Overreporting Of Energy Intake Research Articles

Cardiometabolic Risk is Positively Associated with Underreporting and Inversely Associated with Overreporting of Energy Intake Among European Adolescents: The Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) Study

BackgroundDietary misreporting is the main limitation of dietary assessments and has been associated with BMI during youth. However there are no prior studies assessing misreporting and cardiometabolic risks (CMRs) in adolescence. ObjectivesTo examine the associations between dietary misreporting and CMR factors in adolescents and to assess the potential bias in the association between CMR and energy intake (EI) driven by dietary misreporting. MethodsTwo 24-hour dietary recalls were obtained from 1512 European adolescents (54.8% girls) aged 12.5–17.5 years. Physical activity was measured by accelerometry. Cut-offs suggested by Huang were applied to identify misreporters. Height, waist circumference (WC), the sum of 4 skinfold thicknesses, diastolic blood pressure (DBP), systolic blood pressure (SBP), and cardiorespiratory fitness (CRF) measurements were taken and serum triglycerides and total-/high-density lipoprotein cholesterol ratio were analyzed. A sex- and age-specific clustered CMR score (n = 364) was computed. Associations were investigated by multilevel regression analyses adjusting for age, sex, center, socioeconomic status, and physical activity. ResultsUnderreporting (24.8% adolescents) was significantly (P < 0.05) associated with a higher WC, waist-to-height ratio (WHeR), and sum of skinfold thickness, whereas overreporting (23.4% adolescents) was significantly associated with a lower WC, WHeR, sum of skinfold thickness, and SBP. Associations between CMR factors and EI were significantly affected by misreporting, considering various approaches. Significant, positive associations became inverse after adjusting for misreporting for WC and WHeR. The opposite was true for the sum of skinfold thickness, SBP, and CMR score. The associations between EI and DBP and CRF did not remain significant after adjusting for misreporting. ConclusionsCMR factors differed among misreporting groups, and both abdominal and total fat mass indicators were more strongly associated with all forms of misreporting than was BMI. Moreover, misreporting seems to bias EI and CMR associations in adolescents. Therefore, energy misreporting should be taken into account when examining diet-CMR associations.

Prevalence and determinants of misreporting of energy intake among Latin American populations: results from ELANS study

Underreporting and overreporting of energy intake (EI) have been recognized as potential sources of bias. Dietary data mainly rely on proxy respondents, but little is known about the determinants of misreporting of EI among Latin American (LA) populations. This study was conducted using data from the multicenter Latin American Study of Nutrition and Health that consisted of information about sociodemographics, physical activity, and dietary intake from 9218 individuals aged 15 to 65 years who were living in urban areas in 8 LA countries (Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru, and Venezuela). Goldberg methodology was applied to classify the participants into categories of overreporter (OR), plausible reporter (PR), or underreporter (UR) of EI. Associations between misreporting and covariates were examined by the Kruskal-Wallis test, logistic regression, and linear regression. The prevalence of UR was 12.1% and OR was 14.1%. Costa Rica had the highest percentage of UR (24.4%) and the lowest of OR (7.3%), and Colombia had the lowest of UR (5.7%) and the highest of OR (22.4%). Furthermore, underreporters were more likely to be females from older groups with minimal education, white, physically active, overweight or obese, and living in Costa Rica. Overreporters were more likely to be younger, single, of low socioeconomic level, nonwhite, physically active, underweight or with normal weight, and from Colombia. The results demonstrated that sex, age, race, education status, and nationality seemed to influence the reporting behavior, which is essential to correctly interpreting potentially biased associations between diet and health outcomes, and improving nutritional interventions and public health policies.

Prevalence and characteristics of misreporting of energy intake in Japanese adults: the 2012 National Health and Nutrition Survey.

