Process/Structure Visual Submission

Partner: Sora Johnson

Title. From 24-Hour Recalls to NOVA Classification: A Data Flow Diagram

Legend. This visual depicts the flow of data from 24-hour dietary recalls in the National Health and Nutrition Examination Survey (NHANES) to the final NOVA classification of food groups, which is based on the nature, extent, and purpose of processing they undergo. Blue-outline boxes and text indicate the steps taken by researchers within this process, while blue italicized text indicates the particular function of a database or dataset; the right side of the diagram depicts final NOVA classifications of foods, 

Process/Structure Visual Revision

Partners. Sora Johnson

Title. From 24-Hour Recalls to NOVA Classification: A Data Flow Diagram

Legend. This visual depicts the flow of data from 24-hour dietary recalls in the National Health and Nutrition Examination Survey (NHANES) to the final NOVA classification of food groups, which is based on the nature, extent, and purpose of processing they undergo. Blue-outline boxes and text indicate the steps taken by researchers within this process, while blue italicized text indicates the particular function of a database or dataset; the right side of the diagram depicts final NOVA classifications of foods, 

Abstract

The Dietary Guidelines for Americans are meant to provide recommendations to improve health and prevent chronic disease, yet how can researchers and providers track adherence to these guidelines and other dietary advice? Knowing how to extract information on dietary consumption and then utilize the NOVA system of classification is a key research tool for doing this. This visual depicts the flow of data from patient reports to NOVA classification, including the points where information on nutrient and energy content are extracted. Dietary information is collected from the National Health and Nutrition Examination Survey (NHANES), which utilizes self-reported 24-hour dietary recalls. As depicted in this visual, various databases are used to identify the nutrient and energy contents of all foods reported within NHANES; foods and food groups can then be classified using the NOVA classification definitions, which are based on the nature, purpose, and extent of food processing.

Abstract

The Dietary Guidelines for Americans are meant to provide recommendations to improve health and prevent chronic disease, yet how can researchers and providers track adherence to these guidelines and other dietary advice? Knowing how to extract information on dietary consumption and then utilize the NOVA system of classification is a key research tool for doing this. This visual depicts the flow of data from patient reports to NOVA classification, including the points where information on nutrient and energy content are extracted. Dietary information is collected from the National Health and Nutrition Examination Survey (NHANES), which utilizes self-reported 24-hour dietary recalls. As depicted in this visual, various databases are used to identify the nutrient and energy contents of all foods reported within NHANES; foods and food groups can then be classified using the NOVA classification definitions, which are based on the nature, purpose, and extent of food processing.

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Keywords

Data flow, NHANES, NOVA classification, ultraprocessed foods, USDA database

Keywords

Data flow, NHANES, NOVA classification, ultraprocessed foods, USDA database

Highlights

• Our visual depicts data flow from patient reports to NOVA classification, including the points where information on nutrient and energy content are extracted.
• Our visual serves to demystify the “black box” transformation of dietary data to information on the consumption of ultraprocessed foods.

Highlights

• Our visual depicts data flow from patient reports to NOVA classification, including the points where information on nutrient and energy content are extracted.
• Our visual serves to demystify the “black box” transformation of dietary data to information on the consumption of ultraprocessed foods.der above.

Visual Brief

The Dietary Guidelines for Americans are meant to provide recommendations to improve health and prevent chronic disease, yet how can researchers and providers track adherence to these guidelines and other dietary advice?

This question is especially important when trying to determine the impact of the guidelines on vulnerable populations such as cancer survivors. Diet is especially important for this group, given the toxicity of radiation and chemotherapy they receive. Three out of five survivors will experience late effects due to their treatment.¹However, a healthy diet rich in fruits, vegetables, and whole grains and low in excess sugars and salts has a known protective effect.^2-5

The NOVA classification system of foods offers a tool to better understand food quality and health effects, based on the nature, extent, and purpose of any processing that foods undergo. The highest category, ultraprocessed foods, are high in unhealthy fats, refined starches, sugars, and salt, and low in dietary fibers and micronutrients: in other words, poor dietary choices for cancer survivors.^6,7

Collecting information on the dietary habits and food choices of cancer survivors and then utilizing the NOVA system is key to better understanding the impact of dietary guidelines within this population, with specific consideration of ultraprocessed foods. We created this visual to depict the flow of data from patient reports to NOVA classification, including the points where information on nutrient and energy content are extracted. Dietary information is collected from the National Health and Nutrition Examination Survey (NHANES), which utilizes self-reported 24-hour dietary recalls. As depicted in this visual, various databases are used to identify the nutrient and energy contents of all foods reported within NHANES. Foods and food groups can then be classified using the NOVA classification definitions, which are based on the nature, purpose, and extent of food processing.^8,9

We used blue outlined boxes and text to indicate the steps taken by researchers within the data collection, extraction, manipulation, and analysis process. Blue italicized text indicates the particular function of a database or dataset. The right side of the diagram depicts final NOVA classifications of foods, with color schemes to indicate the extent of processing at each level. Given the negative health outcomes associated with ultraprocessed foods, this category is reflected by a red outlined box, while less processed groups are shown by first orange, then yellow, then green-outlined boxes. This color scheme also mimics the color-coded healthy food label system, similar to a traffic light, to encourage the consumption of certain foods versus others.

