Critical evaluation of energy intake using the Goldberg cut-off for energy intake:basal metabolic rate. A practical guide to its calculation, use and limitations

Relationships between human thirst, hunger, drinking, and feeding

There is a widely held view that hunger prompts feeding to ensure energy needs are met, while thirst cues drinking to address hydration requirements. However, recent changes in the nature of the food supply and eating patterns have raised questions about the functionality of these relationships with respect to maintaining energy balance. The increasing consumption of energy-yielding beverages and foods with diluted energy density, through the use of ingredients such as high-intensity sweeteners and fat replacers, poses new challenges to presumed homeostatic energy regulatory mechanisms. This review draws on findings from a recent observational study and other published evidence to explore whether shifts of food composition and use patterns may be disrupting relationships between thirst, hunger, drinking, and eating, resulting in positive energy balance (e.g., drinking low satiety, energy-yielding beverages in response to hunger). The observational study entailed collecting hourly appetitive ratings and dietary recalls from 50 adults for seven consecutive days. These data reveal a clear bimodal daily hunger pattern, whereas thirst is stronger and more stable throughout the day. Further, approximately 75% of fluid intake occurs peri-prandially, with the majority derived from energy-yielding beverages. While there is published evidence that drinking is responsive to feeding, support for the view that drinking is the more tightly regulated behavior is stronger. Our data indicates that, due to a number of plausible factors, neither absolute values nor changes of hunger or thirst are strong predictors of energy intake. However, it is proposed that stable, high thirst facilitates drinking, and with the increased availability and use of energy-yielding beverages that have low satiety properties, can promote positive energy balance. There are marked individual differences in mean daily hunger and thirst ratings with unknown implications for energy balance.

Predictors of iron status in well-nourished 4-y-old children

BACKGROUND

Iron status in childhood is influenced by diet. Other factors affecting iron status at that age are unclear.

OBJECTIVES

The objectives of the study were to evaluate iron status in 4-y-old children, to track that status from infancy to childhood, and to examine the associations of iron status with dietary factors, growth, and heredity.

DESIGN

This study consisted of a longitudinal follow-up at age 4 y of children (n = 127) from the cohort of a study that began at age 6 mo. Blood samples and anthropometry were assessed in both children and their parents; food records were collected from children only.

RESULTS

Dietary intake was not significantly correlated with hemoglobin concentrations, whereas the consumption of meat products had a positive effect on serum ferritin concentrations and mean corpuscular volume in boys (P = 0.015 and 0.04, respectively). The prevalences of anemia and iron deficiency were low, affecting 2 (1.8%) and 3 (2.8%) children, respectively; no child had iron deficiency anemia. There was significant within-subject tracking of hemoglobin and mean corpuscular volume from age 6 mo to 4 y. The mother's but not the father's hemoglobin correlated with the child's hemoglobin over time.

CONCLUSIONS

Food choices had little effect on iron status. Hemoglobin concentrations and mean corpuscular volume were tracked from infancy to childhood. In healthy, well-nourished children with a low prevalence of iron deficiency, the mother's hemoglobin was significantly associated with that of her child, but the underlying mechanism is unclear.

Short-term dietary compensation in free-living adults

Evidence suggests that compensatory behaviors operate in infants and pre-school children, such that the high variance characteristic of single eating occasions is much reduced over the day. However, the concept has not been fully explored in adults. The present within-subject, observational study investigated short-term dietary compensation patterns in fifty, weight-stable, normal weight (n=27), overweight (n=14), and obese (n=9) free-living adults (11 M, 39 F; age 30+/-11 y; BMI 26.3+/-5.9). Twenty four-hour diet recalls were obtained for 7 consecutive days, by the multi-pass technique. Each 24-h period was divided into 7 eating occasions. The coefficient of variation for energy intake was calculated for each adult, for each eating occasion, and over each 24-h period. Sub-group variability was assessed by BMI and frequency of consumption of sweetened energy-yielding beverages. The mean coefficient of variation for energy intake for the 7 eating occasions was 110.5%, compared to 28.9% for the day as a whole. Correlations between energy intakes at successive eating events were uniformly negative. No significant differences were noted in the sub-group analyses. Significantly greater variation in energy intake was noted for snacks compared to meals (P<0.0001). These data suggest that adults regulate energy intake over a 24-h period more closely than they do at individual eating occasions, similar to the pattern previously observed in children. Further studies of compensatory responses by larger sub-groups of individuals at risk for weight gain are warranted.

Plausible reports of energy intake may predict body mass index in pre-adolescent girls

Inaccurate reporting of energy intake makes it difficult to study the associations between diet and weight status. This study examined reported energy intake at age 9 years as a predictor of girls' body mass index (BMI) at age 11 years, before and after adjusting for parents' BMI and girls' pubertal status. This prospective, observational cohort study included 177 non-Hispanic white girls and their parents. When the subjects were 9 years of age, three 24-hour recalls were used to categorize girls as plausible or implausible over-reporters and under-reporters based on previously published methods. Height and weight was measured to calculate BMI. Linear and hierarchical regression analyses were used to predict girls' BMI. Results revealed that girls who under-reported had significantly higher BMIs than plausible and overreporters. Among the total sample and among implausible reporters, reported energy intake was not a significant predictor of BMI; however, among plausible reporters, reported energy intake explained 14% of the variance in BMI and remained a significant predictor after adjusting for parental BMI and girls' pubertal status. Systematic bias related to underreporting in dietary data can obscure relationships with weight status, even among young girls. A relatively simple analytical procedure can be used to identify the magnitude and nature of reporting bias in dietary data.

Psychosocial and behavioral profile and predictors of self-reported energy underreporting in obese middle-aged women

Energy underreporting is a concern with dietary intake data; therefore, subject characteristics associated with underreporting energy intake should be elucidated. Baseline self-reported dietary intake and measures of diet and weight history, life status, weight-loss readiness, psychology, eating behavior, physical activity, and self-image of obese middle-aged women (mean body mass index [calculated as kg/m(2)]=31.0) enrolled in a lifestyle weight-loss program were evaluated. Of the 155 participating, 71 women were identified as underreporting energy intake using the Goldberg cutoff values. Comparison of means between psychosocial and behavioral measures from energy underreporters and energy accurate reporters were used to help develop logistic regression models that could predict likelihood to underreport energy intake based on baseline measures. Characteristics most predictive of energy underreporting included fewer years of education (P=0.01), less-realistic weight-loss goals (P=0.02), higher perceived exercise competence (P=0.07), more social support to exercise (P=0.04), more body-shape concern (P=0.01), and higher perception of physical condition (P=0.03). These results highlight distinct psychosocial and behavioral characteristics that, at baseline, can help identify the likelihood an overweight middle-aged woman entering a weight-loss intervention will underreport energy intake. These results can help provide a framework for screening study participants for probability of energy underreporting, based on baseline psychosocial and behavioral measures. This knowledge can help researchers target at-risk subjects and, through education and training, improve the accuracy of self-reported energy intake and, ultimately, the accuracy of energy and nutrient intake relationships with health and disease.

Monetary costs of dietary energy reported by young Japanese women: association with food and nutrient intake and body mass index

Objective

Little is known about the relationship of monetary diet costs to dietary intake and obesity, particularly in non-Western populations. This study examined monetary cost of dietary energy in relation to diet quality and body mass index (BMI) among young Japanese women.

Design

Dietary intake was assessed by a validated, self-administered, diet history questionnaire. Diet costs were estimated using retail food prices. Monetary cost of dietary energy (Japanese yen 1000 kcal−1) was then calculated. BMI was computed from self-reported body weight and height.

Subjects

A total of 3931 female Japanese dietetic students aged 18–20 years.

Results

Monetary cost of dietary energy was positively associated with intakes of fruits, vegetables, fish and shellfish, and pulses; however, higher monetary cost of dietary energy was also associated with higher consumption of fat and oil, meat and energy-containing beverages, and lower consumption of cereals (rice, bread and noodles) (all P for trend <0.01). At the nutrient level, monetary cost of dietary energy was positively associated with intakes of dietary fibre and key vitamins and minerals, but also associated positively with intakes of fat, saturated fatty acids, cholesterol and sodium, and negatively with carbohydrate intake (all P for trend <0.0001). After adjustment for possible confounders, monetary cost of dietary energy was quite weakly but significantly negatively associated with BMI (P for trend = 0.0197).