Information on a whole array of characteristics associated with dietary misreporting in a representative sample in each country is still limited. Using data from the 2012 National Health and Nutrition Survey, Japan, we investigated the prevalence and characteristics of under- and over-reporting of energy intake among 19,986 Japanese adults aged >=20 years. Each individual's energy intake was calculated based on a 1-day semi-weighed dietary record. Under-, plausible, and over-reporters were identified based on the 95% confidence limits 1) for agreement between the ratio of energy intake to basal metabolic rate and a physical activity level for sedentary lifestyle (1.55), and 2) of the expected ratio of energy intake to estimated energy requirement of 1.0, assuming 'low active' level of physical activity. Almost all subjects (>=92.8%) were classified as plausible reporters by any of the methods applied, with very low percentages of under- and over-reporters (<=6.3% and <=2.0%, respectively). Under-reporting was associated with younger age, overweight and obesity (compared with normal weight), current smoking (compared with never smoking), no alcohol drinking (compared with drinking everyday), and household consisting of a single person (compared with that consisting of two persons). Over-reporting was associated with gender (female), normal weight (compared with overweight), and household consisting of a single person. Overall mean energy intake obtained in this sample of Japanese adults appears to be plausible, but caution should be exercised when assessing the plausibility of energy intake in some subgroups.

Younger and older ages and obesity are associated with energy intake underreporting but not overreporting in Japanese boys and girls aged 1-19 years: the National Health and Nutrition Survey

Evidence on the magnitude and nature of misreporting of food intake in non-Western children and adolescents is sparse. We investigated the hypothesis that under- and overreporting of energy intake (EI) is prevalent and associated with some characteristics in 3866 Japanese boys and girls aged 1-19 years using data from the 2012 National Health and Nutrition Survey, Japan. Each individual's EI was calculated based on a 1-day semiweighed household dietary record, including information on approximate proportions by which each dish was divided among the family members. Under-, acceptable, and overreporters of EI were identified by 2 methods: based on the 95% confidence limits (1) for agreement between the ratio of EI to basal metabolic rate (BMR) and a physical activity level for sedentary lifestyle (1.55) and (2) of the expected ratio of EI to estimated energy requirement (EER) of 1.0. BMR was calculated using Schofield's equations. EER was calculated using equations from the US Dietary Reference Intakes, assuming “low active” level of physical activity. Percentages of under-, acceptable, and overreporters were 2.4%, 97.0%, and 0.5%, respectively, based on EI/BMR and 3.2%, 95.4%, and 1.4%, respectively, based on EI/EER. Underreporting was associated with the youngest (1-5 years) and oldest (15-19 years) age groups and with obesity. Overreporting was not associated with any of the variables examined. In conclusion, although overall mean EI obtained from the National Health and Nutrition Survey, Japan seemed plausible in Japanese boys and girls, younger and older ages and obesity were associated with EI underreporting but not overreporting.

Prevalence and characteristics of misreporting of energy intake in US children and adolescents: National Health and Nutrition Examination Survey (NHANES) 2003-2012.

Using data from the National Health and Nutrition Examination Survey (NHANES) 2003-2012, we investigated the prevalence and characteristics of under- and over-reporting of energy intake (EI) among 14 044 US children and adolescents aged 2-19 years. For the assessment of EI, two 24-h dietary recalls were conducted with the use of the US Department of Agriculture Automated Multiple-Pass Method. Under-, plausible and over-reporters of EI were identified using two methods: based on the 95 % confidence limits (1) for agreement between the ratio of EI:BMR and a physical activity level for sedentary lifestyle (1·55) and (2) of the expected ratio of EI:estimated energy requirement (EER) of 1·0. BMR was calculated using Schofield's equations. EER was calculated using equations from the US Dietary Reference Intakes, assuming 'low active' level of physical activity. The risk of being an under- or over-reporter compared with a plausible reporter was analysed using multiple logistic regression. Percentages of under-, plausible and over-reporters were 13·1, 81·5 and 5·4 %, respectively, based on EI:BMR and 18·8, 72·3 and 8·8 %, respectively, based on EI:EER. Under-reporting was associated with older age, non-Hispanic blacks (compared with non-Hispanic whites) and overweight and obesity (compared with normal weight). Over-reporting was associated with younger age, lower family poverty income ratio, normal weight and the first survey cycle. Similar findings were obtained when analysing only the first 24-h recall data from NHANES 1999-2012 (n 22 949). In conclusion, we found that EI misreporting remains prevalent and differential in US children and adolescents.

