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Fortification of grain foods and NOVA: the potential for altered nutrient intakes while avoiding ultra-processed foods

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Abstract

Purpose

NOVA is a food classification system describing a hierarchy from minimally processed to ultra-processed foods (UPF). Research has associated intake of UPF with chronic diseases. In Australia, the primary sources of grains, both refined and whole, are breads and breakfast cereals, which are typically fortified. Most are classified as UPF, yet are recommended core foods according to the Australian Dietary Guidelines (ADG). This research aimed to identify if avoidance of ultra-processed grain foods would alter nutrient intakes in an Australian population and whether sample diets using substitute (non-UPF) foods would be likely to meet nutrient requirements.

Methods

Quantitative analysis of usual nutrient intake from the National Nutrition and Physical Activity Survey 2011–12 (n = 12,153) for all foods including and excluding UPF. Dietary modelling examined the nutritional adequacy of sample diets aligned with the ADG and another containing replacements for UPF. We particularly focused on grain foods and meeting whole-grain intake targets.

Results

There was a significant decrease (all p < 0.05) in modelled intake of key nutrients when UPF were excluded, specifically, thiamin, folate and iodine, as substitutions are rarely fortified. Diets with no UPF, where substitutes are carefully chosen, have the potential to meet Nutrient Reference Values, but deviation from customary food choices may mean adoption of substitutes is unlikely.

Conclusions

Exclusion of UPF may result in lowered intakes of key nutrients of particular concern for at risk groups (including women of child-bearing age), negating gains made by public health policy of fortification. Substitutions may not be realistic in these at-risk populations.

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Abbreviations

ADG:

Australian Dietary Guidelines

CVD:

Cardiovascular disease

NNPAS:

National Nutrition and Physical Activity Survey

UPF:

Ultra-processed foods

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Acknowledgements

We acknowledge the use of the Nova System Coded Database for NNPAS approved by NUPEN/USP. M.E. conducted the majority of the analysis of data in this manuscript with the assistance of K.R.K. and E.M.B. under the supervision of E.J.B. J. J. provided expert input in the review of the data in the context of dietary guidelines and food product development and expert assistance on nutrient intakes and grain foods. S.G. provided input on the review of data in the context of the Australian food supply. The original manuscript was drafted by M.E. and E.J.B. All authors reviewed and provided expert input to the final manuscript.

Funding

This research received nil funding from any source.

Author information

Authors and Affiliations

  1. School of Medicine, University of Wollongong, Wollongong, NSW, 2522, Australia

    Madeline L. Estell, Katrina R. Kissock, Sara J. Grafenauer & Eleanor J. Beck

  2. Illawarra Health and Medical Research Institute, Wollongong, NSW, 2522, Australia

    Madeline L. Estell, Katrina R. Kissock & Eleanor J. Beck

  3. National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, 2601, Australia

    Eden M. Barrett

  4. Grains & Legumes Nutrition Council, North Ryde, NSW, 2113, Australia

    Sara J. Grafenauer

  5. Foods and Nutrition, St Catherine University, St. Paul, MN, 55105, USA

    Julie Miller Jones

Authors
  1. Madeline L. Estell
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  2. Eden M. Barrett
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  6. Eleanor J. Beck
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Corresponding author

Correspondence to Eleanor J. Beck.

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Conflict of interest

No funding was received for this research undertaken as part of Honours research at the University of Wollongong. Madeline Estell, Katrina Kissock and Eden Barrett have no conflict of interest to declare. Sara Grafenauer is employed by the Grains & Legumes Nutrition Council, a not-for-profit charity and is a member of the Whole Grain Initiative. Julie Jones received funding for presentations and papers on grains from Quaker Oats, General Mills, Inc, Grains Food Foundation, and International Maize and Wheat Improvement Center (known by its Spanish acronym CIMMYT—Centro Internacional de Mejoramiento de Maíz y Trigo (Mexico). She is a member of the working group of the Whole Grain Initiative and on the scientific committee of ILCEREALES. Eleanor Beck has received funding for presentations on whole grain from Quaker Oats and General Mills, Inc and research funding from Cereals Partners Worldwide. She is a member of the working group of the Whole Grain Initiative.

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Estell, M.L., Barrett, E.M., Kissock, K.R. et al. Fortification of grain foods and NOVA: the potential for altered nutrient intakes while avoiding ultra-processed foods. Eur J Nutr 61, 935–945 (2022). https://doi.org/10.1007/s00394-021-02701-1

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  • DOI: https://doi.org/10.1007/s00394-021-02701-1

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