Estimating the Effect of Adhering to the Recommendations of the 2019 Canada’s Food Guide on Health Outcomes in Older Adults: Protocol for a Target Trial Emulation

Supplemental Material

Authors
Affiliations

Didier Brassard

School of Human Nutrition, McGill University

Nancy Presse

Faculty of Medicine and Health Sciences, University of Sherbrooke

Centre de recherche sur le vieillissement, CIUSSS de l’Estrie-CHUS

Stéphanie Chevalier

School of Human Nutrition, McGill University

Research Institute of the McGill University Health Centre

Published

January 23, 2025

Code 
print_table <- "Y"

# ********************************************** #
#                 Quarto set-up                  #
# ********************************************** #

knitr::opts_chunk$set(dpi = 300,
                      out.width = "80%",
                      fig.env = "figure",
                      fig.align = "center"
                      )

## suppress scientific notation
options(scipen = 9999)

# *********************************************** #
#                   Packages                      #
# *********************************************** #

## data
library(dplyr)
library(tidylog)
library(readxl)

## analysis
library(hefi2019)

## results presentation
library(ggplot2)
library(patchwork)
library(gt)
library(tinytex)
library(MetBrewer)
library(dagitty)
library(ggdag)

# ********************************************** #
#               Location of files                #
# ********************************************** #

dir_scripts <- here::here("scripts")
dir_processed <- here::here("data", "processed")
dir_results <- here::here("data", "results")
dir_tab <- here::here("manuscript", "tables")
  if(dir.exists(dir_tab)==FALSE){
    dir.create(dir_tab, recursive = TRUE)
  }
dir_fig <- here::here("manuscript", "figures")
  if(dir.exists(dir_fig)==FALSE){
    dir.create(dir_fig, recursive = TRUE)
  }
dir_supp <- here::here("manuscript", "supplementary")
  if(dir.exists(dir_supp)==FALSE){
    dir.create(dir_supp, recursive = TRUE)
  }

# ********************************************** #
#            Load functions and data             #
# ********************************************** #

## GT Table style
  gtstyle <- function(gtobject,footnote_marker="numbers"){
    gtobject |>
      gt::tab_style(
        style = list(
          cell_text(weight = "bold")  ),
        locations = cells_row_groups(groups = everything())
      ) |>
      gt::opt_align_table_header("left") |>
      gt::opt_footnote_marks(marks=footnote_marker)
  }

Supplemental Methods

Simulated diets from Health Canada

Code 
# #| label: tbl-dietsim
# #| tbl-cap: ""

# ********************************************** #
#             Output sim. diet data              #
# ********************************************** #

# note: See code <1.0-Data_preparation.R> for details

load(file.path(dir_processed, "dietsim_hefi.rdata"))

# revise DRI group formatting
dietsim_hefi$drig_f <- 
  factor(dietsim_hefi$drig,
         levels=c(0,12,13,14,15),
         labels = c("All, 51y+",
                    "Males, 51-70 y",
                    "Females, 51-70 y",
                    "Males 71y+",
                    "Females 71y+"))

# ********************************************** #
#          Output vectors of CFG foods           #
# ********************************************** #

recommended <- c(
  "vegetables and fruits",
  "whole-grain foods",
  "protein foods",
  "unsweetened milk and plant-based beverages with protein"
)

notrecommended <- c(
  "non-whole grain foods",
  #"other foods not recommended",
  "other low nutritive value foods",
  #"other beverages not recommended",
  "juice, sugary drinks and alcohol",
  "fatty foods rich in saturated fats")

# ********************************************** #
#          Generate table of sim. diet           #
# ********************************************** #

