Abstract
The objective of this study was to determine the influence of strategies of handling misestimation of energy intake (EI) on observed associations between dietary patterns and cancer risk. Data from Alberta’s Tomorrow Project participants (n = 9,847 men and 16,241 women) were linked to the Alberta Cancer Registry. The revised-Goldberg method was used to characterize EI misestimation. Four strategies assessed the influence of EI misestimation: Retaining individuals with EI misestimation in the cluster analysis (Inclusion), excluding before (ExBefore) or after cluster analysis (ExAfter), or reassigning into ExBefore clusters using the nearest neighbor method (InclusionNN). Misestimation of EI affected approximately 50% of participants. Cluster analysis identified three patterns: Healthy, Meats/Pizza and Sweets/Dairy. Cox proportional hazard regression models assessed associations between the risk of cancer and dietary patterns. Among men, no significant associations (based on an often-used threshold of p < 0.05) between dietary patterns and cancer risk were observed. In women, significant associations were observed between the Sweets/Dairy and Meats/Pizza patterns and all cancer risk in the ExBefore (HR (95% CI): 1.28 (1.04–1.58)) and InclusionNN (HR (95% CI): 1.14 (1.00–1.30)), respectively. Thus, strategies to address misestimation of EI can influence associations between dietary patterns and disease outcomes. Identifying optimal approaches for addressing EI misestimation, for example, by leveraging biomarker-based studies could improve our ability to characterize diet-disease associations.
Highlights
Cancer continues to exert a large toll on morbidity and mortality globally [1]
The proportion who reported a personal history of chronic disease was highest in the Healthy pattern while in women, the proportion who reported a personal history of chronic disease was very similar across dietary patterns
The findings of this study suggest that misestimation of energy intake (EI), ascertained using a prediction equation and self-reported physical activity and body weight and height, was prevalent among adults whose dietary intake was characterized using a food frequency questionnaires (FFQ) within the context of a cohort study
Summary
Cancer continues to exert a large toll on morbidity and mortality globally [1]. Cancer prevention recommendations emphasize the importance of behaviors such as tobacco cessation, physical activity, and healthy eating [2]. The relationship between diet and disease is complex: foods and beverages are consumed in different combinations that allow for countless interactions between nutrients and other dietary. Examining dietary patterns and their associations with cancer risk acknowledges this complexity and could lead to improved estimates of diet-cancer associations [5], as well as clearer recommendations for promoting health and reducing disease risk. Epidemiological studies investigating associations between eating patterns and disease risk are typically reliant on self-reported intake captured using tools such as food frequency questionnaires (FFQ) [6]. Multiple factors contribute to measurement error, including imperfect recall of intake over long time periods (leading, for example, to omission of consumed foods or beverages or inaccurate portion size estimates), social desirability biases, and characteristics of the tools themselves, such as incomplete food lists and portion size options within
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