How to evaluate Ultra-processed Food Intake in pediatrics? UPF Score: an easy alternative

How to evaluate Ultra-processed Food Intake in pediatrics? UPF Score: an easy alternative | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article How to evaluate Ultra-processed Food Intake in pediatrics? UPF Score: an easy alternative Laura Fernanda Rosales-Arreola, Citlali Ayala-Galván, Estefany Villa-Aguilar, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4909438/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 15 Apr, 2025 Read the published version in BMC Nutrition → Version 1 posted 14 You are reading this latest preprint version Abstract Background The rising intake of ultra-processed foods (UPFs) among children and adolescents poses challenges due to the lack of precise and accessible tools to quantify such intake. This complicates understanding its effects on dietary quality and hampers the design of effective preventive interventions across diverse socioeconomic and geographic contexts. Objective : This paper aims to determine the relationship between the UPF score and dietary characteristics. Methods This cross-sectional study involved 353 participants aged 3 to 17. The methods included (1) a three-day food intake record; (2) an evaluation of intake across five food groups; (3) categorization of intake frequency (0, 1, 2, or up to 3 times weekly); and (4) scoring by cumulative intake. Principal component analysis and regression models were utilized to assess diet associations with UPF score. Results Higher UPF score groups showed increased intake of energy, fats, and sodium (p < 0.01); decreased fiber intake (p = 0.03), vegetables, fruits, and cereals (p < 0.05); higher sugar intake (p < 0.01); and reduced intake of vitamins A and C (p < 0.05). Four principal components, representing over 65% of sample variability, identified two healthy and two less healthy dietary patterns. Linear regression indicated higher fiber intake at lower UPF scores, declining with higher UPF scores. Conclusions The UPF score represents a useful tool for efficiently and swiftly assessing UPF intake and dietary characteristics in pediatric population. Ultra-Processed Foods Dietary Intake Child Nutrition Dietary Patterns Fiber Figures Figure 1 Introduction The NOVA classification system defines ultra-processed food (UPF) 1 as industrial formulations of multiple ingredients manufactured from substances derived from foods, additives, or ingredients not typically used in home food preparation. 2 , 3 These products contain added sugars, unhealthy fats such as saturated and trans fats, and sodium that extend shelf life, 3 making them highly palatable and addictive 4 due to their high energy content. 5 The dietary pattern of the pediatric population has been characterized by a high energy intake, with a prevalence of UPF intake, 6 leading to weight gain that can result in increased adiposity from childhood to adulthood. 7 The intake of these products causes a lower intake of certain nutrients, such as fiber and vitamins, 8 and a higher risk of cardiometabolic diseases, 9 impacting nutrition and health throughout life. 10 Easy availability, aggressive marketing toward young audiences, 11 convenience, palatability, 3 and socioeconomic factors influence UPF intake, 8 which remains alarmingly high among children and adolescents (C&A) worldwide, 12 with Mexico being the fourth country with the highest per capita purchases of these products. 13 While there are strategies to measure UPF intake, most adaptations provide the total calories that UPFs contribute to the daily diet rather than the number of times or portions consumed habitually. 14 , 15 Therefore, a tool is proposed for use during a three-day food log that facilitates classification based on the frequency of intake and its relationship with the diet. 16 This study aims to determine the relationship between a UPF intake score (UPF score) and diet quality in the pediatric population. Methods Study Population A cross-sectional study was conducted between March and November 2022, involving participants aged 3 to 17. Participants with incomplete dietary records (less than three days) or who reported extreme energy intake ( 3500 kcal) were excluded. The research protocol was approved by the Research Ethics Committee in our Institution with registration number 2021/070, and informed assent from participants and consent from their parents or legal guardians were obtained. Dietary Energy Intake The technique for collecting daily dietary and nutritional intake data was obtained before assessment through a three-day food recall (two weekdays and one weekend day). Parents or guardians were given detailed instructions on how to measure and record food quantities using household measures or portion sizes, with the aid of printed food replicas for guidance. Solid and liquid foods, including water and other beverages, were recorded, and the cooking techniques used were specified. This instrument included a list of commonly forgotten ingredients (e.g., water, salt, tortilla, sugar, sauce, and oil); if any were consumed, they were noted as missing. Food records were captured using NutriKcal VO® v.1 software (CONSINFO, S.C., Mexico City, Mexico), which provides the energy and nutritional content per food item. Macronutrient intake was expressed as a percentage of energy, other nutrients compounds in grams, and portions belonging to the same food group per 1000 kcal. Average Daily Energy Intake (DEI) was also calculated in kcal/kg/day, along with Average Daily Protein Intake (DPI) in g/kg/day. UPF score For the development of the UPF score, five groups of UPF foods (i.e., cereals and tubers, processed meats, dairy products, oils and fats, and sugars) were considered. According to the three-day food record, the number of times each participant consumed each of these groups was summed (at least ½ serving daily was classified as significant intake), as described in Table 1 . Table 1 Ultra-processed foods and the creation of the UPF Score. Food Group Foods UPF score No consume 1 time 2 times 3 times Cereals and tubers Boxed sugary cereal, cereal bar, bakery products, cake, industrialized sliced bread, sweet filled pastry, packaged sweet bread, loaf bread, potato chips, cookies, toast. 0 1 2 3 Processed meats Sausage, blood sausage, ham, nugget, pâté, salted/cured/smoked meats, pepperoni, salami, crab sticks, yellow cheeses, industrialized sliced cheese, cream cheese. High-fat content: Pork rinds, offal. 0 1 2 3 Dairy products Sweetened milks, sweetened yogurt (skimmed or whole), petit suisse, ice creams. 0 1 2 3 Oils and fats Margarine, cream, mayonnaise 0 1 2 3 Sugar Soda, carbonated beverages, soft drinks, tomato sauces, ketchup, gummy candies, nougat, condensed milk, evaporated milk, marshmallow, fruit-flavoured beverages, chocolate bars or pieces of candy with and without chocolate, chocolate powder, jellies. 0 1 2 3 Score ( 0–15), represents the number of times per week reported in a 3-day food record Based on Monteiro CA 3 , García-Blanco L 12 , Gonzalez-Ortiz A 43 The scores obtained were divided into tertiles to classify UPF intake, where the lowest tertile represented low intake, the second tertile moderate intake, and the third tertile high intake of UPF. Covariates Anthropometric measurements were recorded at the beginning of the study. Weight and height were taken using a SECA® scale and stadiometer. Nutrition status was determined using Body Mass Index (BMI), utilizing percentiles from the Centers for Disease Control and Prevention (CDC) and the PediTools calculator. Moreover, sociodemographic information was collected through direct interviews with the children’s parents or legal guardians. Statistical Analysis Categorical variables were presented as frequencies and percentages. Continuous variables with normal distribution were expressed as mean and standard deviation (SD), whereas non-normally distributed variables were expressed as median and interquartile range (IQR). Group differences were assessed using the Chi-square test (Chi2) for categorical variables and analysis of variance (ANOVA) for tertile evaluation. Subsequently, a principal component analysis was performed to evaluate the relationship between patterns of food portion intake and UPF intake using a polychoric matrix. The number of components was determined based on the elbow plot (Figure S1 ). Logistic regression models were used to evaluate the relationship between the components (Table S1 ) and the UPF score. Finally, a restricted linear spline of the UPF score with knots chosen so that data are divided into three groups of equal size was performed to assess the association between fiber intake and the UPF score. The covariates selected for the regression models were those with biological plausibility, potential confounders, and a p-value of < 0.20 in bivariate analysis. A p-value of < 0.05 was considered statistically significant using STATA software. Results From a total of 353 participants, a median UPF score of 6 (IQR 4–7), representing the frequency of UPF intake, was obtained. The median age was 11 years (range 7–15), with nearly half being adolescents (n = 164, 47%) and a minority being female (n = 147, 42%). Approximately 60% of the population had a normal nutritional status (n = 208, 58.9%), as detailed in Table 2 . Participants’ characteristics were presented in tertiles to represent UPF intake: “low” (3–5 points), “moderate” (6–7 points), and “high” (8–10 points). Table 2 Sociodemographic characteristics according to the UPF Score Characteristics All participants Intake, UPF Score points P-value Low Moderate High n = 353 n = 170 n = 111 n = 72 UPF score (points), median (IQR) 6 (4–7) 4 (3–5) 6 (6–7) 9 (8–10) < 0.001 Age (years), median (IQR) 11 (7–15) 11 (7–15) 11 (8–14) 10 (6–15) 1.00 Age category, n (%) Preschool 57 (16) 26 (15) 17 (15) 14 (19) 0.84 School-age 132 (37) 66 (39) 43 (39) 23 (32) Adolescent 164 (47) 78 (46) 51 (46) 35 (49) Female, n (%) 147 (42) 80 (47) 43 (39) 24 (33) 0.11 Weight (kg), median (IQR) 37 (23–54) 35.8 (21–54) 37.1 (26.1–54.4) 36.7 (24–53.3) 0.72 Height (cm), median (IQR) 141 (120–158) 141 (118–158) 142 (122–157) 138 (117–161.5) 0.85 BMI (kg/m 2 ), median (IQR) 18.2 (15.7–22.9) 18.2 (15.6–22.9) 18.1 (15.7–22.4) 18.3 (15.9–23.3) 0.68 Nutritional status, n (%) Malnutrition 36 (10.2) 22 (12.9) 8 (7.2) 6 (8.3) 0.07 Well nourished 208 (58.9) 100 (58.8) 67 (60.4) 41 (56.9) Overweight 65 (18.4) 30 (17.6) 26 (23.4) 9 (12.5) Obesity 44 (12.5) 18 (10.6) 10 (9) 16 (22.2) Data are expressed as median (25th percentile, 75th), or number (%), as appropriate. cm: Centimeters; BMI: Body Mass Index; kg: Kilograms; MEDIAN (IQR): Median (interquartile range). Table 3 enumerates the dietary characteristics according to the UPF. The group with the highest UPF score also had the highest energy intake (kcal), fat intake (%), grams of saturated fat, and the lowest fiber intake (p < 0.05 for all). Other variables showed no statistical significance. Additionally, the group with the highest UPF score reported the lowest intake of vegetables and fruits and the highest intake of sugar. The other groups did not exhibit statistically significant differences. Table 3 Dietary characteristics according to the UPF Score Characteristics All participants Intake, UPF Score points P-value Low, 4 (3–5 points) Moderate, 6 (6–7 points) High, 9 (8–10 points) n = 353 n = 170 n = 111 n = 72 Energy (kcal/day), median (IQR) 1609 (1366–1922) 1478 (1228–1730) 1714 (1439–2005) 1873 (1575–2242) < 0.01 DEI (kcal/kg/day), median (IQR) 47 (31–71) 43 (28–66) 46 (33–68) 55 (36–75) 0.05 DPI (g/kg/día), median (IQR) 1.9 (1.3–2.8) 1.7 (1.2–2.8) 1.9 (1.3–2.8) 2.3 (1.3–2.9) 0.29 Percent Daily Macronutrients (%) Proteins, median (IQR) 16 (14–18) 17 (14–18) 16 (14–18) 15 (14–17) 0.08 Fats, mean ± SD 34 ± 7 32 ± 7 35 ± 7 35 ± 6 0.02 Carbohydrate, mean ± SD 50 ± 7 51 ± 7.5 49 ± 7 50 ± 6 0.06 Nutrients/1000 kcal, median (IQR) Saturated Fats, g 9.4 (7.3–11.2) 9.1 (6.6–10.7) 9.3 (7.5–11.5) 10.2 (8.3–11.6) 0.02 Polyunsaturated Fats, g 12.1 (9.4–15.1) 11.6 (8.7–14.4) 12.1 (10.0–15.2) 12.8 (9.8–15.3) 0.08 Monounsaturated Fats, g 5.4 (4.3–6.7) 5.3 (4.1–6.6) 5.5 (4.4–6.8) 5.7 (4.3–6.8) 0.44 Cholesterol, mg 175.7 (127.8–231.1) 181.8 (132.5–234.5) 176.4 (123.6–242.0) 167.2 (118.9–209.9) 0.21 Sugar, g 26.5 (19.9–36.1) 27.1 (18.4–37.2) 25.8 (20.1–34.8) 27.6 (20.9–36.8) 0.76 Fiber, g 8.2 (5.9–10.5) 9.2 (7.1–12.2) 7.7 (5.9–9.5) 6.2 (4.9–8.5) < 0.01 Liquids, ml 539.5 (392.1–758.3) 576.5 (395.8–837.4) 512.5 (401.0–728.2) 521.4 (352.3–665.5) 0.14 Daily servings/1000 kcal, median (IQR) Vegetables 1.2 (0.7–1.8) 1.4 (0.8–2.1) 1.2 (0.8–1.7) 0.7 (0.5–1.3) < 0.01 Fruits 1.0 (0.5–1.6) 1.1 (0.6–1.9) 0.9 (0.4–1.6) 0.9 (0.4–1.4) 0.02 Cereals 4.6 (3.8–5.3) 4.6 (3.8–5.6) 4.5 (3.9–5.3) 4.7 (3.8–5.1) 0.54 Legumes 0.1 (0.0–0.3) 0.1 (0.0–0.4) 0.1 (0.0–0.3) 0.0 (0.0–0.2) 0.06 Animal Products 3.0 (2.4–3.8) 3.0 (2.4–3.8) 3.1 (2.4–3.9) 2.9 (2.3–3.6) 0.41 Dairy 0.7 (0.4–1.0) 0.7 (0.4–1.1) 0.7 (0.5–1.0) 0.8 (0.5–1.0) 0.96 Fats 2.6 (1.7–3.7) 2.5 (1.5–3.6) 2.7 (1.8–3.9) 2.7 (2.0–3.8) 0.24 Sugars 1.6 (0.7–2.4) 1.0 (0.4–2.2) 1.6 (1.0–2.3) 1.9 (1.4–3.1) < 0.01 Data are expressed as mean ± SD, median (25th percentile, 75th), or number (%), as appropriate. DEI: Average Daily Energy Intake; DPI: Daily Protein Intake Regarding vitamin intake (Table 4 ), the group with the lowest UPF score had higher intake of vitamins A and C, as well as iron and potassium (p < 0.05). The rest of the variables demonstrated no statistically significant differences. Table 4 Micronutrient intake, categorized by UPF Score. Nutrients/1000 kcal, median (IQR) All participants Intake, UPF Score points P-value Low, 4 (3–5 points) Moderate, 6 (6–7 points) High, 9 (8–10 points) n = 353 n = 170 n = 111 n = 72 Vitamin A, mcg 464.7 (299.3–787.0) 499.9 (333.2–847.5) 462.8 (327.3–709.6) 340.7 (245.7–605.7) 0.009 Vitamin B1, mg 0.6 (0.5–0.7) 0.6 (0.5–0.7) 0.6 (0.5–0.7) 0.6 (0.5–0.7) 0.720 Vitamin B2, mg 0.8 (0.6–0.9) 0.8 (0.6–1.0) 0.7 (0.6–0.9) 0.8 (0.6–0.9) 0.840 Vitamin B6, mg 0.7 (0.5–1.0) 0.8 (0.6–1.0) 0.7 (0.5–0.9) 0.7 (0.5–0.9) 0.075 Vitamin B12, mcg 1.2 (0.9–1.8) 1.3 (0.8–1.8) 1.2 (0.9–1.8) 1.2 (1.0–1.8) 0.870 