Psychosocial predictors of energy underreporting in a large doubly labeled water study

Food preference questionnaire as a screening tool for assessing dietary risk of cardiovascular disease within health risk appraisals

OBJECTIVE

Nutrition components of health risk appraisals (HRAs) aim to rapidly and accurately assess dietary behaviors that increase disease risk. Because cognitive research suggests that recalling food likes/dislikes may be simpler and more accurate than recalling intake, we tested whether a preference measure was predictive of cardiovascular disease risk factors within an HRA.

METHODS

HRA participants (422 primarily non-Hispanic white men, mean age 46+/-10 years) from a manufacturing company completed surveys to assess fat and sweet food/beverage preference; frequency of consuming fat and sweet foods/beverages, alcoholic beverages, fiber-rich foods (whole grains, fruits, and vegetables); and physical activity. Per measured risk factors, 34% had central obesity (waist circumference>or=102 cm), 32% had hypertension (>or=140 and/or>or=90 mm Hg), 52% had prehypertension (>or=120 to 139 and/or>or=80 to 89 mm Hg), and 52% had an elevated total cholesterol level (>or=200 mg/dL [5.2 mmol/L]).

STATISTICAL ANALYSES

Multiple linear regression models explaining variability in waist circumference, blood pressure, and serum lipids were tested.

RESULTS

Although preference and intake pairs for fat and sweets were significantly correlated, intake of fat and sweets failed to associate significantly with any risk factor. Significant variance in waist circumference was explained by age, fat preference, fiber intake, and physical activity. Those with greater circumferences liked fat more, consumed less fiber, and exercised less. Waist circumference in turn contributed significantly to models predicting serum lipid levels and blood pressure. Alcohol intake explained variability in serum lipid levels-higher intakes were associated with higher high-density lipoprotein cholesterol levels. The models predicting risk were generally more explanatory in younger (<50 years) than in older men.

CONCLUSIONS

Including a preference measure within an HRA appears to enhance cardiovascular disease risk factor assessment. Fat preference, intake of fiber-rich foods, and alcohol proved the best dietary determinants of cardiovascular disease risk factors.

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.

Characteristics of misreporters of dietary intake and physical activity

Objective

To characterise misreporters of energy intake (EI) and energy expenditure (EE).

Design

Cross-sectional study, using a validated position and motion instrument, ActiReg®, as the reference method to study misreporters of EI and of EE. EI was measured using a dietary record and EE using a physical activity questionnaire (PAQ). Misreporters were defined as subjects outside the 95% confidence limits of agreement between EI or EE reported/EE measured.

Setting

Free-living Danish volunteers.

Subjects

One hundred and thirty-eight volunteers aged between 20 and 59 years.

Results

Body mass index, smoking, ‘try to eat healthily’ and worries about weight were related to degree of under-reported EI. The percentage energy from added sugar was lowest (P < 0.001) and the percentage energy from protein (P < 0.001) highest in under-reporters compared with acceptable reporters. Subjects who reported being very physically active at work or in leisure time reported a higher EE than measured EE compared with less physically active subjects (P < 0.05). Likewise, subjects who regard themselves as fit or very fit reported a higher EE than subjects who regard themselves as moderately fit (P < 0.05). Possible over-reporters reported less time as very light activity (P = 0.007), more time as moderate activity (P = 0.01) and more time as vigorous activity (P = 0.02) than acceptable reporters.

Conclusions

Under-reporting of EI should always be taken into consideration; however, only a few characteristics of under-reporters are consistent among studies. Misreporting of EI was more prevalent than misreporting of EE. The level of physical activity more than the time spent involved in various activities was misreported.

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.

Misreporting of dietary energy, protein, potassium and sodium in relation to body mass index in young Japanese women

OBJECTIVE

Although under-reporting of dietary intake is more common in persons with a high body mass index (BMI), it is not well known whether or not misreporting is selective for different foods (and hence energy and nutrients), particularly in non-Western populations. We examined misreporting of dietary intake against biomarkers and its relation with BMI in young Japanese women.

DESIGN

Cross-sectional study.

SUBJECTS

A total of 353 female Japanese dietetic students aged 18-22 years (mean BMI: 21.4 kg/m(2), mean fat intake: 29.8% of energy).

