Translating “protein foods” from the new Canada’s Food Guide to consumers: knowledge gaps and recommendations

While the 2007 version of the Food Guide was hailed as a “tool for the times” (Bush et al. 2007), short-term indicators of its awareness have been mixed. For example, 2 studies with data collected in 2013 reported that >85% of Canadian adults were aware of the Food Guide (Slater and Mudryj 2018; Vanderlee et al. 2015); however, another study reported that only 42% of Canadian adults could recall the 4 food groups and <1% could correctly identify the number of servings recommended in each food group (Vanderlee et al. 2015). Another study conducted with data collected in 2014 noted that only 36% of Canadian parents reported applying the Food Guide to make dietary decisions. Parents who used the Food Guide had higher healthy index scores than parents who did not use the Food Guide (Fernandez et al. 2019a). Although the Food Guide appears to be widely recognized by Canadians and its use is associated with healthier diets, it is not utilized by the majority of Canadians. This may be due to knowledge gaps as supported by a review that found that consumers generally do not act on portion size and serving size guidance because of a lack of understanding (Faulkner et al. 2012).

Another major role of the Food Guide has been to inform nutrition policies, particularly healthy eating standards in institutional settings, including childcare facilities, schools, long-term care homes, and hospitals. The evidence for the adoption and compliance of healthy eating standards based on the Food Guide has been mixed and depends on the province and institution type. For example, in Alberta, the Alberta Nutrition Guidelines for Children and Youth use the Food Guide to provide recommendations for different types of settings (i.e., childcare facilities, recreation/community centres) (Alberta Health Services 2012); however, the guidelines are voluntary and a recent study found that only 27% of childcare settings provide an appropriate balance of healthy foods (usually or always) and many schools do not have a written nutrition policy (Alberta’s 2019 Nutrition Report Card on Food Environments for Children and Youth 2019). Though the Ontario School Food and Beverage policy, based on the Food Guide, is mandatory across the province, many schools were noncompliant with regards to healthy beverage policies (Vine et al. 2017). While there is evidence that implementing mandatory school nutrition policies improves dietary intakes of children and adolescents, 6 out of 10 provinces in Canada have voluntary policies (Acton et al. 2018). In Nova Scotia, the implementation of a mandatory provincial school nutrition policy was associated with greater consumption of milk products among grade 5 students (Fung et al. 2013). These studies suggest that although the Food Guide is integrated into institutional nutrition policies, implementation and adherence to the policies are highly variable. Given that one-third of daily energy intakes are consumed during school hours (Tugault-Lafleur et al. 2017), these institutions are critical environments to ensure adequate access to healthy protein foods and food literacy education. In addition to greater adoption of Food Guide recommendations into school nutrition policies, monitoring and enforcement are also needed.

Despite intentions to address growing chronic disease burden with the 2007 Food Guide, dietary intakes of Canadians remain inconsistent with the Food Guide recommendations. For example, between 2004 and 2015, fewer daily servings of vegetables and fruits and milk and alternatives, as well as more processed meats were consumed (Tugault-Lafleur and Black 2019). Furthermore, there is a substantial economic burden attributed to poor diets in Canada. In 2014 an estimated 13.8 billion dollars were spent on direct and indirect healthcare costs related to poor diet (i.e., not meeting dietary recommendations), and this may underestimate the true burden (Lieffers et al. 2018). A need for improved translation of dietary guidance into action in Canada was evident.