Conclusions

Increasing monetary cost of dietary energy was associated with both favourable and unfavourable dietary intake patterns and a quite small decrease in BMI in young Japanese women.

Effect of a voluntary food fortification policy on folate, related B vitamin status, and homocysteine in healthy adults

BACKGROUND

Mandatory folic acid fortification of food is effective in reducing neural tube defects and may even reduce stroke-related mortality, but it remains controversial because of concerns about potential adverse effects. Thus, it is virtually nonexistent in Europe, albeit many countries allow food fortification on a voluntary basis.

OBJECTIVE

The objective of the study was to examine the effect of a voluntary but liberal food fortification policy on dietary intake and biomarker status of folate and other homocysteine-related B vitamins in a healthy population.

DESIGN

The study was a cross-sectional study. From a convenience sample of 662 adults in Northern Ireland, those who provided a fasting blood sample and dietary intake data were examined (n = 441, aged 18-92 y). Intakes of both natural food folate and folic acid from fortified foods were estimated; we used the latter to categorize participants by fortified food intake.

RESULTS

Fortified foods were associated with significantly higher dietary intakes and biomarker status of folate, vitamin B-12, vitamin B-6, and riboflavin than were unfortified foods. There was no difference in natural food folate intake (range: 179-197 microg/d) between the fortified food categories. Red blood cell folate concentrations were 387 nmol/L higher and plasma total homocysteine concentrations were 2 micromol/L lower in the group with the highest fortified food intake (median intake: 208 microg/d folic acid) than in the nonconsumers of fortified foods (0 microg/d folic acid).

CONCLUSIONS

These results show that voluntary food fortification is associated with a substantial increase in dietary intake and biomarker status of folate and metabolically related B vitamins with potential beneficial effects on health. However, those who do not consume fortified foods regularly may have insufficient B vitamin status to achieve the known and potential health benefits.

Sedentary behaviour, physical activity and a continuous metabolic syndrome risk score in adults

OBJECTIVE

The association of sedentary behaviour and leisure time physical activity with a validated continuous metabolic syndrome risk score was investigated in adults.

SUBJECTS/METHODS

A number of 992 adults (559 men) without cardiovascular disease or diabetes. Subjects reported time spent in leisure time physical activity and television watching/computer activities. A validated metabolic syndrome risk score, based on waist circumference, triglycerides, blood pressure, fasting plasma glucose and high-density lipoprotein cholesterol, was used. The metabolic syndrome risk score and time spent in sedentary behaviour and physical activity were analysed as continuous variables using multiple linear regression.

RESULTS

Metabolic syndrome risk was positively associated with time spent watching television/computer activities, irrespective of physical activity level, and after adjustment for age, education level, smoking status and dietary intake in women aged > or =45 years (beta=0.184, P<0.05). Independent of the time being sedentary, moderate to vigorous leisure time physical activity was inversely associated with metabolic syndrome risk in men (<45 years: beta=-0.183, P<0.01; > or =45 years: beta=-0.192, P<0.01) and women aged > or =45 years (beta=-0.203, P<0.01).

CONCLUSIONS

Although cross-sectional, the present results support inclusion of efforts to decrease sedentary behaviour in metabolic syndrome prevention strategies for women aged > or =45 years, besides promotion of moderate to vigorous physical activity, since both behavioural changes might show additional effects.

Dietary glycemic index and glycemic load are associated with high-density-lipoprotein cholesterol at baseline but not with increased risk of diabetes in the Whitehall II study

BACKGROUND

Findings of the effect of dietary glycemic index (GI) and glycemic load (GL) on the risk of incident diabetes are inconsistent.

OBJECTIVE

We examined the associations of dietary GI and GL with clinical variables at baseline and the incidence of diabetes.

DESIGN

The 7321 white Whitehall II participants (71% men) attending screening in 1991-1993, free of diabetes at baseline, and with food-frequency questionnaire data were followed for 13 y.

RESULTS

At baseline, dietary GI and GL were associated inversely with HDL cholesterol, and GI was associated directly with triacylglycerols. Dietary GI and GL were related inversely to fasting glucose and directly to 2-h postload glucose, but only the association between GI and 2-h postload glucose was robust to statistical adjustments for employment grade, physical activity, smoking status, and intakes of alcohol, fiber, and carbohydrates. High-dietary GI was not associated with increased risk of incident diabetes. Hazard ratios (HRs) across sex-specific tertiles of dietary GI were 1.00, 0.95 (95% CI: 0.73, 1.24), and 0.94 (95% CI: 0.72, 1.22) (adjusted for sex, age, and energy misreporting; P for trend = 0.64). Corresponding HRs across tertiles of dietary GL were 1.00, 0.92 (95% CI: 0.71, 1.19), and 0.70 (95% CI: 0.54, 0.92) (P for trend = 0.01). The protective effect on diabetes risk remained significant after adjustment for employment grade, smoking, and alcohol intake but not after further adjustment for carbohydrate and fiber intakes.

CONCLUSION

The proposed protective effect of low-dietary GI and GL diets on diabetes risk could not be confirmed in this study.

Dietary intake of patients with chronic kidney disease entering the LORD trial: adjusting for underreporting

OBJECTIVE

The study objective was to determine the dietary intake of patients with chronic kidney disease before and after filtering for suspected underreporters and to investigate the impact of underreporting on the interpretation of diet data.

DESIGN

This was a cross-sectional study.

SETTING

The study included outpatients from hospitals and clinics in Northern Tasmania, Australia.

PATIENTS

Data from 113 patients enrolled in the Lipid Lowering and Onset of Renal Disease trial were used in this study. Patients with serum creatinine greater than 120 mmol/L were included, and those taking lipid-lowering medication were excluded.

METHODS

Patients completed a 4-day self-report diet diary, and FoodWorks software was used to determine their daily intake of energy, macronutrients, and specific micronutrients. Diet diaries were assessed for likely underreporting using the Goldberg cutoff approach with a ratio of energy intake to estimated resting energy expenditure of 1.27. Nutrient intakes were compared with current National Kidney Foundation's Kidney Disease Outcomes Quality Initiative guidelines, World Health Organization recommendations, recommended daily allowances, and daily values adjusted for energy intake.

RESULTS

Demographics of the patients were as follows: male/female, 71/42; age (mean +/- standard deviation), 60 +/- 15 years; body mass index, 28.6 +/- 6.0 kg/m(2), and serum creatinine, 223.4 +/- 110.0 mmol/L. According to the criteria, 80 patients (70.8%) were underreporting their energy intake. Underreporters were more likely to be female and younger, and have a higher body mass index and elevated serum creatinine. In all patients, daily energy intake (89.6 +/- 32.4 kJ/kg) was lower than recommended (125-145 kJ/kg); however, this was not the case for valid reporters (128.3 +/- 23.7 kJ/kg). Protein intake was higher (0.9 +/- 0.3 g/kg) than recommended (0.75 g/kg) in all patients and even higher (1.2 +/- 0.3 g/kg) in valid reporters. Mean calcium, zinc, and dietary fiber intakes were all below recommendations in all patients, but these differences were not apparent in valid reporters.

CONCLUSION

Interpreting self-report diet diary data from patients with chronic kidney disease without attempting to exclude underreporters will lead to erroneous conclusions, especially in respect to energy, protein, dietary fiber, calcium, and zinc intakes.

