Alignment of Food Processing Classification Systems with Nutrient Quality (OR14-01-19)

Abstract Objectives Processed foods are associated with energy-dense eating patterns among children, yet research using food processing classification systems has led to varying conclusions regarding the impact of processed foods on dietary quality. This study utilized three common classification systems to examine (a) agreement between systems for processing level assignment, and (b) relationships between processing level, as determined by each classification system, and individual nutrient concentrations for foods commonly consumed by children. Methods The Nova, International Food Information Council (IFIC), and the University of North Carolina (UNC) systems were examined. Two researchers independently coded processing level according to each system's criteria for the 100 most commonly consumed foods by children 6–12 yrs (NHANES 2013–2014). Inter-rater reliability was assessed using Spearman's rank correlation. Concentration of under- (potassium, fiber, choline, magnesium, calcium, iron, vitamins A, D, E, and C) and over-consumed (added sugars, saturated fat and sodium) nutrients were quantified for 100 grams of each food. Alignment of processing classification systems with nutrient concentration was investigated using linear discriminant analysis and multinomial logistic regression, and compared among systems using Cohen's kappa. Results Most foods were classified as highly processed (70%, 62% 53%, for the Nova, UNC and IFIC system, respectively). The UNC system had the highest inter-rater reliability (r = 0.97, P < 0.001), followed by IFIC (r = 0.78, P < 0.001) and Nova (r = 0.76, P < 0.001). Processing level was associated with greater sodium and total sugars for both UNC and IFIC, and iron for IFIC. Minimal processing was associated with a higher concentration of vitamin C for IFIC and UNC. There were no other significant associations. Agreement was highest between Nova and UNC (k = 0.61, P < 0.001) and lowest between Nova and IFIC (k = 0.52, P < 0.001). Conclusions Processing classification systems may differentiate highly processed foods by their nutrient qualities, but not moderately or minimally processed. Universal definitions for processing level assignment are needed to ensure consistent methodology in studies examining the relationship between processed food intake and health. Funding Sources NA.

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Robustness of Food Processing Classification Systems

Nutrients ◽

10.3390/nu11061344 ◽

2019 ◽

Vol 11 (6) ◽

pp. 1344 ◽

Cited By ~ 7

Author(s):

Rachel Bleiweiss-Sande ◽

Kenneth Chui ◽

E. Whitney Evans ◽

Jeanne Goldberg ◽

Sarah Amin ◽

...

Keyword(s):

Food Processing ◽

Nutrient Concentration ◽

Multinomial Logistic Regression ◽

Classification Systems ◽

Dietary Quality ◽

Minimally Processed ◽

Rater Reliability ◽

Linear Discriminant ◽

The Relationship

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.

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Perceptions of Processed Foods Among Low-Income and Immigrant Parents

Health Education & Behavior ◽

10.1177/1090198119885419 ◽

2019 ◽

Vol 47 (1) ◽

pp. 101-110 ◽

Cited By ~ 1

Author(s):

Rachel Bleiweiss-Sande ◽

Jeanne Goldberg ◽

E. Whitney Evans ◽

Kenneth Chui ◽

Jennifer Sacheck

Keyword(s):

Focus Groups ◽

Low Income ◽

Food Processing ◽

Classification Systems ◽

Future Research ◽

Immigrant Parents ◽

Processed Foods ◽

Foreign Born ◽

Processing Level ◽

Definition Of

Background. Parent-aimed guidance on the topic of processed foods may help limit highly processed foods in children’s diets, but little is known about parent understanding and perceptions of these products. Aims. To determine how parent perceptions of processing align with processing classification systems used in research, and to identify opportunities for future research in communicating information about processed foods. Method. Six focus groups with lower income, racial/ethnic minority and immigrant parents of fourth to sixth graders ( n = 37) were conducted. Parents were asked to discuss their views on terminology related to food processing, classification of foods according to their processing level, the healthfulness of select foods, and criteria for choosing snacks for their children. Focus groups were guided by a thematic approach. NVivo 12 (QSR International) was used to facilitate analyses. Results. Thirty mothers and seven fathers participated. Two thirds (62%) were foreign-born; 38% identified as Hispanic. The term “processing” lacked consistent meaning among parents, with variation by immigrant status. Participants associated highly processed foods with convenience, packaging, and added ingredients; “less-processed” versions of foods (e.g., fresh; homemade) were perceived as healthier. Children’s preferences were the main criteria for choosing snacks. Foreign-born parents were more likely to associate processed foods with positive characteristics (e.g., properly cooked). Conclusion. The concept of food processing is an area of misconception among parents, providing an opportunity for education that may be extended to larger audiences. A universally accepted definition of food classification by processing level is necessary to effectively communicate the link between processing and healthfulness.