Our purpose in creating this visual is to empower the scientific community to utilize NHANES data in concert with the NOVA classification system. We hope to reveal and clarify the connected processes of dietary data collection, transformation, extraction, and classification. Including the linking of various databases. Utilizing and maximizing the impact of these tools is essential to understanding the dietary quality of cancer survivors and improving their quality of life.

1. American Cancer Society. (2022). Long-Term Side Effects of Cancer. Retrieved 10-14-2022 from https://www.cancer.org/treatment/survivorship-during-and-after-treatment/long-term-health-concerns/long-term-side-effects-of-cancer.html

2. Hurtado-Barroso, S., Trius-Soler, M., Lamuela-Raventós, R. M., & Zamora-Ros, R. (2020). Vegetable and Fruit Consumption and Prognosis Among Cancer Survivors: A Systematic Review and Meta-Analysis of Cohort Studies. Adv Nutr, 11(6), 1569-1582. https://doi.org/10.1093/advances/nmaa082

3. Klonoff-Cohen, H., & Polavarapu, M. (2020). Existence of late-effects instruments for cancer survivors: A systematic review. PLOS ONE, 15(2), e0229222. https://doi.org/10.1371/journal.pone.0229222

4. Monteiro, C. A., Cannon, G., Moubarac, J.-C., Levy, R. B., Louzada, M. L. C., & Jaime, P. C. (2018). The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing. Public Health Nutrition, 21(1), 5-17. https://doi.org/10.1017/s1368980017000234

5. National Cancer Institute. Learn More about Food Composition Databases for 24-hour Dietary Recalls and Food Records | Dietary Assessment Primer. Retrieved 4/6/23 from https://dietassessmentprimer.cancer.gov/learn/recall-record.html

files/388/recall-record.html

6. Schwedhelm, C., Boeing, H., Hoffmann, G., Aleksandrova, K., & Schwingshackl, L. (2016). Effect of diet on mortality and cancer recurrence among cancer survivors: a systematic review and meta-analysis of cohort studies. Nutr Rev, 74(12), 737-748. https://doi.org/10.1093/nutrit/nuw045

7. USDA Food and Nutrition Service, H. a. H. S. Data Analysis for the 2020 Dietary Guidelines Advisory Committee | Dietary Guidelines for Americans. Retrieved 4/6/23 from https://www.dietaryguidelines.gov/advisory-committee-approaches-to-examine-the-evidence/data-analysis

files/386/data-analysis.html

8. Van Blarigan, E. L., Fuchs, C. S., Niedzwiecki, D., Zhang, S., Saltz, L. B., Mayer, R. J., Mowat, R. B., Whittom, R., Hantel, A., Benson, A., Atienza, D., Messino, M., Kindler, H., Venook, A., Ogino, S., Giovannucci, E. L., Ng, K., & Meyerhardt, J. A. (2018). Association of Survival With Adherence to the American Cancer Society Nutrition and Physical Activity Guidelines for Cancer Survivors After Colon Cancer Diagnosis: The CALGB 89803/Alliance Trial. JAMA Oncol, 4(6), 783-790. https://doi.org/10.1001/jamaoncol.2018.0126

9. Wang, L., Martínez Steele, E., Du, M., Pomeranz, J. L., O’Connor, L. E., Herrick, K. A., Luo, H., Zhang, X., Mozaffarian, D., & Zhang, F. F. (2021). Trends in Consumption of Ultraprocessed Foods Among US Youths Aged 2-19 Years, 1999-2018. Jama, 326(6), 519-530. https://doi.org/10.1001/jama.2021.10238

Visual Brief

The Dietary Guidelines for Americans are meant to provide recommendations to improve health and prevent chronic disease,. Yet how can researchers and providers track adherence to these guidelines and other dietary advice?

