An Overlap Between "Ultraprocessed" Foods and the Preexisting Nutrient Rich Foods Index?

The category of "ultra-processed" foods in the NOVA food classification scheme is ostensibly based on industrial processing. We compared NOVA category assignments with the pre-existing family of Nutrient Rich Food (NRF) indices, first developed in 2005. NRF indices are composed of two subscores; the positive NRn based on protein, fiber, and n vitamins and minerals, and the negative LIM subscore based on saturated fat, added sugar, and sodium. The 378 foods that were components of the widely used Fred Hutchinson Cancer Center food frequency questionnaire were assigned to NOVA categories and scored using multiple NRF indices. Contrary to published claims, NOVA was largely based on the foods' content of saturated fat, added sugars, and sodium. There were strong similarities between NOVA categories and NRF scores that were largely driven by the foods' content of fat, sugar, and salt. Nutrient density increased NRF scores but had less impact on NOVA categories. As a result, the NOVA scheme misclassified some nutrient-rich foods. Both NOVA categories and NRF scores were strongly affected by the amounts of saturated fat, added sugars, and sodium. Ultra-processed foods and culinary ingredients received lower NRF scores. We conclude that the arbitrary NOVA classification scheme adds little to the pre-existing nutrient profiling models. The purported links between NOVA categories and health outcomes could have been obtained using pre-existing NRF nutrient density metrics.