An Overlap Between “Ultraprocessed” Foods and the Preexisting Nutrient Rich Foods Index?

Abstract

The category of “ultraprocessed” foods in the NOVA food classification scheme is ostensibly based on industrial processing. We compared NOVA category assignments with the preexisting family of Nutrient Rich Food (NRF) indices, first developed in 2004. The NRF indices are composed of 2 subscores: the positive NR based on protein, fiber, and vitamins and minerals, and the negative LIM subscore based on saturated fat, added sugars, and sodium. The 378 foods that were components of the widely used Fred Hutchinson Cancer Center food frequency questionnaire were assigned to NOVA categories and scored using multiple NRF indices. Contrary to published claims, NOVA was largely based on the foods' content of saturated fat, added sugars, and sodium. There were strong similarities between NOVA categories and NRF scores that were largely driven by the nutrients to limit. Nutrient density led to higher increased NRF scores but had less impact on NOVA categories. As a result, the NOVA scheme misclassified some nutrient-rich foods. We conclude that the NOVA classification scheme adds little to the preexisting nutrient profiling models. The purported links between NOVA categories and health outcomes could have been obtained using preexisting NRFn.3 nutrient density metrics.

Diet and Economic Modelling to Improve the Quality and Affordability of the Australian Diet for Low and Medium Socioeconomic Households

“…Despite a substantial reduction in ultra-processed foods in the healthier, low-cost diets, a quarter of the diet remained to consist of ultra-processed foods. The finding that a subset of low-cost, ultra-processed foods can be classified as nutrient dense, such as the ultra-processed wholegrain breads and ready-to-eat breakfast cereals with ≤20 g sugars/100 g, suggests misalignment between the NOVA scheme and nutrient density [ 19 , 20 ], especially when considering diet affordability. It has been proposed that lower SES groups readily select processed and ultra-processed foods for lower overall daily food costs, with a glass ceiling precluding their access to many unprocessed core foods [ 18 ].…”

“…The NRF9.3 [ 36 ] was developed in the USA and selected as the preferred tool to measure nutrient density, rather than the Nutrient Profiling Scoring Criterion (NPSC) or the Health Star Rating (HSR) system, developed by Food Standards Australia New Zealand (FSANZ), and the Australasian governments, respectively. The NRF9.3 is a validated nutrient density tool, which has been used previously to compare the nutrient density of foods and assess the relationship nutrient density and cost [ 16 , 19 , 20 , 36 ]. However, it excludes some micronutrients, including all B-group vitamins, and it is important to consider that other nutrient density calculations may rank food categories differently as compared with the method used in this study.…”

“…Processed and ultra-processed foods that contain refined grains, added sugars, and added fats have been highlighted as some of the lowest-cost sources of dietary energy, and represent both core (contributing to nutrient requirements) and discretionary (negligible contribution to nutrient requirements) foods [ 18 ]. Although ultra-processed foods are linked with poor diet quality and negative health outcomes, a recent study of foods in the USA found that 17% and 33% of ultra-processed and processed foods, respectively, can be classified as nutrient dense [ 19 ], and some ultra-processed and processed foods have been classified as both low-cost and nutrient dense (e.g., fortified cereals, beans, milk, and yoghurt) [ 20 , 21 ]. The NOVA processing classification system is the most widely used method for categorizing foods according to their processing level (unprocessed or minimally processed, culinary processed, processed, and ultra-processed) [ 22 ].…”

Management Accounting for Healthy Nutrition Education: Meta-Analysis

“…The author of Polish origin and affiliated with American institutions, Adam Drewnowski, heads cluster 1 (the central and most numerous) and is Professor of Epidemiology at the University of Washington and Director of the Center for Nutrition for Public Health at the School of Public Health of the University. His interest in public health, obesity and nutrition allows him to direct his contributions to the education, health and accounting aspects of this subject [94,95].…”

“…The 1738 articles on the research topic have been developed by authors affiliated with 4596 different international research institutions. Table 2 shows [94,95].…”