The 2019 edition of the Food Guide continues to aim towards improving health, meeting nutrient needs and reducing risks of diet-related diseases by helping Canadians make healthy food choices (Health Canada 2019c). The changes in the 2019 version of Food Guide were intended to strengthen dietary guidance and communicate recommendations in a way that is more appropriate for different groups’ needs (public, policy makers, and health professionals). In accordance with established international recommendations for developing and updating FBDGs, the Food Guide is intended to provide practical, dynamic, and flexible guidance rather than a prescriptive diet (World Health Organization and Food and Agricultural Organization of the United Nations 1996). Like the American MyPlate, the Canadian Food Guide Snapshot provides simpler guidance making it easier for the public to understand and assimilate the information (Webb and Byrd-Bredbenner 2015). The Food Guide Snapshot also fits within a broader Canadian Healthy Eating Strategy designed to provide greater support to Canadians in making healthy eating choices and provide opportunities for multi-level public health nutrition interventions (Health Canada 2019d). A shift in the format of the Food Guide from a single multipurpose resource that served as both a policy document and educational tool to multiple guidance documents will help clarify and tailor messages for the needs of different groups (Health Canada 2019d). From a communications perspective, the simplified Food Guide Snapshot format provides a better opportunity to translate healthy eating information to the public by providing understandable and accessible messages, taking into account health literacy and numeracy (Bernhardt 2004). For the public, the Food Guide’s 2-page Snapshot is accompanied by a 1-page Healthy Eating Recommendations document and a suite of resources online that include tips for healthy eating, recipes, and short vignettes. There are also separate documents for professionals: Canada’s Dietary Guidelines for health professionals and policy makers, evidence behind the food guide, and documents that outline the revision process. Table 1 lists key differences between the 2007 and the 2019 versions of the Food Guide. Arguably the most notable difference is the shift from 4 food groups in 2007 to 3 food groups in 2019 by combining meat and alternatives with milk and alternatives into a single protein foods group. This change is expected to have broad implications for different groups of consumers and knowledge users that depend on the Guide to serve food in institutions and develop food products.

The current Recommended Dietary Allowance (RDA) for protein is estimated, from nitrogen balance, at 0.8 g/kg per day for adults of all ages, except pregnant and lactating women (Institute of Medicine 2005). The Acceptable Macronutrient Distribution Range (AMDR) for protein is very large, representing between 10% to 35% of total daily energy intakes (Institute of Medicine 2005). The higher RDA for children and youth, between 0.85–1.1 g/kg per day, depending on age, is extrapolated from the adult RDA (Institute of Medicine 2005). Though the RDA (0.8 g/kg per day) is the same for all adults, increasing evidence supports higher protein requirements are needed for older adults to maintain optimal physical function (Bauer et al. 2013; Baum et al. 2016; Phillips et al. 2016; Rodriguez and Garlick 2008). Additionally, stable isotope-based studies also suggest that protein requirements may actually be higher (1.1–1.2 g/kg per day) than the established RDAs for adults (Elango et al. 2010; Humayun et al. 2007) and children (Elango et al. 2011). Furthermore, total protein requirements need to be balanced against the RDAs for individual indispensable amino acids, which may vary depending on life stage, age, and disease state (Layman et al. 2015).

Typically, protein quality is characterized by its digestibility and its indispensable amino acid content that are needed to support amino acid requiring processes specific to life stage (e.g., growth, development, pregnancy) (Millward et al. 2008). Protein quality is commonly measured using the protein digestibility-corrected amino acid score (PDCAAS) or the digestible indispensable amino acid score (DIAAS) (Pencharz et al. 2016). Consumption of protein foods, rich in indispensable amino acids and nutrient density, is associated with greater overall diet quality and nutrient adequacy (Phillips et al. 2015). Major sources of dietary protein such as dairy, meat, legumes, nuts, and seeds also contribute substantially to other nutrients that are frequently deficient in North American diets, including calcium, vitamin D, potassium, fibre, as well as iron and folate for women of childbearing age and vitamin B₁₂ for older adults (U.S. Department of Agriculture and U.S. Department of Health and Human Services 2010). The source of protein will obviously vary in terms of its contribution to different nutrients, with animal proteins being a substantial source of zinc, vitamin B₁₂, and iron, whereas plant proteins provide a source of vitamin E, fibre, and magnesium. Essentially, a diet that includes proteins from a variety of sources is ideal to provide a variety of nutrients in sufficient amounts to the diet — animal and plant proteins are complementary sources of dietary nutrients (Phillips et al. 2015). However, the bioavailability and digestibility of amino acids within protein foods can be affected by various factors including antinutritional elements (dietary fibre, phytates, and reaction of amino acids such as lysine with carbohydrates) within the food matrix, especially in plant proteins (Butts et al. 2012; Sarwar Gilani et al. 2012). Thus, dietary sources of protein may vary significantly in quality in terms of their contribution to RDAs of individual indispensable amino acids and intakes of complementary vitamins, minerals, and fibre. However, even with a plant-based diet, eating a variety of plant proteins is key to accommodate this variability in protein quality and levels of indispensable amino acids. Different food sources (dairy, animals, and plants) of protein will provide a diverse range of nutrients, making it important to consume a variety of protein food sources (Phillips et al. 2015).

