055ab253cf85b95904d54fceb8990be3 pmc_34371982.pdf e63e3a413f20b12287eebc7cbc2f889e0c2eea3c pmc_34371982.pdf 51aa33d31f4fe7a4968eb7590c0bbe429d1f5acbfe216b087a0b5e76b822cdf7 pmc_34371982.pdf Title: Use of Different Food Classification Systems to Assess the Association between Ultra-Processed Food Consumption and Cardiometabolic Health in an Elderly Population with Metabolic Syndrome (PREDIMED-Plus Cohort) Subject: The association between ultra-processed food (UPF) and risk of cardiometabolic disorders is an ongoing concern. Different food processing-based classification systems have originated discrepancies in the conclusions among studies. To test whether the association between UPF consumption and cardiometabolic markers changes with the classification system, we used baseline data from 5636 participants (48.5% female and 51.5% male, mean age 65.1 4.9) of the PREDIMED-Plus (“PREvention with MEDiterranean DIet”) trial. Subjects presented with overweight or obesity and met at least three metabolic syndrome (MetS) criteria. Food consumption was classified using a 143-item food frequency questionnaire according to four food processing-based classifications: NOVA, International Agency for Research on Cancer (IARC), International Food Information Council (IFIC) and University of North Carolina (UNC). Mean changes in nutritional and cardiometabolic markers were assessed according to quintiles of UPF consumption for each system. The association between UPF consumption and cardiometabolic markers was assessed using linear regression analysis. The concordance of the different classifications was assessed with intra-class correlation coefficients (ICC3, overall = 0.51). The highest UPF consumption was obtained with the IARC classification (45.9%) and the lowest with NOVA (7.9%). Subjects with high UPF consumption showed a poor dietary profile. We detected a direct association between UPF consumption and BMI (p = 0.001) when using the NOVA system, and with systolic (p = 0.018) and diastolic (p = 0.042) blood pressure when using the UNC system. Food classification methodologies markedly influenced the association between UPF consumption and cardiometabolic risk markers. Keywords: cardiometabolic risk; classification systems; diet; food processing; IARC; IFIC; NOVA; PREDIMED-Plus; ultra-processed food; UNC Author: Celia Martinez-Perez, Rodrigo San-Cristobal, Pilar Guallar-Castillon, Miguel Ángel Martínez-González, Jordi Salas-Salvadó, Dolores Corella, Olga Castañer, Jose Alfredo Martinez, Ángel M. Alonso-Gómez, Julia Wärnberg, Jesús Vioque, Dora Romaguera, José López-Miranda, Ramon Estruch, Francisco J. Tinahones, José Lapetra, Lluis Serra-Majem, Aurora Bueno-Cavanillas, Josep A. Tur, Vicente Martín Sánchez, Xavier Pintó, José J. Gaforio, Pilar Matía-Martín, Josep Vidal, Clotilde Vázquez, Emilio Ros, Maira Bes-Rastrollo, Nancy Babio, Jose V. Sorlí, Camille Lassale, Beatriz Pérez-Sanz, Jessica Vaquero-Luna, María Julia Ajejas Bazán, María Concepción Barceló-Iglesias, Jadwiga Konieczna, Antonio García Ríos, María Rosa Bernal-López, José Manuel Santos-Lozano, Estefanía Toledo, Nerea Becerra-Tomás, Olga Portoles, María Dolores Zomeño, Itziar Abete, Anai Moreno-Rodriguez, Oscar Lecea-Juarez, Stephanie K. Nishi, Júlia Muñoz-Martínez, José M. Ordovás and Lidia Daimiel Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Tue Jul 20 12:03:01 2021 CEST ModDate: Tue Jul 20 12:06:39 2021 CEST Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 18 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 1358581 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- IVTCMY+VnURWPalladioL Type 1 Custom yes yes no 10 0 CVVJBD+URWPalladioL-Ital Type 1 Custom yes yes no 15 0 IGFBPX+URWPalladioL-Bold Type 1 Custom yes yes no 20 0 