ABSTRACT BACKGROUND Processed foods have been implicated in the pathogenesis of inflammatory bowel diseases (IBD). Our goal was to develop a validated processed foods frequency questionnaire

(PFQ) and assess its reliability and validity. METHODS We recruited adult IBD patients to fill-in a PFQ in this prospective single-center study. Food intake was categorized into three

groups of processed food levels: unprocessed, processed, and ultra-processed. Reliability was assessed by comparing the PFQ results of each patient at 2 time points. Validity was assessed by

comparing the PFQ results to a 3–7 day food diary (FD), and by comparing urine sodium as a biomarker for the high intake of sodium that is mostly present in processed food. RESULTS

urine sodium levels in patients with high processed foods consumption compared with low consumption (104.57 ± 53.26 vs. 78.62 ± 39.08 mmol/L, respectively, _P_ = 0.022). Agreement between

PFQ and the FD in categorizing patients to high and low processed food consumption groups was fair (Kappa 0.23–0.35). CONCLUSIONS The PFQ is a reliable and valid tool for the assessment of

processed foods consumption in IBD patients and can be utilized for studying the association between processed food consumption and IBD etiopathogenesis. Access through your institution Buy

or subscribe This is a preview of subscription content, access via your institution ACCESS OPTIONS Access through your institution Subscribe to this journal Receive 12 print issues and

online access $259.00 per year only $21.58 per issue Learn more Buy this article * Purchase on SpringerLink * Instant access to full article PDF Buy now Prices may be subject to local taxes

which are calculated during checkout ADDITIONAL ACCESS OPTIONS: * Log in * Learn about institutional subscriptions * Read our FAQs * Contact customer support SIMILAR CONTENT BEING VIEWED BY

OTHERS NUTRITIONAL KNOWLEDGE, FIBER INTAKE, BODY MASS INDEX, AND SEX ASSOCIATED WITH CONSTIPATION SYMPTOMS IN PERUVIAN ADULTS Article Open access 12 April 2025 ASSOCIATION BETWEEN FOOD-BASED

DIETARY INFLAMMATORY POTENTIAL AND ULCERATIVE COLITIS: A CASE–CONTROL STUDY Article Open access 25 May 2023 REPRODUCIBILITY AND VALIDITY OF THE TORONTO-MODIFIED HARVARD FOOD FREQUENCY

QUESTIONNAIRE IN A MULTI-ETHNIC SAMPLE OF YOUNG ADULTS Article 13 September 2022 REFERENCES * Molodecky NA, Soon IS, Rabi DM, Ghali WA, Ferris M, Chernoff G, et al. Increasing incidence and

prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology. 2012;142:46–54.e42. Article  PubMed  Google Scholar  * Kaplan GG, Ng SC. Understanding

and preventing the global increase of inflammatory bowel disease. Gastroenterology. 2017;152:313–21.e2. Article  PubMed  Google Scholar  * Levine A, Sigall Boneh R, Wine E. Evolving role of

diet in the pathogenesis and treatment of inflammatory bowel diseases. Gut. 2018;67:1726–38. Article  CAS  PubMed  Google Scholar  * Lewis JD, Abreu MT. Diet as a trigger or therapy for

inflammatory bowel diseases. Gastroenterology. 2017;152:398–414.e6. Article  CAS  PubMed  Google Scholar  * Sarbagili-Shabat C, Sigall-Boneh R, Levine A. Nutritional therapy in inflammatory

bowel disease. Curr Opin Gastroenterol. 2015;31:303–8. Article  CAS  PubMed  Google Scholar  * Hu FB. Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opin

Lipidol. 2002;13:3–9. Article  CAS  PubMed  Google Scholar  * Monteiro CA, Moubarac J-C, Cannon G, Ng SW, Popkin B. Ultra-processed products are becoming dominant in the global food system.

