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Comparison of food processing classification frameworks in the NHANES 2017-2018.

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Comparing food processing classification systems reveals consistent links between highly processed foods and poorer health outcomes, highlighting the need for a standardized approach. These findings are crucial for nutrition science, public health policy, and understanding cardiometabolic health.

Keywords:
International Agency for Research on CancerInternational Food Information CouncilNHANESNOVA classificationdiet and nutritionfood classification systemsprocessed foodsultraprocessed foods

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Area of Science:

  • Nutrition Science
  • Public Health
  • Food Policy

Background:

  • Food processing's link to adverse health outcomes is a key focus in nutrition science.
  • Evaluating diverse food processing classification systems offers insights into definitions and implications for research, health, and policy.

Purpose of the Study:

  • To compare the NOVA, International Agency for Research on Cancer (IARC), International Food Information Council (IFIC), and University of North Carolina (UNC) food processing classification systems.
  • To assess their characteristics, reliability, and associations with nutrient intake and cardiometabolic risk factors.

Main Methods:

  • Utilized data from 4,392 adult participants in the 2017-2018 National Health and Nutrition Examination Survey (NHANES).
  • Categorized 4,605 food and beverage items using four classification systems, harmonizing processing levels into minimally processed, processed, and highly processed/formulated foods.
  • Analyzed sociodemographic characteristics, nutrient profiles, and cardiometabolic risk factors using weighted linear regression models.

Main Results:

  • Inter-rater reliability ranged from 68% to 86%. Significant variations in classification proportions were observed across systems (e.g., IARC vs. IFIC for highly processed foods).
  • Top contributors to highly processed/formulated food intake included grain products, meat/poultry/fish mixtures, and sugars/sweets/beverages.
  • Higher intake of highly processed/formulated foods consistently correlated with younger age, specific racial/ethnic groups, lower education, reduced nutrient intake (protein, fiber, micronutrients), increased BMI, and elevated high-sensitivity C-reactive protein levels.

Conclusions:

  • Despite differing classification criteria, consistent associations were found across systems regarding nutrient intake, sociodemographic factors, and cardiometabolic parameters.
  • A standardized food classification system is essential for a unified understanding of ultra-processed foods and their health impacts.