Loftfield Erikka, Zhang Pei, O'Connell Caitlin P, Kahle Lisa L, Herrick Kirsten, Abar Leila, Khandpur Neha, Steele Eurídice Martínez, Hong Hyokyoung G
Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, United States.
Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, United States.
J Nutr. 2025 Jul;155(7):2376-2384. doi: 10.1016/j.tjnut.2025.04.029. Epub 2025 May 5.
How accurately ultraprocessed food (UPF) intake is measured by food frequency questionnaire (FFQ) is unknown.
We evaluated the performance of a 124-item FFQ for estimating UPF intake with Nova.
In 1311 NIH-AARP Diet and Health Study participants who completed 2 nonconsecutive 24-hour dietary recalls (24HDR) and 2 FFQ, we used 2 methods to estimate UPF intake. First, 4 experts independently matched FFQ items to food descriptions from another FFQ classified previously according to Nova. Discordant descriptions were discussed, and a consensus reached. Second, data from the 1994-1996 Continuing Survey of Food Intake of Individuals were used to match disaggregated FFQ items to Food and Nutrient Database for Dietary Studies (FNDDS) and standard reference (SR) codes. Nova classification of FNDDS and SR codes was based on database linkage. We evaluated FFQ performance using a measurement error model with 2 24HDR as the reference to estimate validity coefficients (ρ) and attenuation factors (λ). We applied parametric bootstrapping to construct 95% confidence intervals, accounting for the repeated measures structure in the data.
For energy-adjusted, kilocalories from UPF (kcal/d), ρ were 0.50 (0.39-0.61) and 0.44 (0.30-0.59), for males and females, respectively, for the expert consensus method (ECM) and 0.52 (0.40-0.63) and 0.43 (0.29-0.57) for the food code method (FCM). For energy-adjusted, gram weight from UPF (g/d), ρ were 0.65 (0.60-0.71) and 0.66 (0.60-0.72) for the ECM and 0.66 (0.52-0.65) and 0.66 (0.59-0.72) for the FCM; λ were ≥0.50 for both methods. UPF variables, defined using the ECM and FCM but expressed in the same unit, were highly correlated (r ≥ 0.97).
FCM, performed similarly to ECM but has the potential to standardize UPF exposures across studies because the Nova categorization is assigned at a more granular level through database linkage. UPF intake based on energy-adjusted gram weight outperformed intake based on energy alone.
食物频率问卷（FFQ）对超加工食品（UPF）摄入量的测量准确性尚不清楚。
我们评估了一份包含124个条目的FFQ使用诺瓦分类法估算UPF摄入量的性能。
在1311名完成了2次非连续24小时膳食回顾（24HDR）和2次FFQ的美国国立卫生研究院-美国退休人员协会饮食与健康研究参与者中，我们使用两种方法估算UPF摄入量。首先，4名专家独立将FFQ条目与先前根据诺瓦分类法分类的另一份FFQ中的食物描述进行匹配。对不一致的描述进行讨论并达成共识。其次，利用1994 - 1996年个人食物摄入量持续调查的数据，将分解后的FFQ条目与膳食研究食物和营养数据库（FNDDS）及标准参考（SR）代码进行匹配。FNDDS和SR代码的诺瓦分类基于数据库链接。我们使用以2次24HDR为参考的测量误差模型评估FFQ性能，以估计效度系数（ρ）和衰减因子（λ）。我们应用参数自举法构建95%置信区间，考虑到数据中的重复测量结构。
对于能量调整后的UPF千卡摄入量（千卡/天），专家共识法（ECM）中男性和女性的ρ分别为0.50（0.39 - 0.61）和0.44（0.30 - 0.59），食物编码法（FCM）中分别为0.52（0.40 - 0.63）和0.43（0.29 - 0.57）。对于能量调整后的UPF克重量摄入量（克/天），ECM的ρ为0.65（0.60 - 0.71）和0.66（0.60 - 0.72），FCM的ρ为0.66（0.52 - 0.65）和0.66（0.59 - 0.72）；两种方法的λ均≥0.50。使用ECM和FCM定义但以相同单位表示的UPF变量高度相关（r≥0.97）。
FCM的表现与ECM相似，但有可能在各项研究中标准化UPF暴露情况，因为诺瓦分类是通过数据库链接在更精细的层面上进行分配的。基于能量调整后的克重量的UPF摄入量比仅基于能量的摄入量表现更好。