Obes Rev.2013;14(Suppl 2):21–8. Article  PubMed  Google Scholar  * Rashvand S, Behrooz M, Samsamikor M, Jacobson K, Hekmatdoost A. Dietary patterns and risk of ulcerative colitis: a

case-control study. J Hum Nutr Diet. 2018;31:408–12. Article  CAS  PubMed  Google Scholar  * D’Souza S, Levy E, Mack D, Israel D, Lambrette P, Ghadirian P, et al. Dietary patterns and risk

for Crohn’s disease in children. Inflamm Bowel Dis. 2008;14:367–73. Article  PubMed  Google Scholar  * Chassaing B, Van De Wiele T, De Bodt J, Marzorati M, Gewirtz AT. Dietary emulsifiers

directly alter human microbiota composition and gene expression ex vivo potentiating intestinal inflammation. Gut. 2017;66:1414–27. Article  CAS  PubMed  Google Scholar  * Jowett SL, Seal

CJ, Pearce MS, Phillips E, Gregory W, Barton JR, et al. Influence of dietary factors on the clinical course of ulcerative colitis: a prospective cohort study. Gut. 2004;53:1479–84. Article 

CAS  PubMed  PubMed Central  Google Scholar  * Zinöcker MK, Lindseth IA. The western diet-microbiome-host interaction and its role in metabolic disease. Nutrients. 2018;10:365. Article 

PubMed Central  CAS  Google Scholar  * Albenberg L, Brensinger CM, Wu Q, Gilroy E, Kappelman MD, Sandler RS, et al. A diet low in red and processed meat does not reduce rate of crohn’s

disease flares. Gastroenterology. 2019;157:128–136.e5. Article  PubMed  Google Scholar  * Santos Costa C, Del-Ponte B, Cecília M, Assunção F, Santos IS. Consumption of ultra-processed foods

and body fat during childhood and adolescence: a systematic review. Public Health Nutr. 2018;21:148–59. Article  Google Scholar  * Nelson MC, Lytle LA. Development and evaluation of a brief

screener to estimate fast-food and beverage consumption among adolescents. J Am Diet Assoc. 2009;109:730–4. Article  PubMed  PubMed Central  Google Scholar  * Cantwell M, Mittl B, Curtin J,

Carroll R, Potischman N, Caporaso N, et al. Relative validity of a food frequency questionnaire with a meat-cooking and heterocyclic amine module. Cancer Epidemiol Biomark Prev.

2004;13:293–8. Article  CAS  Google Scholar  * De Cock N, Van Camp J, Kolsteren P, Lachat C, Huybregts L, Maes L, et al. Development and validation of a quantitative snack and beverage food

frequency questionnaire for adolescents. J Hum Nutr Diet. 2017;30:141–50. Article  PubMed  Google Scholar  * Neuhouser ML, Lilley S, Lund A, Johnson DB. Development and validation of a

beverage and snack questionnaire for use in evaluation of school nutrition policies. J Am Diet Assoc. 2009;109:1587–92. Article  PubMed  Google Scholar  * Laura Da Costa Louzada M, Galastri

Baraldi L, Martinez Steele E, Paula A, Martins B, Canella DS, et al. Consumption of ultra-processed foods and obesity in Brazilian adolescents and adults. Prev Med. 2015;81:9–15. Article 

Google Scholar  * Schnabel L, Buscail C, Sabate JM, Bouchoucha M, Kesse-Guyot E, Allès B, et al. Association between ultra-processed food consumption and functional gastrointestinal

disorders: results from the french NutriNet-Santé cohort. Am J Gastroenterol. 2018;113:1217–28. Article  PubMed  Google Scholar  * Fiolet T, Srour B, Sellem L, Kesse-Guyot E, Allès B, Méjean

C, et al. Consumption of ultra-processed foods and cancer risk: results from NutriNet-Santé prospective cohort. BMJ. 2018;360:322. Article  Google Scholar  * Miele E, Shami R, Aloi M, Assa

A, Braegger C, Bronsky J, et al. Nutrition in pediatric inflammatory bowel disease: a position paper on behalf of the porto inflammatory bowel disease group of the european society of

pediatric gastroenterology, hepatology and nutrition. J Pediatr Gastroenterol Nutr. 2018;66:687–708. Article  PubMed  Google Scholar  * Forbes A, Escher J, Hébuterne X, Kłęk S, Krznaric Z,