Different sources of protein vary in quality with plant-based proteins generally providing lower anabolic potential than animal proteins, because of a less complete amino acid profile and/or a lower digestibility (van Vliet et al. 2015). Of note, the average protein quality score for a plant-based diet has been reported at 61% based on DIAAS, which is significantly lower than the average for animal protein (Ertl et al. 2016). Given that the current RDA is meant to represent grams of higher quality, utilizable protein, individuals consuming exclusively plant-based diets would need to consume protein in an amount greater than the RDA compared with individuals consuming mixed diets (animal and plants). For example, an individual consuming a plant-based diet may theoretically need to consume a higher quantity of protein to meet the RDA of 0.8 g/kg per day with high quality, utilizable protein (1.31 g plant-based protein × 0.61 protein quality score = 0.8 g). In addition, lower quality protein from plant sources can result in the need to consume more calories to achieve amino acid requirements compared with animal proteins (Pencharz et al. 2016). Despite the lower quality of plant-based proteins, vegetarian diets based on legumes, nuts, and seeds provide sufficient protein for adults; however, further research is needed on the relative importance of protein food complementarity for different protein-based plant diets (e.g., vegan) among specific populations (e.g., children, pregnant women, the elderly) that may have different requirements (Mariotti and Gardner 2019).

In developed countries, population intakes typically exceed the RDA for total protein intake (U.S. Department of Agriculture and U.S. Department of Health and Human Services 2010). Protein intakes reported in epidemiological studies are relatively consistent across populations — Americans, British, and French consume approximately 13%–17% of total energy intake from protein foods (Mariotti and Gardner 2019). Similarly, Canadians who consume mixed diets (i.e., a combination of animal and plant foods) are thought to consume more than enough protein (Health Canada 2019e). The percentage of energy intakes from protein reported in the 2015 Canadian Community Health Survey was within a similar range reported by other populations at 16% and 17% for children and adults, respectively (Statistics Canada 2017). In the EPIC-Oxford Study, dietary intakes of 30 251 adult meat eaters, fish eaters, vegetarians, and vegans were compared. Overall, researchers found significant differences in adherence to dietary recommendations. Meat eaters had the highest intakes of saturated fatty acids (SFA) and were the only group to consume an average intake that was slightly above the 10% of the daily energy threshold (10.4 ± 2.2% energy from SFA). Among vegans, micronutrient inadequacy was low, but there were higher estimates of inadequacy for vitamin B₁₂, iodine, calcium, and zinc. Unsurprisingly, protein intake was highest among meat eaters and lowest among vegans, but all groups had adequate intakes ranging between 0.99 g/kg per day for vegans to 1.28 g/kg per day for meat eaters (Sobiecki et al. 2016). Based on data from the 2011–2014 National Health and Nutrition Examination Survey (NHANES), average protein intakes among Americans were above the RDA, representing 14%–16% of daily energy intakes across all age groups. However, more than 15% of certain subgroups had protein intakes below the RDA such as in 14- to 18-year-old females, women aged ≥51 years, and men aged ≥80 years, indicating that some groups are at risk of suboptimal protein intakes. Should an increase to the protein RDA be recommended, there would be very little risk of exceeding the acceptable macronutrient distribution range (AMDR) for protein, which is between 10%–35% of total energy intake (Berryman et al. 2018).