Vitamin C, mg 43.3 (25.8–72.4) 48.4 (30.0–81.8) 40.6 (25.0–69.5) 41.5 (22.3–54.1) 0.026 Folic Acid, mcg 96.1 (68.8–131.9) 99.1 (71.6–135.2) 90.4 (69.1–133.5) 91.7 (62.6–128.7) 0.310 Pantothenic Acid, mg 1.5 (1.1–2.0) 1.6 (1.1–2.2) 1.5 (1.1–1.9) 1.5 (1.0–1.9) 0.230 Niacin, mg 7.6 (6.1–10.1) 7.9 (5.9–10.7) 7.5 (6.1–9.7) 7.5 (6.2–8.9) 0.290 Vitamin E, mg 2.3 (1.5–3.2) 2.3 (1.6–3.1) 2.4 (1.5–3.4) 2.1 (1.4–3.1) 0.380 Calcium, mg 473.1 (360.5–591.8) 480.8 (373.1–614.0) 474.4 (351.5–581.3) 467.5 (360.5–567.0) 0.510 Iron, mg 7.3 (6.0–8.6) 7.4 (6.5–8.8) 7.3 (6.2–8.5) 6.3 (5.3–8.2) 0.008 Potassium, mg 1052.6 (840.3–1297.5) 1135.2 (863.2–1403.8) 1027.4 (798.3–1223.2) 1012.5 (771.8–1203.8) 0.003 Magnesium, mg 114.5 (83.9–160.2) 120.6 (86.9–162.7) 115.7 (79.0–153.8) 110.1 (84.2–172.1) 0.460 Sodium, mg 1203.5 (998.8–1431.2) 1147.6 (973.2–1473.2) 1238.3 (1026.3–1405.6) 1240.1 (1047.4–1380.3) 0.760 Phosphorus, mg 368.8 (274.4–466.0) 376.6 (271.1–482.3) 354.6 (277.3–435.8) 385.2 (275.5–473.1) 0.390 Selenium, mg 27.0 (21.8–33.2) 27.6 (22.6–33.4) 26.4 (20.6–33.3) 26.2 (19.9–30.8) 0.250 Zinc, mg 3.3 (2.6–4.2) 3.3 (2.5–4.3) 3.2 (2.5–4.4) 3.3 (2.9–3.9) 0.920 mcg/1000 kcal: Micrograms per 1000 kilocalories; mg/1000 kcal: Milligrams per 1000 kilocalories; IQR: interquartile range. Supplementary Table 1 specifies the relationships between different types of foods and their intake patterns. Component 1 (Comp1) identifies a positive association with the intake of cereals, animal products, and fats. Component 2 is positively associated with legume intake and negatively associated with sugar and fats. Component 3 is positively associated with fruit and vegetable intake as well as animal products and negatively associated with sugar. Finally, Component 4 is positively associated with fruits, sugar, milk, and dairy products ( Table S1 ). Table 5 presents the multinomial logistic regression models that evaluate the main components associated with the UPF score, where components 2 and 3 are protective factors for UPF intake, and components 1 and 4 are risk factors. Table 5 Multinomial logistic regression models to assess the main components associated with the UPF score. COMPONENTS 1 + Cereal + Fat + Animal Origin Product 2 -Sugar -Grease + Legumes 3 -Sugar + Fruits + Vegetables + Animal Origin Product 4 + Fruits + Milk and derivatives + Sugar Unadjusted models UPF score OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) Low REF REF REF REF Moderate 1.4 (1.2–1.7) 0.7 (0.5–0.9) 0.8 (0.7–1.1) 1.3 (1.0–1.7) High 1.8 (1.4–2.3) 0.5 (0.4–0.7) 0.6 (0.5–0.8) 1.8 (1.5–2.5) Model 1 UPF score OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) Low REF REF REF REF Moderate 1.4 (1.1–1.8) 0.7 (0.5–0.9) 0.9 (0.7–1.1) 1.3 (0.99–1.8) High 1.8 (1.4–2.4) 0.6 (0.4–0.8) 0.6 (0.4–0.8) 1.8 (1.3–2.4) Model 1 : adjusted for gender, age, body mass index, and residence. Finally, using the linear regression model, an inverse association was observed between fiber intake and the UPF score (Fig. 1 ). Discussion This study proposes using a scoring system to identify low, moderate, or high intake of UPF. The results indicate that lower UPF intake (low frequency of consumption) is associated with better diet quality in C&A. Additionally, high UPF intake is positively associated with unhealthy eating patterns but inversely associated with a healthy diet. The role of UPF in children’s diets extends beyond immediate health effects, 18 – 20 influencing long-term food preferences 18 and the development of healthy dietary patterns in the future. 20 , 21 In Mexico, an increase in UPF intake of approximately 5 percentage points was reported among C&A from 2006 22 to 2016, 23 reflecting growths in the food industry and a radical transformation in the Mexican diet. 24 , 25 Although the complications associated with high UPF intake, such as obesity and chronic diseases, 26 , 27 are well known, it is essential to explore how these foods affect the intake of healthy nutrients. However, no specific amount of UPF that can be considered safe for the pediatric population has been determined. 28 Information regarding UPF and various outcomes has gained significant relevance recently, from observational studies to systematic reviews of clinical trials. 29 , 30 Despite the available information, conducting meta-analyses has been challenging due to data heterogeneity. A recent systematic review mentioned that nutritional interventions aimed at eliminating UPF intake reported no changes in intake. 30 This heterogeneity limits the extrapolation and comparison of results, as well as short- or medium-term goals for its intake. Several studies and health organizations, such as the World Health Organization, 31 emphasize the importance of limiting UPF intake to improve diet quality and prevent chronic diseases, 32 , 33 as a crucial early intervention, especially given the negative impact of UPF. 31 – 35 Energy and macronutrient requirements for C&A are significantly lower than those for adults and should be adjusted according to their stages of growth and development. 36 , 37 However, caloric intake in the high UPF intake group resembles that of a high school teenager, despite the study population having a median age of 11 years. This suggests that energy intake observed in C&A, especially in the moderate and high UPF intake groups, exceeds the expected energy requirements for their age group, 38 which could have negative implications regarding unhealthy daily dietary habits. 33 , 39 – 42 Significant associations between different intake patterns and UPF scores were identified through principal component analysis. For instance, component 2, characterized by lower sugar and fat intake and higher legume intake, acts as a protective factor against high UPF intake. In contrast, component 4, which includes fruits, dairy, and sugar, represents a risk factor. An example of a meal that may appear healthy but includes UPF is chocolate milk with added sugar accompanied by an apple, illustrating how certain healthy foods are paired with high UPF intake due to a lack of awareness of UPF content. Evidence supports the use of principal components for analyzing other diets, enabling the development of indices tailored to specific populations and dietary contexts. 43 , 44 Identifying protective and risk factors associated with UPF intake through dietary patterns provides a basis for future longitudinal research to establish temporal trends and population-specific parameters for more precise guidelines on acceptable UPF intake, contributing to child health. Our findings reveal that a higher UPF score is associated with lower fiber intake and higher intake of fats and sugars. This pattern suggests that children consuming more UPF tend to have lower nutritional quality diets. 12 , 45 – 47 Specifically, participants with “high intake” of UPF (8–10 points) showed significantly higher energy and saturated fat intake and lower fiber intake compared to those with “low intake” (3–5 points). Our results also showed that even within moderate ranges of UPF intake, similar effects were observed across other groups, impacting overall diet quality. 10 , 12 , 32 Our tool adapts and strengthens the NOVA system, which aids in understanding food quality and its health impact, for the pediatric population, considering the magnitude of UPF intake and classifying participants into low, moderate, and high intake tertiles. 14 , 48 Furthermore, this study underscores the importance of promoting healthy eating habits from an early age. Our results find UPF intake to be a global public health issue, primarily affecting vulnerable and low-income populations due to the low cost and high availability of these foods. 49 – 51 The strengths of the UPF score lie in its simplicity as a tool for assessing UPF intake in C&A, and of the main strength of using the UPF score is that being a three-day food record, it helps assess the frequency and quantity of UPF consumed; however, the main limitation is the nature of the study does not allow establishing causal associations, and the exact number of daily servings of UPF consumed was not identified. The study’s findings underscore the importance of limiting UPF intake in children’s diets to promote better nutritional health. Accordingly, using the UPF score can guide nutritionists and healthcare professionals in clinically assessing and monitoring children. Conclusion The study indicates that ultra-processed food (UPF) intake in C&A is associated with poorer diet quality, characterized by higher energy and saturated fat intake and lower fiber intake. The UPF score is a valuable tool for quantifying this intake, adapting to dietary characteristics, and predicting overall diet quality. Abbreviations ANOVA Analysis of Variance BMI Body Mass Index CDC Centers for Disease Control and Prevention Comp1 Component 1 (in Principal Component Analysis) DEI Daily Energy Intake DPI Daily Protein Intake IQR Interquartile Range UPF Ultra-Processed Foods Declarations Ethical approval and consent to participate The research protocol was approved by the Research Ethics Committee in our Institution with registration number 2021/070, and informed assent from participants and consent from their parents or legal guardians were obtained. Consent for publication Consent for the publication of the results of this study was obtained in accordance with established ethical requirements. Availability of data and materials The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. Competing interests The authors declare that they have no competing interests. Funding statement This work was financially supported by Instituto Nacional de Pediatría through the E022 Program. Authors' contributions LFRA Participated in study conception and design the research generation, analysis of the data and writing the paper. AGO Participated in study conception, design, revision, and analysis of the data, writing the paper and approval of the final version of the manuscript. AVG Participated in study conception and design the research generation, analysis of the data and writing the paper. CAG, EVA, RSR, BPG, JOGZ participated in interpretation of the data and/or critical revision of the manuscript to its final form. All authors read and approved the final manuscript. Acknowledgements No aplicable. References Monteiro CA, Cannon G, Moubarac JC, Levy RB, Louzada MLC, Jaime PC. The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing. Public Health Nutr. 2018;21(1):5–17. 10.1017/s1368980017000234 . Capozzi F, Magkos F, Fava F, Milani GP, Agostoni C, Astrup A, et al. A Multidisciplinary Perspective of Ultra-Processed Foods and Associated Food Processing Technologies: A View of the Sustainable Road Ahead. Nutrients. 2021;13(11). 10.3390/nu13113948 . Monteiro CA, Levy RB, Claro RM, Castro IR, Cannon G. A new classification of foods based on the extent and purpose of their processing. Cadernos de saude publica. 2010;26(11):2039–49. 10.1590/s0102-311x2010001100005 . Gearhardt AN, DiFeliceantonio AG. Highly processed foods can be considered addictive substances based on established scientific criteria. Addiction. 2023;118(4):589–98. 10.1111/add.16065 . Marrón-Ponce J, Sánchez T, Louzada ML, Batis C. Energy contribution of NOVA food groups and sociodemographic determinants of ultra-processed food intake in the Mexican population. Public Health Nutr. 2017;21:1–8. 10.1017/S1368980017002129 . Costa CS, Del-Ponte B, Assunção MCF, Santos IS. Intake of ultra-processed foods and body fat during childhood and adolescence: a systematic review. Public Health Nutr. 2018;21(1):148–59. 10.1017/s1368980017001331 . Chang K, Khandpur N, Neri D, Touvier M, Huybrechts I, Millett C, et al. Association Between Childhood Intake of Ultraprocessed Food and Adiposity Trajectories in the Avon Longitudinal Study of Parents and Children Birth Cohort. JAMA Pediatr. 2021;175(9):e211573. 10.1001/jamapediatrics.2021.1573 . Calcaterra V, Cena H, Rossi V, Santero S, Bianchi A, Zuccotti G. Ultra-Processed Food, Reward System and Childhood Obesity. Child (Basel). 2023;10(5). 10.3390/children10050804 . Touvier M, da Costa Louzada ML, Mozaffarian D, Baker P, Juul F, Srour B. Ultra-processed foods and cardiometabolic health: public health policies to reduce intake cannot wait. BMJ. 2023;383:e075294. 10.1136/bmj-2023-075294 . Fonseca MM, Coimbra RVG, Oliveira JSE, Soares ADN, Gomes JMG. Intake of ultra-processed foods and associated factors in children from Barbacena (MG), Brazil. Revista paulista de pediatria: orgao oficial da Sociedade de. Pediatria de Sao Paulo. 2023;42:e2022127. 10.1590/1984-0462/2024/42/2022127 . Nieto C, Espinosa F, Valero-Morales I, Boyland E, Potvin Kent M, Tatlow-Golden M, et al. Digital food and beverage marketing appealing to children and adolescents: An emerging challenge in Mexico. Pediatr Obes. 2023;18(7):e13036. 10.1111/ijpo.13036 . García-Blanco L, de la Santiago OV, Pouso S, Martínez-González A, Martín-Calvo M. High intake of ultra-processed foods is associated with increased risk of micronutrient inadequacy in children: The SENDO project. Eur J Pediatr. 2023;182(8):3537–47. 10.1007/s00431-023-05026-9 . Marrón-Ponce JA, Tolentino-Mayo L, Hernández FM, Batis C. Trends in Ultra-Processed Food Purchases from 1984 to 2016 in Mexican Households. Nutrients. 2018;11(1). 10.3390/nu11010045 . Costa CDS, Faria FR, Gabe KT, Sattamini IF, Khandpur N, Leite FHM, et al. Nova score for the intake of ultra-processed foods: description and performance evaluation in Brazil. Rev Saude Publica. 2021;55:13. 10.11606/s1518-8787.2021055003588 . Kébé SD, Diouf A, Sylla P, Kane K, Dos Santos Costa C, Leite FHM, et al. Assessment of ultra processed foods intake in Senegal: validation of the Nova-UPF screener. Arch Public Health. 2024;82(1):4. 10.1186/s13690-024-01239-y . Schröder H, Covas MI, Marrugat J, Vila J, Pena A, Alcántara M, et al. Use of a three-day estimated food record, a 72-hour recall and a food-frequency questionnaire for dietary assessment in a Mediterranean Spanish population. Clin Nutr. 2001;20(5):429–37. 10.1054/clnu.2001.0460 . Chou JH, Roumiantsev S, Singh R. PediTools Electronic Growth Chart Calculators: Applications in Clinical Care, Research, and Quality Improvement. J Med Internet Res. 2020;22(1):e16204. 