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The objective of this study was to inform consumer-facing dietary guidance by (1) adapting the current University of North Carolina at Chapel Hill (UNC) food processing framework to include a home processing (HP) component and (2) pilot testing the adapted version using a nationally representative sample of foods consumed in the U.S. The UNC framework was adapted to include guidelines for categorizing home-prepared (HP) foods. The original UNC and adapted HP frameworks were used to code dietary recalls from a random sample of National Health and Nutrition Examination Survey (2015&ndash, 2016 cycle) participants (n = 100, ages 2&ndash, 80 years). Percent changes between the UNC and HP adapted frameworks for each processing category were calculated using Microsoft Excel, version 16.23. Participants were 56% female, 35% non-Hispanic white (mean age = 31.3 &plusmn, 23.8). There were 1,376 foods with 651 unique foods reported. Using the HP compared to the UNC framework, unprocessed/minimally processed foods declined by 11.7% (UNC: 31.0% vs. HP: 27.4%), basic processed foods increased by 116.8% (UNC: 8.2% vs. HP: 17.8%), moderately processed foods increased by 16.3% (UNC: 14.2% vs. HP: 16.6%), and highly processed foods decreased by 17.8% (UNC: 46.5% vs. HP: 38.2%). Home-prepared foods should be considered as distinct from industrially produced foods when coding dietary data by processing category. This has implications for consumer-facing dietary guidance that incorporates processing level as an indicator of diet quality.

Objective:To determine how children interpret terms related to food processing; whether their categorisation of foods according to processing level is consistent with those used in research; and whether they associate the degree of processing with healthfulness.Design:Qualitative data were collected from ten focus groups. Focus groups were audio-recorded, transcribed verbatim, and thematic analysis was conducted.Setting:Four elementary and afterschool programmes in a large, urban school district in the USA that served predominantly low-income, racial/ethnic minority students.Participants:Children, 9–12 years old, in the fourth–sixth grades (n 53).Results:The sample was 40 % male, 47 % Hispanic with a mean age of 10·4 ± 1·1 years. Children’s understanding of unprocessed foods was well aligned with research classifications, while concordance of highly processed foods with research categorisations varied. Five primary themes regarding the way children categorised foods according to their processing level emerged: type and amount of added ingredients; preparation method; packaging and storage; change in physical state or sensory experience; and growing method. Most children associated processing level with healthfulness, describing unprocessed foods as healthier. The most common reason provided for the unhealthfulness of processed foods was added ingredients, including ‘chemicals’ and ‘sugar’.Conclusions:The current study demonstrated that children have a working knowledge of processing that could be leveraged to encourage healthier eating patterns; however, their understanding is not always consistent with the classification systems used in research. The vocabulary used by researchers and consumers to talk about processing must be reconciled to translate findings into actionable messages.

Excess consumption of highly processed foods may be associated with lower diet quality and obesity prevalence, but few studies have examined these relationships in children from low-income households. Therefore, the objective of this study was to evaluate the relationship between food consumption by processing category, diet quality as measured by the Healthy Eating Index-2015 (HEI-2015) and body mass index (BMI) in a sample of low-income children. Data from a study assessing the impact of Summer Food Service participation on diet quality and weight status (N = 131) was used to conduct a cross-sectional analysis of children aged six to twelve years from low-income communities in the Northeastern U.S. Total HEI-2015 score and percentage of calories consumed by processing level were computed per day from three 24-h diet recalls. Multivariable linear regression was used to assess the relationship between percentage of calories from foods by processing category (unprocessed and minimally, basic, moderately and highly processed), HEI-2015 and BMI-z score. The final sample was 58% male and 33.8% obese. On average, children consumed 39.8 ± 17.2% of calories from highly processed foods. A 10% increase in calories consumed from highly processed foods was associated with a 2.0 point decrease in total HEI-2015 score [95% CI (−2.7, −1.2)], and a 10% increase in calories from minimally processed foods was associated with a 3.0 increase in HEI-2015 score [95% CI (2.1, 3.8)]. Relationships between processing level and BMI-z score were not significant. Among this sample of low-income children, greater intake of highly processed foods was associated with lower dietary quality, but not weight status. Future research should explore prospective associations between food consumption by processing category and weight status in children.