Prevalence and characteristics of misreporting of energy intake in US adults: NHANES 2003-2012.

Using data from the National Health and Nutrition Examination Survey (NHANES) 2003-2012, we investigated the prevalence and characteristics of under-reporting and over-reporting of energy intake (EI) among 19 693 US adults ≥20 years of age. For the assessment of EI, two 24-h dietary recalls were conducted using the US Department of Agriculture Automated Multiple-Pass Method. Under-reporters, acceptable reporters and over-reporters of EI were identified by two methods based on the 95 % confidence limits: (1) for agreement between the ratio of EI to BMR and a physical activity level for sedentary lifestyle (1·55) and (2) of the expected ratio of EI to estimated energy requirement (EER) of 1·0. BMR was calculated using Schofield's equations. EER was calculated using equations from the US Dietary Reference Intakes, assuming 'low active' level of physical activity. The risk of being an under-reporter or over-reporter compared with an acceptable reporter was analysed using multiple logistic regression. Percentages of under-reporters, acceptable reporters and over-reporters were 25·1, 73·5 and 1·4 %, respectively, based on EI:BMR, and 25·7, 71·8 and 2·5 %, respectively, based on EI:EER. Under-reporting was associated with female sex, older age, non-Hispanic blacks (compared with non-Hispanic whites), lower education, lower family poverty income ratio and overweight and obesity. Over-reporting was associated with male sex, younger age, lower family poverty income ratio, current smoking (compared with never smoking) and underweight. Similar findings were obtained when analysing only the first 24-h recall data from NHANES 1999-2012 (n 28 794). In conclusion, we found that misreporting of EI, particularly under-reporting, remains prevalent and differential in US adults.

Validity of energy intake reports in relation to dietary patterns.

The role of under- and overreporting of energy intake in determining the dietary patterns is yet unclear, especially in the Middle Eastern countries. This study identifies the prevalence of misreporting among Tehranian women aged 18-45 years and to compare the dietary intake patterns of plausible and all energy reporters. Dietary intakes and anthropometric data were collected. FitMate metabolic analyzer and Goldberg equation were used in determining the under/overreporting of energy intake. Underreporters were more likely to be overweight and older compared to plausible reporters. Three dietary patterns emerged for all reporters, and two were identified for plausible reporters. Using only plausible reporters to determine dietary patterns was not similar to using all reporters. The proportion of underreporters was 59.3% in the mixture cluster, 30.4% in the unhealthy cluster, and 35.3% in the healthy cluster (p < 0.05). Underreporting of energy intake is not uniformly distributed among dietary pattern clusters and tends to be less severe among subjects in the unhealthy cluster. Our data suggested that misreporting of energy intake might affect the dietary pattern analysis.

Misreporting of energy intake in the 2007 Australian Children's Survey: differences in the reporting of food types between plausible, under‐ and over‐reporters of energy intake

Misreporting is common when collecting dietary intake data, although relatively little is known about the types of foods misreported among children. The present study aimed to identify differences in the reporting of food types between plausible and misreporters of energy intake in a national nutrition survey of Australian children. Dietary data were collected using a 24-h recall from 4826 children aged 2-16 years who were participating in the 2007 Australian National Children's Nutrition and Physical Activity Survey. Misreporters of energy intake were classified using the Goldberg criteria. Differences in the reporting of a range of food types were examined between plausible, under- and over-reporters. Compared with plausible reporters, under-reporters reported less frequent consumption and smaller quantities of consumption of both core and noncore foods. Older children (self-report) under-reported a larger selection of noncore foods than younger children (parental report). Over-reporters reported similar percentages of consumption of many core and noncore foods, with some exceptions. The quantities consumed by over-reporters were generally much larger and this was evident in younger and older children. Compared with plausible reporters, under-reporters had significantly higher intakes of protein and starch but lower intakes of sugar and fat, as percentage energy, than plausible reporters, whereas over-reporters had higher fat and lower carbohydrate intakes. Differences in the reporting of food types were common between plausible, under- and over-reporters of energy intake by children (or their parents) and were not restricted to noncore foods.

