Impact of interviewer's body mass index on underreporting energy intake in overweight and obese women

Food Insecurity is Associated with Maladaptive Eating Behaviors and Objectively Measured Overeating

OBJECTIVE

The association between food insecurity and obesity may be partially explained by overeating in response to unpredictable food availability cycles. The aim of this study was to measure objective food intake in food-insecure individuals.

METHODS

Eighty-two volunteers (53 m; BMI 29 ± 7; 38 ± 12 years) were admitted to our inpatient Clinical Research Unit and completed the Food Security Short Form, Three-Factor Eating Questionnaire, Gormally Binge Eating Scale, and body composition assessment (dual-energy x-ray absorptiometry). After 5 days of a weight-maintaining diet, participants self-selected food from an ad libitum vending machine paradigm for 3 days. Mean daily intake (kilocalories), macronutrient intake, and percentage of weight-maintaining energy needs (%WMEN) were calculated.

RESULTS

Based on Food Security Short Form cutoffs, food-insecure participants (n = 46; 56%) had higher body weight (P = 0.04), fat-free mass (P = 0.05), disinhibition (P = 0.008), hunger (P = 0.02), and binge-eating scores (P = 0.02) but not cognitive restraint (P = 0.37) compared with food-secure individuals. They overate more kilocalories (P = 0.001), %WMEN (P = 0.003), fat (P = 0.003), and carbohydrates (P = 0.004) during the vending machine paradigm, continued to increase their hourly rate of kilocalories (group × time; β = 37.7 cumulative kcal/h; P < 0.0001), and ate more total kilocalories across the 72 hours (β = 47.09 kcal/h; P = 0.003).

CONCLUSIONS

Food insecurity may amplify susceptibility to weight gain via overeating during times of unlimited food access.

Dietary underreporting in women affected by polycystic ovary syndrome: A pilot study

AIM

The first-line therapy for polycystic ovary syndrome (PCOS) is weight loss focussing on diet and regular exercise; measurement of diet and energy intake (EI) is important to determine associations between nutrients and health in women with PCOS. The EI underreporting (UR) is a condition characterised by reports of habitual EI that is implausibly low, compared with estimated requirements. This case-control study aims to evaluate UR in women with PCOS.

METHODS

Thirty-six women with PCOS were enrolled according to the Rotterdam criteria; 37 healthy women were enrolled as controls.

INCLUSION CRITERIA

age range 18-45 and body mass index ≥18.5 kg/m² in subjects without eating disorders and/or diabetes mellitus. Nutritional assessment included: anthropometry, basal metabolic rate (BMR), weight history and physical activity assessment. Subjects completed a non-consecutive three-day dietary diary to identify energy and macronutrient intake. UR was calculated (Goldberg Index: EI/BMR).

RESULTS

Although women with PCOS reported a significantly higher mean BMR than controls (P < 0.0001), their EI was lower (P < 0.001), suggesting an UR in 47.2% of women with PCOS versus 2.7% of controls (P < 0.0001). The EI from simple sugars was lower in women with PCOS than controls (P < 0.01). The protein intake was increased in controls than women with PCOS (P < 0.0001). Weight cycling was more frequent in women with PCOS (P < 0.001). Logistic regression analysis identified UR associated with PCOS (P = 0.001).

CONCLUSIONS

Women with PCOS underreport foods rich in simple sugars rather than underreport their total dietary intake. These results may have implications for the interpretation of diet and health correlations in this patient population.

High Fat and Sugar Consumption During Ad Libitum Intake Predicts Weight Gain

OBJECTIVE

To determine how macronutrients accompanying foods with high energy density (EnDen) affect energy intake and weight gain.

