Categorising ultra-processed foods in large-scale cohort studies: evidence from the Nurses' Health Studies, the Health Professionals Follow-up Study, and the Growing Up Today Study

Author(s):Show less -

Khandpur, Neha ^{[1, 2]} ; Rossato, Sinara ^{[1, 3]} ; Drouin-Chartier, Jean-Philippe ^{[4, 1, 5]} ; Du, Mengxi ^[6] ; Martinez, Euridice ^[2] ; Sampson, Laura ^[1] ; Monteiro, Carlos ^[2] ; Zhang, Fang Fang ^[6] ; Willett, Walter ^{[7, 8, 9, 1]} ; Fung, Teresa T. ^{[1, 10]} ; Sun, Qi ^{[7, 8, 9, 1]}

Affiliation

^[1] Harvard TH Chan Sch Publ Hlth, Dept Nutr, Boston, MA 02115 - USA

^[2] Univ Sao Paulo, Dept Nutr, Sch Publ Hlth, Av Dr Arnaldo 715, Sao Paulo - Brazil

^[3] Univ Fed Uberlandia, Dept Publ Hlth, Uberlandia, MG - Brazil

^[4] Laval Univ, Fac Pharm, Quebec City, PQ - Canada

^[5] Laval Univ, Inst Nutr & Funct Foods INAF, Ctr Nutr Hlth & Soc NUTRISS, Quebec City, PQ - Canada

^[6] Tufts Univ, Dept Publ Hlth & Community Med, Friedman Sch Nutr, Medford, MA 02155 - USA

^[7] Harvard TH Chan Sch Publ Hlth, Dept Epidemiol, Boston, MA - USA

^[8] Harvard Med Sch, Boston, MA 02115 - USA

^[9] Brigham & Womens Hosp, Dept Med, Channing Div Network Med, 75 Francis St, Boston, MA 02115 - USA

^[10] Simmons Univ, Dept Nutr, Boston, MA - USA

• Document type: Journal article
• Source: JOURNAL OF NUTRITIONAL SCIENCE; v. 10, SEP 16 2021.
• Web of Science Citations: 0

Abstract

This manuscript details the strategy employed for categorising food items based on their processing levels into the four NOVA groups. Semi-quantitative food frequency questionnaires (FFQs) from the Nurses' Health Studies (NHS) I and II, the Health Professionals Follow-up Study (HPFS) and the Growing Up Today Studies (GUTS) I and II cohorts were used. The four-stage approach included: (i) the creation of a complete food list from the FFQs; (ii) assignment of food items to a NOVA group by three researchers; (iii) checking for consensus in categorisation and shortlisting discordant food items; (iv) discussions with experts and use of additional resources (research dieticians, cohort-specific documents, online grocery store scans) to guide the final categorisation of the short-listed items. At stage 1, 205 and 315 food items were compiled from the NHS and HPFS, and the GUTS FFQs, respectively. Over 70 % of food items from all cohorts were assigned to a NOVA group after stage 2. The remainder were shortlisted for further discussion (stage 3). After two rounds of reviews at stage 4, 95.6 % of food items (NHS + HPFS) and 90.7 % items (GUTS) were categorised. The remaining products were assigned to a non-ultra-processed food group ( primary categorisation) and flagged for sensitivity analyses at which point they would be categorised as ultra-processed. Of all items in the food lists, 36.1 % in the NHS and HPFS cohorts and 43.5 % in the GUTS cohorts were identified as ultra-processed. Future work is needed to validate this approach. Documentation and discussions of alternative approaches for categorisation are encouraged. (AU)

• FAPESP's process: 19/22278-7 - Assessing the impact of front-of-package nutrition labeling on public health in Brazil
• Grantee: Neha Khandpur
• Support Opportunities: Scholarships in Brazil - Young Researchers
• FAPESP's process: 18/17972-9 - Ultra-processed foods and 'protein leverage hypothesis': a study in seven countries
• Grantee: Eurídice Martínez Steele
• Support Opportunities: Scholarships in Brazil - Post-Doctoral