Geographical and Temporal Variability of Ultra-Processed Food Consumption in the Spanish Population: Findings from the DRECE Study
, Pilar Cancelas Navia 1,2, David Lora Pablos 1,2,4,5,† and Agustín Gómez de la Cámara 1,2,4,†
Round 1
Reviewer 1 Report
Researchers presented data on ultra-processed food consumption in the Spanish population from the DECRE study.
Methods section; is it possible to provide more details on DECRE IV as a new cohort and the sample characteristics compared to the other DECRE. The concern is that it seems that the first 3 DECRE have a different set of people, even though DECRE 4 follow the same geographical and population strata design as the initial population. If it is a new cohort, why it is called DECRE 4? It will be helpful to provide more clarification on this.
Author Response
We are very thankful for the comments and suggestions of reviewers. We have made all the changes proposed and we hope the manuscript has improved notably now. Below each concern you can find the answer proposed and the section and paragraph where we have made the changes.
Reviewer 1
Researchers presented data on ultra-processed food consumption in the Spanish population from the DECRE study.
Methods section; is it possible to provide more details on DECRE IV as a new cohort and the sample characteristics compared to the other DECRE. The concern is that it seems that the first 3 DECRE have a different set of people, even though DECRE 4 follow the same geographical and population strata design as the initial population. If it is a new cohort, why it is called DECRE 4? It will be helpful to provide more clarification on this.
We thank the reviewer for this remark. The DRECE project began in 1991, based on a cross-sectional study in a representative sample of the Spanish population (called DRECE I) which included 4,787 people, stratified by sex and age, between 5 and 59 years of age, randomly selected throughout the national territory by postcode, and distributed in 8 regions. The cohort was partially reviewed at 5 years (DRECE II) and 12 years (DRECE III) of follow-up. After 20 years since the start of DRECE, the cohort was intended to be followed up again but participants from the initial cohort could not be located and re-screened. To solve this problem and to be able to continue studying the evolution of the general Spanish population over time, a new cohort of 5,038 individuals was recruited to replace the original DRECE cohort at this time point (2008). The initial distribution of DRECE I in 8 geographical regions was respected, and sampling was carried out in the same geographical locations (same postcodes) and with the same strata. A sample covering almost all age ranges was obtained so that it could be a representative sample of the current Spanish population and also an extension of the DRECE project. For this reason, this new cohort was called DRECE IV. In addition, all cohorts responded the same food frequency questionnaire.
Therefore, the methodology of analysis used is mixed models in order to be able to work with the correlated data from the first three DRECE and the data from the last DRECE cohort. In addition, the characteristics of all cohorts are listed in Supplementary Table 2.
We have now tried to clarify this part of the methodology in the main text (line 91-96).
Reviewer 2 Report
The proposal about “Geographical and temporal variability of ultra-processed food consumption in the Spanish population: Findings from the DRECE Study” is attractive. To improve, you need the next questions:
-Title. It is right.
-Abstract. It is right.
-Theoretical framework. It is correct. Check if some references can be updated. For example, in “Nutrients” there is a very linked article from 2022 about ultra-processed food in Spain. To be prudent, try to update some new references if you find.
-Methods. In general, it is right. I suggest to complete the quantitative data with qualitative sources (in-deep interviews or a Delphi).
-Results. It is right, statistically correct.
-Conclusion and discussion. Conclusions are too much brief. Try to enlarge it.
Author Response
We are very thankful for the comments and suggestions of reviewers. We have made all the changes proposed and we hope the manuscript has improved notably now. Below each concern you can find the answer proposed and the section and paragraph where we have made the changes.
Reviewer 2
The proposal about “Geographical and temporal variability of ultra-processed food consumption in the Spanish population: Findings from the DRECE Study” is attractive. To improve, you need the next questions:
-Title. It is right.
-Abstract. It is right.
We thank reviewer 2 for his/her kind words.
-Theoretical framework. It is correct. Check if some references can be updated. For example, in “Nutrients” there is a very linked article from 2022 about ultra-processed food in Spain. To be prudent, try to update some new references if you find.
We thank the reviewer for this highly pertinent remark on the references. We have now included more recent references (references added: 18, 35, 38, 78).
- 18. Casas, R. Moving towards a Healthier Dietary Pattern Free of Ultra-Processed Foods. Nutrients 2022, 14, 118, doi:10.3390/nu14010118.
- 35. Neri, D.; Steele, E.M.; Khandpur, N.; Cediel, G.; Zapata, M.E.; Rauber, F.; Marrón-Ponce, J.A.; Machado, P.; da Costa Louzada, M.L.; Andrade, G.C.; et al. Ultraprocessed Food Consumption and Dietary Nutrient Profiles Associated with Obesity: A Multicountry Study of Children and Adolescents. Obes Rev 2022, 23 Suppl 1, e13387, doi:10.1111/obr.13387
- 38. Martinez-Perez, C.; San-Cristobal, R.; Guallar-Castillon, P.; Martínez-González, M.Á.; Salas-Salvadó, J.; Corella, D.; Castañer, O.; Martinez, J.A.; Alonso-Gómez, Á.M.; Wärnberg, J.; et al. Use of Different Food Classification Systems to Assess the Association between Ultra-Processed Food Consumption and Cardiometabolic Health in an Elderly Population with Metabolic Syndrome (PREDIMED-Plus Cohort). Nutrients 2021, 13, 2471, doi:10.3390/nu13072471.
- 78. Dinu, M.; Tristan Asensi, M.; Pagliai, G.; Lotti, S.; Martini, D.; Colombini, B.; Sofi, F. Consumption of Ultra-Processed Foods Is Inversely Associated with Adherence to the Mediterranean Diet: A Cross-Sectional Study. Nutrients 2022, 14, 2073, doi:10.3390/nu14102073.
-Methods. In general, it is right. I suggest to complete the quantitative data with qualitative sources (in-deep interviews or a Delphi).
We appreciate this suggestion. The data collection started in 1991, and since then, the questionnaire has been maintained with the purpose of comparing data across cohorts. Thus, no further qualitative data such as in-depth interviews were planned to be included. As we do not have this data we cannot include it, and collecting it now is not feasible. We will take this view into account for future research, and we have included it as a future improvement in the limitation section (line 339-340).
-Results. It is right, statistically correct.
-Conclusion and discussion. Conclusions are too much brief. Try to enlarge it.
Following this suggestion, we have discussed the need to create educational programmes that promote healthier food environments especially for young people (line 344-355).
