Response to an ultra-processed diet meeting national dietary guidelines valid and fit for purpose

Authors: Hess, Julie

Submitted to: Journal of Nutrition
Publication Type: Other
Publication Acceptance Date: 10/25/2023
Publication Date: 10/31/2023
Citation: Hess, J.M. 2023. Response to an ultra-processed diet meeting national dietary guidelines valid and fit for purpose. Journal of Nutrition. 153(12):1. https://doi.org/10.1016/j.tjnut.2023.10.020.
DOI: https://doi.org/10.1016/j.tjnut.2023.10.020

Interpretive Summary:

Technical Abstract: Thank you for the opportunity to reply to the letter you received about our paper entitled “Dietary Guidelines Meet NOVA: Developing a Menu for A Healthy Dietary Pattern Using Ultra-Processed Foods.” We thank the letter authors, Mr. Dicken and his coauthors, for the careful read of our study and for their thoughtful feedback. We would like to first provide a general reminder that this article presents a proof-of-concept study only, and we recognize that much more research is needed on this topic. To clarify our approach with this work and respond more directly to the letter writer concerns, the menu developed in our study was intended to match the MyPyramid menu as closely as possible, in terms of food groups and food items. We did not monitor nutrient content while developing the menu, and the foods we selected to include were filtered to match the original MyPyramid menu after being evaluated for DGA “fitness” and NOVA categorization by our external graders. Therefore, the final menu in our study does exceed sodium recommendations and does not meet whole grain recommendations in part because we prioritized the integrity of the process we developed to generate the menu. We avoided making edits to the final menu, such as swapping in low-sodium alternatives or adding whole grain foods, that may have increased the diet quality score or improved the nutrient profile. With different criteria for food searches, identification, and selection, it may be possible to generate a menu that contains mostly energy from UPF and remains within DGA boundaries all food groups and nutrients. Yet, while our menu does not perfectly align with the DGA, the diet quality score of 86/100 indicates moderately high alignment with the DGA, because DGA adherence can be measured with the Healthy Eating Index. This proof-of-concept study is only a first step. There is much work to be done in this area including a need for randomized controlled trials- as well as studies of the various practical considerations Mr. Dicken et al. so eloquently outline. O’Connor et al. highlight next steps needed in research on processed foods in a recent Advances in Nutrition publication. We deeply appreciate the insight on this work by Mr. Dicken and colleagues and look forward to reading their future research on this topic.