Low-energy-density diets are associated with higher diet quality and higher diet costs in French adults

Low-energy-density diets are often recommended for weight control. Such diets have a higher nutrient content than do high-energy-density diets. This study tested the hypothesis that energy-dense diets have a relatively low monetary cost, whereas less energy-dense diets are more expensive. In this cross-sectional study, dietary intakes of 1,474 French adults (672 men, 802 women), aged 15 to 92 years, were assessed using 7-day diet records. Dietary energy density (kcal/g) was calculated by dividing total dietary energy by the edible weight of foods and caloric beverages consumed. Diet cost ($/7 days or $/2,000 kcal) was estimated using mean national food prices for 895 foods. The relationship between dietary energy density and diet cost was examined in a linear regression model. Within each quintile of energy intakes, the more energy-dense diets were associated with lower diet quality and with lower diet costs (r(2)=0.38 to 0.44). In a regression model, the more energy-dense diets cost less, whereas low-energy-density diets cost substantially more, adjusting for energy intakes, sex, and age. The finding that energy-dense diets cost less per 2,000 kcal may help explain why the highest rates of obesity are observed among groups of limited economic means. The finding that low-energy-density diets are associated with higher diet costs suggests that lasting improvements in diet quality may require economic as well as behavioral interventions.

Nutrient-dense food groups have high energy costs: an econometric approach to nutrient profiling

Consumers wishing to replace some of the foods in their diets with more nutrient-dense options need to be able to identify such foods on the basis of nutrient profiling. The present study used nutrient profiling to rank 7 major food groups and 25 subgroups in terms of their contribution to dietary energy, diet quality, and diet cost for 1332 adult participants in the French National INCA1 Study. Nutrient profiles were based on the presence of 23 qualifying nutrients, expressed as the percentage of nutrient adequacy per 8 MJ, and 3 negative or disqualifying nutrients, expressed as the percentage of the maximal recommended values for saturated fatty acids, added sugar, and sodium per 1.4 kg. Calculated cost of energy (euro/8 MJ) was based on the mean retail price of 619 foods in the nutrient composition database. The meat and the fruit and vegetables food groups had the highest nutritional quality but were associated with highest energy costs. Sweets and salted snacks had the lowest nutritional quality but were also one of the least expensive sources of dietary energy. Starches and grains were unique because they were low in disqualifying nutrients yet provided low-cost dietary energy. Within each major food group, some subgroups had a higher nutritient-to-price ratio than others. However, the fact that food groups with the more favorable nutrient profiles were also associated with higher energy costs suggests that the present structure of food prices may be a barrier to the adoption of food-based dietary guidelines, at least by low-income households.

Children’s Preference for Large Portions: Prevalence, Determinants, and Consequences

BACKGROUND

Proliferation of large portions of snack and fast foods parallels dramatic increases in childhood obesity. This study investigates the prevalence, determinants, and consequences of large portions in children's diets.

METHODS

As part of the 2003 Children's Lifestyle and School-performance Study, we surveyed 4,966 children in Nova Scotia regarding their usual portion sizes of french fries, meats, vegetables, and potato chips using three-dimensional graduated food models. We measured heights and weights and assessed dietary intake with the Harvard Youth Adolescent Food Frequency Questionnaire. Diet quality was summarized using the Diet Quality Index International (DQI-I). Parents were surveyed on food habits and socioeconomic background.

STATISTICAL ANALYSIS

We used multilevel regression methods to examine determinants of children's large portion size choice and to evaluate the effect of this selection on energy intake, diet quality, and overweight.

RESULTS

Children reported preference for portions of french fries, meats, and potato chips that are larger and vegetable portions that are smaller than what is recommended. Children from socioeconomically disadvantaged families or who frequently eat while watching television and in fast-food restaurants preferred larger portions of french fries and potato chips. Consequences of consuming large portions of these foods included poor diet quality and increased energy intake. Consuming large portions of vegetables was associated with lower energy intake and better diet quality.

CONCLUSIONS

Successful marketing of large portions of french fries and potato chips may be at the expense of diet quality and appropriate energy intake. Policy regulations and nutrition education emphasizing appropriate portion sizes provide opportunities to prevent overweight and improve future health.

The impact of voluntary fortification of foods on micronutrient intakes in Irish adults

The objective of this work was to quantify the impact of the voluntary fortification of foods on dietary intakes of vitamins and minerals of Irish adults. Foods that were voluntarily fortified were identified and pre- and post-fortification levels of micronutrients were determined from data supplied by manufacturers and food composition tables. Using food consumption data in 1379 adults aged 18–64 years, estimated using a 7-d food diary during the North/South Ireland Food Consumption Survey, intakes of micronutrients were determined, both including and excluding the fortification component in foods. Of approximately 3000 foods recorded as consumed, 1·9 % were fortified, mainly breakfast cereals and beverages. Median micronutrient content of fortified foods (FF) ranged from 18–33 % EC RDA per typical serving. Among consumers (65 % of men, 68 % of women), FF contributed, on average, 3·9 % (men) and 5·0 % (women) to mean daily intake (MDI) of energy. Relative to their contribution to MDI of energy, FF contribute a greater % MDI for Fe (men 16, women 19), folate (men 18, women 21), vitamins B1(men 14, women 16), B2(men 16, women 18), B6(men 12, women 15), D (men 5, women 11), B12(men 5, women 7) and niacin (men 10, women 12). Fortification significantly improved the adequacy of intake of some micronutrients, particularly of riboflavin, folate, vitamin D and Fe in women and did not contribute to an increased risk of adverse effects from excessive intake of any micronutrient.

Iron intake in relation to diet and iron status of young adult women

AIMS

To determine the iron intake and food sources of iron in young adult women and to compare women with high versus low iron intake on diet and iron status.

METHODS

Iron intake and food sources were assessed by a 2-day estimated food record. Iron status was determined by a fasting venous blood sample. Differences in diet and iron status between women with high versus low iron intake were examined by comparing women of the fourth respectively first quartile of total iron intake (mg/day).

RESULTS

The median total, heme and non-heme iron intake was 10.6, 0.6 and 9.8 mg/day, respectively. The median iron intake was 93 and 131% of the estimated average requirement (EAR) of the UK (11.4 mg/day) and USA (8.1 mg/day), respectively. The most important iron intake contributors were cereals and cereal products (31%), meat and meat products (12%) and vegetables (10%). Women with a high iron intake showed a significantly higher energy-adjusted intake of alcoholic beverages and soups and a lower intake of non-alcoholic beverages than women with a low iron intake. Approximately 5% of the women had anemia, of which 3% had iron deficiency anemia (IDA). Almost 20% was iron-deficient non-anemic. In this regard, no significant differences were found between the iron intake quartiles.

CONCLUSION

The median iron intake in this study population is considerably below the national recommended dietary allowance (20 mg/day). However, based on the approach of the Dietary Guidelines Advisory Committee, iron intake seems to pose no major health problem when using the EAR as a reference. The number of women with IDA was indeed not alarming (3%), although 20% was iron-deficient non-anemic. The question remains whether an increase in iron intake can improve iron status.

The effects of large neutral amino acid supplements in PKU: an MRS and neuropsychological study

OBJECTIVE

To determine the effects of large neutral amino acid (LNAA) supplements on brain and plasma phenylalanine (Phe) levels and other metabolites in early treated subjects with classical phenylketonuria (PKU), and to investigate the relationship between these metabolites and neuropsychological performance.

METHODS

This was a prospective, double blind, cross over study consisting of four two-week phases with a 4 week washout period. Sixteen subjects (7 males), with classical PKU were recruited into the study and completed all 4 phases. Each phase consisted of either the LNAA supplement or placebo, and either the patient's usual medical product or not. Subjects were instructed to follow their usual Phe restricted diet, maintain energy intake and complete a 3-day food record during each phase. At the end of each phase, brain Phe and other metabolites were measured by proton magnetic resonance spectroscopy (MRS), and plasma amino acids quantified. A detailed neuropsychological assessment was performed on the same day as the MRS and plasma collection.

RESULTS

There was no correlation between plasma and brain Phe, but few of the plasma Phe readings were over 1200 micromol/L. Plasma Phe decreased with LNAA supplementation when patients were not taking their medical formula. LNAA supplementation had a specific impact on executive functions particularly in verbal generativity and cognitive flexibility. Measures of attention were better on medical product, with or without LNAA supplements.

