Decision flowchart for food classification by the extension and purpose of industrial processing: update and practical application
Keywords:
Classification, Flowchart, Food processing, Healthy eatingAbstract
Objective
To describe the development and update of an instrument for food categorisation according to the extension and purpose of industrial processing, and to test its practical application.
Methods
After updating the instrument based on a recent publication on the NOVA classification, it was applied by five researchers to a database of 108 food items. These items are part of a database of foods announced in the health-related sections of supermarket promotional circulars. The Cohen’s weighted kappa coefficient was calculated to determine intra-rater agreement; Fleiss’ kappa and Kendall’s coefficient were applied to determine inter-rater agreement.
Results
In the updated version, two classes of additives and eight substances considered by the most recent publication as specific to ultra-processed foods were added. The intra-rater agreement was 100% (p<0.001), indicating an “almost perfect” agreement; Fleiss’ agreement among all raters ranged from 74% to 97% (p<0.001), which represents an agreement that ranged from “strong” to “almost perfect”; Kendall’s W was higher than 0.93 (p<0.001) among all raters.
Conclusion
The updated instrument showed high agreement and proved to be a methodologically sound and applicable tool for the purpose of classifying foods by the extension and purpose of industrial processing.
References
Food and Agriculture Organization of the United Nations. Guidelines on the collection of information on food processing through food consumption surveys. Rome: The Organization; 2015 [cited 2021 May 5]. Available from: http://www.fao.org/3/i4690e/i4690e.pdf
Pan American Health Organization of the World Health Organization. Ultra- processed food and drink products in Latin America: trends, impact on obesity, policy implications. Washington: The Organization; 2015 [cited 2021 Apr 26]. Available from: https://iris.paho.org/bitstream/handle/10665.2/7699/9789275118641_eng.pdf
Moubarac J-C, Parra DC, Cannon G, Monteiro CA. Food Classification Systems Based on Food Processing: significance and implications for policies and actions: a systematic literature review and assessment. Curr Obes Rep. 2014;3(2):256-72, https://doi.org/10.1007/s13679-014-0092-0
Ministério da Saúde (Brasil). Dietary Guidelines for the Brazilian Population. Brasília: Ministério; 2015. [cited 2020 Dec 2]. Available from: http://bvsms.saude.gov.br/bvs/publicacoes/dietary_guidelines_brazilian_population.pdf
Monteiro CA, Cannon G, Moubarac J-C, Levy RB, Louzada MLC, Jaime PC. The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing. Public Health Nutr. 2018;21(1):5-17, https://doi.org/10.1017/s1368980017000234
World Health Organization. Global Strategy on Diet Physical Activity and Health. Geneva: Organization; 2004 [cited 2021 Mar 15]. Available from: https://www.who.int/dietphysicalactivity/strategy/eb11344/strategy_english_web.pdf
Monteiro CA, Cannon G, Levy R, Moubarac J-C, Jaime P, Martins AP, et al. NOVA: the star shines bright. World Nutr. 2016;7(1-3):28-38.
Martins APB, Levy RB, Claro RM, Moubarac JC, Monteiro CA, Martins APB, et al. Participação crescente de produtos ultraprocessados na dieta brasileira (1987-2009). Rev Saude Publica. 2013;47(4):656-65, https://doi.org/10.1590/S0034-8910.2013047004968
Canella DS, Levy RB, Martins APB, Claro RM, Moubarac J-C, Baraldi LG, et al. Ultra-processed food products and obesity in brazilian households (2008-2009). Plos One. 2014;9(3):e92752, https://doi.org/10.1371/journal.pone.0092752
Louzada MLC, Martins APB, Canella DS, Baraldi LG, Levy RB, Claro RM, et al. Ultra-processed foods and the nutritional dietary profile in Brazil. Rev Saude Publica. 2015;49(38):1-17. https://doi.org/10.1590/S0034-8910.2015049006132
Steele EM, Baraldi LG, Louzada MLC, Moubarac J-C, Mozaffarian D, Monteiro CA. Ultra-processed foods and added sugars in the US diet: evidence from a nationally representative cross-sectional study. BMJ Open. 2016;6(3):e009892, http://dx.doi.org/10.1136/bmjopen-2015-009892
Cediel G, Reyes M, Louzada MLC, Steele EM, Monteiro CA, Corvalán C, et al. Ultra-processed foods and added sugars in the Chilean diet (2010). Public Health Nutr. 2018;21(1):125-33, https://doi.org/10.1017/s1368980017001161
Marrón-Ponce JA, Sánchez-Pimienta TG, Louzada MLC, Batis C. Energy contribution of NOVA food groups and sociodemographic determinants of ultra-processed food consumption in the Mexican population. Public Health Nutr. 2018;21(1):87-93, https://doi.org/10.1017/s1368980017002129
Rauber F, Steele EM, Louzada MLC, Millett C, Monteiro CA, Levy RB. Ultra-processed food consumption and indicators of obesity in the United Kingdom population (2008-2016). Plos One. 2020;15(5): e0232676. https://doi.org/10.1371/journal.pone.0232676
Ministério da Saúde (Brasil). Resolução RDC no 259, de 20 de setembro de 2002. Aprova o regulamento técnico sobre rotulagem de alimentos embalados. Brasília: Diário Oficial da União; 2002.