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A Multidisciplinary Perspective of Ultra-Processed Foods and Associated Food Processing Technologies: A View of the Sustainable Road Ahead

Nutrients ◽

10.3390/nu13113948 ◽

2021 ◽

Vol 13 (11) ◽

pp. 3948

Author(s):

Francesco Capozzi ◽

Faidon Magkos ◽

Fabio Fava ◽

Gregorio Paolo Milani ◽

Carlo Agostoni ◽

...

Keyword(s):

Health Outcomes ◽

Food Processing ◽

Low Cost ◽

Classification Systems ◽

Processed Foods ◽

Processing Technologies ◽

Adverse Health Outcomes ◽

Increased Risk ◽

Multidisciplinary Perspective ◽

By Products

Ultra-processed foods (UPFs) are negatively perceived by part of the scientific community, the public, and policymakers alike, to the extent they are sometimes referred to as not “real food”. Many observational surveys have linked consumption of UPFs to adverse health outcomes. This narrative synthesis and scientific reappraisal of available evidence aims to: (i) critically evaluate UPF-related scientific literature on diet and disease and identify possible research gaps or biases in the interpretation of data; (ii) emphasize the innovative potential of various processing technologies that can lead to modifications of the food matrix with beneficial health effects; (iii) highlight the possible links between processing, sustainability and circular economy through the valorisation of by-products; and (iv) delineate the conceptual parameters of new paradigms in food evaluation and classification systems. Although greater consumption of UPFs has been associated with obesity, unfavorable cardiometabolic risk factor profiles, and increased risk for non-communicable diseases, whether specific food processing techniques leading to ultra-processed formulations are responsible for the observed links between UPFs and various health outcomes remains elusive and far from being understood. Evolving technologies can be used in the context of sustainable valorisation of food processing by-products to create novel, low-cost UPFs with improved nutritional value and health potential. New paradigms of food evaluation and assessment should be funded and developed on several novel pillars—enginomics, signalling, and precision nutrition—taking advantage of available digital technologies and artificial intelligence. Research is needed to generate required scientific knowledge to either expand the current or create new food evaluation and classification systems, incorporating processing aspects that may have a significant impact on health and wellness, together with factors related to the personalization of foods and diets, while not neglecting recycling and sustainability aspects. The complexity and the predicted immense size of these tasks calls for open innovation mentality and a new mindset promoting multidisciplinary collaborations and partnerships between academia and industry.

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Variation of Adolescent Snack Food Choices and Preferences along a Continuum of Processing Levels: The Case of Apples

Foods ◽

10.3390/foods8020050 ◽

2019 ◽

Vol 8 (2) ◽

pp. 50 ◽

Cited By ~ 2

Author(s):

Elizabeth Svisco ◽

Carmen Byker Shanks ◽

Selena Ahmed ◽

Katie Bark

Keyword(s):