The degree of misreporting of the energy-adjusted intake of protein, potassium, and sodium does not differ among under-, acceptable, and over-reporters of energy intake

It is unclear whether misreporting of nutrient intakes differs according to energy reporting status. We examined misreporting of dietary protein, potassium, and sodium in under-, acceptable, and over-reporters of energy intake. Our hypothesis was that degree of misreporting of these three nutrients differs among under-, acceptable, and over-reporters. Participants were 1043 Japanese women aged 18 to 22 years. Self-reported dietary intake was obtained using a diet history questionnaire. Under-, acceptable, and over-reporters of energy intake were identified based on the ratio of self-reported energy intake to estimated energy requirement (<0.70 [17.2%], 0.70-1.30 [78.1%], and >1.30 [4.7%], respectively). Misreporting of dietary protein, potassium, and sodium was assessed against the corresponding biomarker-based estimate derived from 24-hour urinary excretion. On average, the degree of misreporting of intake of energy and the three nutrients varied considerably. Absolute intake (amount per day) of the three nutrients was under-reported in under-reporters of energy intake and over-reported in over-reporters compared with acceptable reporters. However, mainly because of high correlations between the ratio of self-reported energy intake to estimated energy requirement and the ratio of self-reported to biomarker-based estimates of absolute intake of three nutrients (Pearson correlation coefficient: 0.64 for protein, 0.51 for potassium, and 0.37 for sodium), the degree of misreporting of the energy-adjusted intake of these nutrients based on the density method did not differ across categories of energy reporting status. In conclusion, these findings may lend support to the usefulness of adjustment for energy misreporting and the futility of merely excluding energy misreporters from analysis.

Characteristics of Under- and Over-Reporters of Energy Intake among Young Japanese Women

Evidence on factors associated with misreporting of energy intake is limited, particularly in non-Western populations. We examined the characteristics of under- and over-reporters of energy intake in young Japanese women. Subjects were 3,956 female Japanese dietetic students aged 18-20 y (mean body mass index: 20.9 kg/m(2)). Energy intake was assessed using a comprehensive self-administered diet history questionnaire. Estimated energy requirement was calculated based on self-reported information on age, body height and weight, and physical activity with the use of an equation from the US Dietary Reference Intakes. Under-, acceptable, and over-reporters of energy intake were identified based on the ratio of energy intake to estimated energy requirement, according to whether the individual's ratio was below, within, or above the 95% confidence limits of the expected ratio of 1.0 (<0.70, 0.70-1.30, and >1.30, respectively). Risk of being an under- or over-reporter of energy intake compared to an acceptable reporter was analyzed using multiple logistic regression. The percentage of under-, acceptable, and over-reporters of energy intake was 18.4, 73.1, and 8.4%, respectively. Under-reporting was associated with overweight or obesity, perception that one's own weight was too heavy or light, lower dietary consciousness, active lifestyle, living without family, and living in a city (compared with a metropolitan area). Over-reporting was associated with sedentary lifestyle only. This study of lean young Japanese women showed that energy intake misreporting, particularly under-reporting, was common and differential among populations. Particularly, perceived weight status was associated with under-reporting of energy intake, independent of actual weight status.

