study were to describe, overall and by demographic groups, the performance and feasibility of ASA24-2011 recalls and co...

Background: All self-report dietary intake data are characterized by measurement error, and validation studies indicate that the estimation of energy intake (EI) is particularly affected. Methods: Using self-report food frequency and physical activity data from Alberta’s Tomorrow Project participants (n=9,847 men 16,241 women), we compared the revi...

Objectives The objective of this study was to examine the impact of numeric versus interpretive calorie labelling on consumer noticing, use, and perceptions of labels. We hypothesized that due to their at-a-glance format, interpretive labels would outperform numeric labels. Methods Using a pre-post quasi-experimental controlled trial design, three...

Research related to body weight management often focuses on weight loss but attempts to gain weight may be common given societal ideals related to body shape and size. The objectives of this study were to examine the prevalence and correlates of intentional weight gain attempts and to characterize weight gain strategies reported among young Canadia...

Background: Conventional analytic approaches for studying diet patterns assume no dietary synergy, which can lead to bias if incorrectly modeled. Machine learning algorithms can overcome these limitations. Objectives: We estimated associations between fruit and vegetable intake relative to total energy intake and adverse pregnancy outcomes using...

Purpose: The aim of this study was to assess the healthfulness of a sample of campus eateries at 2 time points, 2 years apart. Methods: Five eateries at the University of Waterloo were audited using the Nutrition Environment Measures Survey adapted for university campuses (NEMS-UC) in 2015 and late 2017–early 2018. Based on the availability of heal...

The objective of this study was to determine the influence of strategies of handling misestimation of energy intake (EI) on observed associations between dietary patterns and cancer risk. Data from Alberta’s Tomorrow Project participants (n = 9,847 men and 16,241 women) were linked to the Alberta Cancer Registry. The revised-Goldberg method was use...

To reduce errors in portion size estimation, a number of aids have been developed and tested. This systematic review synthesizes what is known about error associated with use of different portion size estimation aids (PSEAs) within self-reported dietary recall studies in children (aged ≤18 years). Eight electronic databases were searched using rele...

Abstract Background Among adults and children consuming Western diets, beverages are significant sources of free sugars, saturated fats, excess calories, and alcohol, with relevance to chronic disease risk. The impact of recent healthy eating policies and beverage market evolutions on population-level consumption patterns in Canada is unknown. The...

Careful consideration of the validity and reliability of methods intended to assess dietary intake is central to the robustness of nutrition research. A dietary assessment method with high validity is capable of providing useful measurement for a given purpose and context. More specifically, a method with high validity is well grounded in theory; i...

Background: Web-based health interventions may be easier to access and time efficient relative to face-to-face interventions and therefore may be the most appropriate mode to engage young adults. Objective: This study aims to investigate the impact of 3 different levels of personalized web-based dietary feedback and support on changes in diet qu...

BACKGROUND Web-based health interventions may be easier to access and time efficient relative to face-to-face interventions and therefore may be the most appropriate mode to engage young adults. OBJECTIVE This study aims to investigate the impact of 3 different levels of personalized web-based dietary feedback and support on changes in diet qualit...

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Objectives: Selection of appropriate and robust measures for capturing individual-level diet behaviors and the environmental factors that influence these behaviors is critical to advancing the knowledge base on effective approaches to promote health and well-being among children. However, selecting appropriate measures for a given research or eval...

Background: Technological innovations allow for collection of 24-h recalls (24HRs) in a broader range of studies than previously possible. The web-based Automated Self-Administered 24-Hour Dietary Assessment Tool (ASA24) has been shown to be feasible and to perform well in capturing true intake among adults. However, data to inform use with childr...

Background Sugar taxes and front-of-package (FOP) nutrition labelling systems are strategies to address diet-related non-communicable diseases. However, there is relatively little experimental data on how these strategies influence consumer behavior and how they may interact. This study examined the relative impact of different sugar taxes and FOP...

Dietary factors are major contributors to morbidity and mortality, and significant attention is being paid to interventions to support healthy eating, including through the creation of a healthier food supply. The objective of this study was to inform interventions to support healthy eating by examining the top dietary sources of calories, sodium,...

Canadian post-secondary students are vulnerable to food insecurity, yet lack of examination of this issue has prevented identification of policy and program solutions. This mixed-methods study aimed to characterize the experience of food insecurity among undergraduate students by eliciting barriers to food security, strategies used to manage food a...