Comparison of Ultra-Processed Food Intake Estimates Between Food Frequency Questionnaire and 24-Hour Dietary Recalls: Findings from the National Health and Nutrition Examination Survey (NHANES) 2003-2006.
Jul 2026· Journal of NutriLife· Vol 156, pp.
101736
· 0 citations· 29 references
Medicine
TL;DR
Differences in UPF intake estimates were consistently observed between FFQ and 24HDR in the overall U.S. population and across demographic subgroups, highlighting the need for standardized approaches to classifying foods according to processing level.
Abstract
Background
Ultra-processed foods (UPFs) are a major component of modern diets and are associated with many adverse health outcomes. Accurate assessment of UPF consumption is essential for nutritional research.
Objective
We compared estimates of UPF consumption derived from 24-hour dietary recall (24HDR) and food frequency questionnaire (FFQ) data in National Health and Nutrition Examination Survey (NHANES) 2003-2006 and assessed agreement between these methods in classifying UPF consumption.
Methods
This study included 10,937 participants in the NHANES 2003-2004 and 2005-2006 cycles with FFQ and 24HDR data. UPFs were classified according to the Nova classification system. Spearman's rank correlation coefficients and weighted kappa statistics were used to assess agreement between 24HDR and FFQ in estimating UPF intake. The Wilcoxon signed-rank test was used to compare mean UPF intake percentages reported by the two methods. FFQ weights were used to account for sampling.
Results
UPFs accounted for 34.7% of energy using the FFQ and 52.2% of energy intake using the 24HDR, with a mean difference of 18.9% of energy (p < 0.001). This difference was observed across age, sex, and race subgroups. There was a weak positive correlation (Spearman's r: 0.20, p<0.001) and slight agreement (weighted kappa: 0.05) in classifying energy intake from UPF using the two methods. The difference in estimating UPF intake by 24HDR and FFQ was substantially smaller after reclassifying food items on FFQ with ambiguous classification level.
Conclusions
Differences in UPF intake estimates were consistently observed between FFQ and 24HDR in the overall U.S. population and across demographic subgroups. Nova classification decisions for foods with ambiguous processing levels may contribute to differences between methods, highlighting the need for standardized approaches to classifying foods according to processing level. These findings highlight the need to further the development of dietary assessment instruments designed to capture UPF consumption.
Ultra-processed food (UPF) intake is linked to poor health, though some subgroups may offer affordable, nutritious options. Few studies have examined how UPF consumption-overall and by subgroup-relates to diet quality among populations with low income. We evaluated UPF subgroup intake and associations with diet quality among adults participating in the Supplemental Nutrition Assistance Program (SNAP). Rhode Island (RI) and Connecticut (CT) participants (n = 1244, 92% female, 58% food insecure) completed an online sociodemographic survey and food frequency questionnaire (FFQ). We categorized food codes (n = 301) using NOVA, and developed thirteen UPF subgroups within NOVA group 4. We calculated UPF intake (total %kcal and by subgroup) and evaluated diet quality using the Healthy Eating Index-2020 (HEI-2020). We performed Kruskal-Wallis and Jonckheere-Terpstra tests to compare total and UPF subgroup consumption across Total HEI-2020 tertiles. Mean Total HEI-2020 score was 63.9 ± 11.5. While higher total UPF intake was associated with lower Total HEI-2020 scores, associations between subgroups and diet quality differed. Ultra-processed refined grains, sugar-sweetened beverages, and ready-to-eat/heat mixed dishes were associated with lower Total HEI-2020 scores, whereas whole grains, yogurt, and plant-based products were associated with higher Total HEI-2020 scores. UPFs are heterogeneous, with select subgroups associated with higher diet quality in a sample of SNAP-participating adults. As policymakers consider SNAP UPF waivers and restrictions, accounting for subgroup differences will be imperative to avoid unintentionally restricting access to foods that support higher diet quality among individuals with low income.
Yarisbel Melo Herrera, Emily G. Elenio, Alison Tovar et al.· Eating Behaviors· 0 citations
BACKGROUND
Accurate dietary assessment data is vital for understanding dietary patterns and the associated nutrition and health outcomes. However, research on misreporting from self-reported dietary assessment tools has remained limited in low- and middle-income countries. Our study aims to investigate energy intake misreporting and its determinants among adolescents in Lao People's Democratic Republic (PDR).
METHODS
We conducted a cross-sectional secondary analysis of seven-day estimated food records collected from 405 adolescents aged 10-18 years attending secondary schools in Vientiane Province, Lao PDR, between March and April 2019. We identified energy intake misreporting using the Goldberg cut-off method, and analyzed factors associated with energy intake underreporting using multivariable logistic regression analyses. We compared the percentage energy intake from each food group between plausible reporters and underreporters, using the Mann-Whitney U-test.