CONCLUSIONS

LNAA supplementation was associated with a trend to a lowering of plasma Phe levels. LNAA supplementation had a specific impact on executive functions particularly in verbal generativity and flexibility. For individuals already complying with diet and PKU medical product, additional supplementation with LNAA is of limited value. LNAA supplementation may be of benefit to those unable to comply with PKU medical product by reducing plasma Phe, perhaps by competing with Phe at the level of transport across the gut.

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.

Trends in energy and macronutrient intakes, body weight and physical activity in female university students (1988–2003), and effects of excluding under-reporters

The present study investigated trends in reported energy intake, macronutrient intake, physical activity level (PAL) and body weight and effects of excluding under-reporters (UR). Dietary intake and time spent in sixteen activity categories were recorded by 887 female university students (median age 29 years) from 1988 to 2003. Energy expenditure (EE) and PAL were measured using a factorial method. All data collected were self-reported. Individuals with reported EI:EE<0·76 were classified as UR. The remainder were classified as non-under-reporters (NUR). Trends were determined from simple linear regression of median data for each year for the entire cohort (ALL) and for NUR and UR separately, and from multiple regression analysis with the subgroups (NUR and UR) as an additional predictor (BOTH). Prevalence of under-reporting and overweight increased between 1988 and 2003. In ALL and BOTH there were trends to increased body mass, protein intake (g/d and % energy) and carbohydrate intake (% energy only) and decreased fat and alcohol intakes (g/d and % energy). In BOTH there were also increases in reported EI and carbohydrate intake (g/d). None of the trends in NUR was significantly different from those in UR, but some trends in ALL and/or BOTH were not significant when UR were excluded. Trends remaining significant in NUR were increased reported energy intake, protein (g/d) and carbohydrate (g/d) intakes, and decreased fat (% energy only) intake. There were no significant trends in PAL. We conclude that some, but not all, dietary trends were affected by exclusion of UR.

Issues in dietary intake assessment of children and adolescents

Studies of food habits and dietary intakes face a number of unique respondent and observer considerations at different stages from early childhood to late adolescence. Despite this, intakes have often been reported as if valid, and the interpretation of links between intake and health has been based, often erroneously, on the assumption of validity. However, validation studies of energy intake data have led to the widespread recognition that much of the dietary data on children and adolescents is prone to reporting error, mostly through under-reporting. Reporting error is influenced by body weight status and does not occur systematically across different age groups or different dietary survey techniques. It appears that the available methods for assessing the dietary intakes of children are, at best, able to provide unbiased estimates of energy intake only at the group level, while the food intake data of most adolescents are particularly prone to reporting error at both the group and the individual level. Moreover, evidence for the existence of subject-specific responding in dietary assessments challenges the assumption that repeated measurements of dietary intake will eventually obtain valid data. Only limited progress has been made in understanding the variables associated with misreporting in these age groups, the associated biases in estimating nutrient intakes and the most appropriate way to interpret unrepresentative dietary data. Until these issues are better understood, researchers should exercise considerable caution when evaluating all such data.

Sources of saturated fatty acids in Belgian adolescents' diet: implications for the development of food-based dietary guidelines

The objectives of the present study are to describe the dietary sources of total fat and of saturated fatty acids (SFA) and to formulate food-based dietary guidelines for SFA in Belgian adolescents. A random sample of 13–18-year-old adolescents was drawn from secondary schools in the region of Ghent. A 7d estimated food record method was used to quantify nutrient and food intake. The average daily SFA intake is 4% above the recommended 10% of the total energy contribution. The most important contributors of SFA on food group level were ‘fats, oils and savoury sauces’, ‘meat and meat products’, ‘sugar, confectionery, sweet fillings and sauces’, ‘cheese’, ‘milk and milk products’ and ‘bread, rusk and breakfast rolls’. On food subgroup level ‘fresh meat’, ‘high-fat margarine’ and ‘high-fat cheese’ had the highest contribution to SFA intake in all adolescents. Adolescents with a low SFA intake (lowest tertile) were compared with adolescents with a high intake (highest tertile). In the lowest tertile the intake of total fat and MUFA was significantly lower than in the highest tertile, while the intake of total carbohydrates, mono- and disaccharides and complex carbohydrates was significantly higher. Overall, the high-fat cheese intake is significantly lower in the lowest tertile, while the fruit intake is higher. The present analysis shows that the nutritional profile of Belgian adolescents could be potentially improved by decreasing the portion sizes of fresh meat (in boys), high-fat margarine, high-fat cheese and reducing intake of commercially prepared baked goods and processed foods, including fast foods.

Adiposity, education and weight loss effort are independently associated with energy reporting quality in the Ontario Food Survey

OBJECTIVES

To examine the associations of adiposity, dietary restraint and other personal characteristics with energy reporting quality.

DESIGN/SUBJECTS

Secondary analysis of 230 women and 158 men from the 1997/98 Ontario Food Survey.

METHODS

Energy reporting quality was estimated by ratios of energy intake (EI) to both basal metabolic rate (BMR) and total energy expenditure (TEE). Multivariate regression analyses were conducted to examine energy reporting quality between two dietary recalls and in relation to body mass index (BMI) with adjustment for potential confounders. Energy reporting quality was explored across categories of age, BMI, income, education, dieting status and food insecurity through analysis of variance (ANOVA).

RESULTS

From the ANOVA, energy reporting quality was associated with BMI group, age category and weight loss for men and women, as well as with education among women (P 0.05). EI:BMR and EI:TEE on the first and second 24-hour recalls were positively related (P < 0.0001 for men and women). A higher proportion of variance in energy reporting quality was explained for women than for men (R2 = 0.19 and 0.14, respectively).

CONCLUSIONS

Studies of diet and adiposity are probably hindered to some extent by BMI-related variation in energy reporting quality. Methods to address this issue are urgently needed if population surveys will continue to serve as the primary source of dietary intake data.

Effects of two weeks' mandatory snack consumption on energy intake and energy balance

OBJECTIVE

Our goal was to compare the effects of mandatory consumption of commercial snack products (CSPs) on energy intakes and energy balance in free-living adults and to assess the interaction between habitual level of CSP consumption and the interventions.

RESEARCH METHODS AND PROCEDURES

Four groups of 18 subjects (lean and overweight, males and females) were studied using a crossover design. Subjects consumed one type of CSP (high-carbohydrate, high-fat, or mixed composition) at three manipulations of energy 0 MJ (control), 1.5 MJ (low-energy), and 3.0 MJ (high-energy) each day during three 14-day interventions. The study design was parallel for type of CSP (macronutrient composition) and within-subjects for energy level. Subjects self-recorded food intakes between Days 8 and 14, and body weights were investigator-recorded on Days 1, 8, and 15 of each intervention period. Daily energy expenditure was estimated by heart rate monitoring.

RESULTS

Daily energy intakes increased from 10.4 MJ (control) to 11.1 MJ (low-energy) and 11.5 MJ (high-energy) (p < 0.001), resulting in a trend (not significant) for body weight gain. Energy balance was more positive when subjects were not recording their food intakes than when they were (p < 0.001). There was a trend (not significant) for greater increases in energy intake with increasing fat content, and energy density, of the interventions. Frequent CSP consumers compensated more for the interventions than did infrequent CSP consumers (R2 = 0.125, p = 0.003).

DISCUSSION

Subjects partially compensated for energy when supplemented with CSPs over 14-day periods, although this was insufficient to prevent some increase in energy balance. The level of compensation correlated with habitual energy intake from CSPs.

Evaluation of a 2-day food record to determine iron, calcium and vitamin C intake in young Belgian women

OBJECTIVE

Evaluation of a 2-day food record (FR) for the assessment of iron, calcium and vitamin C intake.

DESIGN

In a subsample of a large-scale epidemiological study, iron, calcium and vitamin C intake were estimated using a 2-day FR and compared to the nutrient intakes assessed by an 11-day FR (reference method).

SETTING

City of Ghent, Dutch speaking part of Belgium.

SUBJECTS

A number of 51 non-pregnant women (18-39 years).