10.2196/16204 . de Oliveira PG, de Sousa JM, Assunção DGF, de Araujo EKS, Bezerra DS, Dametto J, et al. Impacts of Intake of Ultra-Processed Foods on the Maternal-Child Health: A Systematic Review. Front Nutr. 2022;9:821657. 10.3389/fnut.2022.821657 . Rousham EK, Goudet S, Markey O, Griffiths P, Boxer B, Carroll C, et al. Unhealthy Food and Beverage Intake in Children and Risk of Overweight and Obesity: A Systematic Review and Meta-Analysis. Adv Nutr. 2022;13(5):1669–96. 10.1093/advances/nmac032 . Hou M, Qiu C. Ultra-Processed Food as Mediator of the Association between Birthweight and Childhood Body Weight Outcomes: A Retrospective Cohort Study. Nutrients. 2023;15(19). 10.3390/nu15194178 . Boushey C, Ard J, Bazzano L, Heymsfield S, Mayer-Davis E, Sabaté J et al. USDA Nutrition Evidence Systematic Reviews. Dietary Patterns and All-Cause Mortality: A Systematic Review. Alexandria (VA): USDA Nutrition Evidence Systematic Review; 2020. 10.52570/nesr.Dgac2020.Sr0108 Olaiz-Fernández G, Rivera-Dommarco J, Shamah-Levy T, Rojas R, Villalpando-Hernández S, Hernández-Avila M et al. Encuesta Nacional de Salud y Nutrición 2006. Cuernavaca, México: Instituto Nacional de Salud Pública; 2006. 2013. Oviedo-Solís CI, Monterrubio-Flores EA, Cediel G, Denova-Gutiérrez E, Barquera S. Trend of Ultraprocessed Product Intake Is Associated with the Double Burden of Malnutrition in Mexican Children and Adolescents. Nutrients. 2022;14(20). 10.3390/nu14204347 . Rampalli KK, Blake CE, Frongillo EA, Montoya J. Why understanding food choice is crucial to transform food systems for human and planetary health. BMJ Glob Health. 2023;8(5). 10.1136/bmjgh-2022-010876 . Monteiro CA, Lawrence M, Millett C, Nestle M, Popkin BM, Scrinis G, et al. The need to reshape global food processing: a call to the United Nations Food Systems Summit. BMJ Glob Health. 2021;6(7). 10.1136/bmjgh-2021-006885 . Shu L, Zhang X, Zhou J, Zhu Q, Si C. Ultra-processed food intake and increased risk of metabolic syndrome: a systematic review and meta-analysis of observational studies. Front Nutr. 2023;10:1211797. 10.3389/fnut.2023.1211797 . Pagliai G, Dinu M, Madarena MP, Bonaccio M, Iacoviello L, Sofi F. Intake of ultra-processed foods and health status: a systematic review and meta-analysis. Br J Nutr. 2021;125(3):308–18. 10.1017/s0007114520002688 . UNICEF, UNICEF. El sobrepeso en la niñez Un llamado para la prevención en América Latina y el Caribe. Panama: UNICEF Panama City; 2022. Leone A, De la Fuente-Arrillaga C, Mas MV, Sayon-Orea C, Menichetti F, Martínez-Gonzalez MA, et al. Association between the intake of ultra-processed foods and the incidence of peptic ulcer disease in the SUN project: a Spanish prospective cohort study. Eur J Nutr. 2024. 10.1007/s00394-024-03439-2 . Aramburu A, Alvarado-Gamarra G, Cornejo R, Curi-Quinto K, Díaz-Parra CDP, Rojas-Limache G, et al. Ultra-processed foods intake and health-related outcomes: a systematic review of randomized controlled trials. Front Nutr. 2024;11:1421728. 10.3389/fnut.2024.1421728 . Organization WH. Healthy diet. World Health Organization. Regional Office for the Eastern Mediterranean; 2019. Angelino D, Dinu M, Gandossi B, Pellegrini N, Martini D. Processing and Nutritional Quality of Breakfast Cereals Sold in Italy: Results from the Food Labelling of Italian Products (FLIP) Study. Nutrients. 2023;15(8). 10.3390/nu15082013 . Khoury N, Martínez M, Garcidueñas-Fimbres TE, Pastor-Villaescusa B, Leis R, de Las Heras-Delgado S, et al. Ultraprocessed Food Intake and Cardiometabolic Risk Factors in Children. JAMA Netw Open. 2024;7(5):e2411852. 10.1001/jamanetworkopen.2024.11852 . Monteiro CA, Cannon G, Levy RB, Moubarac JC, Louzada ML, Rauber F, et al. Ultra-processed foods: what they are and how to identify them. Public Health Nutr. 2019;22(5):936–41. 10.1017/s1368980018003762 . Wang L, Martínez Steele E, Du M, Pomeranz JL, O'Connor LE, Herrick KA, et al. Trends in Intake of Ultraprocessed Foods Among US Youths Aged 2–19 Years, 1999–2018. JAMA. 2021;326(6):519–30. 10.1001/jama.2021.10238 . Mendoza E, Bourges H, Morales L, Chávez A. Tablas de composición de alimentos y productos alimenticios (versión condensada 2015). Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán: Mexico City, Mexico. 2015. doi. Kaufer-Horwitz M, Robledo LMG, Pérez-Lizaur AB, Barragán VER. Nutriología médica: Editorial Médica Panamericana; 2023. doi. Rodríguez B, Jorge R. Recomendaciones de ingestión de nutrimentos para la población mexicana. 2005. doi. Abdoli M, Scotto Rosato M, Cipriano A, Napolano R, Cotrufo P, Barberis N, et al. Affect, Body, and Eating Habits in Children: A Systematic Review. Nutrients. 2023;15(15). 10.3390/nu15153343 . Bowman SA, Gortmaker SL, Ebbeling CB, Pereira MA, Ludwig DS. Effects of fast-food intake on energy intake and diet quality among children in a national household survey. Pediatrics. 2004;113(1 Pt 1):112–8. 10.1542/peds.113.1.112 . Kenney EL, Lee MM, Barrett JL, Ward ZJ, Long MW, Cradock AL, et al. Cost-effectiveness of Improved WIC Food Package for Preventing Childhood Obesity. Pediatrics. 2024;153(2). 10.1542/peds.2023-063182 . Oliveira GAL, Santos Gonçalves VS, Nakano EY, Toral N. Intake of ultra-processed foods and low dietary diversity are associated with sedentary and unhealthy eating behaviors: A nationwide study with Brazilian Schoolchildren. PLoS ONE. 2024;19(1):e0294871. 10.1371/journal.pone.0294871 . González-Ortiz A, Xu H, Avesani CM, Lindholm B, Cederholm T, Risérus U, et al. Plant-based diets, insulin sensitivity and inflammation in elderly men with chronic kidney disease. J Nephrol. 2020;33(5):1091–101. 10.1007/s40620-020-00765-6 . Mescoloto SB, Pongiluppi G, Domene S. Ultra-processed food intake and children and adolescents' health. J Pediatr (Rio J). 2024;100(Suppl 1):S18–30. 10.1016/j.jped.2023.09.006 . Marrón-Ponce J, Flores M, Cediel GG, Monteiro C, Batis C. Associations Between Intake of Ultra-Processed Foods and Intake of Nutrients Related to Chronic Non-Communicable Diseases in Mexico. J Am Acad Nutr Dietetics. 2019;1:1. 10.1016/j.jand.2019.04.020 . Malamatenios O, Campbell JL, Schofield G, Zinn C. The Human Interference Scoring System (HISS): A New Tool for Quantifying Food Quality Based on Its Level of Processing. Nutrients. 2024;16(4). 10.3390/nu16040536 . Martines RM, Machado PP, Neri DA, Levy RB, Rauber F. Association between watching TV whilst eating and children's intake of ultraprocessed foods in United Kingdom. Matern Child Nutr. 2019;15(4):e12819. 10.1111/mcn.12819 . Correa-Madrid MC, Correa Guzmán N, Bergeron G, Restrepo-Mesa SL, Cediel G. Validation of the NOVA score for the intake of ultra-processed foods by young women of Medellín, Colombia. Ann N Y Acad Sci. 2023;1528(1):69–76. 10.1111/nyas.15054 . Silva P, Araújo R, Lopes F, Ray S. Nutrition and Food Literacy: Framing the Challenges to Health Communication. Nutrients. 2023;15(22). 10.3390/nu15224708 . Pemjean I, Mediano F, Ferrer P, Garmendia ML, Corvalán C. Food access, domestic environments, and dietary quality of low-middle income Chilean children during the COVID-19 pandemic. Front Public Health. 2023;11:1164357. 10.3389/fpubh.2023.1164357 . Clemente-Suárez VJ, Beltrán-Velasco AI, Redondo-Flórez L, Martín-Rodríguez A, Tornero-Aguilera JF. Global Impacts of Western Diet and Its Effects on Metabolism and Health: A Narrative Review. Nutrients. 2023;15(12). 10.3390/nu15122749 . Additional Declarations No competing interests reported. Supplementary Files 2Supplementarymaterial.pdf Cite Share Download PDF Status: Published Journal Publication published 15 Apr, 2025 Read the published version in BMC Nutrition → Version 1 posted Editorial decision: Revision requested 27 Jan, 2025 Reviews received at journal 08 Nov, 2024 Reviews received at journal 03 Nov, 2024 Reviewers agreed at journal 28 Oct, 2024 Reviews received at journal 25 Oct, 2024 Reviewers agreed at journal 24 Oct, 2024 Reviews received at journal 20 Oct, 2024 Reviewers agreed at journal 20 Oct, 2024 Reviewers agreed at journal 17 Oct, 2024 Reviewers invited by journal 17 Oct, 2024 Editor invited by journal 22 Aug, 2024 Editor assigned by journal 15 Aug, 2024 Submission checks completed at journal 15 Aug, 2024 First submitted to journal 13 Aug, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4909438","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":345896686,"identity":"5d5bdc44-20ec-46c3-b7d0-ab0d83dada04","order_by":0,"name":"Laura Fernanda Rosales-Arreola","email":"","orcid":"","institution":"Instituto Nacional de Pediatria","correspondingAuthor":false,"prefix":"","firstName":"Laura","middleName":"Fernanda","lastName":"Rosales-Arreola","suffix":""},{"id":345896687,"identity":"8acdfa1d-7a5d-4d91-aa52-8b90a7feb80b","order_by":1,"name":"Citlali Ayala-Galván","email":"","orcid":"","institution":"Instituto Nacional de Pediatria","correspondingAuthor":false,"prefix":"","firstName":"Citlali","middleName":"","lastName":"Ayala-Galván","suffix":""},{"id":345896688,"identity":"3f16a8e0-3c4b-418a-af10-df403b1cbb11","order_by":2,"name":"Estefany Villa-Aguilar","email":"","orcid":"","institution":"Instituto Nacional de Pediatria","correspondingAuthor":false,"prefix":"","firstName":"Estefany","middleName":"","lastName":"Villa-Aguilar","suffix":""},{"id":345896689,"identity":"eab23c2d-d222-49c1-8764-bef7e1d2687c","order_by":3,"name":"Analí Villegas-González","email":"","orcid":"","institution":"Instituto Nacional de Pediatria","correspondingAuthor":false,"prefix":"","firstName":"Analí","middleName":"","lastName":"Villegas-González","suffix":""},{"id":345896691,"identity":"e145ce0e-050f-4830-ab52-ac534ca16ebc","order_by":4,"name":"Rosa E Soriano-Rosales","email":"","orcid":"","institution":"Instituto Nacional de Pediatria","correspondingAuthor":false,"prefix":"","firstName":"Rosa","middleName":"E","lastName":"Soriano-Rosales","suffix":""},{"id":345896692,"identity":"c763e141-4002-45a3-9008-31b0ddeda986","order_by":5,"name":"Beatriz Pérez-Guillé","email":"","orcid":"","institution":"Instituto Nacional de Pediatria","correspondingAuthor":false,"prefix":"","firstName":"Beatriz","middleName":"","lastName":"Pérez-Guillé","suffix":""},{"id":345896693,"identity":"530ad225-f214-418d-8b9f-0072f079d183","order_by":6,"name":"José Francisco González-Zamora","email":"","orcid":"","institution":"Instituto Nacional de Pediatria","correspondingAuthor":false,"prefix":"","firstName":"José","middleName":"Francisco","lastName":"González-Zamora","suffix":""},{"id":345896694,"identity":"e2a7e8e1-4cc0-4339-a529-1375df0377c8","order_by":7,"name":"Ailema González-Ortiz","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0klEQVRIiWNgGAWjYDACZuYGBgkGBjkQ+8AD4rQwgrUYg7UkEGcNUAsQJIJJorTwtzM2PrD4ZZM+P+zwQ6AtdnK6DQS0SBxmbDaQ7EvL3Xg7zQCoJdnY7AAhaw4ztklI9hzO3Tg7AaTlQOI2QlrkDzO2/wBqSTecnf6BOC0GQFsYJH4cTpCXziHSFkOgXyQkG9IMN0jnFBxIMCDCL3LnDx/8LPHHRl5+dvrmDx8q7OQIex8ImCXbgC4EqzQgQjkIMH74AwyHBiJVj4JRMApGwcgDAEG/R2UKk8meAAAAAElFTkSuQmCC","orcid":"","institution":"Instituto Nacional de Pediatria","correspondingAuthor":true,"prefix":"","firstName":"Ailema","middleName":"","lastName":"González-Ortiz","suffix":""}],"badges":[],"createdAt":"2024-08-13 21:14:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4909438/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4909438/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s40795-025-01056-8","type":"published","date":"2025-04-15T15:57:51+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":66528358,"identity":"743cded1-9f6f-4778-a6df-e698000d4609","added_by":"auto","created_at":"2024-10-14 05:26:49","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":38650,"visible":true,"origin":"","legend":"\u003cp\u003eLinear regression model associated with UPF Score and fiber intake.\u003c/p\u003e","description":"","filename":"Figure1.LinearregressionmodelassociatedwithUPFScoreandfiberintake.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4909438/v1/f1d09e3fef11b581590a767f.jpg"},{"id":81050994,"identity":"a5283cd3-2c9e-4bf2-a5e9-df284663291b","added_by":"auto","created_at":"2025-04-21 16:09:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1315836,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4909438/v1/eefc7060-e31f-46f5-8a56-8c153652ac0f.pdf"},{"id":66528296,"identity":"7b9f7481-48ba-4331-b0fa-9844e59d61e1","added_by":"auto","created_at":"2024-10-14 05:26:26","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":140418,"visible":true,"origin":"","legend":"","description":"","filename":"2Supplementarymaterial.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4909438/v1/783b22a87317a99428985625.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"How to evaluate Ultra-processed Food Intake in pediatrics? UPF Score: an easy alternative","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe NOVA classification system defines ultra-processed food (UPF) \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e as industrial formulations of multiple ingredients manufactured from substances derived from foods, additives, or ingredients not typically used in home food preparation. \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e These products contain added sugars, unhealthy fats such as saturated and trans fats, and sodium that extend shelf life, \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e making them highly palatable and addictive \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e due to their high energy content. \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe dietary pattern of the pediatric population has been characterized by a high energy intake, with a prevalence of UPF intake, \u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e leading to weight gain that can result in increased adiposity from childhood to adulthood. \u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e The intake of these products causes a lower intake of certain nutrients, such as fiber and vitamins, \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e and a higher risk of cardiometabolic diseases, \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e impacting nutrition and health throughout life. \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e Easy availability, aggressive marketing toward young audiences, \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e convenience, palatability, \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e and socioeconomic factors influence UPF intake, \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e which remains alarmingly high among children and adolescents (C\u0026amp;A) worldwide, \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e with Mexico being the fourth country with the highest per capita purchases of these products. \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eWhile there are strategies to measure UPF intake, most adaptations provide the total calories that UPFs contribute to the daily diet rather than the number of times or portions consumed habitually. \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e Therefore, a tool is proposed for use during a three-day food log that facilitates classification based on the frequency of intake and its relationship with the diet. \u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e This study aims to determine the relationship between a UPF intake score (UPF score) and diet quality in the pediatric population.