Integrative development of a short screening questionnaire of highly processed food consumption (sQ-HPF)
Authors: Martinez-Perez Celia , Daimiel Lidia , Climent-Mainar Cristina , Martínez-González Miguel Ángel , Salas-Salvadó Jordi , Corella Dolores , Schröder Helmut , Martinez Jose Alfredo , Alonso-Gómez Ángel M. , Wärnberg Julia , Vioque Jesús , Romaguera Dora , López-Miranda José , Estruch Ramón , Tinahones Francisco J. , Lapetra José , Serra-Majem Lluis , Bueno-Cavanillas Aurora , Tur Josep A. , Sánchez Vicente Martín , Pintó Xavier , Delgado-Rodríguez Miguel , Matía-Martín Pilar , Vidal Josep , Vázquez Clotilde , Ros Emilio , Basterra Javier , Babio Nancy , Guillem-Saiz Patricia , Zomeño María Dolores , Abete Itziar , Vaquero-Luna Jessica , Barón-López Francisco Javier , Gonzalez-Palacios Sandra , Konieczna Jadwiga , Garcia-Rios Antonio , Bernal-López María Rosa , Santos-Lozano José Manuel , Bes-Rastrollo Maira , Khoury Nadine , Saiz Carmen , Pérez-Vega Karla Alejandra , Zulet María Angeles , Tojal-Sierra Lucas , Ruiz Zenaida Vázquez , Martinez Maria Angeles , Malcampo Mireia , Ordovás José M. , San-Cristobal Rodrigo 
Published: January 2022

Background

Recent lifestyle changes include increased consumption of highly processed foods (HPF), which has been associated with an increased risk of non-communicable diseases (NCDs). However, nutritional information relies on the estimation of HPF consumption from food-frequency questionnaires (FFQ) that are not explicitly developed for this purpose. We aimed to develop a short screening questionnaire of HPF consumption (sQ-HPF) that integrates criteria from the existing food classification systems.

Methods

Data from 4400 participants (48.1% female and 51.9% male, 64.9 ± 4.9 years) of the Spanish PREDIMED-Plus (“PREvention with MEDiterranean DIet”) trial were used for this analysis. Items from the FFQ were classified according to four main food processing-based classification systems (NOVA, IARC, IFIC and UNC). Participants were classified into tertiles of HPF consumption according to each system. Using binomial logistic regression, food groups associated with agreement in the highest tertile for at least two classification systems were chosen as items for the questionnaire. ROC analysis was used to determine cut-off points for the frequency of consumption of each item, from which a score was calculated. Internal consistency of the questionnaire was assessed through exploratory factor analysis (EFA) and Cronbach’s analysis, and agreement with the four classifications was assessed with weighted kappa coefficients.

Results

Regression analysis identified 14 food groups (items) associated with high HPF consumption for at least two classification systems. EFA showed that items were representative contributors of a single underlying factor, the “HPF dietary pattern” (factor loadings around 0.2). We constructed a questionnaire asking about the frequency of consumption of those items. The threshold frequency of consumption was selected using ROC analysis. Comparison of the four classification systems and the sQ-HPF showed a fair to high agreement. Significant changes in lifestyle characteristics were detected across tertiles of the sQ-HPF score. Longitudinal changes in HPF consumption were also detected by the sQ-HPF, concordantly with existing classification systems.

Conclusions

We developed a practical tool to measure HPF consumption, the sQ-HPF. This may be a valuable instrument to study its relationship with NCDs.

Trial registration

Retrospectively registered at the International Standard Randomized Controlled Trial Registry (ISRCTN89898870) on July 24, 2014.