Use of Different Food Classification Systems to Assess the Association between Ultra-Processed Food Consumption and Cardiometabolic Health in an Elderly Population with Metabolic Syndrome (PREDIMED-Plus Cohort)

Abstract

The association between ultra-processed food (UPF) and risk of cardiometabolic disorders is an ongoing concern. Different food processing-based classification systems have originated discrepancies in the conclusions among studies. To test whether the association between UPF consumption and cardiometabolic markers changes with the classification system, we used baseline data from 5636 participants (48.5% female and 51.5% male, mean age 65.1 ± 4.9) of the PREDIMED-Plus (“PREvention with MEDiterranean DIet”) trial. Subjects presented with overweight or obesity and met at least three metabolic syndrome (MetS) criteria. Food consumption was classified using a 143-item food frequency questionnaire according to four food processing-based classifications: NOVA, International Agency for Research on Cancer (IARC), International Food Information Council (IFIC) and University of North Carolina (UNC). Mean changes in nutritional and cardiometabolic markers were assessed according to quintiles of UPF consumption for each system. The association between UPF consumption and cardiometabolic markers was assessed using linear regression analysis. The concordance of the different classifications was assessed with intra-class correlation coefficients (ICC3, overall = 0.51). The highest UPF consumption was obtained with the IARC classification (45.9%) and the lowest with NOVA (7.9%). Subjects with high UPF consumption showed a poor dietary profile. We detected a direct association between UPF consumption and BMI (p = 0.001) when using the NOVA system, and with systolic (p = 0.018) and diastolic (p = 0.042) blood pressure when using the UNC system. Food classification methodologies markedly influenced the association between UPF consumption and cardiometabolic risk markers.

Associations between Taste Perception Profiles and Empirically Derived Dietary Patterns: An Exploratory Analysis among Older Adults with Metabolic Syndrome

“…Post hoc exploratory analyses further suggested several interactions by sex in regression models predicting dietary pattern adherence; however, there was insufficient statistical power to conduct stratified analyses by sex in this study. Additionally, in contrast to many Westernized countries, this cohort does not consume large quantities of processed hyperpalatable foods [ 42 ], which may have influenced their taste perception profiles and food choices. To fully understand the impact of taste perception profiles on diet quality will require the replication of this analysis in multiple, diverse cohorts and in various food environments.…”

Integrative development of a short screening questionnaire of highly processed food consumption (sQ-HPF)

“…This, together with the evidence showing their negative impact on health [ 9 , 10 , 14 – 18 ], has turned UPF consumption into a potential public health concern [ 19 ] in need of more solid research. While the term UPF is mainly attributed to the NOVA system, other food processing-based classification systems have described foods and drinks of similar characteristics under their categories of HPF [ 20 , 21 ], so we will use the term HPF to refer to this type of foods.…”

“…Although numerous studies have demonstrated a link between the risk of developing non-communicable diseases and HPF consumption [ 12 , 17 , 22 – 27 ], epidemiological research faces some hurdles in this field. First, the existence of multiple food processing-based classification systems based on different criteria [ 21 , 28 ] results in heterogeneous conclusions regarding health outcomes depending on the system used, as shown recently for cardiometabolic health markers [ 20 ]. Second, the lack of an effective tool to assess HPF consumption in clinical studies severely hinders the downstream analysis of its relationship to disease risk.…”

“…For instance, in the PREDIMED-Plus (from the Spanish “PREvention with MEDiterranean DIet”) trial, dietary intake was assessed through a lengthy food frequency questionnaire (FFQ). Therefore, estimation of HPF consumption requires the classification of FFQ items according to the selected classification system, as previously done [ 20 , 24 , 25 , 29 ]. This process is time-consuming and subject to bias on the part of the researcher classifying the items since FFQs are not specifically designed to include HPF.…”

“…This process is time-consuming and subject to bias on the part of the researcher classifying the items since FFQs are not specifically designed to include HPF. This is because an FFQ is designed to estimate consumption of general commonly consumed foods, of which some may fall into the HPF category, but this depends on the classification system used [ 20 ]. In addition, calculations of daily consumption of each HPF item and percentage over total intake (in grams or kcal per day) are commonly used to infer their association with health outcomes [ 9 , 17 , 30 ].…”