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Population\u003c/h2\u003e \u003cp\u003eA cross-sectional study was conducted between March and November 2022, involving participants aged 3 to 17. Participants with incomplete dietary records (less than three days) or who reported extreme energy intake (\u0026lt;\u0026thinsp;800 kcal or \u0026gt;\u0026thinsp;3500 kcal) were excluded. The research protocol was approved by the Research Ethics Committee in our Institution with registration number 2021/070, and informed assent from participants and consent from their parents or legal guardians were obtained.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eDietary Energy Intake\u003c/h2\u003e \u003cp\u003eThe technique for collecting daily dietary and nutritional intake data was obtained before assessment through a three-day food recall (two weekdays and one weekend day). Parents or guardians were given detailed instructions on how to measure and record food quantities using household measures or portion sizes, with the aid of printed food replicas for guidance. Solid and liquid foods, including water and other beverages, were recorded, and the cooking techniques used were specified. This instrument included a list of commonly forgotten ingredients (e.g., water, salt, tortilla, sugar, sauce, and oil); if any were consumed, they were noted as missing.\u003c/p\u003e \u003cp\u003eFood records were captured using NutriKcal VO\u0026reg; v.1 software (CONSINFO, S.C., Mexico City, Mexico), which provides the energy and nutritional content per food item. Macronutrient intake was expressed as a percentage of energy, other nutrients compounds in grams, and portions belonging to the same food group per 1000 kcal. Average Daily Energy Intake (DEI) was also calculated in kcal/kg/day, along with Average Daily Protein Intake (DPI) in g/kg/day.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eUPF score\u003c/h2\u003e \u003cp\u003eFor the development of the UPF score, five groups of UPF foods (i.e., cereals and tubers, processed meats, dairy products, oils and fats, and sugars) were considered. According to the three-day food record, the number of times each participant consumed each of these groups was summed (at least \u0026frac12; serving daily was classified as significant intake), as described in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUltra-processed foods and the creation of the UPF Score.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFood Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFoods\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e \u003cp\u003eUPF score\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo consume\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 time\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 times\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 times\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCereals and tubers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBoxed sugary cereal, cereal bar, bakery products, cake, industrialized sliced bread, sweet filled pastry, packaged sweet bread, loaf bread, potato chips, cookies, toast.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProcessed meats\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSausage, blood sausage, ham, nugget, p\u0026acirc;t\u0026eacute;, salted/cured/smoked meats, pepperoni, salami, crab sticks, yellow cheeses, industrialized sliced cheese, cream cheese. High-fat content: Pork rinds, offal.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDairy products\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSweetened milks, sweetened yogurt (skimmed or whole), petit suisse, ice creams.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOils and fats\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMargarine, cream, mayonnaise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSugar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSoda, carbonated beverages, soft drinks, tomato sauces, ketchup, gummy candies, nougat, condensed milk, evaporated milk, marshmallow, fruit-flavoured beverages, chocolate bars or pieces of candy with and without chocolate, chocolate powder, jellies.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eScore\u003c/b\u003e (\u003cb\u003e0\u0026ndash;15), represents the number of times per week reported in a 3-day food record\u003c/b\u003e\u003c/p\u003e \u003cp\u003eBased on Monteiro CA\u003csup\u003e3\u003c/sup\u003e, Garc\u0026iacute;a-Blanco L\u003csup\u003e12\u003c/sup\u003e, Gonzalez-Ortiz A\u003csup\u003e43\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe scores obtained were divided into tertiles to classify UPF intake, where the lowest tertile represented low intake, the second tertile moderate intake, and the third tertile high intake of UPF.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eCovariates\u003c/h2\u003e \u003cp\u003eAnthropometric measurements were recorded at the beginning of the study. Weight and height were taken using a SECA\u0026reg; scale and stadiometer. Nutrition status was determined using Body Mass Index (BMI), utilizing percentiles from the Centers for Disease Control and Prevention (CDC) and the PediTools calculator.\u003c/p\u003e \u003cp\u003e Moreover, sociodemographic information was collected through direct interviews with the children\u0026rsquo;s parents or legal guardians.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eCategorical variables were presented as frequencies and percentages. Continuous variables with normal distribution were expressed as mean and standard deviation (SD), whereas non-normally distributed variables were expressed as median and interquartile range (IQR).\u003c/p\u003e \u003cp\u003eGroup differences were assessed using the Chi-square test (Chi2) for categorical variables and analysis of variance (ANOVA) for tertile evaluation.\u003c/p\u003e \u003cp\u003eSubsequently, a principal component analysis was performed to evaluate the relationship between patterns of food portion intake and UPF intake using a polychoric matrix. The number of components was determined based on the elbow plot (Figure \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e). Logistic regression models were used to evaluate the relationship between the components (Table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e) and the UPF score.\u003c/p\u003e \u003cp\u003eFinally, a restricted linear spline of the UPF score with knots chosen so that data are divided into three groups of equal size was performed to assess the association between fiber intake and the UPF score. The covariates selected for the regression models were those with biological plausibility, potential confounders, and a p-value of \u0026lt;\u0026thinsp;0.20 in bivariate analysis. A p-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant using STATA software.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eFrom a total of 353 participants, a median UPF score of 6 (IQR 4\u0026ndash;7), representing the frequency of UPF intake, was obtained. The median age was 11 years (range 7\u0026ndash;15), with nearly half being adolescents (n\u0026thinsp;=\u0026thinsp;164, 47%) and a minority being female (n\u0026thinsp;=\u0026thinsp;147, 42%). Approximately 60% of the population had a normal nutritional status (n\u0026thinsp;=\u0026thinsp;208, 58.9%), as detailed in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Participants\u0026rsquo; characteristics were presented in tertiles to represent UPF intake: \u0026ldquo;low\u0026rdquo; (3\u0026ndash;5 points), \u0026ldquo;moderate\u0026rdquo; (6\u0026ndash;7 points), and \u0026ldquo;high\u0026rdquo; (8\u0026ndash;10 points).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic characteristics according to the UPF Score\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAll participants\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eIntake, UPF Score points\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;353\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;170\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;111\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;72\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUPF score (points), median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (4\u0026ndash;7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (3\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (6\u0026ndash;7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (8\u0026ndash;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years), median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (7\u0026ndash;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (7\u0026ndash;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (8\u0026ndash;14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 (6\u0026ndash;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eAge category, n (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreschool\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57 (16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14 (19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSchool-age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e132 (37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66 (39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43 (39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23 (32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdolescent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e164 (47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78 (46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51 (46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35 (49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e147 (42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80 (47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43 (39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24 (33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight (kg), median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37 (23\u0026ndash;54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.8 (21\u0026ndash;54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37.1 (26.1\u0026ndash;54.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36.7 (24\u0026ndash;53.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeight (cm), median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e141 (120\u0026ndash;158)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e141 (118\u0026ndash;158)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e142 (122\u0026ndash;157)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e138 (117\u0026ndash;161.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e), median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18.2 (15.7\u0026ndash;22.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.2 (15.6\u0026ndash;22.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.1 (15.7\u0026ndash;22.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.3 (15.9\u0026ndash;23.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.68\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eNutritional status, n (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMalnutrition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 (10.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (12.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (7.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWell nourished\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e208 (58.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100 (58.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67 (60.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e41 (56.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65 (18.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (17.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26 (23.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObesity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (10.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16 (22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eData are expressed as median (25th percentile, 75th), or number (%), as appropriate.\u003c/p\u003e \u003cp\u003ecm: Centimeters; BMI: Body Mass Index; kg: Kilograms; MEDIAN (IQR): Median (interquartile range).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e enumerates the dietary characteristics according to the UPF. The group with the highest UPF score also had the highest energy intake (kcal), fat intake (%), grams of saturated fat, and the lowest fiber intake (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 for all). Other variables showed no statistical significance. Additionally, the group with the highest UPF score reported the lowest intake of vegetables and fruits and the highest intake of sugar. The other groups did not exhibit statistically significant differences.