Abstract
BackgroundMisreporting of energy intake is common and can contribute to biased estimates of the relationship between diet and disease. Energy intake misreporting is poorly understood in pregnancy and there is limited research assessing characteristics of women who misreport energy intake or changes in misreporting of energy intake across pregnancy.MethodsAn observational study in n = 945 overweight or obese pregnant women receiving standard antenatal care who participated in the LIMIT randomised trial. Diet, physical activity, psychological factors, body image satisfaction and dieting behaviour were assessed at trial entry (10–20 weeks gestation) and 36 weeks gestation. Energy misreporting status was assessed through the ratio of daily energy intake over basal metabolic rate. Logistic regression analyses were conducted with the dependent variable of under reporting of energy intake at study entry or 36 weeks in separate analysis.ResultsAt study entry and 36 weeks, women were classified as under reporters (38 vs 49.4%), adequate reporters (59.7 vs 49.8%) or over reporters of energy intake (2.3 vs 0.8%) respectively. The prevalence of under reporting energy intake at 36 weeks was higher than at study entry (early pregnancy). Body mass index (BMI) at study entry and 36 weeks and socioeconomic status, dieting behaviour and risk of depression at 36 weeks were independent predictors of under reporting of energy intake.ConclusionsUnder reporting of energy intake was present in over a third of overweight and obese pregnant women and was higher in late compared to early pregnancy. Characteristics such as BMI, socioeconomic status, past dieting behaviour and risk of depression may aid in identifying women who either require support in accurate recording of food intake or attention for improving diet quality. Results were unable to distinguish whether under reporting reflects misreporting or a true restriction of dietary intake.Trial registrationAustralian and New Zealand Clinical Trials Registry ACTRN12607000161426, registered 9/3/2007.
Highlights
Misreporting of energy intake is common and can contribute to biased estimates of the relationship between diet and disease
Low energy reporting may result from biasing of reported intake towards foods deemed more appropriate [4, 5] with a lower intake of unhealthier foods high in fat and sugar or unhealthy eating habits resulting in an overall lower diet quality [4]
As there were only a small number of women who over reported their energy intake at each time point, further statistical analysis with this subgroup was not possible and they were excluded from all further analyses
Summary
Misreporting of energy intake is common and can contribute to biased estimates of the relationship between diet and disease. It may be related to failure to record accurate food intake due to recall bias or memory lapses, poor awareness of quantities or types of foods eaten [2], the inconvenience of reporting, or reporting an incomplete or simplified version of what is consumed secondary to inaccurate portion size estimation [6]. The misreporting of dietary intake, if systematic and non-random, can result in incorrect assessments of the relationships between dietary components and clinical outcomes. The common under reporting of energy intake or specific dietary components in obesity may result in a specific bias in studies investigating the relationship between the aetiology and consequences of obesity. Obesity or obesity-associated health conditions or biomarkers of diet or obesity-related health have been previously reported in adequate compared to under reporters of energy intake [7, 8]
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