RESULTS

Mean iron, calcium and vitamin C intakes were not significantly different between the reference method and 2-day FR. Correlation coefficients of 0.63 (iron) and 0.76 (calcium, vitamin C) were reached. The iron intake of 95% of the individuals assessed by the 2-day FR varied between 5 mg above or below the reference intake. Over 50% of the women were correctly classified and 4% or fewer were extremely misclassified by the 2-day FR. Mean 11-day FR intakes increased progressively over the tertiles defined by the 2-day FR. The 11-day energy intake was under-reported by 28% of the women; no over-reporters were identified.

CONCLUSIONS

The 2-day FR is able to estimate mean iron, calcium and vitamin C intake and to rank individuals along the distribution of intakes.

Financial incentive for diet recall accuracy does not affect reported energy intake or number of underreporters in a sample of overweight females

Underreporting of energy intake in diet recalls is common, especially among obese individuals. Incentives have been used to ameliorate the problem, but are typically provided without efficacy assessment. The present study sought to determine whether financial incentives decrease underreporting in diet recalls. Three groups were used to assess incentive timing effects in this parallel group crossover study. One group received a $50 bonus for accurate diet recalls on the first two of four recalls. Accuracy was purportedly verified by salivary analysis. Another group received the $50 bonus for the last two recalls. A third group received no incentive. Mean energy intake during the first two visits was compared to mean energy intake during the last two visits to assess differences resulting from the incentive. Underreporters were identified using a Goldberg cutoff and energy intake <76% of estimated energy expenditure. Energy intake did not differ within or between groups at any time, and the number of underreporters was not associated with group at any time. Overall, the incentive was ineffective in this small, homogeneous sample. Future studies should assess different forms of incentives, other study populations, and the probability of incentives causing undereating.

Under- and overreporting of energy is related to obesity, lifestyle factors and food group intakes in Jamaican adults

Objective:

Research in industrialised countries has documented a high prevalence of underreported energy intakes associated with characteristics such as obesity. This paper examines the prevalence, patterns and impact of energy under- and overreporting on diet–obesity relationships in a middle-income developing country.

Design:

A 70-item food-frequency questionnaire was used. Underreporters had reported energy intakes < 1.35 × basal metabolic rate (BMR), overreporters > 2.4 × BMR. Multinomial models were used to identify characteristics associated with implausible reporting. Intakes were compared across reporting groups to assess evidence of bias. Associations between diet and obesity were compared with and without adjustment for implausible reporting.

Setting:

Spanish Town, neighbouring the capital city of Kingston, Jamaica.

Subjects:

Eight hundred and ninety-one Jamaican adults, aged 25–75 years, were randomly recruited.

Results:

More women than men (38.6% vs. 22.5%) underreported, but more men overreported energy (23.7% vs. 16.0%). Underreporting was positively associated with obesity, special diets, smoking and age; age was inversely associated with overreporting. Underreporters estimated lower energy from potentially socially undesirable food groups (e.g. snacks) and higher intakes of ‘healthy’ foods (e.g. fruit) than did plausible reporters. For some of these food groups, significant differences in intakes among normal-weight versus obese subjects observed among plausible reporters were absent when implausible reporters were included. In models of food group–obesity associations, adjusting for implausible energy yielded more credible results that more closely resembled findings in plausible reporters.

Conclusions:

Energy under- and overreporting are highly prevalent in Jamaica. Adjusting for implausible reporting may help to reduce bias in diet–health outcome associations.

Energy-dense diets are associated with lower diet costs: a community study of French adults

Objective:

High consumption of energy-dense foods has been linked to high energy intakes and excess weight gain. This study tested the hypothesis that high energy density of the total diet is associated with lower diet costs.

Design:

Dietary intakes of 837 French adults, aged 18–76 years, were assessed using a dietary history method. Dietary energy density (MJ kg−1) was calculated by dividing total energy by the edible weight of foods consumed. Daily diet cost (€day−1) was estimated using mean national food prices for 57 food items. The relationship between dietary energy density and diet cost at each level of energy intake was examined in a regression model, adjusted for gender and age.

Results:

The more energy-dense refined grains, sweets and fats provided energy at a lower cost than did lean meats, vegetables and fruit. Within each quintile of energy intake, diets of lower energy density (MJ kg−1) were associated with higher diet costs (€day−1).

Conclusion:

In this observational study, energy-dense diets cost less whereas energy-dilute diets cost more, adjusting for energy intakes. The finding that energy-dilute diets are associated with higher diet costs has implications for dietary guidelines and current strategies for dietary change.

Underreporting of energy intake among Japanese women aged 18–20 years and its association with reported nutrient and food group intakes

Objectives:

To evaluate the ratio of energy intake to basal metabolic rate (EI/BMR) among young female Japanese adults, and to compare the lifestyle and dietary characteristics between relatively low and high reporters.

Design:

Dietary intakes were assessed over a 1-month period with a validated, self-administered, diet history questionnaire, and lifestyle variables were assessed by a second questionnaire designed for this survey. The ratio of EI/BMR was calculated from reported energy intake and estimated basal metabolic rate.

Subjects:

In total, 1889 female Japanese university students aged 18–20 years who were enrolled in dietetics courses.

Results:

Ninety-five per cent of the subjects were classified into a non-obese group (body mass index (BMI) <25 kg m−2; mean±standard deviation (SD): 20.8±2.6 kg m−2). EI/BMR was 1.43±0.40 (mean±SD). Sixty-eight per cent of the subjects showed an EI/BMR level below the possibly balanced value of 1.56, 37% showed EI/BMR below the minimum survival value of 1.27 and 2% of the subjects showed EI/BMR exceeding the maximum value for a sustainable lifestyle of 2.4. BMI, body weight and BMR decreased significantly with the increase in EI/BMR (P<0.001). The percentage of energy from carbohydrate was significantly higher, whereas those from fat and protein were significantly lower, among the lower EI/BMR groups. As for food groups, a significantly declining trend from the lowest to the highest EI/BMR groups was observed for cereals.

Conclusion:

Underreporting, rather than overreporting, of energy intake was predominant in this relatively lean Japanese female population. BMI was the most important factor affecting the reporting accuracy of energy intake.

The stability of soft drinks intake from adolescence to adult age and the association between long-term consumption of soft drinks and lifestyle factors and body weight

Objectives

To investigate the tracking of sugar-sweetened, carbonated soft drinks intake from age 15 to 33 years and the association between this intake and lifestyle factors and body weight.

Design

A longitudinal study with 18–20 years of follow-up. Data about diet, physical activity, smoking and dieting were collected in 1981/1979, 1991 and 1999. Body weight and height were measured in 1981/1979 and self-reported in 1999.

Setting

Oslo, Norway.

Subjects

Four hundred and twenty-two men and women.

Results

Tracking of soft drinks intake from adolescence into early adulthood (age 25 years) and from early adulthood into later adulthood (33 years) was moderate to high, while tracking from adolescence into later adulthood was low. Comparing those reporting a high intake of soft drinks in both 1991 and 1999 with those reporting a low intake at both times, male long-term high consumers were more likely to smoke (48 vs. 21%, P = 0.002) and reported higher intakes of energy (12.2 vs. 10.2 MJ day−1, P = 0.005) and sugar (142 vs. 50 g day−1, P < 0.001) in 1999 than did long-term low consumers. Women high consumers were less likely to be physically active (14 vs. 42%, P = 0.03) and had higher sugar intake (87 vs. 41 g day−1, P < 0.001) in 1999 than did women low consumers. There were no differences in body mass index, overweight or obesity in 1999 between long-term high and low consumers.

Conclusion

In this study, stability of soft drinks intake from age 15 to 25 years and from age 25 to 33 years was moderate to high, while from age 15 to 33 years it was low. Soft drinks intake from age 25 to 33 years was associated with smoking and physical inactivity, but not with body weight.

