Validation of NOVA 27 ultra-processed food screener: Adaptation and performance in Ecuador

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 h-Recall (24-HR) automated multiple-pass method, used as the gold standard. Setting: The study included Quito's urban population for validation and secondary data from ENSANUT-Ecu. Participants: Three hundred and twenty-seven adults aged 18-64 from Quito were included in the validation phase, and 3510 adults from the ENSANUT-Ecu dataset were analysed in the secondary analysis. Results: The screener adaptation identified twenty-seven subgroups of commonly consumed UPF, summarising 90 % of UPF energy 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 UPF 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.