tab_dietsim <- 
  dietsim_hefi |>
  mutate(
  #combine FAM+FAP
    FAM_n_FAP = fam+fap,
  # rescale as RA
    milk_plantbev = milk_plantbev/258) |>
  select(-c(drig,starts_with("HEFI2019C"),starts_with("RATIO"),
            milk,plantbev,SFA_PERC,SUG_PERC,SODDEN,pro)) |>
  gt::gt() |>
  gt::cols_move_to_start(drig_f) |>
  gt::tab_spanner(label="Foods, Reference Amounts (RA)",
                  columns = c(vf,wg,pfpb,pfab, milk_plantbev, ufa)) |>
  gt::tab_spanner(label="Total nutrients",
                  columns = c(ekc,fsug, fas, FAM_n_FAP, sod)) |>
  gt::fmt_number(columns = c(vf, wg, pfpb, pfab, milk_plantbev, ufa, fsug, fas, fam, fap, FAM_n_FAP, HEFI2019_TOTAL_SCORE),decimals = 1) |>
  gt::fmt_number(columns = c(ekc, sod), decimals = 0) |>
  gt::cols_hide(columns=c(totfoodsRA, fam, fap)) |>
  gt::cols_label(
    drig_f = "Age/sex group",
    vf     = "Vegetables & fruits",
    wg     = "Whole grains",
    pfpb   = "Protein foods, plant-based",
    pfab   = "Protein foods, animal-based",
    milk_plantbev = "Milk & Plant-based bev. with protein",
    ufa    = "Unsaturated oils & fats",
    ekc    = "Energy, kcal",
    fsug   = "Free sugars, g",
    fas    = "SFA, g",
    FAM_n_FAP = "Unsaturated fats, g",
    #FAM    = "MUFA, g",FAP    = "PUFA, g",
    sod    = "Sodium, mg",
    HEFI2019_TOTAL_SCORE = "HEFI-2019 score (/80), points" ) |>
  gt::tab_header(title="Supplemental Table 1. HEFI-2019 dietary constituents and score among simulated diets by Health Canada, by age and sex group") |>
  gt::tab_footnote(footnote = "Data adapted from Health Canada. Simulated composite diets. https://open.canada.ca/data/en/dataset/0490749d-b0b0-410a-9577-a903c6cec2be: Open Government Portal, 2022. CFG-2019, Canada's Food Guide; DRI, Dietary Reference Intake; HEFI-2019, Healthy Eating Food Index 2019; RA, reference amounts; SFA, saturated fats.", locations = cells_title("title")) |>
  gt::tab_footnote(footnote = glue::glue("The HEFI-2019 total score has a maximum of 80 points. Foods not recommended (i.e., {knitr::combine_words(notrecommended)}) were all assigned 0 consumption."),
                   locations = cells_column_labels(columns="HEFI2019_TOTAL_SCORE") )

# ********************************************** #
#                  Print table                   #
# ********************************************** #

if(print_table=="Y") {
  tab_dietsim |> gtstyle()
}
Supplemental Table 1. HEFI-2019 dietary constituents and score among simulated diets by Health Canada, by age and sex group1
Age/sex group
Foods, Reference Amounts (RA)
Total nutrients
HEFI-2019 score (/80), points2
Vegetables & fruits Whole grains Protein foods, plant-based Protein foods, animal-based Milk & Plant-based bev. with protein Unsaturated oils & fats Energy, kcal Free sugars, g SFA, g Unsaturated fats, g Sodium, mg
All, 51y+ 9.0 3.9 2.0 1.9 1.0 1.0 1,865 6.4 10.2 41.6 1,066 78.5
Males, 51-70 y 9.9 5.0 2.4 2.3 1.0 1.0 2,259 7.1 11.7 45.2 1,174 78.3
Females, 51-70 y 8.6 3.5 2.0 1.9 1.0 1.0 1,737 5.5 9.7 41.3 993 78.3
Males 71y+ 9.9 4.2 2.0 1.8 1.0 1.0 1,959 7.0 10.6 43.0 1,142 78.6
Females 71y+ 7.7 3.0 1.7 1.6 1.0 1.0 1,507 5.9 8.7 36.8 954 78.0
1 Data adapted from Health Canada. Simulated composite diets. https://open.canada.ca/data/en/dataset/0490749d-b0b0-410a-9577-a903c6cec2be: Open Government Portal, 2022. CFG-2019, Canada's Food Guide; DRI, Dietary Reference Intake; HEFI-2019, Healthy Eating Food Index 2019; RA, reference amounts; SFA, saturated fats.
2 The HEFI-2019 total score has a maximum of 80 points. Foods not recommended (i.e., non-whole grain foods, other low nutritive value foods, juice, sugary drinks and alcohol, and fatty foods rich in saturated fats) were all assigned 0 consumption.
Code 
# ********************************************** #
#                   Save table                   #
# ********************************************** #

gt::gtsave(tab_dietsim,
           filename = file.path(dir_supp,"tab_dietsim.docx"))