Relative Validity and Reproducibility of a Food Frequency Questionnaire to Assess Energy Intake from Minimally Processed and Ultra-Processed Foods in Young Children.

Rachael W. Taylor,Anne-Louise M. Heath,Jillian J. Haszard,Claudia Leong,Louise J. Fangupo,Elizabeth A. Fleming

doi:10.3390/nu11061290

Rachael W. Taylor, Anne-Louise M. Heath + Show 4 more

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https://doi.org/10.3390/nu11061290

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Journal: Nutrients	Publication Date: Jun 7, 2019
Citations: 16	License type: CC BY 4.0

Affiliation: University of Otago, Cancer Society of New Zealand

Abstract

NOVA is a food classification system that categorises food items into one of four categories according to the extent and purpose of their processing: minimally processed food (MPF), processed culinary ingredient (PCI), processed food (PF), or ultra-processed food (UPF). The aim of this study was to determine the relative validity and reproducibility of a food frequency questionnaire (EAT5 FFQ) for measuring daily energy intake (EI kJ) and percentage of daily energy intake (EI%) from each NOVA group in New Zealand children. One hundred parents of five year old children completed the 123 item EAT5 FFQ on two occasions four weeks apart. A 3 day weighed diet record (WDR) was completed on non-consecutive randomly assigned days between FFQ appointments. The FFQ overestimated EI (both as kJ and %) from MPF and UPF, and underestimated intakes from PCI and PF, compared with the WDR. Bland–Altman plots indicated reasonably consistent agreement between FFQ and WDR for MPF and UPF but not PCI or PF. Correlation coefficients between the FFQ and WDR were acceptable for EI (%) for MPF (r = 0.31) and UPF (r = 0.30). The FFQ differentiated between the highest and lowest quartiles for EI (%) from MPF and UPF foods (p-values for the trends were 0.006 and 0.009 respectively), and for EI (kJ) from UPF foods (p-value for trend 0.003). Bland–Altman plots indicated consistent agreement between repeat administrations of FFQ for MPF and UPF only, while intra-class correlations suggested good reproducibility for EI (kJ and %) for all four NOVA categories (range 0.51–0.76). The EAT5 FFQ has acceptable relative validity for ranking EI (%) from MPF and UPF. It has good reproducibility for measuring EI from all four NOVA categories, in young children.

Highlights

In recent years, the NOVA food classification system has increasingly been used in the literature to categorise foods according to the extent and purpose of food processing
One parent-child pair completed only the first food frequency questionnaire (FFQ) and the 3 day weighed diet record (WDR), meaning that 100 participants were included in the validity analysis and 99 participants in the reproducibility analysis
We have shown that our EAT5 FFQ provides a valid and reliable tool for ranking energy intake (EI) (%) from minimally processed food (MPF)

Summary

Introduction

The NOVA (not an acronym) food classification system has increasingly been used in the literature to categorise foods according to the extent and purpose of food processing In this system, individual foods and drinks are placed into one of four categories: minimally processed (including unprocessed) (MPF), processed culinary ingredient (PCI), processed food (PF), or ultra-processed food. Ultra-processed foods in particular have come under scrutiny They have been described as “formulations of mostly cheap industrial sources of dietary energy and nutrients plus additives” [2]. In many countries, both their availability and consumption has increased substantially [3,4,5], which is concerning because high UPF consumption has been shown to be predictive of poor diet quality [6,7,8]. Most of the studies that have included children have been undertaken in Brazil [14,15,16,17], a middle income country where UPF intakes, while increasing, are lower than those seen in high income countries such as Canada and

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