Schneider S, et al. ESPEN guideline: clinical nutrition in inflammatory bowel disease. Clin Nutr. 2017;36:321–47. Article  PubMed  Google Scholar  * Monteiro CA, Cannon G, Moubarac J-C, Levy

RB, Louzada MLC, Jaime PC. The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing. Public Health Nutr. 2018;21:5–17. Article  PubMed  Google Scholar

  * Eicher-Miller HA, Fulgoni VL III, Keast DR. Contributions of processed foods to dietary intake in the us from 2003–2008: a report of the food and nutrition science solutions joint task

force of the academy of nutrition and dietetics, american society for nutrition, institute of food technologists, and international food information council. J Nutr. 2012;142:2065S. Article

  CAS  PubMed  PubMed Central  Google Scholar  * Moubarac J-C, Parra DC, Cannon G, Monteiro CA. Food classification systems based on food processing: significance and implications for

policies and actions: a systematic literature review and assessment. Curr Obes Rep. 2014;3:256–72. Article  PubMed  Google Scholar  * Monteiro CA, Cannon G, Levy RB, Moubarac J-C, Louzada

ML, Rauber F, et al. Ultra-processed foods: what they are and how to identify them. Public Health Nutr. 2019;22:936–41. Article  PubMed  Google Scholar  * Monteiro CA, Levy RB, Claro RM,

Castro IRR, de, Cannon G. A new classification of foods based on the extent and purpose of their processing. Cad Saude Publica. 2010;26:2039–49. Article  PubMed  Google Scholar  * Lam MCL,

Adams J. Association between home food preparation skills and behaviour, and consumption of ultra-processed foods: cross-sectional analysis of the UK National Diet and nutrition survey

(2008-2009). Int J Behav Nutr Phys Act. 2017;14:68. Article  PubMed  PubMed Central  Google Scholar  * MABAT. First Israeli national health and nutrition survey 1999–2001 part 2: what

Israelis eat. Food and nutrition services, Ministry of Health and Israel Center for Disease Control. Publication no. 228. 2004.

https://www.health.gov.il/PublicationsFiles/Mabat_1999-2001-b.pdf. * Mercado CI, Cogswell ME, Valderrama AL, Wang C-Y, Loria CM, Moshfegh AJ, et al. Difference between 24-h diet recall and

urine excretion for assessing population sodium and potassium intake in adults aged 18–39 y. Am J Clin Nutr. 2015;101:376–86. Article  CAS  PubMed  Google Scholar  * Umesawa M, Yamagishi K,

Noda H, Ikeda A, Sawachi S, Muraki I, et al. The relationship between sodium concentrations in spot urine and blood pressure increases: a prospective study of Japanese general population:

the Circulatory Risk in Communities Study (CIRCS). BMC Cardiovasc Disord. 2016;16:55. Article  PubMed  PubMed Central  CAS  Google Scholar  * Lee S-G, Lee W, Kwon OH, Kim J-H. Association of

urinary sodium/creatinine ratio and urinary sodium/specific gravity unit ratio with blood pressure and hypertension: KNHANES 2009–2010. Clin Chim Acta. 2013;424:168–73. Article  CAS  PubMed

  Google Scholar  * Joosten MM, Gansevoort RT, Mukamal KJ, Lambers Heerspink HJ, Geleijnse JM, Feskens EJM, et al. Sodium excretion and risk of developing coronary heart disease.

Circulation. 2014;129:1121–28. Article  CAS  PubMed  Google Scholar  * Brown IJ, Tzoulaki I, Candeias V, Elliott P. Salt intakes around the world: implications for public health. Int J

Epidemiol. 2009;38:791–813. Article  PubMed  Google Scholar  * Ni Mhurchu C, Capelin C, Dunford EK, Webster JL, Neal BC, Jebb SA. Sodium content of processed foods in the United Kingdom:

analysis of 44,000 foods purchased by 21,000 households. Am J Clin Nutr. 2011;93:594–600. Article  PubMed  CAS  Google Scholar  * Landis JR, Koch GG. The measurement of observer agreement

for categorical data. Biometrics. 1977;33:159–74. Article  CAS  PubMed  Google Scholar  * Charlton KE, Steyn K, Levitt NS, Jonathan D, Zulu JV, Nel JH. Development and validation of a short

questionnaire to assess sodium intake. Public Health Nutr. 2007;11:83–94. Article  PubMed  Google Scholar  * Lemogoum D, Ngatchou W, Lele CB, Okalla C, Leeman M, Degaute J-P, et al.