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDietary characteristics according to the UPF Score\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAll participants\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eIntake, UPF Score points\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLow, 4 (3\u0026ndash;5 points)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eModerate, 6 (6\u0026ndash;7 points)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHigh, 9 (8\u0026ndash;10 points)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;353\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;170\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;111\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;72\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnergy (kcal/day), median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1609 (1366\u0026ndash;1922)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1478 (1228\u0026ndash;1730)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1714 (1439\u0026ndash;2005)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1873 (1575\u0026ndash;2242)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDEI (kcal/kg/day), median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47 (31\u0026ndash;71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43 (28\u0026ndash;66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46 (33\u0026ndash;68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e55 (36\u0026ndash;75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDPI (g/kg/d\u0026iacute;a), median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.9 (1.3\u0026ndash;2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.7 (1.2\u0026ndash;2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.9 (1.3\u0026ndash;2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.3 (1.3\u0026ndash;2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePercent Daily Macronutrients (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProteins, median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (14\u0026ndash;18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (14\u0026ndash;18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (14\u0026ndash;18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15 (14\u0026ndash;17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFats, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34\u0026thinsp;\u0026plusmn;\u0026thinsp;7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32\u0026thinsp;\u0026plusmn;\u0026thinsp;7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35\u0026thinsp;\u0026plusmn;\u0026thinsp;7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35\u0026thinsp;\u0026plusmn;\u0026thinsp;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCarbohydrate, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50\u0026thinsp;\u0026plusmn;\u0026thinsp;7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51\u0026thinsp;\u0026plusmn;\u0026thinsp;7.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49\u0026thinsp;\u0026plusmn;\u0026thinsp;7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e50\u0026thinsp;\u0026plusmn;\u0026thinsp;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNutrients/1000 kcal, median (IQR)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSaturated Fats, g\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.4 (7.3\u0026ndash;11.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.1 (6.6\u0026ndash;10.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.3 (7.5\u0026ndash;11.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.2 (8.3\u0026ndash;11.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePolyunsaturated Fats, g\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.1 (9.4\u0026ndash;15.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.6 (8.7\u0026ndash;14.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.1 (10.0\u0026ndash;15.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.8 (9.8\u0026ndash;15.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMonounsaturated Fats, g\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.4 (4.3\u0026ndash;6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.3 (4.1\u0026ndash;6.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.5 (4.4\u0026ndash;6.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.7 (4.3\u0026ndash;6.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCholesterol, mg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e175.7 (127.8\u0026ndash;231.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e181.8 (132.5\u0026ndash;234.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e176.4 (123.6\u0026ndash;242.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e167.2 (118.9\u0026ndash;209.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSugar, g\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.5 (19.9\u0026ndash;36.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.1 (18.4\u0026ndash;37.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.8 (20.1\u0026ndash;34.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27.6 (20.9\u0026ndash;36.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFiber, g\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.2 (5.9\u0026ndash;10.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.2 (7.1\u0026ndash;12.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.7 (5.9\u0026ndash;9.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.2 (4.9\u0026ndash;8.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiquids, ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e539.5 (392.1\u0026ndash;758.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e576.5 (395.8\u0026ndash;837.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e512.5 (401.0\u0026ndash;728.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e521.4 (352.3\u0026ndash;665.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDaily servings/1000 kcal, median (IQR)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVegetables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.2 (0.7\u0026ndash;1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.4 (0.8\u0026ndash;2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.2 (0.8\u0026ndash;1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.7 (0.5\u0026ndash;1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFruits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.0 (0.5\u0026ndash;1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.1 (0.6\u0026ndash;1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.9 (0.4\u0026ndash;1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.9 (0.4\u0026ndash;1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCereals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.6 (3.8\u0026ndash;5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.6 (3.8\u0026ndash;5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.5 (3.9\u0026ndash;5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.7 (3.8\u0026ndash;5.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLegumes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.1 (0.0\u0026ndash;0.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.1 (0.0\u0026ndash;0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.1 (0.0\u0026ndash;0.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0 (0.0\u0026ndash;0.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnimal Products\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.0 (2.4\u0026ndash;3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.0 (2.4\u0026ndash;3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.1 (2.4\u0026ndash;3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.9 (2.3\u0026ndash;3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDairy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.7 (0.4\u0026ndash;1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.7 (0.4\u0026ndash;1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.7 (0.5\u0026ndash;1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.8 (0.5\u0026ndash;1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFats\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.6 (1.7\u0026ndash;3.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.5 (1.5\u0026ndash;3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.7 (1.8\u0026ndash;3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.7 (2.0\u0026ndash;3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSugars\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.6 (0.7\u0026ndash;2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.0 (0.4\u0026ndash;2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.6 (1.0\u0026ndash;2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.9 (1.4\u0026ndash;3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eData are expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, median (25th percentile, 75th), or number (%), as appropriate.\u003c/p\u003e \u003cp\u003eDEI: Average Daily Energy Intake; DPI: Daily Protein Intake\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eRegarding vitamin intake (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e), the group with the lowest UPF score had higher intake of vitamins A and C, as well as iron and potassium (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The rest of the variables demonstrated no statistically significant differences.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMicronutrient intake, categorized by UPF Score.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eNutrients/1000 kcal, median (IQR)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAll participants\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eIntake, UPF Score points\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLow, 4 (3\u0026ndash;5 points)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eModerate, 6 (6\u0026ndash;7 points)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHigh, 9 (8\u0026ndash;10 points)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;353\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;170\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;111\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;72\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVitamin A, mcg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e464.7 (299.3\u0026ndash;787.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e499.9 (333.2\u0026ndash;847.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e462.8 (327.3\u0026ndash;709.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e340.7 (245.7\u0026ndash;605.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVitamin B1, mg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.6 (0.5\u0026ndash;0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.6 (0.5\u0026ndash;0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.6 (0.5\u0026ndash;0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.6 (0.5\u0026ndash;0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.720\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVitamin B2, mg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.8 (0.6\u0026ndash;0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.8 (0.6\u0026ndash;1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.7 (0.6\u0026ndash;0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.8 (0.6\u0026ndash;0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.840\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVitamin B6, mg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.7 (0.5\u0026ndash;1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.8 (0.6\u0026ndash;1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.7 (0.5\u0026ndash;0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.7 (0.5\u0026ndash;0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.075\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVitamin B12, mcg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.2 (0.9\u0026ndash;1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.3 (0.8\u0026ndash;1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.2 (0.9\u0026ndash;1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.2 (1.0\u0026ndash;1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.870\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVitamin C, mg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43.3 (25.8\u0026ndash;72.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48.4 (30.0\u0026ndash;81.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40.6 (25.0\u0026ndash;69.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e41.5 (22.3\u0026ndash;54.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFolic Acid, mcg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e96.1 (68.8\u0026ndash;131.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99.1 (71.6\u0026ndash;135.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e90.4 (69.1\u0026ndash;133.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e91.7 (62.6\u0026ndash;128.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.310\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePantothenic Acid, mg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.5 (1.1\u0026ndash;2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.6 (1.1\u0026ndash;2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.5 (1.1\u0026ndash;1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.5 (1.0\u0026ndash;1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.230\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNiacin, mg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.6 (6.1\u0026ndash;10.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.9 (5.9\u0026ndash;10.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.5 (6.1\u0026ndash;9.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.5 (6.2\u0026ndash;8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.290\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVitamin E, mg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.3 (1.5\u0026ndash;3.