Low Energy Reporting Research Articles

Assessment of dietary habits and the adequacy of dietary intake of patients with cirrhosis-the KIRRHOS study

Undernutrition is widely prevalent in patients with cirrhosis and affects prognosis. Given the lack of data regarding the dietary intake (DI) and habits of patients with cirrhosis, the aim of the present study was to evaluate them by assessing diet's adequacy compared to the new guidelines, and the association of DI with nutritional status indicators. One hundred and eighty-seven patients (57.8% male, 59.9±10.9 years old, 44.9% decompensated ones) with cirrhosis of various etiologies were enrolled. The patients' DI was assessed using three 24h recalls, which were analyzed regarding macronutrients' intake, food groups consumption, adherence to the Mediterranean diet and meal patterns. The Goldberg cut-off limits for the ratio of energy intake to resting energy expenditure were used to evaluate dietary underreporting and patients were accordingly classified as low or adequate energy reporters (LERs and AERs). Among the AERs (n=91, 48.7%) only 29.7% and 31.9% met current recommendations regarding energy and protein intake, accordingly. Patients reported low intake of several healthy food groups and low adherence to the Mediterranean diet. They reported a median of 4.3 eating episodes per day and they frequently omitted late evening snack. Nevertheless, no statistically significant associations were found between parameters of DI and annual and two-year survival. Low energy reporting was very frequent in this sample of patients with liver cirrhosis. Diet quality was rather poor, whereas energy and protein intakes were lower than those recommended.

Energy misreporting is more prevalent for those of lower socio-economic status and is associated with lower reported intake of discretionary foods.

The role of socio-economic status (SES) on the misreporting of food and energy intakes is not well understood with disagreement in the literature. The aim of this study was to examine the associations between low energy reporting, dietary quality and SES in a representative sample of adults. Dietary data were collected using 2 d of 24-h recalls for 6114 adults aged 19 years and over, participating in the Australian National Nutrition and Physical Activity Survey 2011-2012. Low energy reporters (LER) and plausible reporters (PR) were identified. Discretionary food intake was used as a proxy indicator of diet quality. SES was determined using area-level SES and educational attainment. Regression analysis was applied to examine the effects of LER and SES on diet quality, adjusting for potential confounders. LER was more common in populations of lower SES than higher SES (area-level OR 1·46 (95 % CI 1·06, 2·00); education OR 1·64 (95 % CI 1·28, 2·09). LER and SES were independently associated with diet quality, with LER reporting lower percentage energy from discretionary foods compared with PR (27·4 v. 34·2, P < 0·001), and those of lower area-level SES and education reporting lower diet quality compared with those of higher SES (33·7 v. 31·2, P < 0·001; and 33·5 v. 29·6, P < 0·001, respectively). No interaction effect was found between LER and SES, indicating percentage energy in discretionary foods was not differentially misreported across the SES areas (0·3078) or education (P = 0·7078). In conclusion, LER and higher SES were associated with better diet quality.

Correlates of low dietary energy reporting in free-living elderly: The MEDIS study

ObjectivesTo evaluate the prevalence of low energy reporting (LER) and associations between LER and lifestyle, psychological and clinical parameters, in elderly people living in eastern Mediterranean islands. Methods1190 men and women, aged 65–100 years, participated in this cross-sectional study. Socio-demographic, clinical and lifestyle characteristics were recorded for the study participants. Among others, the ratio of energy intake to estimated basal metabolic rate (EI/BMR) was calculated and was used for the assessment of LER. ResultsPrevalence of LER was 47.7%. Lower EI/BMR (i.e., higher risk for LER) was associated with older age (p=0.001), male sex (p<0.001), higher body mass index (BMI; p=0.04), lower adherence to the Mediterranean diet (p<0.001) and non-current smoking (p=0.007). The sex-specific analysis revealed that, lower EI/BMR values were associated with lower adherence to the Mediterranean diet and being non-current smoker in both men and women (p≤0.05), as well as with older age (p=0.01), higher BMI (p=0.02) and hypercholesterolemia (p=0.02), only in women. ConclusionIn elderly, several clinical and lifestyle factors seem to be related to LER, and they should be taken into account in their nutritional assessment.

Predictors of measurement error in energy intake during pregnancy.

