Assessing the Consumption of Ultra-Processed Foods in People with Diabetes: Is a Specific NOVA Questionnaire Always Necessary?

BACKGROUND/OBJECTIVES: Despite the accumulating evidence on the detrimental impact of UPFs on health, a common limit of the available studies concerns the instruments used to collect information about the consumption of processed foods. Recently, a specific NOVA-FFQ was proposed for the evaluation of ultra-processed food (UPF) consumption, but it does not allow the simultaneous assessment of energy and nutrient intake. We evaluate the concordance between the NOVA-FFQ and a common questionnaire (EPIC-FFQ) when assessing (1) the intake of foods with different degrees of processing and (2) the relationship between diet composition and cardiometabolic profile.

METHODS

One hundred and thirty people with diabetes (70 men and 60 women) completed the NOVA-FFQ and the EPIC-FFQ in random order two weeks apart. Anthropometric and major cardiovascular risk factors were measured.

RESULTS

Non-significant differences were detected for processed culinary ingredients and processed foods; larger significant differences were observed for minimally processed foods and UPFs, which were somewhat underestimated by the EPIC-FFQ (-24% vs. -21%, respectively; < 0.001). However, Bland-Altman plots showed intraindividual differences between the two questionnaires within an acceptable range, and the intraclass correlation showed a moderate consistency. Furthermore, the energy and nutrient composition of the diet and the metabolic parameters were comparable for people classified in the highest tertile of UPF consumption by either method.

CONCLUSIONS

The NOVA-FFQ provides more detailed information on the consumption of UPF foods; however, the EPIC-FFQ is a valid alternative, particularly practical when the simultaneous assessment of the overall quality of the diet is needed.