METHODS

A total of 214 subjects (130 males, BMI: 32 ± 7 kg/m² ) ate ad libitum for 3 days. Food intake was expressed as the mean daily intake (in kilocalories) and the percentage of weight-maintaining energy needs (%WMEN). EnDen was expressed as the ratio of intake (in kilocalories) to food weight (in grams). Food choices were expressed as absolute and percent intake (kilocalories), categorized as high in fat (HF; ≥ 45% kcal) or low in fat (LF; < 20% kcal), and further categorized as high in complex carbohydrates (≥ 30% kcal), high in simple sugars (HSS; ≥ 30% kcal), or high in protein (HP; ≥ 13% kcal). Follow-up weights were available from 99 subjects (65 males, range: 6 months to 11 years).

RESULTS

EnDen was associated with BMI (r = 0.28, P < 0.0001), percent body fat (r = 0.18, P = 0.007), and percent intake from HF/HP (r = 0.34, P < 0.0001), HF/HSS (r = 0.31, P < 0.0001), LF/HP (r = -0.37, P < 0.0001) and LF/HSS (r = -0.68, P < 0.0001). The %WMEN was associated with EnDen (r = 0.16, P = 0.01), HF/HSS (r = 0.33, P < 0.0001), and LF/HP intake (r = -0.25, P = 0.0002). In a multivariate model, only HF/HSS intake remained a significant predictor of %WMEN (β = 1.4% per 1% change, P < 0.0001). The percent intake from HF/HSS (r = 0.23, P = 0.02), not EnDen (P = 0.54), was associated with weight gain, even after adjusting for follow-up time (in years) and covariates.

CONCLUSIONS

Relatively greater consumption of HF/HSS foods independently predicted overeating and weight gain. Nutrient compositions of high-EnDen foods may be important for weight management.

People with a body mass index ⩾30 under-report their dietary intake: A systematic review

Under-reporting of total energy intake is a common and well-known source of measurement error in dietary assessment, and evidence suggests that this bias is particularly significant in obese individuals. After a multi-stage selection process of eligible papers, this literature review appraised 34 papers detailing the accuracy of self-reported dietary intake in people with an obese body mass index (BMI ⩾ 30). The available literature to date shows that having a body mass index ⩾30 is associated with significant under-reporting of food intake. Future research should look into identifying effective techniques to reduce this bias in clinical practice.

Resistance training is associated with spontaneous changes in aerobic physical activity but not overall diet quality in adults with prediabetes

BACKGROUND

Aerobic exercise interventions have been shown to result in alterations to dietary intake and non-exercise physical activity (PA). To date, the ability for resistance training (RT) to influence other health-related behaviors has not been examined. This study aimed to determine if initiation and maintenance of RT is associated with spontaneous changes in dietary quality and non-RT PA in adults with prediabetes.

METHODS

Overweight/obese adults (n=170, BMI=32.9±3.8kg·m², age=59.5±5.5years, 73% female) with prediabetes were enrolled in the 15-month Resist Diabetes trial. Participants completed a supervised 3-month RT initiation phase followed by a 6-month maintenance phase and a 6-month no-contact phase. Participants were not encouraged to change eating or non-RT PA behaviors. At baseline, and months 3, 9, and 15, three 24-hour diet recalls were collected to evaluate dietary intake and quality, the Aerobics Institute Longitudinal Study Questionnaire was completed to evaluate non-RT PA, and body mass, body composition (DXA), and muscular strength were measured. At months 3, 9, and 15 social cognitive theory (SCT) constructs were assessed with a RT Health Beliefs Questionnaire. Mixed effects models were used to assess changes in dietary intake and non-RT PA over the 15-month study period.

RESULTS

Energy and carbohydrate intake decreased with RT initiation and maintenance phases (baseline to month 9: β=-87.9, p=0.015 and β=-16.3, p<0.001, respectively). No change in overall dietary quality (Healthy Eating Index [HEI]-2010 score: β=-0.13, p=0.722) occurred, but alterations in HEI-2010 sub-scores were detected. Maintenance of RT was accompanied by an increase in MET-min/week of total non-RT PA (month 3 to month 9: β=146.2, p=0.01), which was predicted by increased self-regulation and decreased negative outcome expectancies for RT (β=83.7, p=0.014 and β=-70.0, p=0.038, respectively).