METHODS

Misreporting of dietary energy, protein, potassium and sodium (assessed by a self-administered diet history questionnaire) was examined against respective biomarkers (estimated energy expenditure and 24-h urinary excretion). Reporting accuracy was calculated as the ratio of reported intake to that estimated from corresponding biomarkers (complete accuracy: 1.00).

RESULTS

Mean reporting accuracy of absolute intake (amount per day) varied considerably (0.86-1.14). Reporting accuracy of absolute intake decreased with increasing BMI (P for trend <0.001). However, no association was observed between reporting accuracy of energy-adjusted values and BMI (P for trend >0.15), indicating that BMI-dependent misreporting was canceled by energy adjustment. This was owing to positive correlation between the reporting accuracy of energy intake and that of absolute intake of the three nutrients (Pearson correlation coefficient: 0.49-0.67, P<0.0001).

CONCLUSIONS

Although differential misreporting of absolute intake was associated with BMI, differential misreporting of energy-adjusted value was not. These findings support the use of energy-adjusted values in the investigation of diet-disease relationships among lean populations with a low-fat intake.

OPEN about obesity: recovery biomarkers, dietary reporting errors and BMI

OBJECTIVE

Obesity-related under-reporting of usual dietary intake is one of the most persistent sources of bias in nutrition research. The aim of this paper is to characterize obese and non-obese individuals with respect to reporting errors observed with two common dietary instruments, using energy and protein recovery biomarkers as reference measures.

POPULATION AND METHODS

This report employs data from the Observing Protein and Energy Nutrition (OPEN) study. Analyses are based on stratified samples of 211 (57 obese) men and 179 (50 obese) women who completed 24-h recalls (24HR), food frequency questionnaires (FFQ), doubly labelled water (DLW) and urinary nitrogen (UN) assessments.

RESULTS

In obese and non-obese subgroups, FFQ yielded lower energy and protein intake estimates than 24HR, although biomarker-based information indicated under-reporting with both dietary instruments. Gender differences in obesity-related bias were noted. Among women, the DLW-based energy requirement was 378 kcal greater in obese than in non-obese groups; the FFQ was able to detect a statistically significant portion of this extra energy, while the 24HR was not. Among men, the DLW-based energy requirement was 485 kcal greater in the obese group; however, neither FFQ nor 24HR detected this difference in energy requirement. Combining protein and energy estimates, obese men significantly over-reported the proportion of energy from protein using the 24HR, but not with the FFQ. In obese women, no significant reporting error for energy percent protein was observed by either method. At the individual level, correlations between energy expenditure and reported energy intake tended to be weaker in obese than non-obese groups, particularly with the 24HR. Correlations between true and reported protein density were consistently higher than for protein or energy alone, and did not vary significantly with obesity.

CONCLUSION

This work adds to existing evidence that neither of these commonly used dietary reporting methods adequately measures energy or protein intake in obese groups. The 24HR, while capturing more realistic energy distributions for usual intake, may be particularly problematic in the obese.

The effect of an increased intake of vegetables and fruit on weight loss, blood pressure and antioxidant defense in subjects with sleep related breathing disorders

OBJECTIVE

To assess the effect of an increased consumption of vegetables and fruit on body weight, risk factors for cardiovascular disease (CVD) and antioxidant defense in obese patients with sleep-related breathing disorders (SRBD).

DESIGN

Randomized, controlled trial of an intervention to increase the intake of vegetables to 400 g/day and fruit to 300 g/day. Dietary intake was calculated from a food frequency questionnaire. Antioxidant status was assessed with the ferric-reducing/antioxidant power (FRAP) assay. Plasma carotenoids were biomarkers for the intake of vegetables and fruit.

SETTING

A hospital clinic preventing risk factors for CVD.

SUBJECTS

Subjects were 103 men and 35 women with a body mass index of 36.7+/-5.8 kg/m(2) of which 57 (86%) in the control and 68 (94%) in the intervention group completed the study.

INTERVENTION

Group-based behavioral program during 3 months.

