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Can adverse effects of dietary fat intake be overestimated as a consequence of dietary fat underreporting?

  • Berit Lilienthal Heitmann (a1) (a2) and Lauren Lissner (a3)

Abstract

Objective

To describe the consequences of systematic reporting bias by the obese for diet–disease relationships.

Design

The present report used 24-hour urinary nitrogen and estimates of 24-hour energy expenditure to assess error in diet reporting, and examined the consequence of accounting for this error for associations between dietary fat intake and serum low-density lipoprotein (LDL)-cholesterol.

Setting

Sub-study to the Danish MONICA (Monitoring Trends and Determinants in Cardiovascular Disease) project, carried out in 1987–1988.

Subjects

A random sub-sample of the adult Danish male population (n = 152).

Results

Correcting dietary fat for underreporting error weakened, rather than strengthened, the association between dietary fat intake and LDL-cholesterol by reducing the slope of the regression from β = 3.4, P = 0.02 to β = 2.7, P = 0.04.

Conclusion

This example illustrates that systematic underreporting of dietary fat by high-risk groups such as the obese may produce an overestimated association. These results imply that previous epidemiological studies showing a positive association between percentage of energy from fat and other health outcomes, e.g. cancer and heart disease, may have overestimated the negative effects of a high-fat diet. If we were able to correctly assess dietary fat intake in general populations, recommendations for fat intake may be more liberal than the 30% suggested today. Improved assessment of fat intake in epidemiological studies is necessary for future development of evidence-based recommendations for diet and health.

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Copyright

Corresponding author

*Corresponding author: Email blh@ipm.hosp.dk

References

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Public Health Nutrition
  • ISSN: 1368-9800
  • EISSN: 1475-2727
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