LFSMOX+URWPalladioL-Roma Type 1 Custom yes yes no 24 0 WIRPUU+VnURWPalladioL-Bold Type 1 Custom yes yes no 28 0 HGMNRX+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 36 0 MCBCCI+SourceSansRoman-Regular Type 1C Custom yes yes no 58 0 MCBCCM+SourceSansRoman.613wght Type 1C Custom yes yes no 62 0 MCBCCO+SourceSansRoman-Bold Type 1C Custom yes yes no 66 0 VFNYCD+CMSY10 Type 1 Builtin yes yes no 78 0 BCDEEE+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 93 0 BCDFEE+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 97 0 BCDGEE+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 101 0 BCDHEE+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 105 0 BCDEEE+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 125 0 BCDFEE+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 129 0 BCDGEE+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 133 0 BCDHEE+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 137 0 BCDEEE+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 154 0 BCDFEE+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 158 0 BCDGEE+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 162 0 BCDHEE+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 166 0 TimesNewRomanPSMT CID TrueType Identity-H yes no yes 173 0 EPRKOS+MSAM10 Type 1 Builtin yes yes no 186 0 MPUDFL+PazoMath Type 1 Builtin yes yes no 190 0 LWLIVD+EURM10 Type 1 Builtin yes yes no 197 0 CTGVMV+EURB7 Type 1 Builtin yes yes no 204 0 WBVKDJ+URWPalladioL-BoldItal Type 1 Custom yes yes no 208 0 JBTTSN+VnURWPalladioL-Italic Type 1 Custom yes yes no 231 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2024-10-02 03:07:45 CEST RepresentationInformation: pmc_34371982.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2023-03-31 12:14:47 CEST Size: 1358581 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 550 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Materials and Methods Destination: section.2 Item: Title: Results Destination: section.3 Children: Item: Title: UPF Consumption in the PREDIMED-Plus Cohort Destination: subsection.3.1 Item: Title: Nutritional Profile of UPF Consumption Quintiles According to the Classification System Destination: subsection.3.2 Item: Title: Association between Cardiometabolic Health Markers and UPF Consumption with Different Classification Systems Destination: subsection.3.3 Item: Title: Concordance and Subject Agreement between Classification Systems in Quintiles of UPF Consumption Destination: subsection.3.4 Item: Title: Discussion Destination: section.4 Item: Title: Conclusions Destination: section.5 Item: Title: References Destination: section.5 Info: Title: Use of Different Food Classification Systems to Assess the Association between Ultra-Processed Food Consumption and Cardiometabolic Health in an Elderly Population with Metabolic Syndrome (PREDIMED-Plus Cohort) Author: Celia Martinez-Perez, Rodrigo San-Cristobal, Pilar Guallar-Castillon, Miguel Ángel Martínez-González, Jordi Salas-Salvadó, Dolores Corella, Olga Castañer, Jose Alfredo Martinez, Ángel M. Alonso-Gómez, Julia Wärnberg, Jesús Vioque, Dora Romaguera, José López-Miranda, Ramon Estruch, Francisco J. Tinahones, José Lapetra, Lluis Serra-Majem, Aurora Bueno-Cavanillas, Josep A. Tur, Vicente Martín Sánchez, Xavier Pintó, José J. Gaforio, Pilar Matía-Martín, Josep Vidal, Clotilde Vázquez, Emilio Ros, Maira Bes-Rastrollo, Nancy Babio, Jose V. Sorlí, Camille Lassale, Beatriz Pérez-Sanz, Jessica Vaquero-Luna, María Julia Ajejas Bazán, María Concepción Barceló-Iglesias, Jadwiga Konieczna, Antonio García Ríos, María Rosa Bernal-López, José Manuel Santos-Lozano, Estefanía Toledo, Nerea Becerra-Tomás, Olga Portoles, María Dolores Zomeño, Itziar Abete, Anai Moreno-Rodriguez, Oscar Lecea-Juarez, Stephanie