RESULTS

The mean between group differences in body weight was -2.0% (95% CI -3.6, -0.5), P<0.0001. The mean between group difference in systolic and diastolic blood pressure (BP) was -7.1 mm Hg (95% CI: -11.6, -2.6), P=0.0022 and -3.9 mm Hg (95% CI: -7.0, -0.9), P=0.0120, respectively. The mean change in daily intake of vegetables and fruit was 12 g (95% CI: -33, 57) and -4 g (95% CI: -79, 71) versus 245 g (95% CI: 194, 296) and 248 g (95% CI: 176, 320) in the control and intervention groups, respectively. This was reflected in higher concentrations of alpha-carotene and beta-carotene. No change in FRAP was seen. In a multiple regression analysis the change in intake of vegetables was a significant contributor (R(adj)(2)=0.073 (95% CI: 0.019, 0.214)) to the change in weight.

CONCLUSION

Targeted dietary advice to increase the intake of vegetables and fruit among subjects with SRBD contributed to weight reduction and reduced systolic and diastolic BP, but had no effect on antioxidant defense measured with FRAP.

Conventional energy and macronutrient variables distort the accuracy of children's dietary reports: illustrative data from a validation study of effect of order prompts

OBJECTIVE

Validation-study data are used to illustrate that conventional energy and macronutrient (protein, carbohydrate, fat) variables, which disregard accuracy of reported items and amounts, misrepresent reporting accuracy. Reporting-error-sensitive variables are proposed which classify reported items as matches or intrusions, and reported amounts as corresponding or overreported.

METHODS

58 girls and 63 boys were each observed eating school meals on 2 days separated by > or =4 weeks, and interviewed the morning after each observation day. One interview per child had forward-order (morning-to-evening) prompts; one had reverse-order prompts. Original food-item-level analyses found a sex-x-order prompt interaction for omission rates. Current analyses compared reference (observed) and reported information transformed to energy and macronutrients.

RESULTS

Using conventional variables, reported amounts were less than reference amounts (ps<0.001; paired t-tests); report rates were higher for the first than second interview for energy, protein, and carbohydrate (ps< or =0.049; mixed models). Using reporting-error-sensitive variables, correspondence rates were higher for girls with forward- but boys with reverse-order prompts (ps< or =0.041; mixed models); inflation ratios were lower with reverse- than forward-order prompts for energy, carbohydrate, and fat (ps< or =0.045; mixed models).

CONCLUSIONS

Conventional variables overestimated reporting accuracy and masked order prompt and sex effects. Reporting-error-sensitive variables are recommended when assessing accuracy for energy and macronutrients in validation studies.

The influence of age and body mass index on relative accuracy of energy intake among Japanese adults

OBJECTIVE

To examine relationships between the ratio of energy intake to basal metabolic rate (EI/BMR) and age and body mass index (BMI) among Japanese adults.

DESIGN

Energy intake was assessed by 4-day semi-weighed diet records in each of four seasons (16 days in total). The EI/BMR ratio was calculated from reported energy intake and estimated basal metabolic rate as an indicator of reporting accuracy.

SETTING

Residents in three areas in Japan, namely Osaka (urban), Nagano (rural inland) and Tottori (rural coastal).

SUBJECTS

One hundred and eighty-three healthy Japanese men and women aged > or =30 years.

RESULTS

The oldest age group (> or =60 years) had higher EI/BMR values than the youngest age group (30-39 years) in both sexes (1.74 vs. 1.37 for men; 1.65 vs. 1.43 for women). In multiple regression analyses, age correlated positively (partial correlation coefficient, beta = 0.012, P < 0.001 for men; beta = 0.011, P < 0.001 for women) and BMI correlated negatively (beta = -0.031, P < 0.001 for men; beta = -0.025, P < 0.01 for women) with EI/BMR.

CONCLUSION

Age and BMI may influence the relative accuracy of energy intake among Japanese adults.

Assessment of usual dietary intake in population studies of gene-diet interaction

AIMS

Dietary intake is a critical environmental exposure when considering the effect of many genetic factors on disease risk. However, dietary intake is a complex and changing measure that requires particular care in assessment.

DATA SYNTHESIS

Although weighed diet records can theoretically provide the most accurate assessment of intake, they are usually not realistic in large population studies due to heavy respondent burden, likelihood of poor compliance, and the cost of data entry. Multiple 24-h dietary recalls can provide excellent detail, allowing for diverse dietary practices, but they are costly and require multiple contacts with participants. Food frequency questionnaires are the most cost-effective tool for assessing usual intake, particularly for micronutrients with high day-to-day variability. However, they have limitations for diverse populations and recent studies have questioned their ability to measure macronutrient intakes for assessing diet and disease relationships.

