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Comparison of food processing classification frameworks in the NHANES 2017-2018
Shutong Du1, Jiaqi Yang1, Valerie K Sullivan1
1Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, United States; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States.
The American Journal of Clinical Nutrition
|January 30, 2026
Summary
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.
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.
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