Diet quality among Indigenous and non-Indigenous children and youth in Canada in 2004 and 2015: a repeated cross-sectional design

Objective: The objectives were to describe changes in diet quality between off-reserve Indigenous and non-Indigenous children and youth from 2004 to 2015 and examine the association between food security and diet quality. Design: We utilised a repeated cross-sectional design using both the 2004 and 2015 nutrition-focused Canadian Community Health Surveys, including 24-h dietary recall. Diet quality was estimated according to the Healthy Eating Index (HEI). Setting: The surveys were conducted off-reserve in Canada's ten provinces. Participants: Our analysis included children and youth 2-17 years old (n 18 189). Indigenous and non-Indigenous participants were matched, and using a general linear model, we tested time period and (non-)Indigenous identifiers, including their interaction effect, as predictors of HEI. Results: Both Indigenous and non-Indigenous children and youth had significantly higher HEI scores in 2015 as compared to 2004. There was not a significant (non-)Indigenous and time period interaction effect, indicating the improvements in diet quality in 2015 were similar between both Indigenous and non-Indigenous populations. Improvements in diet quality are largely attributed to reductions in percentage energy from 'other' foods, though a disparity between Indigenous and non-Indigenous children and youth persisted in 2015. Overall, food security was lower among the Indigenous population and positively, and independently, associated with diet quality overall, though this relationship differed between boys and girls. Conclusions: School policies may have contributed to similar improvements in diet quality among Indigenous and non-Indigenous populations. However, an in-depth sex and gender-based analysis of the relationship between food security and diet quality is required.