CONCLUSION

At the present time, food frequencies remain the most cost-effective tool for large population studies. However, their limitations must be fully appreciated and demonstration of validity for nutrients of concern in the populations under study is essential. When macronutrients are of key interest, consideration should be given to the use of multiple recalls. Records may be used only in educated and compliant populations. Continued efforts to improve dietary assessment methodology must be investigated.

Can Self-Reported Dieting and Dietary Restraint Identify Underreporters of Energy Intake in Dietary Surveys?

Underreporting is endemic in most dietary studies and ways to reliably identify individuals who may underreport energy intake are needed. Whether questions on self-reported dieting and dietary restraint, in addition to weight status, would identify individuals who may underreport energy intakes was examined in a United Kingdom representative survey. Mean daily energy intake was calculated from the 7-day dietary record of 668 men and 826 women. Reported physical activity was used to assign each subject's activity level and to calculate estimated energy requirements from published equations. Underreporting was calculated as estimated energy requirements minus energy intake with adjustment for daily variation. The Dutch Eating Behavior Questionnaire assessed dietary restraint. Underreporting was higher in men and women reporting current dieting than nondieters (P<0.001) and higher in high-restrained (P<0.001) than low-restrained. When stratified by body mass index category, in men these associations were only significant in the overweight (P<0.001). Dieting was associated with greater underreporting in both lean (P<0.01) and overweight women (P<0.001). Underreporting was higher in lean high-restrained women than low-restrained (P=0.02), but similar in overweight women regardless of restraint score. Questions to assess dietary restraint and current dieting may be useful tools to identify and evaluate underreporting at an individual level in dietary surveys.

Meal size, not body size, explains errors in estimating the calorie content of meals

BACKGROUND

Although most people underestimate the calories they consume during a meal or during the day, calorie underestimation is especially extreme among overweight persons. The reason for this systematic bias is unknown.

OBJECTIVE

To investigate whether the association between calorie underestimation and body mass reflects a tendency for all persons to underestimate calories as the size of a meal increases.

DESIGN

Overweight and normal-weight adults estimated the number of calories of a fast-food meal they had ordered and eaten (study 1) or of 15 fast-food meals that were chosen by the experimenter (study 2) in a randomized, controlled trial. Their estimations were compared with the actual number of calories of the meals.

SETTING

Study 1 was a field study conducted in fast-food restaurants in 3 medium-sized midwestern U.S. cities. Study 2 was conducted in a laboratory at a major U.S. research university.

PARTICIPANTS

Study 1 involved 105 lunchtime diners (average body mass index [BMI], 24.2 kg/m2 [range, 17.2 to 33.5 kg/m2]). Study 2 involved 40 undergraduate students (average BMI, 23.2 kg/m2 [range, 16.1 to 32.3 kg/m2]).

MEASUREMENTS

Participants were asked to estimate the number of calories in a fast-food meal they had ordered and eaten (study 1) or in 15 sizes of the same fast-food meal (study 2). The actual number of calories in the meals in the field study was obtained by unobtrusively recording the food that was ordered (identified from the wrappings and containers). Weight and height were self-reported.

RESULTS

Although participants strongly underestimated the number of calories in larger meals (by -38.0% in study 1 and by -22.6% in study 2), they almost perfectly estimated the number of calories in smaller meals (by -2.9% in study 1 and by 3.0% in study 2). After the authors controlled for body weight-related differences in meal size, the calorie estimations of normal-weight and overweight participants were identical in both studies.

LIMITATIONS

These studies examined fast-food meals. Weight and height were self-reported. There were too few observations to distinguish between obese (BMI > or =30 kg/m2) and overweight (BMI >25 kg/m2 but <30 kg/m2) participants.

CONCLUSIONS

Greater underestimation of calories by overweight persons is a consequence of their tendency to consume larger meals. Calorie underestimation is related to meal size, not body size.

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

BACKGROUND

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.

OBJECTIVE

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.

DESIGN

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.

RESULTS

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.

CONCLUSIONS

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.

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.