Adherence to a Mediterranean diet is associated with reduced 3-year incidence of obesity

Few studies have prospectively examined dietary patterns and adult weight change, and results to date are inconsistent. This study examines whether a Mediterranean diet (MD) pattern is associated with reduced 3-y incidence of obesity using data from the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Spain). The sample included 17,238 women and 10,589 men not obese and aged 29-65 y at baseline (1992-96). Height and weight were measured at baseline; weight was self-reported in a follow-up survey a mean of 3.3 y later. Detailed dietary history data, collected using a validated method, were used to construct a MD score. Logistic regression models were used to estimate odds of becoming overweight or obese. Among initially overweight subjects, 7.9% of women and 6.9% of men became obese, whereas 13.8% of normal weight men and 23.0% women became overweight. High MD adherence was associated with significantly lower likelihood of becoming obese among overweight subjects, with stronger associations after adjusting for underreporting of dietary data. Associations (odds ratios with 95% CI) were similar in women (0.69, 0.54-0.89) and men (0.68, 0.53-0.89). Adjusting for the plausibility of reported dietary intakes increased the magnitude of these associations, which were approximately 0.8 without this adjustment. MD adherence was not associated with incidence of overweight in initially normal-weight subjects. Nonetheless, results suggest that promoting eating habits consistent with MD patterns may be a useful part of efforts to combat obesity.

Eating habits in relation to body fatness and gender in adolescents--results from the 'SWEDES' study

OBJECTIVE

To investigate if eating habits among adolescents are related to body fatness and gender.

DESIGN

Cross-sectional study.

SETTING

Obesity Unit, Huddinge University Hospital, Sweden, 2001-2002.

SUBJECTS

Two hundred and seventy-five girls and 199 boys, aged 16-17 years.

METHOD

Questionnaires were used for dietary intake and meal frequency, BodPod for measuring body fatness (BF%). In all, 169 girls and 128 boys were classified as adequate reporters (AR) of energy intake, and were used in the dietary analyses. The whole sample was used in the meal frequency analyses.

RESULTS

The correlation between reported energy intake and weight in the AR group was 0.23 (P<0.01) for girls and 0.36 for boys (P<0.001). The correlations were inverse or not significant in the whole sample. The following variables correlated significantly with a high BF% (r (s)=+/-0.2): a low intake of milk in both girls and boys, a high intake of fibre and alcohol and a low intake of sugar in girls and a low intake of breakfast cereals in boys. Those with regular breakfast habits had healthier food choices than others, but this was not related to BF%. Boys had more meals per day (4.9 vs 4.6, P=0.02), especially early in the morning and late at night, whereas girls reported a higher relative intake of light meals and fruit and a lower intake of milk than boys.

CONCLUSIONS

A few associations between eating habits and body fatness were found, but without any obvious patterns. The true differences in eating habits between lean and overweight adolescents are probably very small.

Eating patterns and dietary composition in relation to BMI in younger and older adults

OBJECTIVE

To compare relative associations of eating patterns and dietary composition with body mass index (BMI) in younger (aged 20-59 years, n=1792) and older (aged 60-90 years, n=893) participants in the Continuing Survey of Food Intakes by Individuals, collected 1994-1996.

METHODS

Data from two 24-h dietary recalls from individuals reporting physiologically plausible energy intake (within +/-22% of predicted energy requirements, based on previously published methods) were used.

RESULTS

Mean reported energy intake was 96 and 95% of predicted energy requirements in younger and older subjects, respectively. Older subjects were less likely than younger subjects to skip a meal, but snacking was common in both age groups. Fiber density was significantly higher in the older group. A higher BMI in both age groups was associated with a higher total daily energy intake, and higher energy intakes at all eating occasions. In both age groups, eating frequency was positively associated with energy intake, and eating more than three times a day was associated with being overweight or obese. In the younger group but not the older group, a lower fiber density coupled with higher percentage of energy from fat was independently associated with having a higher BMI.

CONCLUSIONS

While no one eating occasion contributes more than any other to excess adiposity, eating more often than three times a day may play a role in overweight and obesity in both younger and older persons. A reduced satiety response to dietary fiber in addition to lower energy expenditure may potentially further contribute to weight gain in older persons.

The Use of a Personal Digital Assistant for Dietary Self-Monitoring Does Not Improve the Validity of Self-Reports of Energy Intake

Underreporting of energy intake is a pervasive problem and resistant to improvement, especially among people with overweight and obesity. The goal of this study was to investigate whether the use of a personal digital assistant (PDA) for dietary self-monitoring would reduce underreporting prevalence and improve the validity of self-reported energy intake. Adults with overweight and obesity (n=61, 92% women, mean age 48.2 years, mean body mass index 32.3) were provided with a PalmZire 21 (Palm, Inc, Sunnyvale, CA) loaded with Calorie King's Diet Diary software (version 3.2.2, 2002, Family Health Network, Costa Mesa, CA). Subjects participated in a 24-week in-person behavioral weight control program and were asked to self-monitor their diet and exercise habits using the PDA. Basal metabolic rate and physical activity level were estimated at baseline. Energy intake from 7-day electronic food records were collected within the first month of the weight-control program. As subjects were actively losing weight, Bandini's adjustments were used to correct self-reported energy intake for weight loss. In this group, where 41% of the subjects were categorized as low-energy reporters, the use of a PDA did not improve validity of energy reporting when compared to what is reported in the literature.

Dietary patterns and associated lifestyles in preconception, pregnancy and postpartum

OBJECTIVE

To identify dietary patterns in women who are planning immediate pregnancy in preconception, weeks 6, 10, 26 and 38 of pregnancy, and 6 months postpartum, and to describe how particular lifestyles, the body mass index (BMI) and sociodemographic factors are associated to these patterns.

DESIGN

Longitudinal study throughout the reproductive cycle of food consumption carried out in a Spanish Mediterranean city.

SETTING

Faculty of Medicine and Health Sciences, Rovira i Virgili University.

SUBJECTS

In total, 80 healthy female volunteers who were planning immediate pregnancy.

INTERVENTIONS

A seven-consecutive-day dietary record was used to evaluate the dietary intake. Exploratory factor analysis was used to identify the main dietary patterns in each of the periods. Fitted multiple linear regression models were used to study the associations between the lifestyle and sociodemographic variables, and each dietary pattern.

RESULTS

The 'sweetened beverages and sugars' pattern was identified from preconception to 6 months postpartum and the 'vegetables and meat' pattern to the end of pregnancy. The 'sweetened beverages and sugars' pattern is positively associated with smoking and negatively associated with physical activity before conception and in the first trimester of pregnancy. The 'vegetables and meat' pattern is negatively associated with the BMI during the preconception period and positively associated with age in weeks 10 and 38 of pregnancy. It is shown that the patterns do not change significantly throughout the period studied.

CONCLUSIONS

We have identified two stable dietary patterns from preconception to postpartum. The 'sweetened beverages and sugars' pattern is associated with habits of risk for the health of the pregnant woman and her offspring.

SPONSORSHIP

'Comisión Interministerial de Ciencia y Tecnología' (CICYT: ALI89-0388) and 'Instituto de Salud Carlos III', RCMN (C03/08), Madrid, Spain'.

Relative validation of a pre-coded food diary among children, under-reporting varies with reporting day and time of the day

OBJECTIVE

The aim of this study was to validate intake of energy, macro- and micronutrients assessed from pre-coded food diaries (PFDs) by using weighed records (WRs) as the reference method among a group of Norwegian 9-year-olds. We also examined how under-reporters (UR) differed from acceptable reporters (AR) according to the energy intake during the 4-day recording period and energy intake distribution during the day.

SUBJECTS AND DESIGN

One hundred 9-year-olds, 45 girls and 55 boys, were recruited to complete a 4-day record with a PFD followed 3 days later with a 4-day WR.

RESULTS

There were no differences between energy and nutrient intake from the two recording methods among boys, but girls reported significantly higher intakes with PFD compared with WR. The median Spearman correlation coefficient between PFD and WR for energy and nutrients was 0.43 for girls and 0.49 for boys. Twelve participants were classified as UR with the PDF method. Energy percentages from macronutrients were not significantly different between UR and AR with the PFD method. UR had significantly lower energy intake in the last two recording days and from 1000 to 2200 hours during the day compared to AR.

CONCLUSIONS

The PFD method is promising as a tool for assessing food intake in large surveys among children. The present study indicates that the PFD gives more valid data for boys than girls according to the group intake and ranking of nutrient intake when WR is the reference method. However, UR seemed to develop a study fatigue during the day and during the recording period. Increased awareness about the tendency of study fatigue can lead to more specific instructions on how participants can handle the problem.

