Assessment of Ultra-Processed Foods consumption and its impact on health: validation of a Food-Frequency Questionnaire and cross-sectional survey among Italian working adults - Study protocol

In recent years, a new way of thinking about food classification has emerged, no longer based on nutritional content but on processing. A clear example is NOVA classification, developed by Monteiro et al. in 2009, which divides foods into four categories. The fourth group, ultra-processed foods (UPFs), has attracted significant interest, so much so that increasing evidence suggests a potential association between high UPFs consumption and the development of Noncommunicable chronic diseases, overweight and obesity. However, the various limitations identified within the NOVA classification and in currently available studies have led to the recognition that further research is needed. Starting from a critical reassessment of the NOVA classification, this project aims to validate a Food Frequency Questionnaire (FFQ) specifically designed to estimate the consumption of UPFs, as well as the daily intake of macro- and micronutrients in the total diet, and, in a second phase, to assess its impact on health in a sample of Italian workers. This study will involve a minimum of 436 healthy males and females aged ≥18 years, resident in Italy and with Italian citizenship. Enrolment will be carried out nationwide in selected workplaces. Participants’ membership will be voluntary, subject to a written informed consent, and disseminated using the organisations’ mailing list. Based on previously validated tools, the online self-administered FFQ will consider the differences between packaged, homemade and artisanal products, reflecting dietary habits of Italians. For each item, the frequency of consumption and the serving size, using household units and images illustrating dishes in different portion sizes, will be indicated. To assess the tool's temporal stability, it will be administered on two separate occasions, at an interval of 3 to 10 months, and the data obtained will be compared. Additionally, participants will be asked to complete a 7-day weighed dietary record in the week following each administration to validate the FFQ. Data on demographic factors, socio-economic status and health status will also be collected and analysed. The results will provide a new valid tool focused on food processing, potentially useful for future studies.