Monteiro CA, Levy RB, Claro RM, Castro IRR, Cannon G. A new classification of foods based on the extent and purpose of their processing. Cad Saude Publica. 2010;26:2039-49. https://doi.org/10.1590/S0102-311X2010001100005
Monteiro CA, Cannon G, Levy RB, Moubarac J-C, Louzada ML, Rauber F, et al. Ultra-processed foods: what they are and how to identify them. Public Health Nutr. 2019;22(5):936-41. https://doi.org/10.1017/s1368980018003762
Botelho AM, Camargo AM, Dean M, Fiates GMR. Effect of a health reminder on consumers’ selection of ultraprocessed foods in a supermarket. Food Qual Prefer. 2019;71:431-7. https://doi.org/10.1016/j.foodqual.2018.08.017
Botelho AM, Camargo AM, Medeiros KJ, Irmão GB, Dean M, Fiates GMR. Supermarket circulars promoting the sales of “healthy” foods: analysis based on degree of processing. Nutrients. 2020;12(9):e2877, https://doi.org/10.3390/nu12092877
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159-74.
Ministério da Saúde (Brasil). Resolução RDC no 45, de 03 de novembro de 2010. Dispõe sobre aditivos alimentares autorizados para uso segundo as Boas Práticas de Fabricação (BPF). Brasília: Diário Oficial da União; 2010.
Berchtold A. Test–retest: Agreement or reliability? Methodol Innov. 2016;9:e205979911667287. https://doi.org/10.1177%2F2059799116672875
Kottner J, Audigé L, Brorson S, Donner A, Gajewski BJ, Hróbjartsson A, et al. Guidelines for Reporting Reliability and Agreement Studies (GRRAS) were proposed. J Clin Epidemiol. 2011;64(1):96-106. https://doi.org/10.1016/j.jclinepi.2010.03.002
Gisev N, Bell JS, Chen TF. Interrater agreement and interrater reliability: key concepts, approaches, and applications. Res Soc Adm Pharm. 2013;9(3):330-8. https://doi.org/10.1016/j.sapharm.2012.04.004
Mandrekar JN. Measures of Interrater Agreement. J Thorac Oncol. 2011;6(1):6-7. https://doi.org/10.1097/JTO.0b013e318200f983
Legendre P. Species associations: the Kendall coefficient of concordance revisited. J Agric Biol Environ Stat. 2005;10(2):226-45. https://doi.org/10.1198/108571105X46642
Rauber F, Louzada ML, Steele EM, Millett C, Monteiro CA, et al. Ultra-Processed food consumption and chronic noncommunicable diseases-related dietary nutrient profile in the UK (2008–2014). Nutrients. 2018;10(5):e587. https://doi.org/10.3390/nu10050587
Elizabeth L, Machado P, Zinöcker M, Baker P, Lawrence M. Ultra-Processed foods and health outcomes: a narrative review. Nutrients. 2020;12(7):1955. https://dx.doi.org/10.3390%2Fnu12071955
Pagliai G, Dinu M, Madarena MP, Bonaccio M, Iacoviello L, Sofi F. Consumption of ultra-processed foods and health status: a systematic review and meta-analysis. Br J Nutr. 2021;125(3):308-18. https://doi.org/10.1017/s0007114520002688
Ares G, Vidal L, Allegue G, Giménez A, Bandeira E, Moratorio X, et al. Consumers’ conceptualization of ultraprocessed foods. Appetite. 2016;105:611-7. https://doi.org/10.1016/j.appet.2016.06.028
Louzada ML, Baraldi LG, Steele EM, Martins AP, Canella DS, Moubarac J-C, et al. Consumption of ultra-processed foods and obesity in Brazilian adolescents and adults. Am J Prev Med. 2015;81:9-15. https://doi.org/10.1016/j.ypmed.2015.07.018