Understanding reporting bias in the dietary recall data of 11-year-old girls

OBJECTIVE

This study describes patterns of bias in self-reported dietary recall data of girls by examining differences among girls classified as under-reporters, plausible reporters, and over-reporters on weight, dietary patterns, and psychosocial characteristics.

RESEARCH METHODS AND PROCEDURES

Participants included 176 girls at age 11 and their parents. Girls' weight and height were measured. Three 24-hour dietary recalls and responses to psychosocial measures were collected. Plausibility cut-offs for reported energy intake as a percentage of predicted energy requirements were used to divide the sample into under-reporters, plausible reporters, and over-reporters. Differences among these three groups on dietary and psychosocial variables were assessed to examine possible sources of bias in reporting.

RESULTS

Using a +/-1 standard deviation cut-off for energy intake plausibility, 50% of the sample was categorized as plausible reporters, 34% as under-reporters, and 16% as over-reporters. Weight status of under-reporters was significantly higher than that of plausible reporters and over-reporters. With respect to reported dietary intake, under-reporters were no different from plausible reporters on intakes of foods with higher nutrient densities and lower energy densities and were significantly lower than plausible reporters on intakes of foods with lower nutrient densities and higher energy densities. Over-reporters reported significantly higher intakes of all food groups and the majority of subgroups, relative to plausible reporters. Under-reporters had significantly higher levels of weight concern and dietary restraint than both plausible reporters and over-reporters.

DISCUSSION

Techniques to categorize plausible and implausible reporters can and should be used to provide an improved understanding of the nature of error in children's dietary intake data and account for this error in analysis and interpretation.

Food Habits and Intake of Nutrients in Elderly Patients with Parkinson’s Disease

BACKGROUND

Weight loss is reported frequently in patients with Parkinson s disease also early during the disease.

OBJECTIVE

To investigate food habits and nutrient intake in elderly Parkinson s disease patients compared with matched controls, as well as to compare PD patients with and without weight loss.

METHODS

Twenty-six elderly free-living patients with PD, and 26 sex- and age-matched healthy controls, were assessed twice with one year interval between. All food consumed was recorded over 3 consecutive days. Food habits were assessed with the Food Based Concept for Classification of Eating Episodes and intakes of energy and nutrients were calculated. PD symptoms, olfaction, swallowing function, daily activities and serum concentration of different nutrients were investigated.

RESULTS

After 1 year, the PD patients decreased their intakes of daily high quality snacks from 0.5 +/- 0.7 to 0.3 +/- 0.3 (p < 0.05) and their prepared complete meals from 0.8 +/- 0.3 to 0.6 +/- 0.3 (p < 0.05), while their daily number of prepared incomplete meals increased from 0.2 +/- 0.2 to 0.3 +/- 0.3 (p < 0.01). PD patients with weight loss increased their daily intakes of fat by 12 +/- 34 g and their energy intake per kg body weight increased by 21 +/- 31 kJ (p < 0.05), respectively, and this was higher than in those without weight loss (p < 0.01). PD patients required more help with buying and cooking food compared with the controls.

CONCLUSIONS

PD patients' food habits changed so that they consumed a lower number of prepared complete meals. PD patients with weight loss had a higher intake of fat and energy than those without weight loss, although this was obviously not sufficient to prevent weight loss. Impaired absorption of fat in PD should be discussed.

A simple method of measuring total daily energy expenditure and physical activity level from the heart rate in adult men

OBJECTIVE

To evaluate a simple method that uses only a heart rate monitor to predict total energy expenditure (TEE) and physical activity level (PAL) from 24 h heart rate (HR) measurements.

DESIGN

The simple method involved the determination of the physical activity ratio (PAR) from corresponding heart rate ratios (HRR) (ratio of observed to resting HR), from an individualized calibration curve relating activities with known PAR to the HRR. Several curve fits were evaluated for this curve. The PAL was calculated from minute to minute PAR. The TEE was computed as the product of the PAL and the predicted basal metabolic rate (BMR). The accuracy of the simple method was assessed by within-subject comparisons of the simple method versus the oxygen consumption - HR method and a time and motion study.

SETTING

Bangalore City, India.

SUBJECTS

In all, 17 healthy male subjects between 18 and 44 years were recruited for the study.

INTERVENTIONS

None.

RESULTS

The simple method correlated well with both the reference methods when using a calibration curve that involved the fitting of two straight lines at low and high PAR activities, respectively, to the PAR and HRR data. The mean error in TEE, as a product of BMR and PAL, was about 1%, but with limits of agreement between the methods that were about 20% of the TEE. However, the low mean error could have been due to a canceling of errors in the determination of BMR and PAL.

CONCLUSIONS

The simple method is a relatively cheap, useful technique for evaluating TEE and PAL in resource-poor situations. It may particularly be of use in epidemiological investigations where population estimates of TEE and PAL are required.

Trends and dietary determinants of overweight and obesity in a multiethnic population

OBJECTIVES

To describe trends in BMI among different ethnic groups in Hawaii and to explore the relation of nutrient and food intake with excess weight.

RESEARCH METHODS AND PROCEDURES

We pooled demographic, anthropometric, and nutritional data derived from a detailed diet history for 159,683 participants of 18 population-based epidemiological studies conducted in Hawaii over a 25-year period. The age-adjusted prevalence of excess weight (BMI > or = 25 kg/m(2)) was estimated for 5-year intervals. To explore dietary determinants of excess weight, we computed odds ratios using logistic regression.

RESULTS

During the study period, the prevalence of excess weight increased considerably among all ethnic groups. Native Hawaiians had the highest and Asian Americans had the lowest prevalence of excess weight at all times. Although the percentage of calories consumed from carbohydrates increased, the percentage of calories from fat decreased over time. On an individual level, fat and protein consumption predicted a higher BMI, and dietary fiber intake predicted a lower BMI. Similarly, a higher consumption of meat, poultry, and fish was related to excess weight, whereas fruit and vegetable intake were inversely associated with excess weight. After stratification by ethnicity, the associations were not materially altered among women, but carbohydrates seemed to have a stronger association with excess weight among Native Hawaiian and Japanese men than among white men.

DISCUSSION

In this large ethnically diverse population, plant-based foods and dietary fiber emerged as a potential protective factor against excess weight regardless of ethnicity.

Trends in energy and macronutrient intakes in non-under-reporters vary with the method used to identify under-reporters

OBJECTIVE

To investigate effects of using different methods to identify under-reporters on trends in dietary intake and physical activity level (PAL) in non-under-reporters.

DESIGN

Dietary intake and activity pattern were recorded by 887 female university students from 1988 to 2003. Energy expenditure (EE) and PAL were measured using a factorial method. Nine methods were used to identify under-reporters. Trends between 1988 and 2003 were determined from linear regression of median data for each year.

RESULTS

Prevalence of under-reporting varied with the method used, ranging from 22.2% to 66.7%. Trends that were consistent using all methods were a decrease in per cent of energy from fat and no change in alcohol intake or PAL (P<0.05). Trends in energy and macronutrient intakes varied with the method used. Using the four methods that excluded the most under-reporters there were increases in energy and gram carbohydrate (CHO) intakes (P<0.05), but no change in gram fat intake. Using the four methods that excluded the fewest under-reporters there was no change in energy or gram CHO intake, but a decrease in gram fat intake (P<0.05).

CONCLUSION

Trends in energy, fat and CHO intakes in non-under-reporters varied with the method used to identify under-reporters.

The Psychosocial and Behavioral Characteristics Related to Energy Misreporting

Energy underreporting occurs in 2% to 85% and overreporting in 1% to 39% of various populations. Efforts are needed to understand the psychosocial and behavioral characteristics associated with misreporting to help improve the accuracy of dietary self-reporting. Past research suggests that higher social desirability and greater eating restraint are key factors influencing misreporting, while a history of dieting and being overweight are more moderately associated. Eating disinhibition, body image, depression, anxiety, and fear of negative evaluation may be related to energy misreporting, but evidence is insufficient. This review will provide a detailed discussion of the published associations among psychosocial and behavioral characteristics and energy misreporting.