RESULTS
Approximately 61.2% of participants underreported and 0.3% overreported their energy intake. Older adolescents (15-18 years) were 50% less likely to be classified as underreporters than younger adolescents (10-14 years) (Adjusted Odds Ratio [AOR] = 0.54, 95% CI: 0.34-0.88). Higher Body Mass Index was associated with higher odds of underreporting (AOR = 1.09, 95% CI: 1.01-1.18), whereas higher number of reported snacks between meals was associated with lower odds of underreporting (AOR = 0.81, 95% CI: 0.76-0.86). Underreporting increased over the seven-day period (51.4% on day 1 to 65.9% on day 7).
CONCLUSIONS
This study highlights a high prevalence of energy intake underreporting among Lao PDR adolescents when using the seven-day estimated food record method. While this prospective method has advantages, its accuracy depends on sustained participant engagement and motivation. Future research is needed to develop, adapt and validate tools, such as technology-assisted tools, for use among adolescents in Lao PDR.
Thidatheb Kounnavong, Kazuhiko Moji, M. Sato et al.· BMC Nutrition· 0 citations
Background/Objectives: There is continuing debate regarding the association between added sugars (AS) consumption and overall diet quality, which remains a research gap within the Canadian population. This study aimed to assess the association between intakes of added sugars and the Healthy Eating Food Index (HEFI) 2019 that measures adherence to Canada’s Food Guide as an indicator of diet quality. Methods: The first 24 h dietary recalls of Canadians 2 years and older (n = 19,532) from the 2015 Canadian Community Health Survey—Nutrition were used. Added sugars intakes were calculated based on a systematic 10-step algorithm. Descriptive statistics were obtained for total HEFI and component scores across different AS intake categories. The association between AS categories and HEFI scores was tested using a generalized linear model adjusted for age, sex, education level, type of smoker, and misreporting status. Results: The association between continuous AS intake and HEFI scores was non-linear. In the categorical model, AS intake categories were inversely associated with HEFI scores among Canadians (R2 = 0.32, p < 0.001). Large overlaps in HEFI scores were observed among individuals with similar AS intakes for the whole population and each age group. Among high AS consumers (>15% EI), lower HEFI scores were largely due to higher proportions of sweetened beverages (i.e., low beverage scores) and lower intakes of vegetables and fruit and plant-based proteins. Scores for protein food and whole grains were low across all AS intake categories. Conclusions: Large variations in overall HEFI scores were observed amongst those with similar AS intakes, suggesting that added sugars alone may not fully capture overall diet quality or adherence to Canada’s Food Guide.
Y. Wang, Zhongqi Fan, Sandra L. Marsden et al.· Nutrients· 0 citations
This study evaluates whether baseline ultra-processed food (UPF) consumption predicts failure to meet 24-h movement guidelines at 2-year follow-up in early childhood. Data from 586 participants (aged 4–5 years at baseline) from the SENDO project were analyzed. Dietary intake was assessed through a validated 149-item FFQ, completed by parents, and categorized by NOVA classification. Physical activity, screen time, and sleep time were assessed through questionnaires, based on the 24-h movement guidelines established by the Canadian Society for Exercise Physiology and the WHO. Overall, 92.0% of participants adhered to at least one guideline, 38.9% met all three, and only 8.0% met none of the recommendations. After adjusting for confounders, children in the highest UPF tertile (T3) had a rate ratio (RR) of 1.27 (95% CI 1.04–1.55; p = 0.021) compared with the lowest (T1). A significant linear trend was observed across UPF tertiles (p for trend = 0.022). Moreover, children in T3 had a greater likelihood of not meeting the recreational screen time guideline (RR 1.82, 95% CI 1.18–2.64; p = 0.036) than those in T1. Absolute screen time was significantly higher in T3 than T1 (1.31 ± 1.11 vs. 0.94 ± 1.18 h/day; p < 0.001). Conclusion: This study suggests that higher UPF consumption is associated with a lower adherence to 24-h movement recommendations—specifically regarding an increased likelihood of not complying with the recreational screen time recommendation. This highlights the importance of reducing UPF intake to support healthy behaviors over time in early life. What is Known: • Only a limited number of longitudinal studies have investigated the potential long-term association between dietary habits and the 24-h movement guidelines. • Higher consumption of ultra-processed foods (UPFs) is consistently linked to nutrient imbalances and adverse metabolic outcomes in children and adolescents. What is New: • This is the first study to prospectively investigate the relationship between early-life UPF intake and subsequent nonadherence to the 24-h movement guidelines in preschoolers. • Higher baseline UPF intake predicts a lower likelihood of meeting the movement recommendations after a 2-year follow-up, an association primarily driven by increased sedentary screen time. What is Known: • Only a limited number of longitudinal studies have investigated the potential long-term association between dietary habits and the 24-h movement guidelines. • Higher consumption of ultra-processed foods (UPFs) is consistently linked to nutrient imbalances and adverse metabolic outcomes in children and adolescents. What is New: • This is the first study to prospectively investigate the relationship between early-life UPF intake and subsequent nonadherence to the 24-h movement guidelines in preschoolers. • Higher baseline UPF intake predicts a lower likelihood of meeting the movement recommendations after a 2-year follow-up, an association primarily driven by increased sedentary screen time.
