{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T08:23:25Z","timestamp":1787732605512,"version":"build-2784847793"},"reference-count":27,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Science, Innovation and Technological Development of the Republic of Serbia","award":["451-03-137\/2025-03\/200110"],"award-info":[{"award-number":["451-03-137\/2025-03\/200110"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background\/Objectives: Ultra-processed food (UPF) consumption is increasingly recognized as part of broader adverse behavioral and health-related patterns in young people, yet evidence integrating dietary, sleep-related, behavioral, and health characteristics within the same adolescent population remains limited. The relationship between UPF-related dietary patterns and tinnitus is particularly understudied. This study examined factors associated with the highest category of a frequency-based proxy UPF score among adolescents in Belgrade, Serbia. Methods: A school-based cross-sectional study included 1285 students aged 15\u201319 years from 12 four-year secondary schools selected using a stratified multistage cluster probability sampling design. A frequency-based proxy UPF score was constructed from seven questionnaire-based food categories broadly consistent with UPF-related consumption patterns in the Serbian context. Participants were grouped into three categories using empirical tertile cut-points, and the highest category was modeled as the binary outcome in univariable and multivariable logistic regression analyses. Results: Lower academic achievement (aOR = 2.10; 95% CI: 1.38\u20133.21), alcohol consumption (aOR = 1.34; 95% CI: 1.04\u20131.74), and waking tired compared with waking rested (aOR = 1.58; 95% CI: 1.06\u20132.35) were associated with higher odds of being in the highest proxy-score category after adjustment for the measured covariates. Energy drink consumption frequency was also associated with the outcome after adjustment for the measured covariates (overall p &lt; 0.001). Constant tinnitus showed one of the strongest adjusted associations (aOR = 2.55; 95% CI: 1.77\u20133.67). Conclusions: Adolescents in the highest category of the frequency-based proxy UPF score exhibited a broader pattern of academic, sleep-related, behavioral, and health characteristics, including a particularly strong association with constant tinnitus. These cross-sectional findings warrant longitudinal research to clarify temporal relationships and underlying determinants.<\/jats:p>","DOI":"10.3390\/nu18162603","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T08:08:53Z","timestamp":1786349333000},"page":"2603","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Frequency-Based Proxy Score for Ultra-Processed Food Consumption Among Adolescents: Associations with Lifestyle Factors and Tinnitus"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7502-5232","authenticated-orcid":false,"given":"Milena","family":"Tomanic","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Institute of Hygiene and Medical Ecology, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2516-0783","authenticated-orcid":false,"given":"Sr\u0111an","family":"Milovanovi\u0107","sequence":"additional","affiliation":[{"name":"Clinic for Psychiatry, University Clinical Centre of Serbia, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5317-3827","authenticated-orcid":false,"given":"Olivera","family":"Stanojlovi\u0107","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Institute of Medical Physiology, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8921-6232","authenticated-orcid":false,"given":"Du\u0161an","family":"Mladenovi\u0107","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Institute of Pathophysiology, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6640-4134","authenticated-orcid":false,"given":"Dragana","family":"Davidovi\u0107","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Institute of Hygiene and Medical Ecology, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7643-0451","authenticated-orcid":false,"given":"Milan","family":"Dobri\u0107","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"},{"name":"Cardiology Clinic, Institute for Cardiovascular Diseases \u201cDedinje\u201d, 11040 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7505-5466","authenticated-orcid":false,"given":"Milena","family":"Veskovi\u0107","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Institute of Pathophysiology, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1150-4699","authenticated-orcid":false,"given":"Katarina","family":"Djurdjevi\u0107","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Institute of Hygiene and Medical Ecology, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7000-5697","authenticated-orcid":false,"given":"\u0160u\u0107ro","family":"Mad\u017egalj","sequence":"additional","affiliation":[{"name":"Clinic for Mental Disorders \u201cDr Laza Lazarevic\u201d, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2745-1212","authenticated-orcid":false,"given":"Dimitrije","family":"Zdravkovi\u0107","sequence":"additional","affiliation":[{"name":"Cardiology Clinic, Institute for Cardiovascular Diseases \u201cDedinje\u201d, 11040 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6695-3238","authenticated-orcid":false,"given":"Aleksandra","family":"Jovanovi\u0107","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0660-6392","authenticated-orcid":false,"given":"Maja","family":"La\u010dkovi\u0107","sequence":"additional","affiliation":[{"name":"Clinic for Psychiatry, University Clinical Centre of Serbia, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"936","DOI":"10.1017\/S1368980018003762","article-title":"Ultra-processed foods: What they are and how to identify them","volume":"22","author":"Monteiro","year":"2019","journal-title":"Public Health Nutr."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e13126","DOI":"10.1111\/obr.13126","article-title":"Ultra-processed foods and the nutrition transition: Global, regional and national trends, food systems transformations and political economy drivers","volume":"21","author":"Baker","year":"2020","journal-title":"Obes. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e077310","DOI":"10.1136\/bmj-2023-077310","article-title":"Ultra-processed food exposure and adverse health outcomes: Umbrella review of epidemiological meta-analyses","volume":"384","author":"Lane","year":"2024","journal-title":"BMJ"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1093\/nutrit\/nuad095","article-title":"The impact of ultra-processed foods on obesity and cardiometabolic comorbidities in children and adolescents: A systematic review","volume":"82","author":"Petridi","year":"2024","journal-title":"Nutr. Rev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"S18","DOI":"10.1016\/j.jped.2023.09.006","article-title":"Ultra-processed food consumption and children and adolescents\u2019 health","volume":"100","author":"Mescoloto","year":"2024","journal-title":"J. Pediatr."