Elementary School ◽

Food Processing ◽

Food Choices ◽

Snack Food ◽

Processed Foods ◽

Minimally Processed ◽

Food Ingredients ◽

Snack Foods ◽

Food Items ◽

Processing Level

Food processing is used for transforming whole food ingredients into food commodities or edible products. The level of food processing occurs along a continuum from unprocessed to minimally processed, processed, and ultra-processed. Unprocessed foods use little to no processing and have zero additives. Minimally processed foods use finite processing techniques, including drying, freezing, etc., to make whole food ingredients more edible. Processed foods combine culinary ingredients with whole foods using processing and preservation techniques. Ultra-processed foods are manufactured using limited whole food ingredients and a large number of additives. Ultra-processed snack foods are increasing in food environments globally with detrimental implications for human health. This research characterizes the choices, consumption, and taste preferences of adolescents who were offered apple snack food items that varied along a processing level continuum (unprocessed, minimally processed, processed, and ultra-processed). A cross-sectional study was implemented in four elementary school classrooms utilizing a buffet of apple snack food items from the aforementioned four food processing categories. A survey was administered to measure students’ taste acceptance of the snacks. The study found that the students selected significantly (p < 0.0001) greater quantities of ultra-processed snack foods (M = 2.20 servings, SD = 1.23) compared to minimally processed (M = 0.56 servings, SD = 0.43) and unprocessed (M = 0.70 servings, SD = 0.37) snack foods. The students enjoyed the taste of ultra-processed snack foods (M = 2.72, SD = 0.66) significantly more (p < 0.0001) than minimally processed (M = 1.92, SD = 1.0) and unprocessed (M = 2.32, SD = 0.9) snack foods. A linear relationship was found between the selection and consumption quantities for each snack food item (R2 = 0.88). In conclusion, it was found that as processing levels increase in apple snack foods, they become more appealing and more heavily consumed by elementary school students. If applied broadly to snack foods, this conclusion presents one possible explanation regarding the high level of diet-related diseases and nutrient deficiencies across adolescents in America. Food and nutrition education, food product development, and marketing efforts are called upon to improve adolescent food choices and make less-processed snack food options more appealing and accessible to diverse consumers.

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

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18115771 ◽

2021 ◽

Vol 18 (11) ◽

pp. 5771

Author(s):

Michelle Blumfield ◽

Carlene Starck ◽

Tim Keighley ◽

Peter Petocz ◽

Anna Roesler ◽

...

Keyword(s):

Diet Quality ◽

Low Cost ◽

Food Group ◽

Cost Ratio ◽

Economic Modelling ◽

Processed Foods ◽

Added Sugars ◽

Processing Level ◽

Nutrient Density ◽

The Impact

Food costs are a barrier to healthier diet selections, particularly for low socioeconomic households who regularly choose processed foods containing refined grains, added sugars, and added fats. In this study, the objectives were to: (i) identify the nutrient density-to-cost ratio of Australian foods; (ii) model the impact of substituting foods with lower nutrient density-to-cost ratio with those with the highest nutrient density-to-cost ratio for diet quality and affordability in low and medium socioeconomic households; and (iii) evaluate food processing levels. Foods were categorized, coded for processing level, analysed for nutrient density and cost, and ranked by nutrient density-to-cost ratio. The top quartile of nutrient dense, low-cost foods included 54% unprocessed (vegetables and reduced fat dairy), 33% ultra-processed (fortified wholegrain bread and breakfast cereals <20 g sugars/100 g), and 13% processed (fruit juice and canned legumes). Using substitution modelling, diet quality improved by 52% for adults and 71% for children across all households, while diet affordability improved by 25% and 27% for low and medium socioeconomic households, respectively. The results indicate that the quality and affordability of the Australian diet can be improved when nutritious, low-cost foods are selected. Processing levels in the healthier modelled diets suggest that some ultra-processed foods may provide a beneficial source of nutrition when consumed within national food group recommendations.

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Starch Polysaccharides in the Human Diet: Effect of the Different Source and Processing on its Absorption

Natural Product Communications ◽

10.1177/1934578x1701200606 ◽

2017 ◽

Vol 12 (6) ◽

pp. 1934578X1701200 ◽

Cited By ~ 2

Author(s):

Danilo Perin ◽

Erminio Murano

Keyword(s):

Gut Microbiota ◽

Food Processing ◽

Industrial Applications ◽

Processed Foods ◽

Future Trends ◽

Human Diet ◽

Industrial Processing ◽

Food Industries ◽

Starch Composition ◽

The Impact

Starch is the main source of carbohydrates in human diet. It is widely used in food processing and non-food industrial applications. The effects on starch digestion and absorption in humans are reviewed in relation to the starch composition, sources, plant genetic variation, food processing and cooking. The impact of food industrial processing and starch modification on the digestibility of starch containing foods and on gut microbiota are discussed. Considering that the resistant starch (RS) fraction escaped from the small intestine is fermented in large intestine, all the variables that influence starch digestibility and absorption must be taken into account when discussing about healthy properties of fibers. Future trends in food industries are aimed to increase the RS fraction in processed foods in order to improve nutritional quality as well as to clarify the influence of RS3 and RS4 on gut microbiota.

