Description and performance evaluation of two diet quality scores based on the Nova classification system

Abstract

Background and objectives The consumption of unprocessed or minimally processed whole plant foods and of ultra-processed foods, as defined by the Nova food classification system, are associated in opposite ways with diet quality and risk of diseases. However, it can be difficult to evaluate and monitor the consumption of these foods in some contexts due to lack of resources and time constraints for data collection. This study aimed to describe two simple and easily derived diet quality scores and evaluate their performance in reflecting the dietary share of unprocessed or minimally processed whole plant foods and ultra-processed foods.

Methods A total of 812 adults (18 years old or older) answered the Nova24h screener, a 2-minute self-administered questionnaire that measures the consumption of a set of foods on the day before the interview. Food items included in this tool belong to two main groups of Nova classification: unprocessed or minimally processed whole plant foods (WPF, 33 food items) and ultra-processed foods (UPF, 23 food items). Two scores are obtained from this tool by summing the number of items checked - the Nova-WPF and the Nova-UPF. We compared the Nova-WPF and the Nova-UPF scores with the dietary intake (% of total energy) of all unprocessed or minimally processed whole plant foods and all ultra-processed foods, respectively, obtained through a full self-administered web-based 24-hour recall, applied on the same day. We evaluated the relationship between the approximate quintiles or intervals of each score and the corresponding % of energy intake by linear regression, and the agreement between the intervals of each score with the intervals of the corresponding % of energy intake, using the Prevalence-Adjusted and Bias-Adjusted Kappa (PABAK).

Results Approximate quintiles of each score presented a direct and linear relationship with the corresponding % of energy intake (p-value for linear trend <0.001). We found a substantial agreement between the intervals of each score and of the corresponding % of energy intake (PABAK 0.72, 95% CI 0.64-0.81 for the Nova-WPF score and PABAK 0.79, 95% CI 0.69-0.88, for the Nova-UPF score).

Conclusions These two scores performed well against the dietary share of unprocessed or minimally processed whole plant foods and ultra-processed foods in Brazil and can thus be used to evaluate and monitor diet quality.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This study was funded through the Sao Paulo Research Foundation, FAPESP (Grant No. 2021/10993-3), as well as the Innovative Methods and Metrics for Agriculture and Nutrition Action (IMMANA) programme (Grant No. IMMANA 3.06), led by the London School of Hygiene & Tropical Medicine (LSHTM), which does not necessarily share its positions. FR is a beneficiary of a research fellowship from the World Cancer Research Fund.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The ethics committee of the School of Public Health from Sao Paulo University (process No. 88455417.8.0000.5421) approved the study.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Data Availability

All data produced in the present study are available upon reasonable request to the authors

留言 (0)

沒有登入
gif