Nutrition plays a critical role in maternal and fetal health; however, research on error in the measurement of energy intake during pregnancy is limited. The authors analyzed data on 998 women living in central North Carolina with singleton pregnancies during 2001-2005. Second-trimester diet was assessed by food frequency questionnaire. Estimated energy requirements were calculated using Institute of Medicine prediction equations, with adjustment for energy costs during the second trimester. Implausible values for daily energy intake were determined using confidence limits of agreement for energy intake/estimated energy requirements. Prevalences of low energy reporting (LER) and high energy reporting (HER) were 32.8% and 12.9%, respectively. In a multivariable analysis, pregravid body mass index was related to both LER and HER; LER was higher in both overweight (odds ratio = 1.96, 95% confidence interval: 1.26, 3.02; P = 0.031) and obese (odds ratio = 3.29, 95% confidence interval: 2.33, 4.65; P < 0.001) women than in normal-weight counterparts. Other predictors of LER included marriage and higher levels of physical activity. HER was higher among subjects who were underweight, African-American, and less educated and subjects who had higher depressive symptom scores. LER and HER are prevalent during pregnancy. Identifying their predictors may improve data collection and analytic methods for reducing systematic bias in the study of diet and reproductive outcomes.

Predictors of Measurement Error in Energy Intake During Pregnancy

Nutrition plays a critical role in maternal and fetal health; however, research on measurement error of energy intake during pregnancy is limited. Data were analyzed from 1,023 women with singleton pregnancies in the Pregnancy, Infection, and Nutrition Cohort Study. Second trimester diet was assessed using a food frequency questionnaire (FFQ). Estimated energy requirement (EER) was calculated using IOM prediction equations with adjustment for energy costs during the second trimester. Implausible values for daily energy intake (EI) were determined using confidence limits of agreement for EI/EER. Prevalence of low energy reporting (LER) and high energy reporting (HER) was 31.8% and 12.9%, respectively. In a multivariable analysis, pre‐gravid BMI was related to both LER and HER; LER was higher in both overweight (OR=1.96, 95% CI=1.26, 3.02) and obese women (OR=3.29, 95% CI=2.33, 4.65) than in normal weight counterparts. Other predictors of LER included marriage and higher levels of physical activity. HER was higher among subjects who were underweight, African American, less educated, and had higher depressive symptom scores. Nutrient density intakes for fat, calcium, riboflavin, and vitamin C differed between LER and non‐LER subjects. LER and HER are prevalent during pregnancy. Identifying their predictors may improve data collection and analysis methods to reduce systematic bias in reproductive studies.Grant Funding Source: ASN

Misreporting of Energy Intake in the Elderly Using Doubly Labeled Water to Measure Total Energy Expenditure and Weight Change

Background: One of the major problems in dietary assessment is inaccuracy in reporting diet.Objective: To examine the association between self-reported energy intake (EI) by food frequency questionnaire (FFQ) and energy expenditure (EE), measured by doubly labeled water (DLW), among older persons.Design: EE was assessed in 298 high-functioning, community-dwelling older adults (70–79 years of age) over a 2-week period using DLW. Dietary intake was assessed using a Block FFQ. The ratio between reported EI and total energy expenditure (TEE) was calculated. Misreporting was defined as follows: participants with an EI/TEE ratio of <0.77 were categorized as low energy reporters, while participants with an EI/TEE ratio >1.28 were categorized as high energy reporters. Participants with an EI/TEE ratio of 0.77–1.28 were categorized as “true” energy reporters. One-year percent weight change prior to EE visit was used as another validation indicator. Participants who were low energy reporters but lost >2% of their body weight were categorized as undereaters.Results: Two hundred ninety-six participants provided both FFQ and DLW measurements. Forty-three percent of participants were low energy reporters; among them, almost 30% lost weight and, therefore, were categorized as undereaters. The undereaters consumed significantly fewer calories. No difference in the frequency of low energy reporting was detected between genders or racial groups. Underreporters had significantly higher body weight than “true” or high reporters. Undereaters tended to have higher body mass index than the underreporters.Conclusions: Undereating is prevalent in the elderly and may be falsely perceived as underreporting. It should be further addressed and characterized in future studies.

