Description and performance of two diet quality scores based on the Nova classification

Area of Science:

• Nutritional epidemiology
• Public health nutrition
• Food systems classification

Background:

• Diet quality assessment is crucial for public health.
• The Nova classification system categorizes foods based on processing level.
• Low-burden tools are needed to assess adherence to healthy dietary patterns.

Purpose of the Study:

• To introduce and validate two low-burden diet quality scores.
• To evaluate the scores' ability to reflect the proportion of unprocessed or minimally processed whole plant foods (WPF) and ultra-processed foods (UPF) in the diet.
• To assess the performance of these scores within the Brazilian population using the NutriNet-Brasil cohort.

Main Methods:

• Cross-sectional study utilizing the NutriNet-Brasil cohort data.
• Development of two scores (Nova-WPF and Nova-UPF) based on a brief 3-minute questionnaire (Nova24hScreener).
• Comparison of score-derived dietary intake with detailed 24-hour dietary recalls for validation.

Main Results:

• Both Nova-WPF and Nova-UPF scores showed a direct, linear relationship with corresponding dietary energy intake (p < 0.001).
• Substantial agreement was observed between score intervals and actual dietary intake (Nova-WPF PABAK=0.72; Nova-UPF PABAK=0.79).
• High reliability indicates the scores accurately represent dietary patterns.

Conclusions:

• The developed Nova-WPF and Nova-UPF scores are effective tools for assessing diet quality in Brazil.
• These scores demonstrate good performance in reflecting the intake of unprocessed/minimally processed whole plant foods and ultra-processed foods.
• The scores are suitable for evaluating and monitoring diet quality at a population level.