Validation of NOVA 27 Ultra-Processed Food Screener: adaptation and performance in Ecuador.

Abstract

Objective: This study aimed to adapt and validate the NOVA 27 Ultra-Processed Food (UPF) Screener for use in Ecuador by identifying commonly consumed foods, classifying them using the NOVA system, and testing the screener's validity in an urban sample and a national food survey.

Design: A cross-sectional study was conducted in two phases: screener validation with a convenience sample of 327 adults in Quito through an online questionnaire (2021), and assessment of its applicability using data from the 2012 Ecuadorian National Health and Nutrition Survey (ENSANUT-Ecu). The method, adapted from a similar study in Brazil, compared NOVA UPF scores to the 24 Hour-Recall (24-HR) Automated Multiple-Pass Method (AMPM), used as the gold standard.

Setting: The study included Quito's urban population for validation and secondary data from ENSANUT-Ecu.

Participants: 327 adults aged 18 to 64 from Quito were included in the validation phase, and 3510 adults from the ENSANUT-Ecu dataset were analyzed in the secondary analysis.

Results: The screener adaptation identified 27 subgroups of commonly consumed UPFs, summarizing 90% of UPF caloric intake. Validation results indicated significant agreement between the NOVA-UPF score and UPF intake, with PABAK indices above 0·8 for most socio-demographic groups. Higher NOVA-UPF scores corresponded to increased UPF dietary shares, mirroring patterns observed in the ENSANUT-Ecu dataset.

Conclusions: The adapted NOVA 27 UPFs Screener is a valid tool for assessing UPF intake in Ecuador, offering a practical resource for future dietary surveys to monitor and address UPF intake among Ecuadorian adults.