Characteristics of under- and over-reporters of energy intake among Japanese children and adolescents: The Ryukyus Child Health Study

ObjectiveEvidence on factors associated with misreporting of energy intake in children and adolescents is sparse, particularly in non-Western countries. We examined the characteristics of under- and over-reporters of energy intake in Japanese children and adolescents. MethodsThis study included 25 761 Japanese boys and girls 6 to 15 y old. Energy intake was assessed using a self-administered diet history questionnaire developed for Japanese children and adolescents. Estimated energy requirement was calculated from self-reported body weight with the use of equations from the Food and Agriculture Organization (FAO)/World Health Organization (WHO)/United Nations University (UNU) Expert Consultation Report on Human Energy Requirements. Under-reporters, acceptable reporters, and over-reporters of energy intake were identified based on the ratio of energy intake to estimated energy requirement (<0.76, 0.76 to 1.24, and >1.24, respectively). The risk of being an under- or over-reporter of energy intake compared with being an acceptable reporter was analyzed using logistic regression. ResultsThe percentages of under-, acceptable, and over-reporters of energy intake were 31.6%, 53.2%, and 15.2%, respectively. Under-reporting was associated with female sex, older age, overweight and obesity, low parental education, and completion of the dietary questionnaire without the cooperation of parent(s)/caregiver(s). Over-reporting was associated with younger age, normal weight, low parental education, and completion of the dietary questionnaire by the child/adolescent alone (compared with completion by the child/adolescent and parent[s]/caregiver[s]). ConclusionsAlthough under- and over-reporting of energy intake were common and differential in this study of Japanese children and adolescents, the cooperation of parent(s)/caregiver(s) in answering the dietary questionnaire seemed to improve the quality of dietary intake data.

A comparison of two screening methods to determine the validity of 24-h food and drink records in children and adolescents

Dietary assessment in humans is hampered by the phenomena of under and overreporting of energy intake, when food records are used to evaluate habitual dietary intake. Different methods to evaluate mis-reporting have been proposed using cut-offs derived from estimates of reported energy intake and basal metabolic rate, or, from predictions of total energy expenditure. This study compares the effect of using two different cut-off approaches to screen food records for validity, completed by a large cohort of Australian children (n=2460), from Grades 1, 5 and 10 (aged 5-17 years). Energy intake was calculated from 24-h food and drink records for each child. These data were screened using the Goldberg and McCrory cut-offs. The effect of using these two cut-offs on the collected dataset was explored by considering the mean and standard deviation of energy intake in each year level before and after the cut-offs were applied. The use of the Goldberg cut-off resulted in 9% of the total cohort being classified as underreporters, with 60% of these subjects being in Grade 10. The McCrory cut-offs revealed that overall, 22% of the total cohort underreported EI. 33.3% of Grade 1 children were classified as overreporters with this value falling to about 20% of Grade 10 children, while 10-15% of Grade 1 children underreported, with this figure rising to about 30% in Grade 10. Both the Goldberg and McCrory approaches have their advantages and disadvantages, and we suggest that consideration should be given to the reason for screening data before a particular approach is used, with recognition that these methods do differ in their aims and outcomes. The McCrory method consistently classified a greater number of children as underreporters.

Under- and Over-Reporting of Energy Intake in Slovenian Adolescents

To examine under- and over-reporting of energy intake (EI) among adolescents and to compare relative food and nutrient intakes of under-reporters (UR), over-reporters (OR), and the whole population to acceptable reporters (AR). All adolescents completed food frequency questionnaires at regional health centers, and a subgroup also completed a 3-day weighed dietary protocol at home. This study is a part of the first national representative study on dietary habits of Slovenian adolescents. In total, 2,813 adolescents entering high school (10% of the population); participation rate was 95%. Absolute EI and relative intakes of food and nutrients. Prodi (version 5.2 expert plus, Nutri-Science, Stuttgart, Germany, 2004) software was used to evaluate dietary intakes; t test, analysis of variance, and Mann-Whitney testing were used for differences between means, and chi-square was used for differences between proportions. Level of significance was set at P = .05. The prevalence of UR and OR was 34% and 10% among boys, and 27% and 11% among girls. Under-reporters reported lower energy percentage from carbohydrates, higher energy percentage from fats and proteins, and higher micronutrient densities than AR. Under-reporting and over-reporting are widespread among Slovenian adolescents. Exclusion of UR and OR does not influence mean value of EI when assessing the diet of a group as a whole.

