Allowing for never and episodic consumers when correcting for error in food record measurements of dietary intake

Abstract

Food records, including 24-hour recalls and diet diaries, are considered to provide generally superior measures of long-term dietary intake relative to questionnaire-based methods. Despite the expense of processing food records, they are increasingly used as the main dietary measurement in nutritional epidemiology, in particular in sub-studies nested within prospective cohorts. Food records are, however, subject to excess reports of zero intake. Measurement error is a serious problem in nutritional epidemiology because of the lack of gold standard measurements and results in biased estimated diet–disease associations. In this paper, a 3-part measurement error model, which we call the never and episodic consumers (NEC) model, is outlined for food records. It allows for both real zeros, due to never consumers, and excess zeros, due to episodic consumers (EC). Repeated measurements are required for some study participants to fit the model. Simulation studies are used to compare the results from using the proposed model to correct for measurement error with the results from 3 alternative approaches: a crude approach using the mean of repeated food record measurements as the exposure, a linear regression calibration (RC) approach, and an EC model which does not allow real zeros. The crude approach results in badly attenuated odds ratio estimates, except in the unlikely situation in which a large number of repeat measurements is available for all participants. Where repeat measurements are available for all participants, the 3 correction methods perform equally well. However, when only a subset of the study population has repeat measurements, the NEC model appears to provide the best method for correcting for measurement error, with the 2 alternative correction methods, in particular the linear RC approach, resulting in greater bias and loss of coverage. The NEC model is extended to include adjustment for measurements from food frequency questionnaires, enabling better estimation of the proportion of never consumers when the number of repeat measurements is small. The methods are applied to 7-day diary measurements of alcohol intake in the EPIC-Norfolk study.