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"111908","DOI":"10.1016\/j.nut.2022.111908","article-title":"Intake of ultra-processed foods and sleep-related outcomes: A systematic review and meta-analysis","volume":"106","author":"Delpino","year":"2023","journal-title":"Nutrition"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"L\u00f3pez-Gil, J.F., Cisneros-V\u00e1squez, E., Olivares-Arancibia, J., Ya\u00f1\u00e9z-Sep\u00falveda, R., and Guti\u00e9rrez-Espinoza, H. (2025). Investigating the relationship between ultra-processed food consumption and academic performance in the adolescent population: The EHDLA Study. 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Nutrients, 14.","DOI":"10.3390\/nu14183813"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1001\/jamaneurol.2022.2189","article-title":"Global prevalence and incidence of tinnitus: A systematic review and meta-analysis","volume":"79","author":"Jarach","year":"2022","journal-title":"JAMA Neurol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1007\/s10162-024-00944-3","article-title":"Tinnitus in children","volume":"25","author":"Hoare","year":"2024","journal-title":"J. Assoc. Res. Otolaryngol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Tomanic, M., Belojevic, G., Jovanovic, A., Vasiljevic, N., Davidovic, D., and Maksimovic, K. (2020). Dietary factors and tinnitus among adolescents. Nutrients, 12.","DOI":"10.3390\/nu12113291"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1006\/pmed.1997.0200","article-title":"Validation of a Youth\/Adolescent Food Frequency Questionnaire","volume":"26","author":"Rockett","year":"1997","journal-title":"Prev. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1044\/2016_AJA-15-0076","article-title":"Tinnitus Screener: Results from the first 100 participants in an epidemiology study","volume":"25","author":"Henry","year":"2016","journal-title":"Am. J. Audiol."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Lane, M.M., Gamage, E., Travica, N., Dissanayaka, T., Ashtree, D.N., Gauci, S., Lotfaliany, M., O\u2019Neil, A., Jacka, F.N., and Marx, W. (2022). Ultra-processed food consumption and mental health: A systematic review and meta-analysis of observational studies. Nutrients, 14.","DOI":"10.3390\/nu14132568"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2709","DOI":"10.1007\/s00394-024-03458-z","article-title":"Ultra-Processed Food Consumption in UK Adolescents: Distribution, Trends, and Sociodemographic Correlates Using the National Diet and Nutrition Survey 2008\/09 to 2018\/19","volume":"63","author":"Jago","year":"2024","journal-title":"Eur. J. Nutr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1017\/S0954422423000240","article-title":"Who Consumes Ultra-Processed Food? A Systematic Review of Sociodemographic Determinants of Ultra-Processed Food Consumption from Nationally Representative Samples","volume":"37","author":"Dicken","year":"2024","journal-title":"Nutr. Res. Rev."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2961","DOI":"10.3390\/nu7042961","article-title":"A Western Dietary Pattern Is Associated with Poor Academic Performance in Australian Adolescents","volume":"7","author":"Nyaradi","year":"2015","journal-title":"Nutrients"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Wadolowska, L., Hamulka, J., Kowalkowska, J., Kostecka, M., Wadolowska, K., Biezanowska-Kopec, R., Czarniecka-Skubina, E., Kozirok, W., and Piotrowska, A. (2018). Prudent-Active and Fast-Food-Sedentary Dietary-Lifestyle Patterns: The Association with Adiposity, Nutrition Knowledge and Sociodemographic Factors in Polish Teenagers\u2014The ABC of Healthy Eating Project. Nutrients, 10.","DOI":"10.3390\/nu10121988"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1016\/j.puhe.2020.05.040","article-title":"Determinants of Energy Drink Consumption in Adolescents: Identification of Sex-Specific Patterns","volume":"185","author":"Lebacq","year":"2020","journal-title":"Public Health"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Scott, S., Elamin, W., Giles, E.L., Hillier-Brown, F., Byrnes, K., Connor, N., Newbury-Birch, D., and Ells, L. (2019). Socio-Ecological Influences on Adolescent (Aged 10\u201317) Alcohol Use and Unhealthy Eating Behaviours: A Systematic Review and Synthesis of Qualitative Studies. Nutrients, 11.","DOI":"10.3390\/nu11081914"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e091507","DOI":"10.1136\/bmjopen-2024-091507","article-title":"Association of 15 Common Dietary Factors with Tinnitus: A Systematic Review and Meta-Analysis of Observational Studies","volume":"15","author":"Zhang","year":"2025","journal-title":"BMJ Open"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Tang, D., Tran, Y., Shekhawat, G.S., Burlutsky, G., Mitchell, P., and Gopinath, B. (2021). Dietary Fibre Intake and the 10-Year Incidence of Tinnitus in Older Adults. Nutrients, 13.","DOI":"10.3390\/nu13114126"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.smrv.2012.04.003","article-title":"Tinnitus and insomnia: Is hyperarousal the common denominator?","volume":"17","author":"Schredl","year":"2013","journal-title":"Sleep Med. Rev."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1080\/14992027.2021.1899312","article-title":"Exposure to leisure noise and intermittent tinnitus among young adults in Bavaria: Longitudinal data from a prospective cohort study","volume":"61","author":"Weilnhammer","year":"2022","journal-title":"Int. J. Audiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"100771","DOI":"10.1016\/j.lanepe.2023.100771","article-title":"Consumption of ultra-processed foods and risk of multimorbidity of cancer and cardiometabolic diseases: A multinational cohort study","volume":"35","author":"Cordova","year":"2023","journal-title":"Lancet Reg. Health Eur."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/16\/2603\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T08:17:13Z","timestamp":1787732233000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/16\/2603"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,10]]},"references-count":27,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["nu18162603"],"URL":"https:\/\/doi.org\/10.3390\/nu18162603","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,10]]}}}