Energy and nutrient intakes in relation to sex and socio-economic status among school adolescents in urban Cameroon, Africa

To assess energy and nutrient intakes and physical activity of adolescents in urban Cameroon according to sex and socio-economic status (SES). Cross-sectional study with adolescents randomly selected from schools in low-, middle- and high-SES areas. Weight and height were measured and information about food intake and physical activity was obtained through repeated individual 24 h recalls. Under- and over-reporting of energy intake and inadequacy of nutrient intake were assessed. Yaoundé, Cameroon. Boys and girls aged 12-16 years (n 227). Boys had a lower BMI and reported higher energy expenditures and physical activity levels (PAL) than girls. Under-reporting of energy intake was large among boys and girls regardless of PAL; boys under-reported more than girls. Among those with low PAL, over-reporting of energy intake was common. Over 50% of boys and girls had protein below the recommendations. The intake of fat varied; 26% of the adolescents were below and 25% were above the recommendations. Inadequate intakes of vitamin B₁, vitamin B₃ and Fe were more common among girls, while boys more often had inadequate intake of vitamin A. Adolescents with low SES were more likely to be below the recommendations for fat and vitamins B₂, B₃, B₆ and B₁₂ than those with high SES. A high proportion of boys and girls reported inadequate intakes. However under- and over-reporting were also very common. Boys under-reported energy intake more than girls and inadequate nutrient intake was more frequently reported by adolescents with low SES than by those with high SES.

Misreporting of dietary energy intake in adolescents

To examine the prevalence of under and overreporting of energy intake in adolescents and their associated factors. Cross-sectional study with 96 postpubertal adolescents (47 normal-weight and 49 obese), mean age of 16.6±1.3 years. Weight and height were measured, and body mass index was calculated. Body composition was assessed by dual energy X-ray absorptiometry. Dietary intake was evaluated by a 3-day dietary record. Biochemical assessment was performed (serum total cholesterol, LDL-cholesterol, HDL-cholesterol, plasma glucose, and insulin). Underreporters reported energy intake < 1.35 x basal metabolic rate (BMR), whereas overreporters reported energy intake > 2.4 x BMR. Energy intake misreporting (under or overreporting) was identified in 65.6% of adolescents (64.6 and 1% of under and overreporting, respectively). Obese adolescents were 5.0 times more likely to underreport energy intake (95%CI 2.0-12.7) than normal-weight participants. Underreporters showed higher rates of insufficient intake of carbohydrate (19.3 vs. 12.1%, p = 0.046) and lipids (11.3 vs. 0%, p < 0.001) than plausible reporters. Cholesterol intake was also lower in underreporters (p = 0.017). There were no significant differences in body composition and biochemical parameters in relation to misreporting. The results obtained demonstrated a high percentage of misreporting of energy intake among adolescents, especially among obese subjects, which suggests that energy-adjusted nutrient intake values should be employed in diet-disease risk analysis in order to contribute to a reduction in errors associated with misreporting.

Characteristics of under- and over-reporters of energy intake among 18–20-year-old males: the Gothenburg Osteoporosis and Obesity Determinants (GOOD) study

To identify and describe characteristics of the bias of reported energy intake of participants in the Gothenburg Osteoporosis and Obesity Determinants (GOOD) study. A validated diet history with a detailed questionnaire and an interview was used. Body fat was analysed by dual-energy X-ray absorptiometry. The ratio of energy intake (EI) to BMR was used to define under-reporters (EI:BMR<1.30), acceptable reporters (EI:BMR >or= 1.30 to <2.64) and over-reporters (EI:BMR >or= 2.64). Sahlgrenska University Hospital, Gothenburg, Sweden. A total of 695 males (18-20 years). Sixty-eight per cent were classed as acceptable reporters, 22% as over-reporters and 10% as under-reporters. The under-reporters had higher BMI and body fat percentage than acceptable reporters (P<0.001), while over-reporters had lower BMI and body fat percentage (P<0.001). Over-reporters had more frequent use of protein supplements than acceptable reporters and higher physical activity. Over-reporters had a more regular and under-reporters a less regular meal pattern compared with acceptable reporters. Important knowledge of dietary reporting bias in a previously sparsely studied population has been provided. Over-reporting of energy intake was more common than under-reporting in the present population of young men and characteristics of under- and over-reporters were identified. The GOOD study was initiated with the central aim to determine environmental and genetic factors involved in the regulation of bone and fat mass, and the nutrient data of the acceptable reporters can be used for further investigation of the health effects of energy and nutrient intake.

