Validation of a screener to assess ultra-processed food consumption in the adult Indian population: The Nova-UPF Screener (for India)

ABSTRACT Increasing prevalence of diet-related non-communicable diseases in India is attributed to overconsumption of energy-dense, nutrient-poor diets and ultra processed foods (UPFs) may potentially contribute to this consumption pattern. Applying standard UPF definition and developing appropriate tools can better capture its consumption among Indians. This cross-sectional study aimed to validate the ‘Nova-UPF Screener (for India)’ and explore its potential to objectively capture UPF consumption among Indian adults. The screener, adapted in prior formative research study from a tool for Brazilian population, was subjected to content, face, and concurrent criterion validation. Subject matter experts (n=74) participated in online consultations to determine its content validity. Adults (18-60 years) from different geographical regions of India were included for face (n=70) and concurrent criterion (n=304) validations. The screener comprised 24 UPF categories specific to Indian food environment. Critical inputs from experts on screener’s appropriateness were incorporated to enhance its content. For face validation, overall percentage agreement of 99.4% for all questions indicated a strong agreement for retaining screener attributes in each question. Half the participants (49.4%) who were administered the finalized screener had Nova-UPF scores between 2 to 4 out of 24. There was almost perfect agreement (Pabak index = 0.85) between distribution of participants based on Nova-UPF scores and fifths of dietary share of UPFs (as energy %) assessed by 24-hour dietary recall. Nova-UPF Screener (for India) is a valid tool to capture UPF consumption in India that can be used for rapid assessment of UPF consumption and informing policies to improve Indian diets.