Consumption of ultra-processed foods among patients with rheumatic diseases: a cross-sectional study and validation of the short screening questionnaire of highly processed food consumption (sQ-HPF) in the Greek language.

Abstract

The consumption of ultra-processed food (UPF) has increased globally and has been linked to chronic inflammation, metabolic dysfunction, and adverse health outcomes. Rheumatic and musculoskeletal diseases (RMDs) are characterized by chronic inflammation, and research has revealed that the consumption of UPF may influence disease outcomes. The present study aimed to assess UPF intake among patients with RMDs, translate and validate the short highly processed foods (sQ-HPF) questionnaire in the Greek language. A total of 152 patients with RMDs were included in the study. Of those, 50 patients and an additional 50 healthy controls were employed for the sQ-HPF validation study. Univariate and multivariable analyses were conducted to identify factors associated with UPF consumption among the total sample of patients with RMDs. For the validation of the sQ-HPF, internal consistency, criterion validity, agreement, and discriminatory ability were assessed. The overall median sQ-HPF-derived UPF estimate was 18.7% (Q1-Q3: 11.3-26.1), corresponding to an estimated UPF contribution of approximately one-fifth (1/5) of total daily food intake. Among patients with RMDs, older age, higher level of attained education -including secondary, tertiary and postgraduate studies- were associated with lower UPF consumption (p = 0.040, p = 0.013 and p = 0.014). On the other hand, being in a relationship was associated with greater sQ-HPF scores compared with being married (p = 0.043). The Greek version of the sQ-HPF demonstrated acceptable internal consistency (Cronbach's α = 0.70), while factor loadings ranged from 0.029 to 0.562 across distinct food groups. UPF intake constitutes a substantial component of the dietary intake of both patients with RMDs and the general population. Given the growing evidence linking UPF intake with adverse health outcomes, strategies aimed at increasing awareness and reducing UPF intake may be particularly relevant for people with RMDs. Furthermore, the Greek version of the sQ-HPF demonstrated satisfactory validity and may serve as a practical tool for assessing UPF intake in the clinical and research settings.