Under- and overreporting of energy in a group of candidates for CABG surgery and its association with some anthropometric and sociodemographic factors, Tehran, Iran

Numerous studies have documented a high prevalence of misreporting energy intakes. This paper examines the prevalence of under- and overreporting of energy intake in a group of candidates for coronary artery bypass graft (CABG) surgery and its association with body mass index (BMI) and some sociodemographic factors. Dietary assessment (using a food frequency questionnaire) and demographic evaluation of 449 CABG surgery candidates was performed. Weight and height was also measured. McCrory equation was used to identify inaccurate records of energy intake. With this equation, reporting energy intake less than 78% and more than 122% of predicted energy expenditure was considered as under- and overreporting, respectively. Less than half of the participants reported energy intakes within the plausible limits. There were more overreporters than underreporters in this sample. The only significant association between misreporting and related factors was seen in BMI groups. As BMI increased, the number of underreporters increased significantly. Expressed as a percentage of total energy, mean carbohydrate intake was significantly lower and mean fat and protein intake was significantly higher in underreporters compared to overreporters. The high prevalence of misreporting suggests more research to examine the characteristics of misreporters. Calibrating data with these characteristics can help to improve intake estimates.

Energy balance and the accuracy of reported energy intake in preadolescent children with cystic fibrosis

Suboptimal growth and nutritional status are common among children with cystic fibrosis (CF) and pancreatic insufficiency (PI). A better understanding of energy balance is required to improve prevention and treatment of malnutrition. Our objective was to characterize energy balance and the reporting accuracy of dietary intake in children with CF by evaluating the relations between energy intake (EI), energy expenditure (EE), fecal energy loss, nutritional status, and growth. The subjects were participants of a 24-mo prospective study of children 6-10 y of age with CF and PI. EE, EI, fecal energy loss, and anthropometric measures were obtained at baseline and at 24 mo. The children (n = 69) had suboptimal growth at baseline (x +/- SD: weight-for-age z score, -0.53 +/- 1.19; adjusted height-for-age z score, -0.67 +/- 1.06; body mass index z score, -0.29 +/- 1.12), and these variables remained suboptimal at 24 mo. The median ratios of EI to EE at baseline and 24 mo were 1.15 and 1.18, respectively, which decreased to 1.09 and 1.10, respectively, when adjusted for fecal energy loss (EI(-FL):EE). At baseline, 7% of subjects were underreporters, 64% were accurate reporters, and 23% were overreporters of energy intake; the percentages were similar at 24 mo. Although EI(-FL):EE ratios were higher than expected at both baseline and 24 mo, this cohort showed only age-appropriate weight gain. Self-reported dietary intake data at the individual level should be interpreted with caution, and weight gain velocity may serve as an objective measure of long-term energy balance.

Nutrient intakes and demographic characteristics of under-reporters, accurate-reporters and over-reporters of total energy intake in the cache county study on memory, health, and aging