Dietary restraint and disinhibition do not affect accuracy of 24-hour recall in a multiethnic population

Some psychological predictors of eating behaviors have been shown to affect usefulness of methods for dietary assessment. Therefore, this study was conducted to determine the association of dietary restraint and disinhibition with dietary recall accuracy for total energy, fat, carbohydrate, and protein. In a cross-sectional study, data were obtained from 79 male and 71 female non-Hispanic whites and African-American volunteers. Participants selected and consumed all foods for a 1-day period under observation and actual intake was determined. The following day, each participant completed a telephone 24-hour recall using the US Department of Agriculture Multiple-Pass method to obtain recalled intake. The Eating Inventory, which measures dietary restraint and disinhibition, was administered prior to eating any food in the study. Repeated measures analyses of variance were used to determine if dietary restraint or disinhibition were independent predictors of recall accuracy. The mean (+/-standard deviation) age and body mass index of the participants was 43+/-12 years and 29+/-5.5 (calculated as kg/m2), respectively. On average, men overreported intake of energy by 265 kcal and women by 250 kcal; both groups also overreported intake of protein, carbohydrate, and fat. When controlling for body mass index, sex, and race, restraint was a significant independent predictor of energy intake (P=0.004) and negatively correlated with energy intake (r=-0.23, P<0.001). Unlike intake of carbohydrate or protein, fat intake was significantly and negatively associated with dietary restraint (P<0.001; r=-0.3). Dietary restraint did not affect accuracy of recall of intake of energy, fat, carbohydrate, or protein, but was significantly associated with intake of energy and fat. Disinhibition was not related to intake or accuracy. Dietetics professionals should consider dietary restraint a possible reason for a lower than expected estimate of energy intake when using 24-hour recalls.

Validation of a pre-coded food diary used among 13-year-olds: comparison of energy intake with energy expenditure

OBJECTIVE

To validate energy intake (EI) estimated from pre-coded food diaries against energy expenditure (EE) measured with a validated position-and-movement monitor (ActiReg) in groups of 13-year-old Norwegian schoolchildren.

DESIGN

Two studies were conducted. In study 1 the monitoring period was 4 days; participants recorded their food intake for four consecutive weekdays using food diaries and wore the ActiReg during the same period. In study 2 the monitoring period was 7 days; participants recorded their food intake for four consecutive days but wore the ActiReg for a whole week.

SETTINGS

Participants were recruited from grade 8 in a school in and one outside Oslo (Norway).

SUBJECTS

Forty-one and 31 participants from study 1 and 2, respectively, completed the study.

RESULTS

The group average EI was 34% lower than the measured EE in study 1 and 24% lower in study 2. The width of the 95% confidence limits of agreement in a Bland-Altman plot for EI and EE varied from -0.2 MJ to 8.2 MJ in study 1 and from -2.3 MJ to 6.9 MJ in study 2. The Pearson correlation coefficients between reported energy intake and expenditure were 0.47 (P=0.002) in study 1 and 0.74 (P<0.001) in study 2.

CONCLUSION

The data showed that there was substantial variability in the accuracy of the food diary at the individual level. Furthermore, the diary underestimated the average energy intake. The ability of the food diary to rank individuals according to energy intake was found to be good in one of the studies and moderate in the other.

Evaluation of dietary intake data using the tolerable upper intake levels

We discuss the problem of assessing nutrient intake relative to the tolerable upper intake levels (UL) for the nutrient proposed by the Institute of Medicine and focus on 2 important topics: the estimation of usual nutrient intake distributions and the extent to which intakes above the UL can be considered risky. With the information that is currently available for most nutrients, it is not possible to estimate the proportion of individuals in a group with intakes that place them at risk. This is because the shape of the dose-response curve needed to carry out a risk assessment is unknown for most nutrients. Thus, intakes above UL cannot be declared to be unsafe. Intakes below the UL, however, are likely to pose no risk to individuals in the group. Because determining the proportion of individuals with intakes below the UL requires estimation of an upper-tail percentile of the intake distribution, the use of 1-d intake data or otherwise unadjusted intake data are likely to lead to severely biased estimates. It is important to remove within-individual variance in intakes from daily intakes so that the tails of the usual intake distribution are accurately estimated. Underreporting of the amount of nutrients consumed will tend to shift the estimated usual nutrient intake distribution downwards. In this case, the true proportion of individuals with intakes below the UL is likely to be overestimated.

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.

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.