Background. Parent-aimed guidance on the topic of processed foods may help limit highly processed foods in children’s diets, but little is known about parent understanding and perceptions of these products. Aims. To determine how parent perceptions of processing align with processing classification systems used in research, and to identify opportunities for future research in communicating information about processed foods. Method. Six focus groups with lower income, racial/ethnic minority and immigrant parents of fourth to sixth graders ( n = 37) were conducted. Parents were asked to discuss their views on terminology related to food processing, classification of foods according to their processing level, the healthfulness of select foods, and criteria for choosing snacks for their children. Focus groups were guided by a thematic approach. NVivo 12 (QSR International) was used to facilitate analyses. Results. Thirty mothers and seven fathers participated. Two thirds (62%) were foreign-born; 38% identified as Hispanic. The term “processing” lacked consistent meaning among parents, with variation by immigrant status. Participants associated highly processed foods with convenience, packaging, and added ingredients; “less-processed” versions of foods (e.g., fresh; homemade) were perceived as healthier. Children’s preferences were the main criteria for choosing snacks. Foreign-born parents were more likely to associate processed foods with positive characteristics (e.g., properly cooked). Conclusion. The concept of food processing is an area of misconception among parents, providing an opportunity for education that may be extended to larger audiences. A universally accepted definition of food classification by processing level is necessary to effectively communicate the link between processing and healthfulness.

Discrepancies exist among food processing classification systems and in the relationship between processed food intake and dietary quality of children. This study compared inter-rater reliability, food processing category, and the relationship between processing category and nutrient concentration among three systems (Nova, International Food Information Council (IFIC), and University of North Carolina at Chapel Hill (UNC)). Processing categories for the top 100 most commonly consumed foods children consume (NHANES 2013&ndash, 2014) were independently coded and compared using Spearman&rsquo, s rank correlation coefficient. Relative ability of nutrient concentration to predict processing category was investigated using linear discriminant analysis and multinomial logistic regression and compared between systems using Cohen&rsquo, s kappa coefficient. UNC had the highest inter-rater reliability (&rho, = 0.97), followed by IFIC (&rho, = 0.78) and Nova (&rho, = 0.76). UNC and Nova had the highest agreement (80%). Lower potassium was predictive of IFIC&rsquo, s classification of foods as moderately compared to minimally processed (p = 0.01), lower vitamin D was predictive of UNC&rsquo, s classification of foods as highly compared to minimally processed (p = 0.04). Sodium and added sugars were predictive of all systems&rsquo, classification of highly compared to minimally processed foods (p &lt, 0.05). Current classification systems may not sufficiently identify foods with high nutrient quality commonly consumed by children in the U.S.

OBJECTIVES: Processed foods are associated with energy-dense eating patterns among children, yet research using food processing classification systems has led to varying conclusions regarding the impact of processed foods on dietary quality. This study utilized three common classification systems to examine (a) agreement between systems for processing level assignment, and (b) relationships between processing level, as determined by each classification system, and individual nutrient concentrations for foods commonly consumed by children. METHODS: The Nova, International Food Information Council (IFIC), and the University of North Carolina (UNC) systems were examined. Two researchers independently coded processing level according to each system's criteria for the 100 most commonly consumed foods by children 6–12 yrs (NHANES 2013–2014). Inter-rater reliability was assessed using Spearman's rank correlation. Concentration of under- (potassium, fiber, choline, magnesium, calcium, iron, vitamins A, D, E, and C) and over-consumed (added sugars, saturated fat and sodium) nutrients were quantified for 100 grams of each food. Alignment of processing classification systems with nutrient concentration was investigated using linear discriminant analysis and multinomial logistic regression, and compared among systems using Cohen's kappa. RESULTS: Most foods were classified as highly processed (70%, 62% 53%, for the Nova, UNC and IFIC system, respectively). The UNC system had the highest inter-rater reliability (r = 0.97, P

OBJECTIVES: Evidence on associations between dietary patterns and academic outcomes is limited. This study examined relationships between dietary pattern, cognitive performance and academic achievement in a diverse sample of children. METHODS: Reported intake of food groups [fruits, vegetables, sweet and salty snacks, sugar-sweetened and unsweetened beverages], dietary patterns (healthful and unhealthful), cognitive measures (Digit Span and Stroop test) and academic achievement (standardized test scores) were obtained from 3(rd) and 4(th) grade urban schoolchildren. Multiple Poisson and multiple linear regression were used to test associations between cognitive scores and diet. Multiple ordered logistic regression was used to assess associations between academic achievement and diet. Potential confounders (age, sex, BMI z-score, race/ethnicity, English language learner status, individualized education plan enrollment, physical activity and parent education level) were included in all models. RESULTS: The sample included 868 children (56.7% girls; 33.2% Non-Hispanic white, 26.2% Hispanic, 17.1% multiracial/other, 8.3% Non-Hispanic black; 40.5% overweight/obese). The most frequently consumed foods were fruits and sweet snacks (1.9 and 1.6 servings per day, respectively). There were no statistically significant associations between diet and cognitive test scores. Greater intake of unhealthful food groups (sweet snacks, salty snacks and sweetened beverages) was associated with lower math (OR = 0.91, CI [0.84, 0.98], P = 0.014) and English standardized test scores (OR = 0.87, CI [0.80, 0.94, P = 0.001). Greater intake of sweet snacks and fruits was associated with lower English scores (OR = 0.72, 95% CI [0.59, 0.88] P = 0.001; and OR = 0.75, 95% CI [0.72, 0.94] P = 0.003, respectively). CONCLUSIONS: Unhealthful dietary patterns were associated with poorer academic achievement. Further research can shed light on unexpected associations between fruit consumption and achievement. Policies targeting multiple dietary components may positively influence child academic achievement and development. FUNDING SOURCES: Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health and the Boston Foundation. SUPPORTING TABLES, IMAGES AND/OR GRAPHS