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Consumption of ultra-processed food and obesity: cross sectional results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort (2008–2010)

Public Health Nutrition ◽

10.1017/s1368980018000861 ◽

2018 ◽

Vol 21 (12) ◽

pp. 2271-2279 ◽

Cited By ~ 24

Author(s):

Fernanda Marcelina Silva ◽

Luana Giatti ◽

Roberta Carvalho de Figueiredo ◽

Maria del Carmen Bisi Molina ◽

Letícia de Oliveira Cardoso ◽

...

Keyword(s):

Longitudinal Study ◽

Total Energy ◽

Energy Intake ◽

Food Processing ◽

Multinomial Logistic Regression ◽

Total Energy Intake ◽

Processed Foods ◽

Adult Health ◽

Energy Contribution ◽

Cross Sectional

AbstractObjectiveTo verify if the intake of ultra-processed foods is associated with higher BMI and waist circumference (WC) among participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort.DesignCross-sectional analysis of the ELSA-Brasil baseline (2008–2010). Dietary information obtained through an FFQ was classified according to characteristics of food processing (NOVA) and used to estimate the percentage energy contribution from ultra-processed foods (i.e. industrial formulations, elaborated from food processing, synthetic constituents and food additives) to individuals’ total energy intake. BMI and WC and their respective cut-off points served as response variables. Associations were estimated through linear and multinomial logistic regression models, after adjusting for confounders and total energy intake.SettingSix Brazilian capital cities, 2008–2010.SubjectsActive and retired civil servants, aged 35–64 years, from universities and research organizations (n8977).ResultsUltra-processed foods accounted for 22·7 % of total energy intake. After adjustments, individuals in the fourth quartile of percentage energy contribution from ultra-processed foods presented (β; 95 % CI) a higher BMI (0·80; CI 0·53, 1·07 kg/m2) and WC (1·71; 1·02, 2·40 cm), and higher chances (OR; 95 % CI) of being overweight (1·31; 1·13, 1·51), obese (1·41; 1·18, 1·69) and having significantly increased WC (1·41; 1·20, 1·66), compared with those in the first quartile. All associations suggest a dose–response gradient.ConclusionsResults indicate the existence of associations between greater energy contribution from ultra-processed foods and higher BMI and WC, which are independent of total energy intake. These findings corroborate public policies designed to reduce the intake of this type of food.

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Addressing Challenges with the Categorization of Foods Processed at Home: A Pilot Methodology to Inform Consumer-Facing Guidance

Nutrients ◽

10.3390/nu12082373 ◽

2020 ◽

Vol 12 (8) ◽

pp. 2373

Author(s):

Rachel Bleiweiss-Sande ◽

Caitlin P. Bailey ◽

Jennifer Sacheck ◽

Jeanne P. Goldberg

Keyword(s):

North Carolina ◽

Food Processing ◽

Processed Foods ◽

Microsoft Excel ◽

Processing Level ◽

Health And Nutrition ◽

Chapel Hill ◽

Nationally Representative ◽

Hispanic White ◽

Processing Framework

The objective of this study was to inform consumer-facing dietary guidance by (1) adapting the current University of North Carolina at Chapel Hill (UNC) food processing framework to include a home processing (HP) component and (2) pilot testing the adapted version using a nationally representative sample of foods consumed in the U.S. The UNC framework was adapted to include guidelines for categorizing home-prepared (HP) foods. The original UNC and adapted HP frameworks were used to code dietary recalls from a random sample of National Health and Nutrition Examination Survey (2015–2016 cycle) participants (n = 100; ages 2–80 years). Percent changes between the UNC and HP adapted frameworks for each processing category were calculated using Microsoft Excel, version 16.23. Participants were 56% female, 35% non-Hispanic white (mean age = 31.3 ± 23.8). There were 1,376 foods with 651 unique foods reported. Using the HP compared to the UNC framework, unprocessed/minimally processed foods declined by 11.7% (UNC: 31.0% vs. HP: 27.4%); basic processed foods increased by 116.8% (UNC: 8.2% vs. HP: 17.8%); moderately processed foods increased by 16.3% (UNC: 14.2% vs. HP: 16.6%); and highly processed foods decreased by 17.8% (UNC: 46.5% vs. HP: 38.2%). Home-prepared foods should be considered as distinct from industrially produced foods when coding dietary data by processing category. This has implications for consumer-facing dietary guidance that incorporates processing level as an indicator of diet quality.

