Table 4.

Credibility of evidence using NutriGrade tool for association between UPF consumption and MetS.

	UPF consumption evaluated by NOVA classification system
NutriGrade items
Risk of biasa	2
Precisionb	1
Indirectness	0
Heterogeneityc	0.5
Publication biasd	0.5
Effect sizee	1
Dose-response	0
Funding bias	1
Total score	6
Credibility of evidence	Moderate

UPF, Ultra-processed food; MetS, Metabolic syndrome.

^aRisk of bias was based on the Newcastle-Ottawa Scale, where ≥7 = 2 points; 4–6.9 = 1 point; and 0–3.9 = 0 points.

^bPrecision is 1 point if the number of events ≥500 and the 95% CI excludes the null value; precision is 0 points if the number of events <500 or number of events ≥500, but 95% CI includes the null value (e.g., CI includes RR of 1.0) and 95% CI fails to exclude an important benefit (RR of 0.8) or harm (RR of 1.2).

^cWhen I² was <40% or I² was ≥40% but the source of heterogeneity was found by subgroup analysis 1 point was assigned; otherwise, 0 points were assigned.

^dBased on the funnel plots, Egger or Begg's test. <5 studies = 0 points; no evidence for publication bias with test or plot (≥10 studies) = 1 point.

^eIf the RR or HR <0.80–0.50 and >1.20–2.00, respectively, 1 point is assigned and the corresponding test is statistically significant; if the RR or HR <0.50 and >2.00, respectively, 0 points are assigned and the corresponding test is statistically significant.