K. Nishi, Júlia Muñoz-Martínez, José M. Ordovás and Lidia Daimiel Subject: The association between ultra-processed food (UPF) and risk of cardiometabolic disorders is an ongoing concern. Different food processing-based classification systems have originated discrepancies in the conclusions among studies. To test whether the association between UPF consumption and cardiometabolic markers changes with the classification system, we used baseline data from 5636 participants (48.5% female and 51.5% male, mean age 65.1 4.9) of the PREDIMED-Plus (“PREvention with MEDiterranean DIet”) trial. Subjects presented with overweight or obesity and met at least three metabolic syndrome (MetS) criteria. Food consumption was classified using a 143-item food frequency questionnaire according to four food processing-based classifications: NOVA, International Agency for Research on Cancer (IARC), International Food Information Council (IFIC) and University of North Carolina (UNC). Mean changes in nutritional and cardiometabolic markers were assessed according to quintiles of UPF consumption for each system. The association between UPF consumption and cardiometabolic markers was assessed using linear regression analysis. The concordance of the different classifications was assessed with intra-class correlation coefficients (ICC3, overall = 0.51). The highest UPF consumption was obtained with the IARC classification (45.9%) and the lowest with NOVA (7.9%). Subjects with high UPF consumption showed a poor dietary profile. We detected a direct association between UPF consumption and BMI (p = 0.001) when using the NOVA system, and with systolic (p = 0.018) and diastolic (p = 0.042) blood pressure when using the UNC system. Food classification methodologies markedly influenced the association between UPF consumption and cardiometabolic risk markers. Keywords: cardiometabolic risk; classification systems; diet; food processing; IARC; IFIC; NOVA; PREDIMED-Plus; ultra-processed food; UNC Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Tue Jul 20 12:03:01 CEST 2021 ModDate: Tue Jul 20 12:06:39 CEST 2021 ID: 0xb03d77f6d62b2f6bb59bc4b1ec6d07b2, 0xb03d77f6d62b2f6bb59bc4b1ec6d07b2 Filters: FilterPipeline: FlateDecode Fonts: Type1: Font: BaseFont: WBVKDJ+URWPalladioL-BoldItal FontSubset: true FirstChar: 112 LastChar: 112 FontDescriptor: FontName: WBVKDJ+URWPalladioL-BoldItal Flags: Symbolic FontBBox: -170, -300, 1073, 935 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: IGFBPX+URWPalladioL-Bold FontSubset: true FirstChar: 2 LastChar: 241 FontDescriptor: FontName: IGFBPX+URWPalladioL-Bold Flags: Symbolic FontBBox: -152, -301, 1000, 935 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: LWLIVD+EURM10 FontSubset: true FirstChar: 12 LastChar: 12 FontDescriptor: FontName: LWLIVD+EURM10 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Annotation: Subtype: Link Rect: 161, 469, 199, 479 Annotation: Subtype: Link Rect: 199, 433, 236, 444 Annotation: Subtype: Link Rect: 462, 410, 500, 421 Annotation: Subtype: Link Rect: 464, 387, 502, 398 Annotation: Subtype: Link Rect: 503, 376, 560, 387 Annotation: Subtype: Link Rect: 56, 364, 509, 375 Annotation: Subtype: Link Rect: 383, 330, 421, 341 Annotation: Subtype: Link Rect: 95, 296, 133, 306 Annotation: Subtype: Link Rect: 139, 296, 175, 306 Annotation: Subtype: Link Rect: 251, 272, 289, 283 Annotation: Subtype: Link Rect: 295, 272, 331, 283 Annotation: Subtype: Link Rect: 95, 238, 133, 249 Annotation: Subtype: Link Rect: 291, 215, 328, 226 Annotation: Subtype: Link Rect: 297, 192, 335, 203 Annotation: Subtype: Link Rect: 341, 192, 377, 203 Annotation: Subtype: Link Rect: 140, 158, 178, 168 Annotation: Subtype: Link Rect: 136, 135, 173, 145 Annotation: Subtype: Link Rect: 449, 