title: Food Classification Systems Based on Food Processing: Significance and Implications for Policies and Actions: A Systematic Literature Review and Assessment.
abstract: This paper is the first to make a systematic review and assessment of the literature that attempts methodically to incorporate food processing into classification of diets. The review identified 1276 papers, of which 110 were screened and 21 studied, derived from five classification systems. This paper analyses and assesses the five systems, one of which has been devised and developed by a research team that includes co-authors of this paper. The quality of the five systems is assessed and scored according to how specific, coherent, clear, comprehensive and workable they are. Their relevance to food, nutrition and health, and their use in various settings, is described. The paper shows that the significance of industrial food processing in shaping global food systems and supplies and thus dietary patterns worldwide, and its role in the pandemic of overweight and obesity, remains overlooked and underestimated. Once food processing is systematically incorporated into food classifications, they will be more useful in assessing and monitoring dietary patterns. Food classification systems that emphasize industrial food processing, and that define and distinguish relevant different types of processing, will improve understanding of how to prevent and control overweight, obesity and related chronic non-communicable diseases, and also malnutrition. They will also be a firmer basis for rational policies and effective actions designed to protect and improve public health at all levels from global to local.
authors.affiliation: Centre for Epidemiological Studies in Health and Nutrition, University of São Paulo, Av. Dr. Arnaldo, 715, São Paulo, Brazil, 01246-907. jcmoubarac@gmail.com.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Moubarac
authors.affiliation: Centre for Epidemiological Studies in Health and Nutrition, University of São Paulo, Av. Dr. Arnaldo, 715, São Paulo, Brazil, 01246-907.|Program in Physical Therapy, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA.
authors.forename: Diana C
authors.initials: DC
authors.lastname: Parra
authors.affiliation: Centre for Epidemiological Studies in Health and Nutrition, University of São Paulo, Av. Dr. Arnaldo, 715, São Paulo, Brazil, 01246-907.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Cannon
authors.affiliation: Centre for Epidemiological Studies in Health and Nutrition, University of São Paulo, Av. Dr. Arnaldo, 715, São Paulo, Brazil, 01246-907.|Department of Nutrition, Faculty of Public Health, University of São Paulo, São Paulo, Brazil.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Monteiro
keywords: Artisanal food; Food classification systems; Food processing and obesity; Highly processed; Industrial food processing; Minimally processed food; NOVA food processing classification; Processed food; Processing; Ultra-processed food products; Unprocessed food