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Pre-pregnancy BMI, gestational weight gain and body image are associated with dietary under-reporting in pregnant Japanese women

  • Mie Shiraishi (a1), Megumi Haruna (a2), Masayo Matsuzaki (a1), Ryoko Murayama (a3) and Satoshi Sasaki (a4)...

Dietary under-reporting is a common problem when using self-reported dietary assessment tools. However, there are few studies regarding under-reporting during pregnancy. This study aimed to explore the demographic and psychosocial characteristics related to dietary under-reporting in pregnant Japanese women. A cross-sectional study was conducted between 2010 and 2011 at a university hospital in Tokyo, Japan. Nutrient intake was assessed using a self-administered Diet History Questionnaire (DHQ), which had questions about the consumption frequency and portion size of selected food items. The 24-h urinary excretion levels of urea N and K were used as the dietary protein and K intake reference values, respectively. Under-reporting of protein and K was defined as the bottom 25 % of the reporting accuracy (the ratio of reported intake on the DHQ to the estimated intake based on urinary excretion). Under-reporters were defined as participants who under-reported both protein and K intake. Multiple logistic regression analysis was performed to examine the factors associated with under-reporters. Of 271 healthy women at 19–23 weeks of gestation, thirty-five participants (12·9 %) were identified as under-reporters. Under-reporters had a lower pre-pregnancy BMI (adjusted OR (AOR) = 0·81) and lower gestational weight gain (AOR = 0·82); they also reported managing their gestational weight gain with the aim to return to their pre-pregnancy weight soon after childbirth (AOR = 2·99). Healthcare professionals should consider the potential for dietary under-reporting and the possible related factors when assessing the dietary intakes of pregnant Japanese women using self-administered questionnaires.

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This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (, which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
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*Corresponding author: Mie Shiraishi, email
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1.Johansson, L, Solvoll, K, Bjørneboe, GE, et al. (1998) Under- and overreporting of energy intake related to weight status and lifestyle in a nationwide sample. Am J Clin Nutr 68, 266274.
2.Yannakoulia, M, Panagiotakos, DB, Pitsavos, C, et al. (2007) Low energy reporting related to lifestyle, clinical, and psychosocial factors in a randomly selected population sample of Greek adults: the ATTICA Study. J Am Coll Nutr 26, 327333.
3.Black, AE, Goldberg, GR, Jebb, SA, et al. (1991) Critical evaluation of energy intake data using fundamental principles of energy physiology: 2. Evaluating the results of published surveys. Eur J Clin Nutr 45, 583599.
4.Winkvist, A, Persson, V & Hartini, TN (2002) Underreporting of energy intake is less common among pregnant women in Indonesia. Public Health Nutr 5, 523529.
5.Nowicki, E, Siega-Riz, AM, Herring, A, et al. (2011) Predictors of measurement error in energy intake during pregnancy. Am J Epidemiol 173, 560568.
6.McGowan, CA & McAuliffe, FM (2012) Maternal nutrient intakes and levels of energy underreporting during early pregnancy. Eur J Clin Nutr 66, 906913.
7.Hébert, JR, Clemow, L, Pbert, L, et al. (1995) Social desirability bias in dietary self-report may compromise the validity of dietary intake measures. Int J Epidemiol 24, 389398.
8.Lafay, L, Basdevant, A, Charles, MA, et al. (1997) Determinants and nature of dietary underreporting in a free-living population: the Fleurbaix Laventie Ville Santé (FLVS) Study. Int J Obes Relat Metab Disord 21, 567573.
9.Briefel, RR, Sempos, CT, McDowell, MA, et al. (1997) Dietary methods research in the third National Health and Nutrition Examination Survey: underreporting of energy intake. Am J Clin Nutr 65, 1203S1209S.
10.Taren, DL, Tobar, M, Hill, A, et al. (1999) The association of energy intake bias with psychological scores of women. Eur J Clin Nutr 53, 570578.
11.Scagliusi, FB, Polacow, VO, Artioli, GG, et al. (2003) Selective underreporting of energy intake in women: magnitude, determinants, and effect of training. J Am Diet Assoc 103, 13061313.
12.Tooze, JA, Subar, AF, Thompson, FE, et al. (2004) Psychosocial predictors of energy underreporting in a large doubly labeled water study. Am J Clin Nutr 79, 795804.
13.Okubo, H & Sasaki, S (2004) Underreporting of energy intake among Japanese women aged 18–20 years and its association with reported nutrient and food group intakes. Public Health Nutr 7, 911917.
14.Okubo, H, Sasaki, S, Hirota, N, et al. (2006) The influence of age and body mass index on relative accuracy of energy intake among Japanese adults. Public Health Nutr 9, 651657.
15.Okubo, H, Sasaki, S, Rafamantanantsoa, HH, et al. (2008) Validation of self-reported energy intake by a self-administered diet history questionnaire using the doubly labeled water method in 140 Japanese adults. Eur J Clin Nutr 62, 13431350.