123, 560, 134 Annotation: Subtype: Link Rect: 56, 111, 449, 122 Annotation: Subtype: Link Rect: 294, 88, 332, 99 Page: Sequence: 17 Annotations: Annotation: Subtype: Link Rect: 221, 699, 259, 709 Annotation: Subtype: Link Rect: 297, 675, 334, 686 Annotation: Subtype: Link Rect: 366, 640, 404, 651 Annotation: Subtype: Link Rect: 410, 640, 446, 651 Annotation: Subtype: Link Rect: 401, 617, 439, 628 Annotation: Subtype: Link Rect: 104, 584, 142, 594 Annotation: Subtype: Link Rect: 478, 560, 515, 571 Annotation: Subtype: Link Rect: 521, 560, 557, 571 Annotation: Subtype: Link Rect: 172, 525, 210, 536 Annotation: Subtype: Link Rect: 216, 525, 252, 536 Annotation: Subtype: Link Rect: 390, 502, 428, 513 Annotation: Subtype: Link Rect: 434, 502, 470, 513 Annotation: Subtype: Link Rect: 95, 469, 133, 479 Annotation: Subtype: Link Rect: 364, 445, 402, 456 Annotation: Subtype: Link Rect: 429, 422, 467, 433 Annotation: Subtype: Link Rect: 473, 422, 509, 433 Annotation: Subtype: Link Rect: 333, 387, 371, 398 Annotation: Subtype: Link Rect: 312, 364, 349, 375 Annotation: Subtype: Link Rect: 355, 364, 391, 375 Annotation: Subtype: Link Rect: 276, 285, 313, 295 Annotation: Subtype: Link Rect: 319, 285, 355, 295 Annotation: Subtype: Link Rect: 409, 272, 521, 283 Annotation: Subtype: Link Rect: 392, 249, 498, 260 Annotation: Subtype: Link Rect: 409, 215, 560, 226 Annotation: Subtype: Link Rect: 56, 203, 98, 214 Annotation: Subtype: Link Rect: 536, 192, 560, 203 Annotation: Subtype: Link Rect: 56, 180, 203, 191 Annotation: Subtype: Link Rect: 228, 157, 409, 168 Annotation: Subtype: Link Rect: 56, 134, 242, 145 Annotation: Subtype: Link Rect: 146, 111, 303, 122 Annotation: Subtype: Link Rect: 113, 89, 150, 99 Annotation: Subtype: Link Rect: 153, 66, 190, 76 Page: Sequence: 18 Annotations: Annotation: Subtype: Link Rect: 477, 721, 515, 732 Annotation: Subtype: Link Rect: 521, 721, 557, 732 Annotation: Subtype: Link Rect: 156, 699, 193, 709 Annotation: Subtype: Link Rect: 502, 675, 540, 686 Annotation: Subtype: Link Rect: 195, 641, 232, 651 Annotation: Subtype: Link Rect: 211, 617, 248, 628 Annotation: Subtype: Link Rect: 254, 617, 290, 628 Annotation: Subtype: Link Rect: 56, 594, 295, 605 Annotation: Subtype: Link Rect: 384, 571, 422, 582 Annotation: Subtype: Link Rect: 428, 571, 464, 582 Annotation: Subtype: Link Rect: 256, 548, 293, 559 Annotation: Subtype: Link Rect: 56, 525, 295, 536 Annotation: Subtype: Link Rect: 266, 503, 304, 513 Annotation: Subtype: Link Rect: 310, 503, 346, 513 Annotation: Subtype: Link Rect: 440, 479, 478, 490 Annotation: Subtype: Link Rect: 484, 479, 520, 490 Annotation: Subtype: Link Rect: 277, 445, 315, 456 Annotation: Subtype: Link Rect: 321, 445, 357, 456 Annotation: Subtype: Link Rect: 453, 422, 491, 433 Annotation: Subtype: Link Rect: 320, 388, 357, 398 Annotation: Subtype: Link Rect: 405, 364, 443, 375 Annotation: Subtype: Link Rect: 364, 341, 401, 352 Annotation: Subtype: Link Rect: 298, 318, 336, 329 Annotation: Subtype: Link Rect: 342, 318, 378, 329 Annotation: Subtype: Link Rect: 109, 296, 146, 306 Annotation: Subtype: Link Rect: 152, 296, 188, 306 Annotation: Subtype: Link Rect: 203, 273, 240, 283 Annotation: Subtype: Link Rect: 247, 273, 283, 283 Annotation: Subtype: Link Rect: 59, 238, 97, 249 Annotation: Subtype: Link Rect: 131, 192, 169, 203 Annotation: Subtype: Link Rect: 375, 169, 560, 180 Annotation: Subtype: Link Rect: 56, 157, 186, 168 Annotation: Subtype: Link Rect: 388, 134, 425, 145 Annotation: Subtype: Link Rect: 145, 100, 182, 111 Checksum: 831eb1c9 Type: CRC32 Checksum: 055ab253cf85b95904d54fceb8990be3 Type: MD5 Checksum: e63e3a413f20b12287eebc7cbc2f889e0c2eea3c Type: SHA-1 Checksum: 51aa33d31f4fe7a4968eb7590c0bbe429d1f5acbfe216b087a0b5e76b822cdf7 Type: SHA-256