Associations between Lifestyle Patterns and Body Mass Index in a Sample of Greek Children and Adolescents

Background Although eating and physical activity behaviors have been previously individually investigated with regard to overweight in children, multidimensional lifestyle patterns, based on these behaviors, have not been explored. Objective To assess lifestyle patterns in relation to body mass index (BMI), in a nationally representative sample of the Greek pediatric population Design Cross-sectional study. Data were collected from May through July 2007. Subjects The sample consisted of 1,305 children and adolescents (ages 3 to 18 years). Main outcome measures Information on participants' dietary intake, eating behaviors, physical activity habits, and BMI were collected. Adherence to the Mediterranean diet guidelines was evaluated using the KIDMED Mediterranean diet quality index; the higher the score in this index the more favorable the dietary pattern. The Goldberg cut-off limits for the ratio of energy intake/basal metabolic rate were used to evaluate dietary low energy reporting and participants were accordingly classified as low-energy reporters. Statistical analysis Principal component analysis was performed to identify participants' lifestyle patterns. Associations between BMI and lifestyle patterns were further evaluated using multiple linear regression analyses, after controlling for potential confounders. Results Principal component analysis identified seven lifestyle patterns explaining 85% of the total variance of lifestyle habits. A lifestyle pattern characterized by higher eating frequency, breakfast consumption and higher KIDMED score was negatively associated with BMI (standardized β=−.125, P<0.001), after controlling for age, sex, and parental education. The association remained significant even when low-energy reporters were excluded from the analysis. Conclusions Results from the study suggest a potential intercorrelation and protective action of selected eating behaviors, namely eating frequency, breakfast consumption, and adherence to the Mediterranean diet, against overweight and obesity in children and adolescents.

Low energy reporting by adults in What We Eat In America, NHANES 2003‐2006

The U.S. Department of Agriculture Automated Multiple Pass Method (AMPM), a 5‐step method for collecting 24‐hour dietary recalls, was recently validated in a large doubly labeled water study and shown to be effective for collecting accurate group energy intake of adults. Since the AMPM is used to collect dietary intakes in What We Eat In America, National Health and Nutrition Examination Survey (NHANES), the objective of this research is to assess energy reporting accuracy in this nationally representative sample of the U.S. population. NHANES data were merged for the periods 2003‐2004 and 2005‐2006 and included men (n=4239) and non‐pregnant women (n=4084), 20 years and older. Energy reporting was assessed by computing a ratio of reported energy intake (EI) to estimated basal metabolic rate (BMR). EI was obtained from Day 1 dietary data and BMR was estimated using age and sex specific Schofield equations. The mean (95% CI) EI:BMR was 1.43 (1.41, 1.46) for men and 1.26 (1.24, 1.29) for women. Overall, for individuals with a body mass index (BMI) in the healthy weight category (18.5 to &lt;25) the EI:BMR was 1.50 (1.47, 1.53). Using a Goldberg cutoff value of &lt;0.9, 17% of men and 25% of women were classified as a low energy reporter (LER). For healthy weight individuals, less than 14% were LERs. The prevalence of low energy reporting was highest in women and in obese individuals (BMI=30). Other characteristics of LERs will be presented.Funding source for this study is USDA

Low Energy Reporting Related to Lifestyle, Clinical, and Psychosocial Factors in a Randomly Selected Population Sample of Greek Adults: The ATTICA Study

Objective: Aim of the present study was to identify potential dietary, lifestyle, psychosocial and clinical correlates of underreporting in a population-based sample.Methods: Following a random multistage sampling, 1514 men (46±13 years old) and 1528 women (45±13 years old) from the Attica area, in Greece, participated in this study. All participants underwent a standard assessment procedure that included clinical, psychosocial and lifestyle parameters. Food consumption was assessed through a validated semi-quantitative food frequency questionnaire. The ratio of energy intake to estimated basal metabolic rate (EI/BMR) and the Goldberg cut-off points were used for the classification of subjects as low energy reporters (LERs) and non-LERs.Results: LERs represented 12.2% of the sample. This percentage was higher in obese subjects compared to overweight or normal weight (20.6 % vs. 9.9 % vs. 10.6 %, p = 0.05), as well as in women compared to men (14.6% vs. 9.9%, p<0.001). Data analysis was stratified by gender, since a significant interaction was observed between gender and LER group on several dietary parameters. Female LERs had higher Med Diet Score compared to non-LERs (30.6 ± 8.2, 95%CI 30.2–31.04 vs. 26.9 ± 6.3, 95%CI 26.05–27.7, p<0.001). Multiple regression analysis revealed that lower EI/BMR values were associated with younger age (p<0.001), higher BMI (p<0.001), presence of diabetes mellitus (p=0.012) and lower depression score (p=0.056) in women, whereas with younger age (p<0.001), higher BMI (p<0.001), higher education level (p=0.046) and higher anxiety score (p=0.08) in men.Conclusion: Several psychosocial and clinical characteristics operate in low energy reporting in both genders. Nutrition-related professionals should be aware of these gender-specific trends in dietary assessment procedures.