To increase the awareness of methodologic issues of importance when using food frequency questionnaires to estimate usual dietary intake in elderly populations. We compared energy-adjusted nutrient intakes and other characteristics among under-, accurate-, and over-reporters of energy intake (EI) in the Cache County Study on Memory, Health and Aging (CCMS) in Utah. The CCMS is a prospective study of 5092 resident men and women who were 65 years of age or older in 1995. Usual energy and nutrient intakes were estimated using a 140-item food frequency questionnaire. Basal metabolic rate (BMR) was estimated using the Harris-Benedict equations and used to calculate the EI:BMR ratio. Participants with EI:BMR<1.27 were classified as under-reporters and participants with EI:BMR>1.7 as over-reporters. Pair-wise multiple comparisons in ANOVA were used to examine differences among the three groups. Under-reporting of energy occurred in 53% of men and 38% of women; 19% of men and 32% of women over-reported energy intake (p-value<0.001). Under-reporters were younger and had a higher body mass index compared to accurate- or over-reporters (p-values≤0.001). Over-reporters scored lower on a test of cognitive function compared to under-reporters (p-value<0.001). We observed few differences in estimated mean energy-adjusted (EA) nutrient intakes among the three groups. Among both men and women, under-reporters reported less EA-fat intake than over-reporters and more EA-calcium intake than either adequate or over-reporters (p-values≤0.01). Among men, under-reporters also reported more EA-iron intake than over-reporters (p-value<0.006). Adjustment for energy intake appears to reduce bias in estimated nutrient intake and this adjustment seems especially important among elderly men and women who over- or under-report energy intake.

Evaluation of under- and overreporting of energy intake in the 24-hour diet recalls in the European Prospective Investigation into Cancer and Nutrition (EPIC).

To evaluate under- and overreporting and their determinants in the EPIC 24-hour diet recall (24-HDR) measurements collected in the European Prospective Investigation into Cancer and Nutrition (EPIC). Cross-sectional analysis. 24-HDR measurements were obtained by means of a standardised computerised interview program (EPIC-SOFT). The ratio of reported energy intake (EI) to estimated basal metabolic rate (BMR) was used to ascertain the magnitude, impact and determinants of misreporting. Goldberg's cut-off points were used to identify participants with physiologically extreme low or high energy intake. At the aggregate level the value of 1.55 for physical activity level (PAL) was chosen as reference. At the individual level we used multivariate statistical techniques to identify factors that could explain EI/BMR variability. Analyses were performed by adjusting for weight, height, age at recall, special diet, smoking status, day of recall (weekday vs. weekend day) and physical activity. Twenty-seven redefined centres in the 10 countries participating in the EPIC project. In total, 35 955 men and women, aged 35-74 years, participating in the nested EPIC calibration sub-studies. While overreporting has only a minor impact, the percentage of subjects identified as extreme underreporters was 13.8% and 10.3% in women and men, respectively. Mean EI/BMR values in men and women were 1.44 and 1.36 including all subjects, and 1.50 and 1.44 after exclusion of misreporters. After exclusion of misreporters, adjusted EI/BMR means were consistently less than 10% different from the expected value of 1.55 for PAL (except for women in Greece and in the UK), with overall differences equal to 4.0% and 7.4% for men and women, respectively. We modelled the probability of being an underreporter in association with several individual characteristics. After adjustment for age, height, special diet, smoking status, day of recall and physical activity at work, logistic regression analyses resulted in an odds ratio (OR) of being an underreporter for the highest vs. the lowest quartile of body mass index (BMI) of 3.52 (95% confidence interval (CI) 2.91-4.26) in men and 4.80 (95% CI 4.11-5.61) in women, indicating that overweight subjects are significantly more likely to underestimate energy intake than subjects in the bottom BMI category. Older people were less likely to underestimate energy intake: ORs were 0.58 (95% CI 0.45-0.77) and 0.74 (95% CI 0.63-0.88) for age (> or =65 years vs. <50 years). Special diet and day of the week showed strong effects. EI tends to be underestimated in the vast majority of the EPIC centres, although to varying degrees; at the aggregate level most centres were below the expected reference value of 1.55. Underreporting seems to be more prevalent among women than men in the EPIC calibration sample. The hypothesis that BMI (or weight) and age are causally related to underreporting seems to be confirmed in the present work. This introduces further complexity in the within-group (centre or country) and between-group calibration of dietary questionnaire measurements to deattenuate the diet-disease relationship.