Abstract
Discrepancies exist among food processing classification systems and in the relationship between processed food intake and dietary quality of children. This study compared inter-rater reliability, food processing category, and the relationship between processing category and nutrient concentration among three systems (Nova, International Food Information Council (IFIC), and University of North Carolina at Chapel Hill (UNC)). Processing categories for the top 100 most commonly consumed foods children consume (NHANES 2013–2014) were independently coded and compared using Spearman’s rank correlation coefficient. Relative ability of nutrient concentration to predict processing category was investigated using linear discriminant analysis and multinomial logistic regression and compared between systems using Cohen’s kappa coefficient. UNC had the highest inter-rater reliability (ρ = 0.97), followed by IFIC (ρ = 0.78) and Nova (ρ = 0.76). UNC and Nova had the highest agreement (80%). Lower potassium was predictive of IFIC’s classification of foods as moderately compared to minimally processed (p = 0.01); lower vitamin D was predictive of UNC’s classification of foods as highly compared to minimally processed (p = 0.04). Sodium and added sugars were predictive of all systems’ classification of highly compared to minimally processed foods (p < 0.05). Current classification systems may not sufficiently identify foods with high nutrient quality commonly consumed by children in the U.S.
Highlights
The prevalence of childhood overweight and obesity remains elevated in the United States (U.S.), in lower-income and minority populations [1,2,3,4]
Since an overarching aim of this research was to evaluate whether processing category is a useful measure of healthfulness in children’s diets, we determined the 100 most commonly foods consumed by children, ages six to twelve years old, who participated in the National Health and Nutrition
Using a nationally representative sample of foods commonly consumed by children in the U.S, this study empirically demonstrates the effect of processing classification system on conclusions regarding the relationship between processing and nutrient concentration, highlighting common and discordant aspects of these systems as well nutritional components that best align with processing category
Summary
The prevalence of childhood overweight and obesity remains elevated in the United States (U.S.), in lower-income and minority populations [1,2,3,4]. It is widely accepted that poor diet is a key contributor to caloric imbalances and weight status in children. Researchers have documented eating pattern shifts that favor sweetened beverages over water and milk [5], takeaway food over meals eaten at home [6], and snacking over traditional meal patterns [7], collectively referred to as the nutrition transition [8]. Modern industrial food processing is a common denominator driving these dietary shifts. Processed foods have been advanced as a potential driver of the child obesity epidemic, but their role in terms of nutrition and health in modern day diets is currently under debate [9].
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