16.Murakami, K, Sasaki, S, Okubo, H, et al. (2012) Characteristics of under- and over-reporters of energy intake among young Japanese women. J Nutr Sci Vitaminol 58, 253262.
17.Stallone, DD, Brunner, EJ, Bingham, SA, et al. (1997) Dietary assessment in Whitehall II: the influence of reporting bias on apparent socioeconomic variation in nutrient intakes. Eur J Clin Nutr 51, 815825.
18.Pomerleau, J, Ostbye, T & Bright-See, E (1999) Potential underreporting of energy intake in the Ontario Health Survey and its relationship with nutrient and food intakes. Eur J Epidemiol 15, 553557.
19.Horner, NK, Patterson, RE, Neuhouser, ML, et al. (2002) Participant characteristics associated with errors in self-reported energy intake from the Women's Health Initiative food-frequency questionnaire. Am J Clin Nutr 76, 766773.
20.Voss, S, Kroke, A, Klipstein-Grobusch, K, et al. (1997) Obesity as a major determinant of underreporting in a self-administered food frequency questionnaire: results from the EPIC-Potsdam Study. Z Ernahrungswiss 36, 229236.
21.Samaras, K, Kelly, PJ & Campbell, LV (1999) Dietary underreporting is prevalent in middle-aged British women and is not related to adiposity (percentage body fat). Int J Obes Relat Metab Disord 23, 881888.
22.Kretsch, MJ, Fong, AK & Green, MW (1999) Behavioral and body size correlates of energy intake underreporting by obese and normal-weight women. J Am Diet Assoc 99, 300308.
23.Lanctot, JQ, Klesges, RC, Stockton, MB, et al. (2008) Prevalence and characteristics of energy underreporting in African-American girls. Obesity 16, 14071412.
24.Walker, LO, Cooney, AT & Riggs, MW (1999) Psychosocial and demographic factors related to health behaviors in the 1st trimester. J Obstet Gynecol Neonatal Nurs 28, 606614.
25.Takimoto, H, Mitsuishi, C & Kato, N (2011) Attitudes toward pregnancy related changes and self-judged dieting behavior. Asia Pac J Clin Nutr 20, 212219.
26.Shiraishi, M, Haruna, M, Matsuzaki, M, et al. (2017) Availability of two self-administered diet history questionnaires for pregnant Japanese women: a validation study using 24-hour urinary markers. J Epidemiol 27, 172179.
27.Ainslie, P, Reilly, T & Westerterp, K (2003) Estimating human energy expenditure: a review of techniques with particular reference to doubly labelled water. Sports Med 33, 683698.
28.Goldberg, GR, Prentice, AM, Coward, WA, et al. (1993) Longitudinal assessment of energy expenditure in pregnancy by the doubly labeled water method. Am J Clin Nutr 57, 494505.
29.Macdiarmid, J & Blundell, J (1998) Assessing dietary intake: who, what and why of under-reporting. Nutr Res Rev 11, 231253.
30.Murakami, K, Sasaki, S, Takahashi, Y, et al. (2008) Misreporting of dietary energy, protein, potassium and sodium in relation to body mass index in young Japanese women. Eur J Clin Nutr 62, 111118.
31.Sasaki, S, Yanagibori, R & Amano, K (1998) Self-administered diet history questionnaire developed for health education: a relative validation of the test-version by comparison with 3-day diet record in women. J Epidemiol 8, 203215.
32.Sasaki, S, Yanagibori, R & Amano, K (1998) Validity of a self-administered diet history questionnaire for assessment of sodium and potassium: comparison with single 24-hour urinary excretion. Jpn Circ J 62, 431435.
33.Sasaki, S, Ushio, F, Amano, K, et al. (2000) Serum biomarker-based validation of a self-administered diet history questionnaire for Japanese subjects. J Nutr Sci Vitaminol 46, 285296.
34.Kobayashi, S, Honda, S, Murakami, K, et al. (2012) Both comprehensive and brief self-administered diet history questionnaires satisfactorily rank nutrient intakes in Japanese adults. J Epidemiol 22, 151159.
35.Ministry of Health, Labor and Welfare (2009) Dietary Reference Intakes for Japanese, 2010, presented by the Ministry of Health, Labor, May 29, 2009. (accessed August 2017).
36.Sasaki, S, Katagiri, A, Tsuji, T, et al. (2003) Self-reported rate of eating correlates with body mass index in 18-y-old Japanese women. Int K Obes Relat Metab Disord 27, 14051410.
37.Cardiovascular Disease and Alimentary Comparison (CARDIAC) Study (1986) Shimane/Geneva: CARDIAC Study Protocol and Manual of Operations. Geneva: WHO Collaborating Center on Primary Prevention of Cardiovascular Diseases, and Cardiovascular Disease Unit.
38.Kitamura, T & Suzuki, T (1986) Japanese version of social desirability scale (article in Japanese). Jpn J Soc Psychiatry 9, 173180.
39.Crowne, DP & Marlowe, D (1960) A new scale of social desirability independent of psychopathology. J Consul Psychol 24, 341354.