While no Canadian data are currently available on different dietary patterns, it would be reasonable to assume that a shortfall of nutrients will vary according to different protein-based dietary patterns, and similar groups (e.g., adolescent women, older women and older men) could be vulnerable to not meeting the RDA of these nutrients. While overall, protein intakes are likely to be adequate in Canada, even among individuals who consume plant-only protein foods, there may be deficiencies (or excesses) of other nutrients, associated with specific protein-based dietary patterns. For example, because dairy products account for 50% of calcium intakes, the trend towards consuming less fluid milk in Canada from 2004 to 2015 among all age groups, especially children (Tugault-Lafleur and Black 2019), may be concerning if Canadians are not replacing milk with alternate foods/beverages that are fortified with both calcium and vitamin D, which is required for proper calcium absorption (Hanley et al. 2010). There are concerns that this trend will be compounded by not highlighting milk and alternatives in the 2019 Food Guide. However, it also appears that over the same time period, Canadians increased intakes of other protein-rich foods such as dairy products (e.g., yogurt), legumes, nuts and seeds, and eggs, potentially mediating the impact of nutrient deficiencies through reduced milk consumption, and indicating a shift in population-wide protein dietary patterns (Tugault-Lafleur and Black 2019). Dietary intakes in Canada need to be regularly monitored for macro- and micronutrient adequacy as new protein-based dietary patterns become more common and new plant-based products enter the mainstream food supply.

Little is known about consumers and the information they need to select and prepare nutrient-rich protein foods. Food and nutrition knowledge, a key component of food literacy, is needed by consumers to develop awareness about protein-rich foods and to understand how to select and integrate them into their diet within an increasingly complex and evolving food environment (Thomas et al. 2019). The communication environment is overwhelming, with multiple food trends, marketing and health claims, and contradictory nutrition information that confuses consumers, which may negatively impact dietary choices (Clark et al. 2019). Contradictory messages not only create consumer confusion about which foods to consume, but can also generate doubt about the soundness of valid nutrition recommendations, undermining the potential success of healthy eating guidance and communication campaigns aimed at educating the public (Nagler 2014). Lack of consumer knowledge about protein requirements and nutrient-rich protein sources could result in selection of foods based on food trends (e.g., processed foods fortified with extra protein), health claims on packaging, or misinformation in the media. Nutrition experts and other health practitioners need to consider the overload of information that consumers face, address confusion, and develop simplified messaging that is realistic and actionable to improve adherence to Food Guide recommendations (Ramondt and Ramirez 2019; Webb and Byrd-Bredbenner 2015). A consumer-centred research program is needed to assess information needs and develop communication strategies, such as surveys, market research, environmental scans, and needs assessments.

Nutrition information is difficult to communicate to the public in an age of information overload, misinformation, and mistrust of science (Garza et al. 2019). Nevertheless, nutrition leaders have the responsibility for ensuring that accurate information reaches the public in formats that are accessible and easy to understand (Garza et al. 2019). The new Food Guide Snapshot and additional tips available online provide basic information and instructions to the public about what and how to eat; however, a few gaps are exposed that could contribute to consumer confusion and misinterpretation. First, consumers may lack the knowledge to select nutritionally adequate sources and combinations of proteins for optimal health without turning to highly processed foods. Second, consumers may lack the skills to integrate plant-based protein foods such as legumes, lentils, and dried peas into their habitual diets. Without additional guidance, consumers may turn to convenient but highly processed plant-based foods (e.g., meatless burgers or meat-free chicken nuggets) that are typically high in nutrients of concern, including sodium, saturated fats, and added sugars. Finally, consumers, particularly parents, cite chronic time deficits as a barrier, and may not have the skillset to cook and prepare meals that are nutritious in a time-efficient manner on a regular basis (Fernandez et al. 2019b). Additional resources and tools (e.g., infographic, pamphlets, webinars, YouTube videos, cookbooks) for professionals and the public are needed to support food literacy and reduce Canadians’ current dependence on highly processed foods, particularly among busy families. Highly processed foods often supply higher than desired amounts of sodium, fats, and free sugars and low amounts of protein, fibre, and vitamins to the diet (Nardocci et al. 2019). Messaging about eating less processed foods needs to be supported with guidance about how to define and identify processed foods to enable the public to select foods that are protein-rich and nutrient-dense (Dwyer et al. 2012). Tools, resources, and messaging need to be tailored to the needs of different media and user groups: children, parents, educators, health professionals, and food service professionals. Short instructional online modules or webinars would be appropriate media to convey messaging to educators and health professionals, whereas YouTube videos, cookbooks, and hands-on workshops would be more appropriate for children and parents. Intermediaries like health professionals and educators who have direct contact with the public also need educational resources such as infographics, factsheets, posters, and recipes.