Participation in a behavioral weight-loss program worsens the prevalence and severity of underreporting among obese and overweight women

Underreporting of energy intake is a serious and pervasive problem, especially among women with overweight and obesity. The aim of this study was to determine if the prevalence and severity of underreporting changed after participating in a behavioral weight-loss program. Women with overweight and obesity (N=156, mean age 39.4 years, mean body mass index 31.9) completed a 6-month behavioral weight-loss program. Basal metabolic rate, physical activity level, and energy intake from 7-day food records were collected at baseline and 6 months. The major finding was that underreporting significantly increased in prevalence (39.7% vs 60.3%; P<.001), as did severity of misreporting (-105+/-583 vs -415+/-504 kcal/day; P<.001) following the behavioral weight-loss program. Thus, after completing a behavioral weight-loss program, the prevalence of underreporting and severity of misreporting became significantly worse among women with overweight and obesity.

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.

Attainment of precision in implementation of 24 h dietary recalls: INTERMAP UK

Collection of complete and accurate dietary intake data is necessary to investigate the association of nutrient intakes with disease outcomes. A standardised multiple-pass 24 h dietary recall method was used in the International Collaborative Study of Macro- and Micronutrients and Blood Pressure (INTERMAP) to obtain maximally objective data. Dietary interviewers were intensively trained and recalls taped, with consent, for randomly selected evaluations by the local site nutritionist (SN) and/or country nutritionists (CN) using a twelve-criterion checklist marked on a four-point scale (1, retrain, to 4, excellent). In the Belfast centre, seven dietary interviewers collected 932 24 h recalls from 40-59-year-old men and women. Total scores from the 134 evaluated recalls ranged from thirty-four to the maximum forty-eight points. All twelve aspects of the interviews were completed satisfactorily on average whether scored by the SN (n 53, range: probing 3.25 to privacy of interview 3.98) or CN (n 19, range: probing 3.26 to pace of interview and general manner of interviewer 3.95); the CN gave significantly lower scores than the SN for recalls evaluated by both nutritionists (n 31, Wilcoxon signed rank test, P=0.001). Five evaluations of three recalls identified areas requiring retraining or work to improve performance. Reporting accuracy was estimated using BMR; energy intake estimates less than 1.2 x BMR identifying under-reporting. Mean ratios in all age, sex and body-mass groups were above this cut-off point; overall, 26.1 % were below. Experiences from the INTERMAP Belfast centre indicate that difficulties in collection of dietary information can be anticipated and contained by the systematic use of methods to prevent, detect and correct errors.

Fat intake and composition of fatty acids in serum phospholipids in a randomized, controlled, Mediterranean dietary intervention study on patients with rheumatoid arthritis

BACKGROUND

We have previously reported that rheumatoid arthritis patients, who adopted a modified Cretan Mediterranean diet, obtained a reduction in disease activity and an improvement in physical function and vitality. This shift in diet is likely to result in an altered intake of fatty acids. Therefore, the objective of the present study was to examine the dietary intake of fatty acids, as well as the fatty acid profile in serum phospholipids, during the dietary intervention study presented earlier.

RESULTS

From baseline to the end of the study, changes in the reported consumption of various food groups were observed in the Mediterranean diet group. The change in diet resulted in a number of differences between the Mediterranean diet group and the control diet group regarding the fatty acid intake. For instance, a lower ratio of n-6 to n-3 fatty acids was observed in the Mediterranean diet group, both assessed by diet history interviews (dietary intake) and measured in serum phospholipids. Moreover, the patients in the Mediterranean diet group that showed a moderate or better clinical improvement during the study (diet responders), had a higher reported intake of n-3 fatty acids and a lower ratio of n-6 to n-3 fatty acids compared to the patients with minor or no improvement. Also the fatty acid profile in serum phospholipids differed in part between the diet responders and the diet non-responders.

CONCLUSION

The changes in the fatty acid profile, indicated both by dietary assessments and through fatty acids in s-phospholipids may, at least in part, explain the beneficial effects of the Cretan Mediterranean diet that we have presented earlier.

Dietary Fiber and Fat Are Associated with Excess Weight in Young and Middle-Aged US Adults

OBJECTIVE

To examine relative associations of dietary composition variables with body mass index (BMI; calculated as kg/m2) among young and middle-aged US adults. We hypothesized that in subjects with physiologically plausible reported energy intakes, fiber intake would be inversely associated with BMI, independent of other dietary composition and sociodemographic variables.

SUBJECTS AND DESIGN

Data from adults age 20 to 59 years in the Continuing Survey of Food Intakes by Individuals (CSFII) 1994-1996 were used. Exclusions were pregnancy or lactation, food insecurity, missing weight or height data, or having only one dietary recall. Based on our previously published methods, a physiologically plausible reported energy intake was calculated as being within +/-22% of predicted energy requirements for the mean of two 24-hour recalls.

RESULTS

Reporting plausibility ([reported energy intake/predicted energy requirements]x100) averaged 83% in the total sample (N=4,539) and increased to 96% in the plausible sample (n=1,932). Only approximately 5% of the plausible sample consumed the Adequate Intake for fiber. In plausibly reporting women, fiber, its interaction with percentage energy from fat, and energy density were independently associated with BMI. Only percentage energy from fat was associated with BMI in men reporting plausibly. Compared with the total sample, stronger relationships between diet and BMI were observed among the plausible reporters. In women, a low-fiber (< 1.5 g/MJ), high-fat (> or = 35% energy) diet was associated with the greatest increase in risk of overweight or obesity compared with a high-fiber, low-fat diet.

CONCLUSIONS

Weight control advice for US women should place greater emphasis on consumption of fiber.

The influence of eating location on nutrient intakes in Irish adults: implications for developing food-based dietary guidelines

OBJECTIVES

To examine the contribution of the food service sector to the nutrient quality of the Irish diet, and to compare intakes at home, work and outside the home ('out') and within the subgroups of the out location (pub, deli, takeaway).

DESIGN AND SETTING

Random sample of adults from the Republic of Ireland. Food intake data were collected using a 7-day food diary. Respondents recorded the location of every eating occasion determined by where the food was prepared rather than consumed.

RESULTS

Intakes of energy, protein, fat and carbohydrate were significantly greater at home than at work or out (P<0.05). The intake of alcohol was significantly (P<0.001) greater out than at home or work. The percentage contribution of fat to energy was above the recommendations (33% of total energy and 35% of food energy) for both men and women at all locations, with the exception of the contribution of fat to total energy for men at the out location. Within the subgroups of the out location, the contribution of alcohol to total energy was greatest in pubs and the contribution of fat to both total and food energy was greatest in takeaways. Intakes of fibre and most micronutrients per 10 MJ of food energy were greater (P<0.05) at home than at work or out.

CONCLUSION

Foods eaten outside the home contribute a disproportionately high level of fat intake and should be targeted in public health nutrition strategies.

The fundamental flaw in obesity research

The basic problem with comparative diet trials is our inability to measure what people eat. All conventional instruments depend on subjects' reports. Most trials lack independent biochemical, physiological or genetic measures of intake. So, we do not know if subjects actually follow the diets being tested and compared. We can assess weight gain/loss, but we fail in a fundamental scientific requirement, accurately measuring the independent variable in a causal experiment. Worse, we know most subjects under-report their energy intake and its components, the obese especially. The problem is compounded by attempts to show diets' effects on other risk factors, like triglycerides. Researchers seek to correlate two variables, without having accurately measured one of them, producing misleading associations. The consequence is we do not know if the results of any current diet trials are valid or reliable. Developing rigorous measures of food intake is the highest priority in obesity research. That involves improvements in technology as well as science. We need: (1) biomarkers of intake for energy, macro- and micro-nutrients and other food components relevant to weight gain/loss; (2) field measuring instruments that are cheap, rapid, painless, non-intrusive and self-administerable; and (3) electronic data transmission systems that preclude subjects' ability to misreport.