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.3 (1.6\u0026ndash;3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.4 (1.5\u0026ndash;3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.1 (1.4\u0026ndash;3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.380\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCalcium, mg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e473.1 (360.5\u0026ndash;591.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e480.8 (373.1\u0026ndash;614.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e474.4 (351.5\u0026ndash;581.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e467.5 (360.5\u0026ndash;567.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.510\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIron, mg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.3 (6.0\u0026ndash;8.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.4 (6.5\u0026ndash;8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.3 (6.2\u0026ndash;8.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.3 (5.3\u0026ndash;8.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePotassium, mg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1052.6 (840.3\u0026ndash;1297.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1135.2 (863.2\u0026ndash;1403.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1027.4 (798.3\u0026ndash;1223.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1012.5 (771.8\u0026ndash;1203.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMagnesium, mg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e114.5 (83.9\u0026ndash;160.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e120.6 (86.9\u0026ndash;162.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e115.7 (79.0\u0026ndash;153.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e110.1 (84.2\u0026ndash;172.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.460\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSodium, mg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1203.5 (998.8\u0026ndash;1431.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1147.6 (973.2\u0026ndash;1473.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1238.3 (1026.3\u0026ndash;1405.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1240.1 (1047.4\u0026ndash;1380.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.760\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhosphorus, mg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e368.8 (274.4\u0026ndash;466.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e376.6 (271.1\u0026ndash;482.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e354.6 (277.3\u0026ndash;435.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e385.2 (275.5\u0026ndash;473.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.390\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelenium, mg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27.0 (21.8\u0026ndash;33.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.6 (22.6\u0026ndash;33.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.4 (20.6\u0026ndash;33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26.2 (19.9\u0026ndash;30.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.250\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZinc, mg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.3 (2.6\u0026ndash;4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.3 (2.5\u0026ndash;4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.2 (2.5\u0026ndash;4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.3 (2.9\u0026ndash;3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.920\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003emcg/1000 kcal: Micrograms per 1000 kilocalories; mg/1000 kcal: Milligrams per 1000 kilocalories; IQR: interquartile range.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSupplementary Table\u0026nbsp;1 specifies the relationships between different types of foods and their intake patterns. Component 1 (Comp1) identifies a positive association with the intake of cereals, animal products, and fats. Component 2 is positively associated with legume intake and negatively associated with sugar and fats. Component 3 is positively associated with fruit and vegetable intake as well as animal products and negatively associated with sugar. Finally, Component 4 is positively associated with fruits, sugar, milk, and dairy products (\u003cb\u003eTable \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e\u003c/b\u003e).\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e presents the multinomial logistic regression models that evaluate the main components associated with the UPF score, where components 2 and 3 are protective factors for UPF intake, and components 1 and 4 are risk factors.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultinomial logistic regression models to assess the main components associated with the UPF score.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eCOMPONENTS\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e+ Cereal\u003c/p\u003e \u003cp\u003e+ Fat\u003c/p\u003e \u003cp\u003e+ Animal Origin Product\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e-Sugar\u003c/p\u003e \u003cp\u003e-Grease\u003c/p\u003e \u003cp\u003e+ Legumes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003cp\u003e-Sugar\u003c/p\u003e \u003cp\u003e+ Fruits\u003c/p\u003e \u003cp\u003e+ Vegetables\u003c/p\u003e \u003cp\u003e+ Animal Origin Product\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003cp\u003e+ Fruits\u003c/p\u003e \u003cp\u003e+ Milk and derivatives\u003c/p\u003e \u003cp\u003e+ Sugar\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUnadjusted models\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUPF score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eREF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eREF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eREF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eREF\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.4 (1.2\u0026ndash;1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.7 (0.5\u0026ndash;0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.8 (0.7\u0026ndash;1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.3 (1.0\u0026ndash;1.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.8 (1.4\u0026ndash;2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.5 (0.4\u0026ndash;0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.6 (0.5\u0026ndash;0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.8 (1.5\u0026ndash;2.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eModel 1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUPF score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eREF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eREF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eREF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eREF\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.4 (1.1\u0026ndash;1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.7 (0.5\u0026ndash;0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.9 (0.7\u0026ndash;1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.3 (0.99\u0026ndash;1.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.8 (1.4\u0026ndash;2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.6 (0.4\u0026ndash;0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.6 (0.4\u0026ndash;0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.8 (1.3\u0026ndash;2.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eModel 1\u003c/b\u003e: adjusted for gender, age, body mass index, and residence.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFinally, using the linear regression model, an inverse association was observed between fiber intake and the UPF score (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study proposes using a scoring system to identify low, moderate, or high intake of UPF. The results indicate that lower UPF intake (low frequency of consumption) is associated with better diet quality in C\u0026amp;A. Additionally, high UPF intake is positively associated with unhealthy eating patterns but inversely associated with a healthy diet. The role of UPF in children\u0026rsquo;s diets extends beyond immediate health effects, \u003csup\u003e\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e influencing long-term food preferences \u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e and the development of healthy dietary patterns in the future. \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e In Mexico, an increase in UPF intake of approximately 5 percentage points was reported among C\u0026amp;A from 2006 \u003csup\u003e22\u003c/sup\u003e to 2016, \u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e reflecting growths in the food industry and a radical transformation in the Mexican diet. \u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e,\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAlthough the complications associated with high UPF intake, such as obesity and chronic diseases, \u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e,\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e are well known, it is essential to explore how these foods affect the intake of healthy nutrients. However, no specific amount of UPF that can be considered safe for the pediatric population has been determined. \u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eInformation regarding UPF and various outcomes has gained significant relevance recently, from observational studies to systematic reviews of clinical trials. \u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e,\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e Despite the available information, conducting meta-analyses has been challenging due to data heterogeneity. A recent systematic review mentioned that nutritional interventions aimed at eliminating UPF intake reported no changes in intake. \u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e This heterogeneity limits the extrapolation and comparison of results, as well as short- or medium-term goals for its intake.\u003c/p\u003e \u003cp\u003eSeveral studies and health organizations, such as the World Health Organization, \u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e emphasize the importance of limiting UPF intake to improve diet quality and prevent chronic diseases, \u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e,\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e as a crucial early intervention, especially given the negative impact of UPF. \u003csup\u003e\u003cspan additionalcitationids=\"CR32 CR33 CR34\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eEnergy and macronutrient requirements for C\u0026amp;A are significantly lower than those for adults and should be adjusted according to their stages of growth and development. \u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e,\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e However, caloric intake in the high UPF intake group resembles that of a high school teenager, despite the study population having a median age of 11 years. This suggests that energy intake observed in C\u0026amp;A, especially in the moderate and high UPF intake groups, exceeds the expected energy requirements for their age group, \u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e which could have negative implications regarding unhealthy daily dietary habits. \u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e,\u003cspan additionalcitationids=\"CR40 CR41\" citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSignificant associations between different intake patterns and UPF scores were identified through principal component analysis. For instance, component 2, characterized by lower sugar and fat intake and higher legume intake, acts as a protective factor against high UPF intake. In contrast, component 4, which includes fruits, dairy, and sugar, represents a risk factor. An example of a meal that may appear healthy but includes UPF is chocolate milk with added sugar accompanied by an apple, illustrating how certain healthy foods are paired with high UPF intake due to a lack of awareness of UPF content. Evidence supports the use of principal components for analyzing other diets, enabling the development of indices tailored to specific populations and dietary contexts. \u003csup\u003e\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e,\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e Identifying protective and risk factors associated with UPF intake through dietary patterns provides a basis for future longitudinal research to establish temporal trends and population-specific parameters for more precise guidelines on acceptable UPF intake, contributing to child health.\u003c/p\u003e \u003cp\u003eOur findings reveal that a higher UPF score is associated with lower fiber intake and higher intake of fats and sugars. This pattern suggests that children consuming more UPF tend to have lower nutritional quality diets. \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan additionalcitationids=\"CR46\" citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u003c/sup\u003e Specifically, participants with \u0026ldquo;high intake\u0026rdquo; of UPF (8\u0026ndash;10 points) showed significantly higher energy and saturated fat intake and lower fiber intake compared to those with \u0026ldquo;low intake\u0026rdquo; (3\u0026ndash;5 points).\u003c/p\u003e \u003cp\u003eOur results also showed that even within moderate ranges of UPF intake, similar effects were observed across other groups, impacting overall diet quality. \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e Our tool adapts and strengthens the NOVA system, which aids in understanding food quality and its health impact, for the pediatric population, considering the magnitude of UPF intake and classifying participants into low, moderate, and high intake tertiles. \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eFurthermore, this study underscores the importance of promoting healthy eating habits from an early age. Our results find UPF intake to be a global public health issue, primarily affecting vulnerable and low-income populations due to the low cost and high availability of these foods. \u003csup\u003e\u003cspan additionalcitationids=\"CR50\" citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe strengths of the UPF score lie in its simplicity as a tool for assessing UPF intake in C\u0026amp;A, and of the main strength of using the UPF score is that being a three-day food record, it helps assess the frequency and quantity of UPF consumed; however, the main limitation is the nature of the study does not allow establishing causal associations, and the exact number of daily servings of UPF consumed was not identified.