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.
Highlights
Ultra-processed foods are ready-to-eat/heat industrial formulations of food substances that have been derived from whole foods, and that typically contain added flavours, colours and other cosmetic additives[1]
About 3 % (n 6 of 205) of the grouped food items in the Nurses’ Health Studies (NHS) and the Health Professionals Follow-up Study (HPFS) cohorts and 7 % (n 22 of 315) in the youth cohort included a combination of food items with potentially different grades of processing
The approach to classifying the remaining 30 % of food items involved discussions with experts that were informed by insights from the research dieticians, information provided by cohort-specific documents and scans of online grocery stores
Summary
Ultra-processed foods are ready-to-eat/heat industrial formulations of food substances that have been derived from whole foods, and that typically contain added flavours, colours and other cosmetic additives[1]. They are one of the four groups that make up the NOVA classification – a system that classifies food based on the extent and purpose of the industrial processing they undergo and accounts for the physical, biological and chemical methods used in their manufacture, including the use of additives[1]. All supporting information that would be useful in identifying the ultra-processed products from the food lists like cooking methods used, food combinations and ingredients, place of food consumption and brand names of packaged products are usually not captured by FFQs
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