High Levels of Low Energy Reporting on 24-Hour Recalls and Three Questionnaires in an Elderly Low-Socioeconomic Status Population

Studies of low energy reporting in the elderly are limited, yet changes in energy balance and the incidence of chronic disease make this a critical time to assess energy intake in this population. The objective of this study was to assess low energy reporting on 24-h recalls (24HR), a FFQ, a picture sort FFQ (PSFFQ), and a meal pattern questionnaire (MPQ), and to relate low energy reporting status to personal characteristics and dietary characteristics, including the Healthy Eating Index. Monthly 24HR were completed over 6 mo, followed by 3 interviewer-administered questionnaires. The Goldberg equation was used to determine reporting status for the dietary assessment methods among older, rural, low socioeconomic status, white, African American, and Native American men and women. The relations of variables of interest to low energy reporting were considered one at a time and in multiple logistic regression models. The percentage of participants classified as accurate reporters varied from 40% (FFQ) to 63% (PSFFQ) among men and 60% (24HR, PSFFQ, MPQ) to 63% (FFQ) among women; high energy reporting was observed on the MPQ. Low energy reporters on the FFQ tended to be men and to be overweight or obese (P < 0.05). Underreporting seemed to be due to omitting foods from major food groups as well as from omitting discretionary energy foods. There was a high degree of low energy reporting in this population, particularly by men, even with six 24HR.

Misreporting of energy: prevalence, characteristics of misreporters and influence on observed risk estimates in the Malmö Diet and Cancer cohort

The present study investigates the prevalence of misreporting of energy in the Malmö Diet and Cancer cohort, and examines anthropometric, socio-economic and lifestyle characteristics of the misreporters. Further, the influence of excluding misreporters on risk estimates of post-menopausal breast cancer was examined. Information of reported energy intake (EI) was obtained from a modified diet history method. A questionnaire provided information on lifestyle and socio-economic characteristics. Individual physical activity level (PAL) was calculated from self-reported information on physical activity at work, leisure time physical activity and household work, and from estimates of hours of sleeping, self-care and passive time. Energy misreporting was defined as having a ratio of EI to BMR outside the 95 % CI limits of the calculated PAL. Logistic regression analysed the risk of being a low-energy reporter or a high-energy reporter. Almost 18 % of the women and 12 % of the men were classified as low-energy reporters, 2.8 % of the women and 3.5 % of the men were classified as high-energy reporters. In both genders high BMI, large waist circumference, short education and being a blue-collar worker were significantly associated with low-energy reporting. High-energy reporting was significantly associated with low BMI, living alone and current smoking. The results add support to the practice of energy adjustment as a means to reduce the influence of errors in risk assessment.

Longitudinal changes in dietary intake in Scottish women around the menopause: changes in dietary pattern result in minor changes in nutrient intake