Though little is known about the most effective methods to translate nutrition information to the public and elicit enduring behaviour change, general science and public health communication tools and interventions should have theoretical underpinnings that may include diffusion of innovation theory (Rogers 2003), social cognitive theory (Bandura 1998), or social marketing (Andreasen 2002). Existing tools can facilitate the process of identifying goals for different audiences and tailoring strategies accordingly with available expertise and resources (Canadian Institutes of Health Research 2012). To improve lifelong dietary habits, children should be the main target audience and efforts to develop effective communication and education strategies for this population are needed. These efforts should be implemented in schools, childcare facilities, and directed at parents. While several tips and ideas to integrate Food Guide messages are available online, consumers have to actively seek them out. Increased visibility of existing tools would also help support the assimilation of current messages; however, awareness and consumer education is not enough, nutrition leaders (e.g., Canadian Nutrition Society, Dietitians of Canada, Health Canada) must be recognized as credible authorities on nutrition by proactively differentiating themselves from unreliable sources of nutrition information (Cornish and Moraes 2015).

Though undocumented, there are also concerns about the potential misinterpretation of the 2019 Food Guide Snapshot. Milk and alternatives are no longer distinctly named, the number of servings of foods are not mentioned, and, unlike the American MyPlate, a glass of water is illustrated next to the healthy plate instead of a glass of milk. The public, the media, foodservice professionals, and nutrition critics are open to interpret or misinterpret the Food Guide Snapshot. For example, the food and agriculture sector, politicians, and the media have suggested that the new Food Guide has eliminated dairy foods completely from its guidance (Gold et al. 2019; Kirkup 2019). There are even published observations that the foods as depicted in the Food Guide Snapshot would not meet dietary requirements of nutrients such as calcium and vitamin D (Barr 2019). However, the new Food Guide Snapshot is not intended to function as standalone dietary advice, but rather a flexible tool that is meant to provide simplified dietary guidance to the general population. Additionally, it should be specified that the Food Guide Snapshot is a simple depiction of a plate, which is meant to represent a “rule of thumb” regarding proportions of foods to eat that is easy to apply. It is not intended to convey that every food on the plate should be eaten at every meal, nor that the plate should be used for every single meal. A suite of tools and resources available on the Food Guide website (https://food-guide.canada.ca/) provides additional information about eating that fits with different populations and lifestyle contexts, including how to adapt and apply the messages to breakfast and snacks (Health Canada 2020). To make it easier to find information about healthy eating, a dedicated search bar on the Food Guide website is recommended.

While the new Food Guide has simplified guidance and provided tailored information for different contexts, the shift from portions to proportions has left institutions that serve food to the public with a large gap in guidance about how to apply the information to their menus. Canada’s Healthy Eating Patterns, meant to be released in 2019, was intended as complementary resource that would fill the gap by providing guidance on amounts and types of foods to eat, which would help guide food procurement policies in institutions (Health Canada 2019b). In the absence of the highly anticipated Canada’s Healthy Eating Patterns resource, the public and stakeholders are left to make assumptions about the Food Guide Snapshot, which could undermine its efforts. Additional guidance to translate the Food Guide Snapshot is needed, particularly for institutions and food service providers that use it to inform food service policies in childcare centres, schools, long-term care facilities, and primary care institutions.