Background: Although there are several valid and reliable dietary screeners to measure child intake patterns, there is a paucity of brief assessment tools targeting under- and overconsumed foods. Objective: To compare the Fueling Learning through Exercise study (FLEX) dietary questionnaire, a screener designed to assess consumption patterns in third to fifth graders, to a validated dietary assessment tool. Methods: The FLEX dietary questionnaire was developed to assess fruit, vegetable, snack, and beverage consumption and was compared to the Block Kids Food Screener (BKFS). Correlations were analyzed using Pearson correlation coefficient. Agreement was assessed using Bland-Altman plots. Results: The sample (n = 63) had mean age of 9.9 years (SD 0.7). Most participants were non-Hispanic white (70%) and eligible for free/reduced price lunch (57%). Correlations between food group categories were significant for all groups ( P < .05) except fruits ( r = 0.51) and sugar-sweetened beverages (SSBs) ( r = 0.21). We found moderate-to-strong correlations between reported vegetable, salty snack, sweet snack, total beverage, milk, and fruit juice consumption (0.62, 0.59, 0.69, 0.47, 0.48, and 0.46, respectively). The FLEX screener reported systematically higher mean servings per day (0.24-1.1) compared to the BKFS (0.05-0.51). Conclusion: Based on these correlations, the FLEX dietary questionnaire performs similarly to a validated tool in assessing intake of under- and overconsumed food groups in a diverse third to fifth grade population. Overall serving size discrepancies are likely due to more relevant food items on the FLEX questionnaire and a more child-friendly format. This study highlights the need to update older diet screeners to reflect current child consumption patterns.

Nutrition plays an important role in proper physical and cognitive functioning. However, there is limited evidence on the relationship between overall diet, cognition, and academic success in children, particularly among low-income and diverse groups. The objective of this study was to examine the relationships between healthful versus less healthful food group intake, cognitive performance, and academic achievement in a diverse sample of schoolchildren. 868 urban schoolchildren (age 8 to 10 years) participated in the study. Intake of healthful (fruits, vegetables, unsweetened beverages) and less healthful (sweet and salty snacks, sugar-sweetened beverages) food groups was determined via a food frequency questionnaire. Digit Span and Stroop test scores were used to assess cognitive performance. Academic achievement was assessed via standardized test scores. Multiple Poisson and multiple linear regression were used to test the associations between diet and cognitive scores. Multiple ordered logistic regression was used to assess the associations between diet and academic achievement. Potential confounders (age, sex, body mass index (BMI) z-score, race/ethnicity, English language learner status, individualized education plan enrollment, physical activity, and parent education level) were tested for inclusion in all models. The sample included 868 children (56.7% girls, 33.2% non-Hispanic white, 26.2% Hispanic, 17.1% multiracial/other, 8.3% non-Hispanic black, 40.5% overweight/obese). The most frequently consumed foods were fruits and sweet snacks (1.9 and 1.6 servings per day, respectively). There were no statistically significant associations between diet and cognitive test scores. Greater intake of less healthful food groups (sweet snacks, salty snacks, and sweetened beverages) was associated with lower math (OR = 0.91, CI [0.84, 0.98], p = 0.014) and English standardized test scores (OR = 0.87, CI [0.80, 0.94, p = 0.001). Greater intake of sweet snacks and fruits was associated with lower English scores (OR = 0.72, 95% CI [0.59, 0.88] p = 0.001, and OR = 0.75, 95% CI [0.72, 0.94] p = 0.003, respectively). Consumption of less healthful food groups was associated with poorer academic achievement. Further research may shed light on unexpected associations between fruit consumption and achievement. Policies targeting multiple dietary components may positively influence child academic achievement and development.