Snacks as an element of energy intake and food consumption

BACKGROUND

An increasing frequency of snacks has been observed in meal pattern studies. Snacks can alter the diet because of their high-energy density and low-nutrient content or on the contrary.

OBJECTIVE

The prominence of snacks in energy intake and food consumption was assessed.

DESIGN

Dietary data were collected for 2007 adults by using a computer-assisted 48-h dietary recall in the national FINDIET 2002 survey. Energy intakes and food consumption were aggregated for snacks and for main meals.

RESULTS

Daily energy was mostly derived from main meals comprising traditional mixed dishes, milk and bread. However, a snack-dominating meal pattern was observed in 19% of men and 24% of women. This meal pattern was associated with urbanization in both genders and with physical work in men. Higher sucrose intake and lower intake of micronutrients were typical of the snack-dominating meal pattern compared to the others.

CONCLUSIONS

As snacks appear to have a higher energy density and a lower content of micronutrients than main meals, a snack-dominating meal pattern is inadvisable. However, further studies are needed to examine the association between meal pattern and health status.

Does contextual information influence positive and negative schizotypy scores in healthy individuals? The answer is maybe

Defensive responding in schizotypy questionnaires might depend on context. Students completed a schizotypy questionnaire in a "psychiatric" context or a "creativity" context. Positive, but not negative, schizotypy scores were lower in the psychiatry than in the creativity group, but findings applied mainly to male participants. The implications of these findings are critically discussed.

Cognitive restraint is associated with higher intake of vegetables in a sample of university students

The main objective of this study was to determine the association between cognitive restraint, nutritional intake and eating patterns in free-leaving subjects. We administered a questionnaire that included information about eating behaviour (restraint, disinhibition, and hunger), dietary intake, and physical activity; 380 students (60% female) completed the study. The association of restraint (low/high) and disinhibition (low/high) with dietary intake was tested using MANOVA in a 2x2 factorial design. Statistically significant main effects were further analyzed using ANOVAs. To identify eating patterns, factorial analysis was employed. Among women, high restrainers reported lower consumption of energy, pastry, and starchy foods, and higher consumption of vegetables, and fish, than low restrainers. In male subjects, high restrainers consumed significantly more vegetables than low restrainers. The major food pattern in female restrainers aggregate: higher consumption of legumes and fruit intake; and lower consumption of pastry, sugar, and starchy foods. In restrained men, the more important food pattern consists of vegetable soup, fruit, milk, and eggs. These differences should be considered in clinical interventions for individuals seeking a better body weight control.

Is energy intake underestimated in nondialyzed chronic kidney disease patients?

OBJECTIVE

To evaluate whether energy intake of nondialyzed chronic kidney disease (CKD) patients is underestimated.

DESIGN

Cross-sectional study.

SETTING

Outpatient clinic of the Federal University of Sao Paulo, Oswaldo Ramos Foundation.

PATIENTS

One hundred and thirty-one nondialyzed CKD patients (86 male, 66%; body mass index [BMI] 26 +/- 4.21, mean +/- standard deviation) were included. Body weight change was evaluated after 6 to 12 months in 59 patients of the entire group.

METHODS

Energy intake was evaluated using 4-day food diaries (3 weekdays and 1 weekend day), and resting energy expenditure (REE) was measured by indirect calorimetry. The ratio of energy intake to REE (EI/REE) was used to evaluate the accuracy of the recorded energy intake. An EI/REE ratio below 1.27 was used to identify patients who were underreporting their current energy intake.

RESULTS

The majority of the patients reported an energy intake substantially below the recommendation (22.4 +/- 7.15 kcal/kg/d) and had an EI/REE ratio lower than 1.27. In patients with a BMI >or= 25, the mean EI/REE ratio was significantly lower than that of patients with a BMI < 25 (1.01 +/- 0.28 versus 1.27 +/- 0.42, P < .01, respectively). In addition, only in the group with higher BMI was the mean ratio indicative of underreporting. When the body weight of a subgroup of patients (n = 59) was evaluated after 7.9 +/- 2.4 months, it was observed that the subgroup of patients who maintained or gained body weight had a mean EI/REE not compatible with this condition (1.13 +/- 0.38). The low ratio, despite increasing or maintaining body weight, is highly suggestive of underreported energy intake.

CONCLUSION

Energy intake of nondialyzed CKD patients seemed to be underestimated and was more pronounced in overweight and obese patients.