\u003c/p\u003e \u003cp\u003eThe study\u0026rsquo;s findings underscore the importance of limiting UPF intake in children\u0026rsquo;s diets to promote better nutritional health. Accordingly, using the UPF score can guide nutritionists and healthcare professionals in clinically assessing and monitoring children.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe study indicates that ultra-processed food (UPF) intake in C\u0026amp;A is associated with poorer diet quality, characterized by higher energy and saturated fat intake and lower fiber intake. The UPF score is a valuable tool for quantifying this intake, adapting to dietary characteristics, and predicting overall diet quality.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eANOVA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAnalysis of Variance\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBMI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBody Mass Index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCDC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCenters for Disease Control and Prevention\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eComp1\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eComponent 1 (in Principal Component Analysis)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDEI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDaily Energy Intake\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDPI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDaily Protein Intake\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIQR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInterquartile Range\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUPF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUltra-Processed Foods\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthical approval and consent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research protocol was approved by the Research Ethics Committee in our Institution with registration number 2021/070, and informed assent from participants and consent from their parents or legal guardians were obtained.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConsent for the publication of the results of this study was obtained in accordance with established ethical requirements.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding statement\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was financially supported by Instituto Nacional de Pediatría through the E022 Program.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors' contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLFRA\u003c/strong\u003e Participated in study conception and design the research generation, analysis of the data and writing the paper.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAGO\u003c/strong\u003e Participated in study conception, design, revision, and analysis of the data, writing the paper and approval of the final version of the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAVG\u003c/strong\u003e Participated in study conception and design the research generation, analysis of the data and writing the paper.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCAG, EVA, RSR, BPG, JOGZ\u0026nbsp;\u003c/strong\u003eparticipated in interpretation of the data and/or critical revision of the manuscript to its final form. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo aplicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMonteiro CA, Cannon G, Moubarac JC, Levy RB, Louzada MLC, Jaime PC. The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing. Public Health Nutr. 2018;21(1):5\u0026ndash;17. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1017/s1368980017000234\u003c/span\u003e\u003cspan address=\"10.1017/s1368980017000234\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCapozzi F, Magkos F, Fava F, Milani GP, Agostoni C, Astrup A, et al. A Multidisciplinary Perspective of Ultra-Processed Foods and Associated Food Processing Technologies: A View of the Sustainable Road Ahead. Nutrients. 2021;13(11). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/nu13113948\u003c/span\u003e\u003cspan address=\"10.3390/nu13113948\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMonteiro CA, Levy RB, Claro RM, Castro IR, Cannon G. A new classification of foods based on the extent and purpose of their processing. Cadernos de saude publica. 2010;26(11):2039\u0026ndash;49. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1590/s0102-311x2010001100005\u003c/span\u003e\u003cspan address=\"10.1590/s0102-311x2010001100005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGearhardt AN, DiFeliceantonio AG. Highly processed foods can be considered addictive substances based on established scientific criteria. Addiction. 2023;118(4):589\u0026ndash;98. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/add.16065\u003c/span\u003e\u003cspan address=\"10.1111/add.16065\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarr\u0026oacute;n-Ponce J, S\u0026aacute;nchez T, Louzada ML, Batis C. Energy contribution of NOVA food groups and sociodemographic determinants of ultra-processed food intake in the Mexican population. Public Health Nutr. 2017;21:1\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1017/S1368980017002129\u003c/span\u003e\u003cspan address=\"10.1017/S1368980017002129\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCosta CS, Del-Ponte B, Assun\u0026ccedil;\u0026atilde;o MCF, Santos IS. Intake of ultra-processed foods and body fat during childhood and adolescence: a systematic review. Public Health Nutr. 2018;21(1):148\u0026ndash;59. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1017/s1368980017001331\u003c/span\u003e\u003cspan address=\"10.1017/s1368980017001331\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChang K, Khandpur N, Neri D, Touvier M, Huybrechts I, Millett C, et al. Association Between Childhood Intake of Ultraprocessed Food and Adiposity Trajectories in the Avon Longitudinal Study of Parents and Children Birth Cohort. JAMA Pediatr. 2021;175(9):e211573. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/jamapediatrics.2021.1573\u003c/span\u003e\u003cspan address=\"10.1001/jamapediatrics.2021.1573\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCalcaterra V, Cena H, Rossi V, Santero S, Bianchi A, Zuccotti G. Ultra-Processed Food, Reward System and Childhood Obesity. Child (Basel). 2023;10(5). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/children10050804\u003c/span\u003e\u003cspan address=\"10.3390/children10050804\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTouvier M, da Costa Louzada ML, Mozaffarian D, Baker P, Juul F, Srour B. Ultra-processed foods and cardiometabolic health: public health policies to reduce intake cannot wait. BMJ. 2023;383:e075294. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bmj-2023-075294\u003c/span\u003e\u003cspan address=\"10.1136/bmj-2023-075294\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFonseca MM, Coimbra RVG, Oliveira JSE, Soares ADN, Gomes JMG. Intake of ultra-processed foods and associated factors in children from Barbacena (MG), Brazil. Revista paulista de pediatria: orgao oficial da Sociedade de. Pediatria de Sao Paulo. 2023;42:e2022127. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1590/1984-0462/2024/42/2022127\u003c/span\u003e\u003cspan address=\"10.1590/1984-0462/2024/42/2022127\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNieto C, Espinosa F, Valero-Morales I, Boyland E, Potvin Kent M, Tatlow-Golden M, et al. Digital food and beverage marketing appealing to children and adolescents: An emerging challenge in Mexico. Pediatr Obes. 2023;18(7):e13036. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/ijpo.13036\u003c/span\u003e\u003cspan address=\"10.1111/ijpo.13036\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGarc\u0026iacute;a-Blanco L, de la Santiago OV, Pouso S, Mart\u0026iacute;nez-Gonz\u0026aacute;lez A, Mart\u0026iacute;n-Calvo M. High intake of ultra-processed foods is associated with increased risk of micronutrient inadequacy in children: The SENDO project. Eur J Pediatr. 2023;182(8):3537\u0026ndash;47. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00431-023-05026-9\u003c/span\u003e\u003cspan address=\"10.1007/s00431-023-05026-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarr\u0026oacute;n-Ponce JA, Tolentino-Mayo L, Hern\u0026aacute;ndez FM, Batis C. Trends in Ultra-Processed Food Purchases from 1984 to 2016 in Mexican Households. Nutrients. 2018;11(1). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/nu11010045\u003c/span\u003e\u003cspan address=\"10.3390/nu11010045\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCosta CDS, Faria FR, Gabe KT, Sattamini IF, Khandpur N, Leite FHM, et al. Nova score for the intake of ultra-processed foods: description and performance evaluation in Brazil. Rev Saude Publica. 2021;55:13. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.11606/s1518-8787.2021055003588\u003c/span\u003e\u003cspan address=\"10.11606/s1518-8787.2021055003588\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eK\u0026eacute;b\u0026eacute; SD, Diouf A, Sylla P, Kane K, Dos Santos Costa C, Leite FHM, et al. Assessment of ultra processed foods intake in Senegal: validation of the Nova-UPF screener. Arch Public Health. 2024;82(1):4. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s13690-024-01239-y\u003c/span\u003e\u003cspan address=\"10.1186/s13690-024-01239-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchr\u0026ouml;der H, Covas MI, Marrugat J, Vila J, Pena A, Alc\u0026aacute;ntara M, et al. Use of a three-day estimated food record, a 72-hour recall and a food-frequency questionnaire for dietary assessment in a Mediterranean Spanish population. Clin Nutr. 2001;20(5):429\u0026ndash;37. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1054/clnu.2001.0460\u003c/span\u003e\u003cspan address=\"10.1054/clnu.2001.0460\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChou JH, Roumiantsev S, Singh R. PediTools Electronic Growth Chart Calculators: Applications in Clinical Care, Research, and Quality Improvement. J Med Internet Res. 2020;22(1):e16204. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2196/16204\u003c/span\u003e\u003cspan address=\"10.2196/16204\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ede Oliveira PG, de Sousa JM, Assun\u0026ccedil;\u0026atilde;o DGF, de Araujo EKS, Bezerra DS, Dametto J, et al. Impacts of Intake of Ultra-Processed Foods on the Maternal-Child Health: A Systematic Review. Front Nutr. 2022;9:821657. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fnut.2022.821657\u003c/span\u003e\u003cspan address=\"10.3389/fnut.2022.821657\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRousham EK, Goudet S, Markey O, Griffiths P, Boxer B, Carroll C, et al. Unhealthy Food and Beverage Intake in Children and Risk of Overweight and Obesity: A Systematic Review and Meta-Analysis. Adv Nutr. 2022;13(5):1669\u0026ndash;96. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/advances/nmac032\u003c/span\u003e\u003cspan address=\"10.1093/advances/nmac032\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHou M, Qiu C. Ultra-Processed Food as Mediator of the Association between Birthweight and Childhood Body Weight Outcomes: A Retrospective Cohort Study. Nutrients. 2023;15(19). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/nu15194178\u003c/span\u003e\u003cspan address=\"10.3390/nu15194178\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoushey C, Ard J, Bazzano L, Heymsfield S, Mayer-Davis E, Sabat\u0026eacute; J et al. USDA Nutrition Evidence Systematic Reviews. Dietary Patterns and All-Cause Mortality: A Systematic Review. Alexandria (VA): USDA Nutrition Evidence Systematic Review; 2020. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.52570/nesr.Dgac2020.Sr0108\u003c/span\u003e\u003cspan address=\"10.52570/nesr.Dgac2020.Sr0108\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOlaiz-Fern\u0026aacute;ndez G, Rivera-Dommarco J, Shamah-Levy T, Rojas R, Villalpando-Hern\u0026aacute;ndez S, Hern\u0026aacute;ndez-Avila M et al. Encuesta Nacional de Salud y Nutrici\u0026oacute;n 2006. Cuernavaca, M\u0026eacute;xico: Instituto Nacional de Salud P\u0026uacute;blica; 2006. 2013.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOviedo-Sol\u0026iacute;s CI, Monterrubio-Flores EA, Cediel G, Denova-Guti\u0026eacute;rrez E, Barquera S. Trend of Ultraprocessed Product Intake Is Associated with the Double Burden of Malnutrition in Mexican Children and Adolescents. Nutrients. 2022;14(20). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/nu14204347\u003c/span\u003e\u003cspan address=\"10.3390/nu14204347\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRampalli KK, Blake CE, Frongillo EA, Montoya J. Why understanding food choice is crucial to transform food systems for human and planetary health. BMJ Glob Health. 2023;8(5). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bmjgh-2022-010876\u003c/span\u003e\u003cspan address=\"10.1136/bmjgh-2022-010876\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMonteiro CA, Lawrence M, Millett C, Nestle M, Popkin BM, Scrinis G, et al. The need to reshape global food processing: a call to the United Nations Food Systems Summit. BMJ Glob Health. 2021;6(7). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bmjgh-2021-006885\u003c/span\u003e\u003cspan address=\"10.1136/bmjgh-2021-006885\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShu L, Zhang X, Zhou J, Zhu Q, Si C. Ultra-processed food intake and increased risk of metabolic syndrome: a systematic review and meta-analysis of observational studies. Front Nutr. 2023;10:1211797. