1Faculdade de Saúde Pública, Universidade de São Paulo, Sao Paulo, Brasil.
Background and objective: Ultra-processed foods intake has been pointed out as a relevant driver of poor diet quality worldwide. Increasing populations’ knowledge on food processing might contribute to promote healthier food choices. This study aimed to analyse the association between food processing knowledge and usual ultra-processed food intake among a subsample of the NutriNet-Brasil cohort. Methods: A random quote-based subsample was obtained from the universe of participants of the NutriNet-Brasil Cohort Study (n=1,245). Participants were asked to rate on a scale from 1 to 10 the healthiness of 12 food items from four categories (fruit, meat, dairy, and grains), including three food groups from Nova classification system: fresh and minimally processed foods, processed foods and ultra-processed foods. Food Processing Knowledge Score (FPK-S) was calculated based on ratings correctness according to Nova within each food category, with less processed foods representing higher healthiness (range: 0 to 8). Average ultra-processed foods healthiness perception was calculated by taking the mean of the healthiness ratings of all the four UPF items. The usual percentage of the daily energy intake from ultra-processed foods (%UPF) was measured using up to three 24h-recall per person completed through the NOVA24, a web-based 24-recall tool developed and validated for the NutriNet-Brasil study. Linear regression models were used to test the association between FNK-S and %UPF. Models were adjusted for age, sex, ethnicity, and level of education. Results: The average FPK-S was 5.7 (SD = 1.3). The average usual intake of ultraprocessed foods was 21.6 (SD = 9.1). According to the adjusted model, to each 1 point of increasing in the FPK-S, the usual %UPF decreases in 0.87% in average (p-value <0.0001). On the other hand, to each 1 point of increasing in the perceived healthiness of UPF items, the usual %UPF increases in 1.4% in average (p-value <0.0001). Conclusions: Higher knowledge to recognize ultra-processed foods unhealthiness and making healthier choices is associated with a lower intake of this food group. Food and nutrition guidance on food processing, including in national dietary guidelines, should be reinforced.
Keywords: dietary Intake; eating behavior; dietary guidelines; health literacy.