40.Martin, HJ (1984) A revised measure of approval motivation and its relationship to social desirability. J Pers Assess 48, 508519.
41.Ueda, S & Yoshimori, M (1991) An attempt to make the Japanese version of the Martin–Larsen Approval Motivation Scale. In Annual Report of Studies of Department of Education, Hiroshima University, vol. 39, pp. 151–156 (in Japanese).
42.Sakano, Y & Tohjoh, M (1986) The General Self-Efficacy Scale (GSES): scale development and validation (article in Japanese). Jpn J. Behav Ther 12, 7382.
43.Labs, SM & Wurtele, SK (1986) Fetal Health Locus of Control Scale; development and validation. J Consult Clin Psychol 54, 814819.
44.Manabe, E, Hayashi, E, Seto, M, et al. (2001) An attempt to make the Japanese version of the Fetal Health Locus of Control Scale (article in Japanese). Quality Nursing 7, 417425.
45.Bingham, SA & Cummings, JH (1985) Urine nitrogen as an independent validatory measure of dietary intake: a study of nitrogen balance in individuals consuming their normal diet. Am J Clin Nutr 42, 12761289.
46.Mojtahedi, M, de Groot, LC, Boekholt, HA, et al. (2002) Nitrogen balance of healthy Dutch women before and during pregnancy. Am J Clin Nutr 75, 10781083.
47.Tasevska, N, Runswick, SA & Bingham, SA (2006) Urinary potassium is as reliable as urinary nitrogen for use as a recovery biomarker in dietary studies of free living individuals. J Nutr 136, 13341340.
48.Hytten, FE & Leitch, I (1971) Dietary requirements and dietary intake. In The Physiology of Human Pregnancy, pp. 409439 [Hytten, F and Leitch, I, editors]. Oxford: Blackwell Scientific Publications.
49.Zhang, J, Temme, EH, Sasaki, S, et al. (2000) Under- and overreporting of energy intake using urinary cations as biomarkers: relation to body mass index. Am J Epidemiol 152, 453462.
50.Black, AE, Welch, AA & Bingham, SA (2000) Validation of dietary intakes measured by diet history against 24 h urinary nitrogen excretion and energy expenditure measured by the doubly-labelled water method in middle-aged women. Br J Nutr 83, 341354.
51.Yates, A, Edman, J & Aruguete, M (2004) Ethnic differences in BMI and body/self-dissatisfaction among Whites, Asian subgroups, Pacific Islanders, and African-Americans. J Adolesc Health 34, 300307.
52.Pinto, E, Severo, M, Correia, S, et al. (2010) Validity and reproducibility of a semi-quantitative food frequency questionnaire for use among Portuguese pregnant women. Matern Child Nutr 6, 105119.
53.Kosa, JL, Guendelman, S, Pearl, M, et al. (2011) The association between pre-pregnancy BMI and preterm delivery in a diverse southern California population of working women. Matern Child Health J 15, 772781.
54.Hayashi, F, Takimoto, H, Yoshita, K, et al. (2006) Perceived body size and desire for thinness of young Japanese women: a population-based survey. Br J Nutr 96, 11541162.
55.Sugawara, A, Saito, K, Sato, M, et al. (2009) Thinness in Japanese young women. Epidemiology 20, 464465.
56.O'Brien, B & Naber, S (1992) Nausea and vomiting during pregnancy: effects on the quality of women's lives. Birth 19, 138143.
57.Lyu, LC, Lo, CC, Chen, HF, et al. (2009) A prospective study of dietary intakes and influential factors from pregnancy to postpartum on maternal weight retention in Taipei, Taiwan. Br J Nutr 102, 18281837.
58.Bathalon, GP, Tucker, KL, Hays, NP, et al. (2000) Psychological measures of eating behavior and the accuracy of 3 common dietary assessment methods in healthy postmenopausal women. Am J Clin Nutr 71, 739745.
59.Rennie, KL, Siervo, M & Jebb, SA (2006) Can self-reported dieting and dietary restraint identify underreporters of energy intake in dietary surveys? J Am Diet Assoc 106, 16671672.
60.Hébert, JR, Peterson, KE, Hurley, TG, et al. (2001) The effect of social desirability trait on self-reported dietary measures among multi-ethnic female health center employees. Ann Epidemiol 11, 417427.
61.Ministry of Health, Labor and Welfare (2015) Vital Statistics. (accessed August 2017).
62.Rand, WM, Scrimshaw, NS & Young, VR (1981) Conventional long term nitrogen-balance studies for protein quality evaluation in adults: rationale and limitations. In Protein Quality in Humans: Assessment and in Vitro Estimation, pp. 5997 [Bodwell, CE, Atkins, JS and Hopkins, DT, editors]. Westport, CT: AVI Publishing Co., Inc.
63.Nakago, S, Ueda, Y, Takeuchi, K, et al. (2002) Implication of maternal nitrogen balance in the regulation of circulating levels of insulin-like growth factor-I in human pregnancy. Endocr J 49, 299305.
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