To examine dietary change that has occurred over 5 to 6 years. A cohort of Scottish women (n=898) with a mean age of 47.5 years (range 45-54 years) at baseline. Dietary intake was assessed by validated food-frequency questionnaire (FFQ) and analysed using the UK Composition of Foods database. Since the first dietary assessment, mean daily energy intake had decreased from 8.2+/-2.3 to 7.9+/-2.2 MJ. The degree of low energy reporting (defined as ratio of energy intake to basal metabolic rate <1.1) had increased from 18.7% at baseline to 25.6% at follow-up. Low energy reporters were significantly heavier than 'normal' energy reporters (mean weight at follow-up, 68.9+/-12.6 vs. 66.8+/-11.3 kg) and could be deliberately restricting intake rather than underreporting. Overall there were decreases in intakes of red meat, processed meat and cheese, but increases in poultry and non-oily fish consumption. Consumption of bread, biscuits and cakes had gone down and there was an increase in cereal and rice/pasta consumption. Intake of potatoes had decreased whereas fruit intake had increased. There were small but statistically significant differences in intakes for most nutrients (<8% change). Nutrient intakes at both visits were similar across menopausal status and usage groups of hormone replacement therapy. Modifications to the computer version of the McCance and Widdowson nutrient database, which differed from the published version, were noted. These changes altered the original baseline values for our study. The menopause per se is not a period of marked change in nutrient intake. Caution is advised when using computer databases of food compositions for longitudinal studies.

The problem of accuracy in dietary surveys. Analysis of the over 65 UK National Diet and Nutrition Survey

STUDY OBJECTIVETo investigate the prevalence and nature of low energy reporting in a dietary survey of British adults over 65 years of age.DESIGNRandomly selected cross sectional sample of 2060 British...

Socioeconomic differences in fat intake in a middle-aged population: report from the Malmo Diet and Cancer Study

Background: The objective was to investigate whether socioeconomic differences in fat intake may explain socioeconomic differences in cardiovascular diseases. Methods: The Malm Diet and Cancer Study is a prospective cohort study. The baseline examinations used in the present cross-sectional study were undertaken in 19921994. Dietary habits were assessed using a modified diet history method consisting of a 7-day menu book and a 168-item questionnaire. A subpopulation of 11 837 individuals born 19261945 was investigated. This study examined high fat intake, defined as >35.9 among men and >34.8 among women (25 quartile limit) of the proportion of the non-alcohol energy intake contributed by fat. The subfractions saturated, mono-unsaturated and poly-unsaturated fatty acids and the P:S ratio (polyunsaturated/saturated fatty acids) were analysed in the same way. The uppermost quartile (75) of total and subgroup fat intake was also studied. Socioeconomic differences before and after adjustment for low energy reporting (LER), defined as energy intake below 1.2 x Basal Metabolic Rate, were examined. Results: No socioeconomic differences in fat intake were seen between the SES groups, except for self-employed men, and male and female pensioners. Approximately 20 in most SES groups were LER. The LER and body mass index were strongly related. The SES pattern of fat intake remained unchanged after adjustment for age, country of origin and LER in a logistic regression model. The results for the subfractions of fat and the P:S ratio did not principally differ from the total fat results. Conclusions: This study provides no evidence that fat intake contributes to the inverse socioeconomic differences in cardiovascular diseases. (Less)

Socioeconomic differences in fat intake in a middle-aged population: report from the Malmö Diet and Cancer Study

The objective was to investigate whether socioeconomic differences in fat intake may explain socioeconomic differences in cardiovascular diseases. The Malmö Diet and Cancer Study is a prospective cohort study. The baseline examinations used in the present cross-sectional study were undertaken in 1992-1994. Dietary habits were assessed using a modified diet history method consisting of a 7-day menu book and a 168-item questionnaire. A subpopulation of 11 837 individuals born 1926-1945 was investigated. This study examined high fat intake, defined as >35.9% among men and >34.8% among women (25% quartile limit) of the proportion of the non-alcohol energy intake contributed by fat. The subfractions saturated, mono-unsaturated and poly-unsaturated fatty acids and the P:S ratio (polyunsaturated/saturated fatty acids) were analysed in the same way. The uppermost quartile (75%) of total and subgroup fat intake was also studied. Socioeconomic differences before and after adjustment for low energy reporting (LER), defined as energy intake below 1.2 x Basal Metabolic Rate, were examined. No socioeconomic differences in fat intake were seen between the SES groups, except for self-employed men, and male and female pensioners. Approximately 20% in most SES groups were LER. The LER and body mass index were strongly related. The SES pattern of fat intake remained unchanged after adjustment for age, country of origin and LER in a logistic regression model. The results for the subfractions of fat and the P:S ratio did not principally differ from the total fat results. This study provides no evidence that fat intake contributes to the inverse socioeconomic differences in cardiovascular diseases.