CONCLUSIONS

Initiation and maintenance of RT may be a gateway behavior leading to improvements in other health-related behaviors. These results provide rationale for single-component lifestyle interventions as an alternative to multi-component interventions, when resources are limited.

The relationship between dietary intake and energy availability, eating attitudes and cognitive restraint in students enrolled in undergraduate nutrition degrees

The aim of this research was to explore the relationship of total energy and macronutrient intake, energy balance and energy availability to eating attitudes and cognitive restraint in students enrolled in undergraduate nutrition degrees. Energy and micronutrient intake was assessed in 63 students (n = 50 nutrition, and n = 13 occupation therapy degrees; n = 51 females, n = 12 males) using three 24-h dietary recalls. Energy requirements were calculated based on measured resting metabolic rate, estimated exercise energy expenditure, and dietary induced thermogenesis. Body composition was assessed using dual energy x-ray absorptiometry. Eating attitudes and cognitive restraint were measured using previously validated tools. Eighteen percent of nutrition students were classified as having low energy availability (<30 kcal kgFFM^-1d^-1) and 38% were in negative energy balance. Eating attitudes and cognitive restraint were not associated with total energy or macronutrient intake. However, female nutrition students with high cognitive restraint had greater exercise energy expenditure and thus lower energy availability than those with low cognitive restraint (371 (302) kcal d^-1 compared to 145 (206) kcal d^-1, P < 0.01, and 35 (7) kcal d^-1 compared to 41 (10) kcal d^-1 of fat free mass, P = 0.005). Additionally, in females, disordered eating attitudes and cognitive restraint negatively correlated with energy availability (r_s = -0.37, P = 0.02 and r_s = -0.51, P < 0.01 respectively). There were no differences in outcomes between nutrition and non-nutrition students. The current study suggests that those students with disordered eating attitudes and cognitive restraint may be controlling their energy balance through exercise, as opposed to restricting food intake.

Interviewer BMI effects on under- and over-reporting of restrained eating: evidence from a national Dutch face-to-face survey and a postal follow-up

Objectives

To determine the effect of interviewer BMI on self-reported restrained eating in a face-to-face survey and to examine under- and over-reporting using the face-to face study and a postal follow-up.

Methods

A sample of 1,212 Dutch adults was assigned to 98 interviewers with different BMI who administered an eating questionnaire. To further evaluate misreporting a mail follow-up was conducted among 504 participants. Data were analyzed using two-level hierarchical models.

Results

Interviewer BMI had a positive effect on restrained eating. Normal weight and pre-obese interviewers obtained valid responses, underweight interviewers stimulated under-reporting whereas obese interviewers triggered over-reporting.

Conclusion

In face-to-face interviews self-reported dietary restraint is distorted by interviewer BMI. This result has implications for public health surveys, the more so given the expanding obesity epidemic.

Assessment of energy and macronutrient intake in young men: a comparison of 4-day food record and 24-hour dietary recall

OBJECTIVE: The objective was to assess the quantitative agreement between a 4-day food record and a 24-hour dietary recall in young men. METHODS: Thirty-four healthy men aged 18-25 years had their food intake estimated by 4-day food record within one week following 24-hour dietary recall in a cross-sectional study. Resting metabolic rate was assessed by indirect calorimetry and Energy Expenditure was estimated by physical activity records completed simultaneously with food intake records. The validity of food records was determined by direct comparison of Energy Intake and Energy Expenditure (95% confidence interval for Energy Intake/Energy Expenditure). RESULTS: There were good agreements between the measurements of energy and macronutrient intakes by 24-hour dietary recall and 4-day food record at the group level, but not at the individual level. Compared to energy expenditure, about 20% and 9% of participants underreported their Energy Intake by 4-day food record and 24-hour dietary recall, respectively. Over 30% of underreporters of Energy Intake estimated by 24-hour dietary recall underreported Energy Intake estimated by 4-day food record. CONCLUSION: Both diet methods, 24-hour dietary recall and 4-day food record, may be used to collect data at the group level, but not at the individual level. Both methods, however, appear to underestimate Energy Intake. Underreporting may be subject-specific and appears that is more difficult to retrieve valid dietary data from some people than others.

