Ultra-processed Foods Frequently Promoted in Canada’s Grocery Flyers from 2014, 2017, and 2021, with Healthier Cover Pages

<b>Purpose:</b> To assess nutritional quality of foods promoted in Canadian grocery flyers including level of processing, and whether adherence to dietary guidance varied by year, region, store type (regular or discount), or location in the flyer. <b>Methods:</b> Observational study; national sample of weekly digitized flyers (n = 53 flyers; n = 8,790 promoted foods and beverages) were collected from Canada's largest market-share national grocer, from 2014, 2017, and 2021. Flyer food items were extracted and coded manually into food groups and categories. Nutritional quality of promoted items was analyzed by three nutrient profiling systems including NOVA level of processing and Canada's Food Guide (CFG). Logistic regression models were used to examine odds of flyer foods aligning with dietary guidance. <b>Results:</b> Mean food items per flyer were 106 (SD = 66.4) in 2014; 174 (SD = 106.2) in 2017; and 215 (SD = 49.8) in 2021. Baked products (11%), non-alcoholic beverages (10.7%) and milk/dairy (10.2%) comprised the largest proportions of flyers. Least healthy/ultra-processed foods were most frequently advertised (CFG: 58.5%; NOVA: 51.2%); but followed by the most healthy/un/minimally processed (CFG: 33.6%: NOVA: 27.8%). Across geographic regions, odds of CFG alignment were similar, and no different in discount versus regular banners. Food items on the flyer cover page had consistently higher odds of CFG alignment. <b>Conclusion:</b> Consistent with past research, flyer foods frequently did not align with dietary guidance.