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====== Ultra-processed food categorization according to the NOVA classification ====== 

Researchers from the [[https://www.rug.nl/staff/m.duan/|University Medical Center Groningen]] developed the Ultra-processed food (UPF) categorization for adults according to the NOVA classification using the [[ffq_sum_scores|Food Frequency Questionnaire Sum scores]] from the heart of the FFQ flower ([[1a_questionnaire_2|1A Questionnaire 2]]). ([[sections]]: [[Nutrition]] and [[secondary & linked variables]]).\\

The UPF food categorization can be requested in the Lifelines catalogue or by mail (data@lifelines.nl). When this data has been used in your research, you will have to include a reference to the the following paper:
  * [[https://doi.org/10.1186/s12916-021-02200-4|Duan, M. J., Vinke, P. C., Navis, G., Corpeleijn, E., & Dekker, L. H. (2022). Ultra-processed food and incident type 2 diabetes: studying the underlying consumption patterns to unravel the health effects of this heterogeneous food category in the prospective Lifelines cohort. BMC medicine, 20(1), 1-11.]]

===== Background information =====
//From the paper of [[https://doi.org/10.1186/s12916-021-02200-4|Duan et al. (2022)]]//\\
Research on UPF has been facilitated by the development of the NOVA classification. The NOVA classification is a frequently used method to categorize food and drinks based on the nature, extent, and purpose of food processing. The NOVA classification comprises four categories, ranging from un-processed/minimally processed food to UPF. According to the NOVA classification, UPF is mostly formulated from food substances and industrial ingredients that undergo a series of chemical and physical manufacturing processes. The resulting food products are often pre-packed, contain little or no intact (un-processed) food, and are considered microbiologically safe, convenient, and palatable.\\
\\


===== Calculation of UPF categorization =====
Using the NOVA classification, the 110 food items from the [[ffq|FFQ heart]] were categorized in four proposed categories: 
  - **Unprocessed or minimally processed food:** for example fresh vegetables or fruits and unprocessed meat
  - **Processed culinary ingredient:** for example butter or oil for cooking, sugar, and salt
  - **Processed food:** for example canned vegetables or fish and fruits in syrup
  - **Ultra-processed food:** for example processed meat, soft drinks

Per category three types of variables have been created:
  * **Classification variable:** which adds up the intake of all food items that belong to the specific category
  * **Intake (nova) weight ratio variable:** which indicates the weight proportion (% grams) of a specific category in the total diet of a day
  * **Intake (nova) energy ratio variable:** which which indicates the energy ratio (grams/1000kcal) of a specific category in the total diet of a day

=== Remarks from the UMCG researchers ===
  - The current categorization doesn't specifically handle the reliability of energy intake (provided in the [[ffq_sum_scores|Food Frequency Questionnaire Sum scores]]). This could be a decision for other researchers using the UPF classification data. To make this easier, the reliability variable from the [[ffq_sum_scores|FFQ sum scores]] has been added as variable.
  - According to the NOVA classification, some alcohol products should also be characterized as ultra-processed food. However, we did not do this because alcohol may have separate health effects. Therefore, we analyze alcohol intake always as a separate covariate. This is also practiced by other papers from other cohorts.

\\

===== Variables =====
| **Label English**                                                                                                    | **Label Dutch**                                                                                                        | **Code**                     | **Variable**           | **Assessment**  | **Age**  |
| food intake (gram per day) / NOVA classification 1: unprocessed or minimally processed food                          | voedselinname (gram per dag) / NOVA classificatie 1: onbewerkte of minimaal bewerkte voeding                           | nova_foodintake_adu_c_1      | nova1                  | sec *           | 18+      |
| food intake (gram per day) / NOVA classification 2: processed culinary ingredient                                    | voedselinname (gram per dag) / NOVA classificatie 2: bewerkt culinair ingrediënt                                       | nova_foodintake_adu_c_2      | nova2                  | sec *           | 18+      |
| food intake (gram per day) / NOVA classification 3: processed food                                                   | voedselinname (gram per dag) / NOVA classificatie 3: bewerkt voedsel                                                   | nova_foodintake_adu_c_3      | nova3                  | sec *           | 18+      |
| food intake (gram per day) / NOVA classification 4: ultra-processed food                                             | voedselinname (gram per dag) / NOVA classificatie 4: ultabewerkt voedsel                                               | nova_foodintake_adu_c_4      | nova4                  | sec *           | 18+      |
| % of the total food intake in gram per day / NOVA classification 1: unprocessed or minimally processed food          | % van de totale voedselinname in gram per dag / NOVA classificatie 1: onbewerkte of minimaal bewerkte voeding          | nova_weightratio_adu_c_1     | nova1prt               | sec *           | 18+      |
| % of the total food intake in gram per day / NOVA classification 2: processed culinary ingredient                    | % van de totale voedselinname in gram per dag / NOVA classificatie 2: bewerkt culinair ingrediënt                      | nova_weightratio_adu_c_2     | nova2prt               | sec *           | 18+      |
| % of the total food intake in gram per day / NOVA classification 3: processed food                                   | % van de totale voedselinname in gram per dag / NOVA classificatie 3: bewerkt voedsel                                  | nova_weightratio_adu_c_3     | nova3prt               | sec *           | 18+      |
| % of the total food intake in gram per day / NOVA classification 4: ultra-processed food                             | % van de totale voedselinname in gram per dag / NOVA classificatie 4: ultabewerkt voedsel                              | nova_weightratio_adu_c_4     | nova4prt               | sec *           | 18+      |
| gram per 1000kcal of the total food intake per day / NOVA classification 1: unprocessed or minimally processed food  | gram per 1000kcal of de totale voedsellinname per dag / NOVA classificatie 1: onbewerkte of minimaal bewerkte voeding  | nova_energyratio_adu_c_1     | nova1kcal              | sec *           | 18+      |
| gram per 1000kcal of the total food intake per day / NOVA classification 2: processed culinary ingredient            | gram per 1000kcal of de totale voedsellinname per dag / NOVA classificatie 2: bewerkt culinair ingrediënt              | nova_energyratio_adu_c_2     | nova2kcal              | sec *           | 18+      |
| gram per 1000kcal of the total food intake per day / NOVA classification 3: processed food                           | gram per 1000kcal of de totale voedsellinname per dag / NOVA classificatie 3: bewerkt voedsel                          | nova_energyratio_adu_c_3     | nova3kcal              | sec *           | 18+      |
| gram per 1000kcal of the total food intake per day / NOVA classification 4: ultra-processed food                     | gram per 1000kcal of de totale voedsellinname per dag / NOVA classificatie 4: ultabewerkt voedsel                      | nova_energyratio_adu_c_4     | nova4kcal              | sec *           | 18+      |
| reliability of the ffq heart results that were used to determine the nove scores                                     | betrouwbaarheid van de ffq hart resultaten die zijn gebruikt voor het bepalen van de nova scores                       | nova_reliabilityffq_adu_c_1  | Betrouwbaarheid__nova  | sec *           | 18+      |

* The UPF categorization according to the NOVA is included as assessment 'sec' because it is based on the FFQ sum scores.
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