Dietary guidelines meet NOVA: developing a menu for a healthy dietary pattern using ultra-processed foods

Authors: Hess, Julie; Comeau, Madeline; Casperson, Shanon; SLAVIN, JOANNE - University Of Minnesota; JOHNSON, GUY - Johnson Nutrition Solutions, Llc; MESSINA, MARK - Soy Nutrition Institute Global; RAATZ, SUSAN - University Of Minnesota; SCHEET, ANGELA - University Of North Dakota; BODENSTEINER, ANNE - University Of North Dakota; PALMER, DANIEL - University Of North Dakota

Submitted to: Journal of Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 6/21/2023
Publication Date: 6/24/2023
Citation: Hess, J.M., Comeau, M.E., Casperson, S.L., Slavin, J., Johnson, G.H., Messina, M., Raatz, S., Scheet, A.J., Bodensteiner, A., Palmer, D. 2023. Dietary guidelines meet NOVA: developing a menu for a healthy dietary pattern using ultra-processed foods. Journal of Nutrition. 153(8):2472-2481. https://doi.org/10.1016/j.tjnut.2023.06.028.
DOI: https://doi.org/10.1016/j.tjnut.2023.06.028

Interpretive Summary: The purpose of our study was to see whether it is possible to develop a healthy dietary pattern that includes mostly “ultra-processed” foods. Ultra-processed foods and their impact on health is one of the topics that the 2025-2030 Dietary Guidelines for Americans (DGA) Scientific Advisory Committee will be exploring. However, there is not a clear definition for what an “ultra-processed food” is. A system called “NOVA” (not an acronym) is widely used to categorize foods by their level of processing on a scale from 1 to 4, where “1” means a food is unprocessed/minimally processed and “4” indicates an “ultra-processed” food. Yet several nutrient-dense foods like sweetened yogurt and whole grain breads are considered “ultra-processed” on the NOVA scale. We were able to create a 7-day menu that aligns with the DGA, includes 91% of its energy (kcal) from “ultra-processed” foods, has a high diet quality score (86 out of 100), and provides adequate amounts of most nutrients. Healthy diets can include most of their energy from ultra-processed foods according to NOVA.

Technical Abstract: Background: A proposed topic for the 2025 Dietary Guidelines for Americans (DGA) Scientific Advisory Committee to address is the relationship between dietary patterns with ultra-processed foods (UPF) and body composition and weight status. Implementing the NOVA system, the most commonly applied framework for determining whether a food is “ultra-processed,” in dietary guidance could omit several nutrient-dense foods from recommended healthy diets in the DGA. Objective: The purpose of this proof of concept study was to determine the feasibility of building a menu that aligns with recommendations for a healthy dietary pattern from the 2020 DGA and includes =80% kcal from UPF as defined by NOVA. Design: To accomplish this objective, we first developed a list of foods that fit NOVA criteria for UPF, fit within dietary patterns in the 2020 DGA, and are commonly consumed by Americans. We then used these foods to develop a 7-day, 2000 kcal menu modeled on MyPyramid sample menus and assessed this menu for nutrient content as well as for diet quality using the Healthy Eating Index-2015 (HEI-2015). Results: In the ultra-processed DGA menu we created, 91% of kcal were from UPF, or category 4 in NOVA. The HEI-2015 score was 86 out of a possible 100 points. This sample menu did not achieve a perfect score due primarily to excess sodium and an insufficient amount of whole grains. This menu provided adequate amounts of all macro- and micronutrients except vitamin D, vitamin E, and choline. Conclusions: Healthy dietary patterns can include most of their energy from UPF and still receive a high diet quality score and contain adequate amounts of most macro- and micronutrients.