Association of urinary sodium excretion with blood pressure and risk factors associated with hypertension among Cameroonian pygmies and bantus: a cross-sectional study. BMC Cardiovasc

Disord. 2018;18:49. Article  PubMed  PubMed Central  Google Scholar  * Jian L, Binns CW, Lee AH. Validity of a food-frequency questionnaire for elderly men in southeast China. Public Health

Nutr. 2006;9:928–33. Article  PubMed  Google Scholar  * Black AE. Critical evaluation of energy intake using the Goldberg cut-off for energy intake:basal metabolic rate. A practical guide to

its calculation, use and limitations. Int J Obes. 2000;24:1119–30. Article  CAS  Google Scholar  * Mente A, O’Donnell M, Rangarajan S, McQueen M, Dagenais G, Wielgosz A, et al. Urinary

sodium excretion, blood pressure, cardiovascular disease, and mortality: a community-level prospective epidemiological cohort study. Lancet. 2018;392:496–506. Article  PubMed  Google Scholar

  Download references AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * IBD Center, Department of Gastroenterology and Liver Diseases, Tel-Aviv Medical Center, Tel-Aviv, Israel Chen

Sarbagili-Shabat, Shira Zelber-Sagi, Naomi Fliss Isakov, Yulia Ron, Ayal Hirsch & Nitsan Maharshak * The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel Chen

Sarbagili-Shabat & Nitsan Maharshak * School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel Shira Zelber-Sagi Authors * Chen

Sarbagili-Shabat View author publications You can also search for this author inPubMed Google Scholar * Shira Zelber-Sagi View author publications You can also search for this author

inPubMed Google Scholar * Naomi Fliss Isakov View author publications You can also search for this author inPubMed Google Scholar * Yulia Ron View author publications You can also search for

this author inPubMed Google Scholar * Ayal Hirsch View author publications You can also search for this author inPubMed Google Scholar * Nitsan Maharshak View author publications You can

also search for this author inPubMed Google Scholar CONTRIBUTIONS The authors’ responsibilities were as follows—CSS: conceived and designed the study, did the data collection, performed the

statistical analysis, and wrote the paper; SZS: conceived and designed the study, provided statistical input, helped with interpretation of the results, and reviewed the paper for important

intellectual content; NFI, YR, and AH: contributed to data collection; NM: conceived and designed the study, supervised on data collection, helped with interpretation of the results, and

reviewed the paper for important intellectual content; all the authors read and approved the final paper. CORRESPONDING AUTHOR Correspondence to Chen Sarbagili-Shabat. ETHICS DECLARATIONS

CONFLICT OF INTEREST The authors declare that they have no conflict of interest. ADDITIONAL INFORMATION PUBLISHER’S NOTE Springer Nature remains neutral with regard to jurisdictional claims

in published maps and institutional affiliations. SUPPLEMENTARY INFORMATION LEGENDS TO SUPPLEMENTARY FIGURE 1 SUPPLEMENTARY TABLE 1 SUPPLEMENTARY TABLE 2 SUPPLEMENTARY FIGURE 1 RIGHTS AND

PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Sarbagili-Shabat, C., Zelber-Sagi, S., Fliss Isakov, N. _et al._ Development and validation of processed foods

questionnaire (PFQ) in adult inflammatory bowel diseases patients. _Eur J Clin Nutr_ 74, 1653–1660 (2020). https://doi.org/10.1038/s41430-020-0632-5 Download citation * Received: 10 October

2019 * Revised: 01 April 2020 * Accepted: 01 April 2020 * Published: 22 April 2020 * Issue Date: December 2020 * DOI: https://doi.org/10.1038/s41430-020-0632-5 SHARE THIS ARTICLE Anyone you

share the following link with will be able to read this content: Get shareable link Sorry, a shareable link is not currently available for this article. Copy to clipboard Provided by the

Springer Nature SharedIt content-sharing initiative