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fnut.2023.1211797\u003c/span\u003e\u003cspan address=\"10.3389/fnut.2023.1211797\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePagliai G, Dinu M, Madarena MP, Bonaccio M, Iacoviello L, Sofi F. Intake of ultra-processed foods and health status: a systematic review and meta-analysis. Br J Nutr. 2021;125(3):308\u0026ndash;18. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1017/s0007114520002688\u003c/span\u003e\u003cspan address=\"10.1017/s0007114520002688\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUNICEF, UNICEF. El sobrepeso en la ni\u0026ntilde;ez Un llamado para la prevenci\u0026oacute;n en Am\u0026eacute;rica Latina y el Caribe. Panama: UNICEF Panama City; 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeone A, De la Fuente-Arrillaga C, Mas MV, Sayon-Orea C, Menichetti F, Mart\u0026iacute;nez-Gonzalez MA, et al. Association between the intake of ultra-processed foods and the incidence of peptic ulcer disease in the SUN project: a Spanish prospective cohort study. Eur J Nutr. 2024. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00394-024-03439-2\u003c/span\u003e\u003cspan address=\"10.1007/s00394-024-03439-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAramburu A, Alvarado-Gamarra G, Cornejo R, Curi-Quinto K, D\u0026iacute;az-Parra CDP, Rojas-Limache G, et al. Ultra-processed foods intake and health-related outcomes: a systematic review of randomized controlled trials. Front Nutr. 2024;11:1421728. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fnut.2024.1421728\u003c/span\u003e\u003cspan address=\"10.3389/fnut.2024.1421728\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOrganization WH. Healthy diet. World Health Organization. Regional Office for the Eastern Mediterranean; 2019.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAngelino D, Dinu M, Gandossi B, Pellegrini N, Martini D. Processing and Nutritional Quality of Breakfast Cereals Sold in Italy: Results from the Food Labelling of Italian Products (FLIP) Study. Nutrients. 2023;15(8). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/nu15082013\u003c/span\u003e\u003cspan address=\"10.3390/nu15082013\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhoury N, Mart\u0026iacute;nez M, Garcidue\u0026ntilde;as-Fimbres TE, Pastor-Villaescusa B, Leis R, de Las Heras-Delgado S, et al. Ultraprocessed Food Intake and Cardiometabolic Risk Factors in Children. JAMA Netw Open. 2024;7(5):e2411852. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/jamanetworkopen.2024.11852\u003c/span\u003e\u003cspan address=\"10.1001/jamanetworkopen.2024.11852\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMonteiro CA, Cannon G, Levy RB, Moubarac JC, Louzada ML, Rauber F, et al. Ultra-processed foods: what they are and how to identify them. Public Health Nutr. 2019;22(5):936\u0026ndash;41. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1017/s1368980018003762\u003c/span\u003e\u003cspan address=\"10.1017/s1368980018003762\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang L, Mart\u0026iacute;nez Steele E, Du M, Pomeranz JL, O'Connor LE, Herrick KA, et al. Trends in Intake of Ultraprocessed Foods Among US Youths Aged 2\u0026ndash;19 Years, 1999\u0026ndash;2018. JAMA. 2021;326(6):519\u0026ndash;30. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/jama.2021.10238\u003c/span\u003e\u003cspan address=\"10.1001/jama.2021.10238\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMendoza E, Bourges H, Morales L, Ch\u0026aacute;vez A. Tablas de composici\u0026oacute;n de alimentos y productos alimenticios (versi\u0026oacute;n condensada 2015). Instituto Nacional de Ciencias M\u0026eacute;dicas y Nutrici\u0026oacute;n Salvador Zubir\u0026aacute;n: Mexico City, Mexico. 2015. doi.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaufer-Horwitz M, Robledo LMG, P\u0026eacute;rez-Lizaur AB, Barrag\u0026aacute;n VER. Nutriolog\u0026iacute;a m\u0026eacute;dica: Editorial M\u0026eacute;dica Panamericana; 2023. doi.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRodr\u0026iacute;guez B, Jorge R. Recomendaciones de ingesti\u0026oacute;n de nutrimentos para la poblaci\u0026oacute;n mexicana. 2005. doi.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbdoli M, Scotto Rosato M, Cipriano A, Napolano R, Cotrufo P, Barberis N, et al. Affect, Body, and Eating Habits in Children: A Systematic Review. Nutrients. 2023;15(15). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/nu15153343\u003c/span\u003e\u003cspan address=\"10.3390/nu15153343\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBowman SA, Gortmaker SL, Ebbeling CB, Pereira MA, Ludwig DS. Effects of fast-food intake on energy intake and diet quality among children in a national household survey. Pediatrics. 2004;113(1 Pt 1):112\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1542/peds.113.1.112\u003c/span\u003e\u003cspan address=\"10.1542/peds.113.1.112\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKenney EL, Lee MM, Barrett JL, Ward ZJ, Long MW, Cradock AL, et al. Cost-effectiveness of Improved WIC Food Package for Preventing Childhood Obesity. Pediatrics. 2024;153(2). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1542/peds.2023-063182\u003c/span\u003e\u003cspan address=\"10.1542/peds.2023-063182\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOliveira GAL, Santos Gon\u0026ccedil;alves VS, Nakano EY, Toral N. Intake of ultra-processed foods and low dietary diversity are associated with sedentary and unhealthy eating behaviors: A nationwide study with Brazilian Schoolchildren. PLoS ONE. 2024;19(1):e0294871. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1371/journal.pone.0294871\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0294871\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGonz\u0026aacute;lez-Ortiz A, Xu H, Avesani CM, Lindholm B, Cederholm T, Ris\u0026eacute;rus U, et al. Plant-based diets, insulin sensitivity and inflammation in elderly men with chronic kidney disease. J Nephrol. 2020;33(5):1091\u0026ndash;101. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s40620-020-00765-6\u003c/span\u003e\u003cspan address=\"10.1007/s40620-020-00765-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMescoloto SB, Pongiluppi G, Domene S. Ultra-processed food intake and children and adolescents' health. J Pediatr (Rio J). 2024;100(Suppl 1):S18\u0026ndash;30. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jped.2023.09.006\u003c/span\u003e\u003cspan address=\"10.1016/j.jped.2023.09.006\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarr\u0026oacute;n-Ponce J, Flores M, Cediel GG, Monteiro C, Batis C. Associations Between Intake of Ultra-Processed Foods and Intake of Nutrients Related to Chronic Non-Communicable Diseases in Mexico. J Am Acad Nutr Dietetics. 2019;1:1. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jand.2019.04.020\u003c/span\u003e\u003cspan address=\"10.1016/j.jand.2019.04.020\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMalamatenios O, Campbell JL, Schofield G, Zinn C. The Human Interference Scoring System (HISS): A New Tool for Quantifying Food Quality Based on Its Level of Processing. Nutrients. 2024;16(4). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/nu16040536\u003c/span\u003e\u003cspan address=\"10.3390/nu16040536\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMartines RM, Machado PP, Neri DA, Levy RB, Rauber F. Association between watching TV whilst eating and children's intake of ultraprocessed foods in United Kingdom. Matern Child Nutr. 2019;15(4):e12819. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/mcn.12819\u003c/span\u003e\u003cspan address=\"10.1111/mcn.12819\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCorrea-Madrid MC, Correa Guzm\u0026aacute;n N, Bergeron G, Restrepo-Mesa SL, Cediel G. Validation of the NOVA score for the intake of ultra-processed foods by young women of Medell\u0026iacute;n, Colombia. Ann N Y Acad Sci. 2023;1528(1):69\u0026ndash;76. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/nyas.15054\u003c/span\u003e\u003cspan address=\"10.1111/nyas.15054\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSilva P, Ara\u0026uacute;jo R, Lopes F, Ray S. Nutrition and Food Literacy: Framing the Challenges to Health Communication. Nutrients. 2023;15(22). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/nu15224708\u003c/span\u003e\u003cspan address=\"10.3390/nu15224708\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePemjean I, Mediano F, Ferrer P, Garmendia ML, Corval\u0026aacute;n C. Food access, domestic environments, and dietary quality of low-middle income Chilean children during the COVID-19 pandemic. Front Public Health. 2023;11:1164357. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fpubh.2023.1164357\u003c/span\u003e\u003cspan address=\"10.3389/fpubh.2023.1164357\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClemente-Su\u0026aacute;rez VJ, Beltr\u0026aacute;n-Velasco AI, Redondo-Fl\u0026oacute;rez L, Mart\u0026iacute;n-Rodr\u0026iacute;guez A, Tornero-Aguilera JF. Global Impacts of Western Diet and Its Effects on Metabolism and Health: A Narrative Review. Nutrients. 2023;15(12). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/nu15122749\u003c/span\u003e\u003cspan address=\"10.3390/nu15122749\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nutrition","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nutn","sideBox":"Learn more about [BMC Nutrition](http://bmcnutr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nutn/default.aspx","title":"BMC Nutrition","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Ultra-Processed Foods, Dietary Intake, Child Nutrition, Dietary Patterns, Fiber","lastPublishedDoi":"10.21203/rs.3.rs-4909438/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4909438/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe rising intake of ultra-processed foods (UPFs) among children and adolescents poses challenges due to the lack of precise and accessible tools to quantify such intake. This complicates understanding its effects on dietary quality and hampers the design of effective preventive interventions across diverse socioeconomic and geographic contexts. \u003cb\u003eObjective\u003c/b\u003e: This paper aims to determine the relationship between the UPF score and dietary characteristics.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis cross-sectional study involved 353 participants aged 3 to 17. The methods included (1) a three-day food intake record; (2) an evaluation of intake across five food groups; (3) categorization of intake frequency (0, 1, 2, or up to 3 times weekly); and (4) scoring by cumulative intake. Principal component analysis and regression models were utilized to assess diet associations with UPF score.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eHigher UPF score groups showed increased intake of energy, fats, and sodium (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01); decreased fiber intake (p\u0026thinsp;=\u0026thinsp;0.03), vegetables, fruits, and cereals (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05); higher sugar intake (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01); and reduced intake of vitamins A and C (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Four principal components, representing over 65% of sample variability, identified two healthy and two less healthy dietary patterns. Linear regression indicated higher fiber intake at lower UPF scores, declining with higher UPF scores.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe UPF score represents a useful tool for efficiently and swiftly assessing UPF intake and dietary characteristics in pediatric population.\u003c/p\u003e","manuscriptTitle":"How to evaluate Ultra-processed Food Intake in pediatrics? UPF Score: an easy alternative","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-14 05:25:34","doi":"10.21203/rs.3.rs-4909438/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-01-27T09:48:18+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-08T08:01:00+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-04T02:33:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"50245306682141337956861062318466231585","date":"2024-10-28T08:53:04+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-10-25T23:54:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"116467595277952416001873439037246461551","date":"2024-10-24T13:42:19+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-10-21T03:58:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"257846717264159720095544238426640237255","date":"2024-10-20T07:11:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"153936120202945804878293502157743364382","date":"2024-10-17T17:14:09+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-10-17T10:49:19+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-08-22T16:48:04+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-08-15T22:12:17+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-08-15T22:12:04+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nutrition","date":"2024-08-13T21:12:36+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nutrition","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nutn","sideBox":"Learn more about [BMC Nutrition](http://bmcnutr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nutn/default.aspx","title":"BMC Nutrition","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"424cea3e-4f45-4214-adb5-43265eb66d99","owner":[],"postedDate":"October 14th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-04-21T16:04:30+00:00","versionOfRecord":{"articleIdentity":"rs-4909438","link":"https://doi.org/10.1186/s40795-025-01056-8","journal":{"identity":"bmc-nutrition","isVorOnly":false,"title":"BMC Nutrition"},"publishedOn":"2025-04-15 15:57:51","publishedOnDateReadable":"April 15th, 2025"},"versionCreatedAt":"2024-10-14 05:25:34","video":"","vorDoi":"10.1186/s40795-025-01056-8","vorDoiUrl":"https://doi.org/10.1186/s40795-025-01056-8","workflowStages":[]},"version":"v1","identity":"rs-4909438","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4909438","identity":"rs-4909438","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}