Misreporting of energy and micronutrient intake estimated by food records and 24 hour recalls, control and adjustment methods in practice

In order to assess nutritional adequacy, valid estimates of nutrient intake are required. One of the main errors in dietary assessment is misreporting. The objective was to review the extent, nature and determinants of misreporting in dietary assessment, how this affects reported intakes of micronutrients and how this is identified and measured, and to identify the best ways of dealing with misreporting when interpreting results. A systematic literature search was conducted for studies of misreporting of dietary intake in adults by 24 hour recalls or by estimated or weighed food records, published up to March 2008. Thirty-seven relevant studies were identified. Possible causes of misreporting were identified. Methods most used to identify misreporting were the Goldberg cut-off (46 % studies) and the doubly labelled water technique (24 % studies). The magnitude of misreporting of energy intake was similar in all three dietary assessment methods. The percentage of under-reporters was about 30 % and energy intake was underestimated by approximately 15 %. Seven papers presented usable data for micronutrient intake. Absolute intakes of Fe, Ca and vitamin C (the three micronutrients addressed in all papers) were on average 30 % lower in low-energy reporters (LER) than that in non-LER and, although results were not consistent, there was a tendency for micronutrient density to be higher in LER. Excluding underreporters or using energy adjustment methods for micronutrient intakes is discussed. Residual method of energy adjustment seems to be a good tool for practice to decrease an influence of misreporting when interpreting results of studies based on food records and 24 hour recalls.

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.

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.

Personality characteristics as predictors of underreporting of energy intake on 24-hour dietary recall interviews

OBJECTIVE

To identify characteristics associated with misreporting of energy intake during 24-hour dietary recalls (24 HR).

DESIGN

Ninety-eight subjects were administered two 24 HRs. Energy expenditure was determined by doubly labeled water (44 subjects) or intake balance (54 subjects). Data on subjects' physical, lifestyle, and psychosocial characteristics were also collected. Subjects/setting At the Beltsville Human Nutrition Research Center 52 women and 46 men were administered 24HR and completed lifestyle and personality questionnaires and a memory test. Physical characteristics such as weight, percent body fat, and total energy expenditure were measured. Statistical analysis The influences of subject parameters on energy misreporting were assessed by linear regression and Pearson product-moment correlation analysis for continuous variables and by ANOVA for discrete variables. Stepwise regression was used to identify key factors in underreporting.

RESULTS

Factors particularly important in predicting underreporting of energy intake include factors indicating dissatisfaction with body image; for example, a 398 kcal/day underreport in subjects attempting weight loss during the past year with a nearly 500 kcal/day underreport in women. Overall, women underreported by 393 kcal/day relative to men and women evinced a social desirability bias amounting to a 26 kcal underreport for each point on the social desirability scale. Gender differences also were evident in the effect of percent body fat (with men underreporting about 16 kcal/day/percent body fat) and in departure from self-reported ideal body weight (with women underreporting about 21 kcal/day/kg).

APPLICATIONS/CONCLUSIONS

Body image and fatness are key factors on which health professionals should focus when seeking predictors of underreporting of dietary intake. Dietary interviews must be conducted to minimize bias related to subjects' tendencies to win approval and avoid censure by the interviewer. In addition, dissatisfaction with body image may lead to underestimation of food intake, therefore reducing likelihood of success in weight loss. Thus, health care professionals involved in weight loss counseling may achieve better success if treatment includes generating a more positive body image.