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Evaluation of under- and overreporting of energy intake in the 24-hour diet recalls in the European Prospective Investigation into Cancer and Nutrition (EPIC)

Published online by Cambridge University Press:  10 December 2008

P Ferrari*
Affiliation:
Unit of Nutrition and Cancer, International Agency for Research on Cancer, 150 cours Albert-Thomas, 69372 Lyon Cedex 08, France
N Slimani
Affiliation:
Unit of Nutrition and Cancer, International Agency for Research on Cancer, 150 cours Albert-Thomas, 69372 Lyon Cedex 08, France
A Ciampi
Affiliation:
Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
A Trichopoulou
Affiliation:
Department of Hygiene and Epidemiology, School of Medicine, University of Athens, Greece
A Naska
Affiliation:
Department of Hygiene and Epidemiology, School of Medicine, University of Athens, Greece
C Lauria
Affiliation:
Cancer Registry, ‘Civile – M.P. Arezzo’ Hosptial, Ragusa, Italy
F Veglia
Affiliation:
Institute for Scientific Interchange Foundation, Turin, Italy
HB Buenode-Mesquita
Affiliation:
Centre of Nutrition and Health, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
MC Ocke
Affiliation:
Centre of Nutrition and Health, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
M Brustad
Affiliation:
Institute of Community Medicine, University of Tromsø, Norway
T Braaten
Affiliation:
Institute of Community Medicine, University of Tromsø, Norway
M José Tormo
Affiliation:
Department of Epidemiology, Regional Council of Health and Social Affairs, Murcia, Spain
P Amiano
Affiliation:
Public Health Division of Gipuzkoa, Health Department of the Basque Government, San Sebastian, Spain
I Mattisson
Affiliation:
Department of Medicine, Surgery and Orthopaedics, Lund University, Malmö, Sweden
G Johansson
Affiliation:
Department of Nutritional Research, University of Umeå, Sweden
A Welch
Affiliation:
Institute of Public Health, School of Clinical Medicine, University of Cambridge, UK
G Davey
Affiliation:
Cancer Research UK, Epidemiology Unit, University of Oxford, UK
K Overvad
Affiliation:
Department of Epidemiology and Social Medicine, University of Aarhus, Denmark
A Tjønneland
Affiliation:
Department of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark
F Clavel-Chapelon
Affiliation:
INSERM, U521, Institute Gustave Roussy, Villejuif, France
A Thiebaut
Affiliation:
INSERM, U521, Institute Gustave Roussy, Villejuif, France
J Linseisen
Affiliation:
Division of Clinical Epidemiology, German Cancer Research Centre, Heidelberg, Germany
H Boeing
Affiliation:
German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany
B Hemon
Affiliation:
Unit of Nutrition and Cancer, International Agency for Research on Cancer, 150 cours Albert-Thomas, 69372 Lyon Cedex 08, France
E Riboli
Affiliation:
Unit of Nutrition and Cancer, International Agency for Research on Cancer, 150 cours Albert-Thomas, 69372 Lyon Cedex 08, France
*
*Corresponding author: Email Ferrari@iarc.fr
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Abstract

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Objective:

To evaluate under- and overreporting and their determinants in the EPIC 24-hour diet recall (24-HDR) measurements collected in the European Prospective Investigation into Cancer and Nutrition (EPIC).

Design:

Cross-sectional analysis. 24-HDR measurements were obtained by means of a standardised computerised interview program (EPIC-SOFT). The ratio of reported energy intake (EI) to estimated basal metabolic rate (BMR) was used to ascertain the magnitude, impact and determinants of misreporting. Goldberg's cut-off points were used to identify participants with physiologically extreme low or high energy intake. At the aggregate level the value of 1.55 for physical activity level (PAL) was chosen as reference. At the individual level we used multivariate statistical techniques to identify factors that could explain EI/BMR variability. Analyses were performed by adjusting for weight, height, age at recall, special diet, smoking status, day of recall (weekday vs. weekend day) and physical activity.

Setting:

Twenty-seven redefined centres in the 10 countries participating in the EPIC project.

Subjects:

In total, 35955 men and women, aged 35–74 years, participating in the nested EPIC calibration sub-studies.

Results:

While overreporting has only a minor impact, the percentage of subjects identified as extreme underreporters was 13.8% and 10.3% in women and men, respectively. Mean EI/BMR values in men and women were 1.44 and 1.36 including all subjects, and 1.50 and 1.44 after exclusion of misreporters. After exclusion of misreporters, adjusted EI/BMR means were consistently less than 10% different from the expected value of 1.55 for PAL (except for women in Greece and in the UK), with overall differences equal to 4.0% and 7.4% for men and women, respectively. We modelled the probability of being an underreporter in association with several individual characteristics. After adjustment for age, height, special diet, smoking status, day of recall and physical activity at work, logistic regression analyses resulted in an odds ratio (OR) of being an underreporter for the highest vs. the lowest quartile of body mass index (BMI) of 3-52 (95% confidence interval (CD 2.91–4.26) in men and 4.80 (95% CI 4.11–5.6l) in women, indicating that overweight subjects are significantly more likely to underestimate energy intake than subjects in the bottom BMI category. Older people were less likely to underestimate energy intake: ORs were 0.58 (95% CI 0.45–0.77) and 0.74 (95% CI 0.63–0.88) for age (≥ 65 years vs. < 50 years). Special diet and day of the week showed strong effects.

Conclusion:

EI tends to be underestimated in the vast majority of the EPIC centres, although to varying degrees; at the aggregate level most centres were below the expected reference value of 1.55. Underreporting seems to be more prevalent among women than men in the EPIC calibration sample. The hypothesis that BMI (or weight) and age are causally related to underreporting seems to be confirmed in the present work. This introduces further complexity in the within-group (centre or country) and between-group calibration of dietary questionnaire measurements to deattenuate the diet—disease relationship.

Type
Research Article
Copyright
Copyright © Cambridge University Press 2002

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