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The following funding bodies contributed to study concept and design, research, and data collection for the PREDIMED-Plus study. The PREDIMED-Plus trial was supported by the European Research Council (Advanced Research grant 2014-2019; agreement #340918; granted to M.A.M-G.); the official Spanish institutions for funding scientific biomedical research, CIBER Fisiopatologia de la Obesidad y Nutricion (CIBEROBN) and Instituto de Salud Carlos III (ISCIII) through the Fondo de Investigacion para la Salud (FIS) which is co-funded by the European Regional Development Fund (coordinated FIS projects led by J.S-S. and J.V., including the following projects: PI13/00673, PI13/00492, PI13/00272, PI13/01123, PI13/00462, PI13/00233, PI13/02184, PI13/00728, PI13/01090, PI13/01056, PI14/01722, PI14/00636, PI14/00618, PI14/00696, PI14/01206, PI14/01919, PI14/00853, PI14/01374, PI14/00972, PI14/00728, PI14/01471, PI16/00473, PI16/00662, PI16/01873, PI16/01094, PI16/00501, PI16/00533, PI16/00381, PI16/00366, PI16/01522, PI16/01120, PI17/00764, PI17/01183, PI17/00855, PI17/01347, PI17/00525, PI17/01827, PI17/00532, PI17/00215, PI17/01441, PI17/00508, PI17/01732, PI17/00926, PI19/00957, PI19/00386, PI19/00309, PI19/01032, PI19/00576, PI19/00017, PI19/01226, PI19/00781, PI19/01560, PI19/01332), and the Especial Action Project "Implementacion y evaluacion de una intervencion intensiva sobre la actividad fisica Cohorte PREDIMED-Plus" (J.S-S.); the Recercaixa (grant number 2013ACUP00194) (J.S-S.). Moreover, J.S-S. gratefully acknowledges the financial support by ICREA under the ICREA Academia program; the SEMERGEN grant; Department of Health of the Government of Navarra (61/2015), the Fundacio La Marato de TV (Ref. 201630.10); the AstraZeneca Young Investigators Award in Category of Obesity and T2D 2017 (D.R.); grants from the Consejeria de Salud de la Junta de Andalucia (PI0458/2013; PS0358/2016; PI0137/2018), the PROMETEO/2017/017 grant from the Generalitat Valenciana, the SEMERGEN grant; grant of support to research groups 35/2011 (Balearic Islands Government; FEDER funds) (J.A.T.). J.K. was financially supported by the Juan de la Cierva-Incorporacion research grant (IJC2019-042420-I) of the Spanish Ministry of Economy, Industry and Competitiveness and the European Social Funds. The following funding bodies contributed to data preparation and analysis, bibliographic research, and manuscript writing. The METHYL-UP project was supported by the Spanish Ministry of Science and Innovation (RTI2018-095569-B-I00, Programa de Proyectos Orientados a los Retos de la Sociedad "Projects Toward Society Challenges Program"). R.S.-C. acknowledges financial support from the Juan de la Cierva Program Training Grants of the Spanish State Research Agency of the Spanish Ministerio de Ciencia e Innovacion y Ministerio de Universidades (FJC2018-038168-I). C.M.-P. was financially supported by a joint grant from the Community of Madrid and the European Social Fund (PEJD-2019-POST/SAL-15892). C. C.-M. was financially supported by the Formacion de Personal Investigador (FPI) grant from the Spanish Ministerio de Ciencia, Innovacion y Universidades (PRE2019-087643).

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Integrative development of a short screening questionnaire of highly processed food consumption (sQ-HPF)

Publicated to:International Journal Of Behavioral Nutrition And Physical Activity. 19 (1): 6-6 - 2022-12-01 19(1), DOI: 10.1186/s12966-021-01240-6

Authors: Martinez-Perez, Celia; Daimiel, Lidia; Climent-Mainar, Cristina; Angel Martinez-Gonzalez, Miguel; Salas-Salvado, Jordi; Corella, Dolores; Schroder, Helmut; Alfredo Martinez, Jose; Alonso-Gomez, Angel M; Warnberg, Julia; Vioque, Jesus; Romaguera, Dora; Lopez-Miranda, Jose; Estruch, Ramon; Tinahones, Francisco J; Lapetra, Jose; Serra-Majem, Lluis; Bueno-Cavanillas, Aurora; Tur, Josep A; Martin Sanchez, Vicente; Pinto, Xavier; Delgado-Rodriguez, Miguel; Matia-Martin, Pilar; Vidal, Josep; Vazquez, Clotilde; Ros, Emilio; Basterra, Javier; Babio, Nancy; Guillem-Saiz, Patricia; Dolores Zomeno, Maria; Abete, Itziar; Vaquero-Luna, Jessica; Javier Baron-Lopez, Francisco; Gonzalez-Palacios, Sandra; Konieczna, Jadwiga; Garcia-Rios, Antonio; Rosa Bernal-Lopez, Maria; Manuel Santos-Lozano, Jose; Bes-Rastrollo, Maira; Khoury, Nadine; Saiz, Carmen; Alejandra Perez-Vega, Karla; Angeles Zulet, Maria; Tojal-Sierra, Lucas; Vazquez Ruiz, Zenaida; Angeles Martinez, Maria; Malcampo, Mireia; Ordovas, Jose M; San-Cristobal, Rodrigo

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Abstract

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.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.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.We developed a practical tool to measure HPF consumption, the sQ-HPF. This may be a valuable instrument to study its relationship with NCDs.Retrospectively registered at the International Standard Randomized Controlled Trial Registry ( ISRCTN89898870 ) on July 24, 2014.© 2022. The Author(s).

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