@misc{10481/79764,
year = {2022},
month = {12},
url = {https://hdl.handle.net/10481/79764},
abstract = {Background: Epidemiological studies have demonstrated an association
between the degree of food processing in our diet and the risk of various
chronic diseases. Much of this evidence is based on the international Nova
classification system, which classifies food into four groups based on the type
of processing: (1) Unprocessed and minimally processed foods, (2) Processed
culinary ingredients, (3) Processed foods, and (4) “Ultra-processed” foods
(UPF). The ability of the Nova classification to accurately characterise the
degree of food processing across consumption patterns in various European
populations has not been investigated so far. Therefore, we applied the Nova
coding to data from the European Prospective Investigation into Cancer and
Nutrition (EPIC) in order to characterize the degree of food processing in our
diet across European populations with diverse cultural and socio-economic
backgrounds and to validate this Nova classification through comparison with
objective biomarker measurements.
Methods: After grouping foods in the EPIC dataset according to the Nova
classification, a total of 476,768 participants in the EPIC cohort (71.5% women;
mean age 51 [standard deviation (SD) 9.93]; median age 52 [percentile (p)25–
p75: 58–66] years) were included in the cross-sectional analysis that
characterised consumption patterns based on the Nova classification. The
consumption of food products classified as different Nova categories were
compared to relevant circulating biomarkers denoting food processing,
measured in various subsamples (N between 417 and 9,460) within the EPIC
cohort via (partial) correlation analyses (unadjusted and adjusted by sex,
age, BMI and country). These biomarkers included an industrial transfatty
acid (ITFA) isomer (elaidic acid; exogenous fatty acid generated during
oil hydrogenation and heating) and urinary 4-methyl syringol sulfate (an
indicator for the consumption of smoked food and a component of liquid
smoke used in UPF). Results: Contributions of UPF intake to the overall diet in % grams/day varied
across countries from 7% (France) to 23% (Norway) and their contributions to
overall % energy intake from 16% (Spain and Italy) to >45% (in the UK and
Norway). Differences were also found between sociodemographic groups;
participants in the highest fourth of UPF consumption tended to be younger,
taller, less educated, current smokers, more physically active, have a higher
reported intake of energy and lower reported intake of alcohol. The UPF
pattern as defined based on the Nova classification (group 4;% kcal/day) was
positively associated with blood levels of industrial elaidic acid (r = 0.54) and
4-methyl syringol sulfate (r = 0.43). Associations for the other 3 Nova groups
with these food processing biomarkers were either inverse or non-significant
(e.g., for unprocessed and minimally processed foods these correlations were
–0.07 and –0.37 for elaidic acid and 4-methyl syringol sulfate, respectively).
Conclusion: These results, based on a large pan-European cohort,
demonstrate sociodemographic and geographical differences in the
consumption of UPF. Furthermore, these results suggest that the Nova
classification can accurately capture consumption of UPF, reflected by
stronger correlations with circulating levels of industrial elaidic acid and a
syringol metabolite compared to diets high in minimally processed foods.},
organization = {International Agency for Research on Cancer (IARC)},
organization = {Imperial College London},
organization = {NIHR
Imperial Biomedical Research Centre (BRC)},
organization = {Danish Cancer Society (Denmark)},
organization = {Ligue Contre le Cancer, Institut Gustave Roussy, Mutuelle
Générale de l’Education Nationale, Institut National de la
Santé et de la Recherche Médicale (INSERM) (France)},
organization = {German Cancer Aid, German Cancer Research Center (DKFZ),
German Institute of Human Nutrition Potsdam-Rehbruecke
(DIfE), Federal Ministry of Education and Research (BMBF)
(Germany)},
organization = {Associazione Italiana per la Ricerca sul Cancro-
AIRC-Italy, Compagnia di SanPaolo and National Research Council (Italy)},
organization = {Dutch Ministry of Public Health, Welfare
and Sports (VWS), Netherlands Cancer Registry (NKR),
LK Research Funds, Dutch Prevention Funds, Dutch ZON
(Zorg Onderzoek Nederland), World Cancer Research Fund
(WCRF), Statistics Netherlands (Netherlands)},
organization = {Health Research
Fund (FIS) - Instituto de Salud Carlos III (ISCIII), Regional
Governments of Andalucía, Asturias, Basque Country, Murcia
and Navarra, and the Catalan Institute of Oncology -
ICO (Spain)},
organization = {Swedish Cancer Society, Swedish Research
Council and County Councils of Skåne and Västerbotten
(Sweden)},
organization = {Cancer Research UK (14136 to EPIC-Norfolk;
C8221/A29017 to EPIC-Oxford), Medical Research Council
(1000143 to EPIC-Norfolk; MR/M012190/1 to EPIC-Oxford)
(United Kingdom)},
publisher = {Frontiers},
keywords = {Food processing},
keywords = {Nova},
keywords = {EPIC},
keywords = {Biomarkers},
keywords = {Elaidic acid},
keywords = {Syringol},
title = {Characterization of the degree of food processing in the European Prospective Investigation into Cancer and Nutrition: Application of the Nova classification and validation using selected biomarkers of food processing},
doi = {10.3389/fnut.2022.1035580},
author = {Huybrechts, Inge and Molina Montes, María Ester},
}