Studies are needed to understand protein requirements and different protein-based dietary patterns of Canadians. Studying population-wide protein intakes of Canadians is important to identify which subgroups may be at risk of micronutrient deficiencies in association with different levels of protein intake or protein-based dietary patterns. This is particularly important given that vulnerable populations, such as youth and older adults, may be at risk of not meeting current protein RDAs (Berryman et al. 2018). To further understand if consumers are eating sufficient protein for optimal health, dietary intake data according to dietary protein patterns are needed at different life stages to inform public health messaging and ensure protein or associated nutrients, including calcium, iron, vitamin D, and B₁₂ do not become nutrients of concern. Additionally, there is a need to understand the impact of timing of protein ingestion in relation to the intake of quality protein (protein complementation) and the resultant ability to meet human protein/amino requirements. Monitoring dietary patterns will help tailor specific messages and guidance for different at-risk populations. Tools to measure diet quality and adequacy according to Canada’s Food Guide 2019 are needed to assess and monitor protein status of Canadians over time. A protein calculator that accommodates protein quality and indispensable amino acid profiles could be a useful tool to guide protein assessments of populations at risk of deficiencies.

By 2030, ∼9.5 million Canadians will be over the age of 65 years (almost 1 in 4 persons), emphasizing a demographic shift that highlights the need to focus on elderly persons (Government of Canada 2014). There is controversy over the protein needs for this segment of the population that highlights a need for resolution of this controversy and clear messaging in the protein foods category (Courtney-Martin et al. 2016; Traylor et al. 2018). Evidence-based practice guidelines, developed by professional associations (Canadian Nutrition Society and Dietitians of Canada), would also be needed to consider the protein needs of different institutionalized populations and life stages, including older adults.

For several years, many experts have been calling for an updated process to evaluate protein content of foods to develop more accurate health claims that align with contemporary diets and our food supply (Marinangeli et al. 2017). In Canada, protein content claims are substantiated by the Protein Rating system, based on the protein efficiency ratio (PER) value in conjunction with reasonable daily intakes of a given food; ratings ≥ 20 represent a “good source” and ratings ≥ 40 represent an “excellent source” of protein (Canadian Food Inspection Agency 2018). The official Protein Rating method was positioned by Health Canada in 1981 and is based on rat growth bioassays (i.e., growth of young rats following the consumption of a reference amount of a protein for 28 days). However, values are based on animals that have different indispensable amino acid requirements than humans; are undergoing a phase of rapid growth; and the quantity of protein actually consumed by the animals may depend on hedonic responses to the type of protein (Marinangeli et al. 2018). Of note, the biggest challenge of the Protein Rating system is that very few PER values are available for foods consisting of 2 or more protein sources (i.e., mixed proteins) and the information on novel protein foods is very limited.

The limitations of the PER method are well-known and it is rarely used by regulators in other countries (Marinangeli and House 2017). The implications of using the PER method in Canada is a regulatory framework that is prohibitive and does not support nor incentivize innovation within the food industry. Manufacturers are restricted to the types of proteins with known values to include in products, as current methods limit the ability to label whole-plant sources of proteins as a “source of protein”. The new protein foods group, which also encourages greater consumption of plant proteins, presents an opportunity to modernize the Canadian regulatory framework. An updated framework that recognizes different sources of protein and better interprets protein quality (particularly for plant and mixed-protein sources) is needed to avoid misleading health claims and to encourage transparency when marketing new food trends. The United States uses the protein PDCAAS, which also has limitations, but is less restrictive.