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Processed and ultra-processed foods are associated with lower-quality nutrient profiles in children from Colombia

Public Health Nutrition ◽

10.1017/s1368980017000891 ◽

2017 ◽

Vol 21 (1) ◽

pp. 142-147 ◽

Cited By ~ 29

Author(s):

Brittany Cornwell ◽

Eduardo Villamor ◽

Mercedes Mora-Plazas ◽

Constanza Marin ◽

Carlos A Monteiro ◽

...

Keyword(s):

School Children ◽

Food Processing ◽

Dietary Quality ◽

Processed Foods ◽

Minimally Processed ◽

Convenience Sample ◽

Middle Income ◽

Dietary Records ◽

Influence Of Food ◽

Nutrient Profiles

AbstractObjectiveTo determine if processed and ultra-processed foods consumed by children in Colombia are associated with lower-quality nutrition profiles than less processed foods.DesignWe obtained information on sociodemographic and anthropometric variables and dietary information through dietary records and 24 h recalls from a convenience sample of the Bogotá School Children Cohort. Foods were classified into three categories: (i) unprocessed and minimally processed foods, (ii) processed culinary ingredients and (iii) processed and ultra-processed foods. We also examined the combination of unprocessed foods and processed culinary ingredients.SettingRepresentative sample of children from low- to middle-income families in Bogotá, Colombia.SubjectsChildren aged 5–12 years in 2011 Bogotá School Children Cohort.ResultsWe found that processed and ultra-processed foods are of lower dietary quality in general. Nutrients that were lower in processed and ultra-processed foods following adjustment for total energy intake included: n-3 PUFA, vitamins A, B12, C and E, Ca and Zn. Nutrients that were higher in energy-adjusted processed and ultra-processed foods compared with unprocessed foods included: Na, sugar and trans-fatty acids, although we also found that some healthy nutrients, including folate and Fe, were higher in processed and ultra-processed foods compared with unprocessed and minimally processed foods.ConclusionsProcessed and ultra-processed foods generally have unhealthy nutrition profiles. Our findings suggest the categorization of foods based on processing characteristics is promising for understanding the influence of food processing on children’s dietary quality. More studies accounting for the type and degree of food processing are needed.

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Chemicals, cans and factories: how grade school children think about processed foods

Public Health Nutrition ◽

10.1017/s1368980019003859 ◽

2020 ◽

Vol 23 (10) ◽

pp. 1735-1744 ◽

Cited By ~ 1

Author(s):

Rachel Bleiweiss-Sande ◽

Jeanne Goldberg ◽

E Whitney Evans ◽

Ken Chui ◽

Caitlin Bailey ◽

...

Keyword(s):

Focus Groups ◽

Low Income ◽

Classification Systems ◽

Urban School District ◽

Processed Foods ◽

Processing Level ◽

The Usa ◽

And Storage ◽

Racial Ethnic ◽

Storage Change

AbstractObjective:To determine how children interpret terms related to food processing; whether their categorisation of foods according to processing level is consistent with those used in research; and whether they associate the degree of processing with healthfulness.Design:Qualitative data were collected from ten focus groups. Focus groups were audio-recorded, transcribed verbatim, and thematic analysis was conducted.Setting:Four elementary and afterschool programmes in a large, urban school district in the USA that served predominantly low-income, racial/ethnic minority students.Participants:Children, 9–12 years old, in the fourth–sixth grades (n 53).Results:The sample was 40 % male, 47 % Hispanic with a mean age of 10·4 ± 1·1 years. Children’s understanding of unprocessed foods was well aligned with research classifications, while concordance of highly processed foods with research categorisations varied. Five primary themes regarding the way children categorised foods according to their processing level emerged: type and amount of added ingredients; preparation method; packaging and storage; change in physical state or sensory experience; and growing method. Most children associated processing level with healthfulness, describing unprocessed foods as healthier. The most common reason provided for the unhealthfulness of processed foods was added ingredients, including ‘chemicals’ and ‘sugar’.Conclusions:The current study demonstrated that children have a working knowledge of processing that could be leveraged to encourage healthier eating patterns; however, their understanding is not always consistent with the classification systems used in research. The vocabulary used by researchers and consumers to talk about processing must be reconciled to translate findings into actionable messages.

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