This question is especially important when trying to determine the impact of the guidelines on vulnerable populations such as cancer survivors. Diet is especially important for this group, given the toxicity of radiation and chemotherapy they receive. Three out of five survivors will experience late-term effects due to their treatment, including cardiometabolic conditions, obesity, and secondary cancers.¹However, a healthy diet rich in fruits, vegetables, and whole grains and low in excess sugars and salts has a known protective effect against these late-effects.^2-5

Developed in 2012, the NOVA classification system of foods offers a tool to better understand food quality and health effects, based on the nature, extent, and purpose of any processing that foods undergo.⁴ The highest category, ultraprocessed foods, are high in unhealthy fats, refined starches, sugars, and salt, and low in dietary fibers and micronutrients: in other words, poor dietary choices for cancer survivors.^4,6,7

Collecting information on the dietary habits and food choices of cancer survivors and then utilizing the NOVA system is key to better understanding the impact of dietary guidelines within this population, with specific consideration of ultraprocessed foods. We created this visual to depict the flow of data from patient reports to NOVA classification, including the points where information on nutrient and energy content are extracted by researchers from NHANES data. Dietary information is collected from the National Health and Nutrition Examination Survey (NHANES), which utilizes self-reported 24-hour dietary recalls. As depicted in this visual, various databases are used to identify the nutrient and energy contents of all foods reported within NHANES. Foods and food groups can then be classified by researchers using the NOVA classification definitions, which are based on the nature, purpose, and extent of food processing.^8,9

We used blue outlined boxes and text to indicate the steps taken by researchers within the data collection, extraction, manipulation, and analysis process. Blue italicized text indicates the particular function of a database or dataset. The right side of the diagram depicts final NOVA classifications of foods, with color schemes to indicate the extent of processing at each level. Given the negative health outcomes associated with ultraprocessed foods, this category is reflected by a red outlined box, while less processed groups are shown by first orange, then yellow, then green-outlined boxes. This color scheme also mimics the color-coded healthy food label system, similar to a traffic light, to encourage the consumption of certain foods versus others.

Our purpose in creating this visual is to empower the scientific community to utilize NHANES data in concert with the NOVA classification system. We hope to reveal and clarify the connected processes of dietary data collection, transformation, extraction, and classification, including the linking of various databases. Utilizing and maximizing the impact of these tools is essential to understanding the dietary quality of cancer survivors and improving their quality of life.

1. American Cancer Society. (2022). Long-Term Side Effects of Cancer. Retrieved 10-14-2022 from https://www.cancer.org/treatment/survivorship-during-and-after-treatment/long-term-health-concerns/long-term-side-effects-of-cancer.html

2. Hurtado-Barroso, S., Trius-Soler, M., Lamuela-Raventós, R. M., & Zamora-Ros, R. (2020). Vegetable and Fruit Consumption and Prognosis Among Cancer Survivors: A Systematic Review and Meta-Analysis of Cohort Studies. Adv Nutr, 11(6), 1569-1582. https://doi.org/10.1093/advances/nmaa082

3. Klonoff-Cohen, H., & Polavarapu, M. (2020). Existence of late-effects instruments for cancer survivors: A systematic review. PLOS ONE, 15(2), e0229222. https://doi.org/10.1371/journal.pone.0229222

4. Monteiro, C. A., Cannon, G., Moubarac, J.-C., Levy, R. B., Louzada, M. L. C., & Jaime, P. C. (2018). The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing. Public Health Nutrition, 21(1), 5-17. https://doi.org/10.1017/s1368980017000234

5. National Cancer Institute. Learn More about Food Composition Databases for 24-hour Dietary Recalls and Food Records | Dietary Assessment Primer. Retrieved 4/6/23 from https://dietassessmentprimer.cancer.gov/learn/recall-record.html

files/388/recall-record.html

6. Schwedhelm, C., Boeing, H., Hoffmann, G., Aleksandrova, K., & Schwingshackl, L. (2016). Effect of diet on mortality and cancer recurrence among cancer survivors: a systematic review and meta-analysis of cohort studies. Nutr Rev, 74(12), 737-748. https://doi.org/10.1093/nutrit/nuw045

7. USDA Food and Nutrition Service, H. a. H. S. Data Analysis for the 2020 Dietary Guidelines Advisory Committee | Dietary Guidelines for Americans. Retrieved 4/6/23 from https://www.dietaryguidelines.gov/advisory-committee-approaches-to-examine-the-evidence/data-analysis

files/386/data-analysis.html

8. Van Blarigan, E. L., Fuchs, C. S., Niedzwiecki, D., Zhang, S., Saltz, L. B., Mayer, R. J., Mowat, R. B., Whittom, R., Hantel, A., Benson, A., Atienza, D., Messino, M., Kindler, H., Venook, A., Ogino, S., Giovannucci, E. L., Ng, K., & Meyerhardt, J. A. (2018). Association of Survival With Adherence to the American Cancer Society Nutrition and Physical Activity Guidelines for Cancer Survivors After Colon Cancer Diagnosis: The CALGB 89803/Alliance Trial. JAMA Oncol, 4(6), 783-790. https://doi.org/10.1001/jamaoncol.2018.0126

9. Wang, L., Martínez Steele, E., Du, M., Pomeranz, J. L., O’Connor, L. E., Herrick, K. A., Luo, H., Zhang, X., Mozaffarian, D., & Zhang, F. F. (2021). Trends in Consumption of Ultraprocessed Foods Among US Youths Aged 2-19 Years, 1999-2018. Jama, 326(6), 519-530. https://doi.org/10.1001/jama.2021.10238

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