Nadia Paladino, M. Martínez-González, J. F. López-Gil et al.· European Journal of Pediatri...· 0 citations
Despite concerns about high consumption of ultra-processed foods (UPFs) among New Zealand adolescents, there has been no formal quantification of their intake. This study is the first to assess UPF consumption in this population and examine its contribution to daily nutrient intake. A cross-sectional study was conducted involving students in Years 7–13 (approximately 10 years and older) from schools in Auckland, Bay of Plenty, and Waikato. Data collection took place in classroom settings during school terms two and three of 2024. Dietary intake was recorded using Intake24, an electronic 24-hour dietary recall tool adapted for the New Zealand context. All foods consumed—including ingredients in mixed meals—were classified into four categories using the NOVA system: Unprocessed or Minimally Processed, Processed Culinary Ingredients, Processed, and Ultra-Processed(1). The proportion of daily energy derived from UPFs was calculated. Participants were divided into tertiles based on UPF consumption, and nutrient intake across these groups was compared using one-way ANOVA. Dietary data were collected from 631 adolescents across 16 schools, encompassing 1,385 unique food items. UPFs accounted for 62.5 ± 25.5% (mean ± SD) of total daily energy intake. While overall energy intake did not differ significantly across UPF consumption tertiles, notable differences in nutrient intake were observed. After adjustment for energy intake and sex, adolescents in the highest UPF tertile had significantly lower intakes of protein (P<0.001), fibre (P=0.04), beta-carotene (P<0.001), magnesium (P<0.001), potassium (P<0.001), zinc (P<0.001), phosphorus (P<0.001), iron (P=0.03) and Vitamin E (p<0.001). Ultra-processed food intake was associated with significantly higher intakes of carbohydrates (P=0.005), saturated fat (P<0.001), sugar (P<0.001) and sodium (P<0.01). These findings provide foundational insight into the extent of UPF consumption among New Zealand adolescents and its impact on diet quality. The proportion of energy derived from UPFs aligns closely with international data from the United States (67%) and the United Kingdom (66%). Further analysis will explore the specific types of UPFs consumed, their sources, and the social contexts in which they are eaten.
Jamie de Seymour, Karen D. Mumme, C. Conlon et al.· Proceedings of the Nutrition...· 0 citations
Abstract In the context of the rapidly evolving modern food environment, there is a need for dietary assessment tools to accurately assess current food intake. The objective of this research was to develop and validate a new food frequency questionnaire (FFQ). A 265 item web-based, self-administered FFQ (PREDICT-FFQ-v1) was developed using information from two FFQs and US and UK cohort level data. Over a 1-month period, 68 participants completed the PREDICT-FFQ-v1 and six 24-h recalls (reference tool; Intake24). Relative validity was assessed using Bland–Altman plots, cross-classification food group analysis, and Spearman’s rank correlation for food groups and nutrients. From the Bland–Altman plots, the median bias between the PREDICT-FFQ-v1 and Intake24 were energy (414 kcal (95%CI 289 to 609) (1734 kj (95% CI 1208 to 2549)), carbohydrate (2.3 %EI, 95%CI 0.08 to 3.68), fat (2.5 %EI, 95%CI 0.23 to 3.52), protein (−1.14 %EI, 95% CI −1.64 to −0.23), and fibre (1.86 g/1000 kcal, 95% CI 1.05 to 2.65). Cross-classification by quartiles of diet quality (plant-based diet index) categorised >76% of participants into the same or adjacent quartiles. Correlation coefficients for food groups assessed using both tools ranged from 0.38 (legumes) to 0.78 (meat), and for energy-adjusted nutrients ranged from 0.28 (total fat) to 0.82 (alcohol). The PREDICT-FFQ-v1 captures intakes of foods that are commonly consumed in modern diets, with greater resolution at the food level than previous tools. The PREDICT-FFQ-v1 has acceptable relative validity in comparison to 24-h dietary recall and provides a valuable alternative for assessing dietary intake in nutritional epidemiology.
K. Bermingham, I. Linenberg, L. Francis et al.· Journal of Nutritional Scien...· 0 citations
