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Repisalud author Martinez-Perez, Celia author Daimiel, Lidia author Climent-Mainar, Cristina author Martínez-González, Miguel Ángel author Salas-Salvadó, Jordi author Corella, Dolores author Schröder, Helmut author Martinez, Jose Alfredo author Alonso-Gómez, Ángel M author Wärnberg, Julia author Vioque, Jesús author Romaguera, Dora author López-Miranda, José author Estruch, Ramón author Tinahones, Francisco J author Lapetra, José author Serra-Majem, Lluis author Bueno-Cavanillas, Aurora author Tur, Josep A author Sánchez, Vicente Martín author Pintó, Xavier author Delgado-Rodríguez, Miguel author Matía-Martín, Pilar author Vidal, Josep author Vázquez, Clotilde author Ros, Emilio author Basterra, Javier author Babio, Nancy author Guillem-Saiz, Patricia author Zomeño, María Dolores author Abete, Itziar author Vaquero-Luna, Jessica author Barón-López, Francisco Javier author Gonzalez-Palacios, Sandra author Konieczna, Jadwiga author Garcia-Rios, Antonio author Bernal-López, María Rosa author Santos-Lozano, José Manuel author Khoury, Nadine author Saiz, Carmen author Pérez-Vega, Karla Alejandra author Zulet, María Angeles author Tojal-Sierra, Lucas author Ruiz, Zenaida Vázquez author Martinez, Maria Angeles author Malcampo, Mireia author Ordovás, José M author San-Cristobal, Rodrigo 2024-02-27T14:57:54Z 2024-02-27T14:57:54Z 2022-01-24 Martinez-Perez C, Daimiel L, Climent-Mainar C, Martinez-Gonzalez MA, Salas-Salvado J, Corella D, et al. Integrative development of a short screening questionnaire of highly processed food consumption (sQ-HPF). Int J Behav Nutr Phys Act. 2022 Jan 24;19(1):6. http://hdl.handle.net/10668/20329https://hdl.handle.net/20.500.13003/19655 http://hdl.handle.net/20.500.12105/18587 35073909 10.1186/s12966-021-01240-6 1479-5868 The international journal of behavioral nutrition and physical activity 2-s2.0-85123621140 746608400001 L2014818098 Background: 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. Methods: 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. Results: 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. Conclusions: We developed a practical tool to measure HPF consumption, the sQ-HPF. This may be a valuable instrument to study its relationship with NCDs. eng Food processing-based classification Highly processed food NOVA PREDIMED-Plus Questionnaire Ultra-processed food Integrative development of a short screening questionnaire of highly processed food consumption (sQ-HPF) research article