To overcome PDCAAS limitations, the Food and Agriculture Organization recommends the DIAAS. DIAAS represents the percentage of the total daily requirement of the most limiting indispensable amino acid that would need to be consumed if the estimated average requirement for daily intake of a test protein is consumed (Wolfe et al. 2018). As such, DIAAS treats individual amino acids as the nutrients of interest, not crude protein. Unlike PER, both DIAAS and PDCAAS enable complementary protein profiles of mixed meals (e.g., beans and rice) to be ranked as high quality, whereas PER values for each food separately would be low based on the limiting indispensable amino acids — lysine and methionine in rice and beans, respectively (Wolfe et al. 2018). Moving away from PER in favour of DIAAS or even PDCAAS, would need to be evaluated in the context of the Canadian food supply (Marinangeli and House 2017). Key issues remaining to be solved include the need to harmonize protein quality evaluation processes and interpretation between Canada and the United States, given the strong integration of food supply chains. Economic opportunities do exist to develop innovative nutrient-dense protein foods that are not highly processed, but need to be balanced with transparent protein content claims that are based on accurate assessments not only of content, but of the physiological and health consequences of consuming those proteins.

M.A.F. received travel support from the Canadian Nutrition Society (CNS) to attend the protein workshop and was contracted by CNS to coordinate and draft the current manuscript. From 2015–2018 M.A.F. worked at the Quebec Heart and Lung Institute and her salary was paid, in part, through a research grant from Danone International.

R.F.B. reports nonfinancial support from CNS, during the conduct of the study. R.F.B. is a member of the Board of Trustees for the International Life Sciences Institute – North America.

A.M.D. is the vice-president research of CNS and received travel support to attend the protein workshop.

S.M.P. reports personal fees from Enhanced Recovery, other from Exerkine, personal fees from US National Dairy Council, personal fees from Dairy Farmers of Canada, personal fees from US Dairy Export Council, grants from Alliance for Potato Research and Education, outside the submitted work. S.M.P. has a patent 3052324 issued to Exerkine, and a patent 16/182891 pending to Exerkine.

R.E. reports travel support from the Canadian Nutrition Society for the protein workshop, grant funding from Dairy Farmers of Canada, National Dairy Council; and travel support from Dairy Farmers of Canada and Canadian Pork Council to present research findings in Scientific Meetings.

D.W.L.M. reports other from The Helderleigh Foundation, grants from the Ontario Ministry of Agriculture, Food and Rural Affairs (OMAFRA), grants from Canadian Institutes of Health Research (CIHR), outside the submitted work. D.W.L.M. is also the Director of the Guelph Family Health Study leading the study of determinants of health in families.

S.D. reports grant from the Institution of Nutrition and Functional Foods (INAF), Université Laval, outside the submitted work and travel funds from the Canadian Nutrition Society to attend the protein workshop.

A.G. is Executive Director of CNS. CNS received funding from the Helderleigh Foundation to support the Protein Foods Initiative. Members of the Helderleigh Foundation were not involved in any aspect of the planning, delivery, or manuscript development.

J.D.H. is past-president of CNS and reports travel support received from CNS and ILSI North America for attendance at protein workshops. During the conduct of this review, J.D.H. reports contract research funds received from University of Saskatchewan, Western Grains Research Foundation, Manitoba Pulse and Soybean Growers Association, University of Saskatchewan/Genome Canada, Good Foods Institute, Saskatchewan Pulse Crop Development Board, Roquette Frères, Egg Farmers of Canada, Manitoba Egg Farmers, Natural Sciences and Engineering Research Council (NSERC), Canola Council of Canada, Alliance for Potato Research and Education, and Alberta Agriculture and Forestry, for research on protein quality. J.D.H. is co-chair of the Canadian Leadership Team of ILSI North America. J.D.H. has a Canadian patent 2981319 “Sunflower, flax, camelina or hemp meal-based tofu-like product” issued, and a US patent application “Sunflower, flax, camelina or hemp meal-based tofu-like product” pending.