Biased Over- Or Under-Reporting is Characteristic of Individuals Whether Over Time or by Different Assessment Methods

doi:10.1016/S0002-8223(01)00018-9

Journal of the American Dietetic Association

Volume 101, Issue 1, January 2001, Pages 70-80

https://doi.org/10.1016/S0002-8223(01)00018-9 Get rights and content

Abstract

Seven studies with repeated measurements of energy intake and/or nitrogen intake were examined to determine whether misreporting is characteristic of some persons or occurs randomly. Four of the studies were validated by doubly labeled water measurements of energy expenditure. Reporting validity was expressed as the ratio of energy intake to energy expenditure. Ratios were consistently below the expected value of 1.0 for some subjects and consistently above 1.0 for others, indicating characteristic reporting validity within subjects. Two year-long studies provided 4 to 12 measurements and a total number of days sufficient to measure individual habitual intake. Subjects mean energy intake to basal metabolic rate (BMR) ratios were <1.35 in 45% and 47% and <1.35 at every measurement in 25% of subjects. This indicated persistent underreporting over time, because 1.35 x BMR is the minimum energy expenditure compatible with a normally active lifestyle. Three of the studies used more than 1 assessment method (validated by doubly labeled water and/or urinary nitrogen excretion). There was a tendency for persons determined to be underreporters by 1 method to be also underreporters when tested by other methods. We conclude that biased over- or underreporting is characteristic of some persons. Thus, repeat measurements do not necessarily provide valid measures of individual intake, extreme intakes may reflect under- and overreporting rather than true low or high intakes, and subjects most prone to reporting bias may be repeatedly misclassified in quantiles of the distribution. This presents a challenge to dietitians nutritionists, and statisticians both for the design of surveys and the handling of flawed data. J Am Diet Assoc.2001; 101: 70-80.

Section snippets

The Studies

Seven studies with repeated dietary assessments were examined. In 5 of the studies, reported energy intake was validated by comparison with doubly labeled water measurements of energy expenditure. In 3 of the studies, validation was by comparison of the energy intake to basal metabolic rate ratio (EI:BMR), with the expected energy requirement expressed as the ratio of energy expenditure to BMR (EE:BMR), here after referred to as the physical activity level (PAL). Two studies also included

Statistics

The dependent variables measuring bias were the log transformed ratios of energy intake to energy expenditure (1n[EI:EE]) or urinary nitrogen excretion to nitrogen intake (1n[UN:NI]). Analysis of variance was used within four of the studies to determine if there were differences in mean bias according to subject and stage of study; subject and calendar month; subject, age, sex, and dietary assessment method; and subject and dietary assessment method.

The presence of subject-specific bias was

Discussion

The studies examined here were all small, but taken together they provide clear evidence for subject-specific bias in response to dietary assessment, whether by repeated records over time or by 2 or more different dietary assessment methods. An underreporter on 1 occasion was likely to be an underreporter on other occasions. That some of these studies were conducted among subjects who volunteered in response to local publicity is discouraging, because it shows that having highly motivated

Applications

Research over the past 10 years has established the existence of underreporting, and the development of external biomarkers of intake has opened up exploration of the true, as opposed to the relative, validity of different dietary assessment methods. Recent reviews have summarised the current state of knowledge (39), 40..

■ Understanding who underreports, why they underreport, and the effects of underreporting on estimates of nutrient intake and conclusions from dietary studies is, however,

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Biased Over- Or Under-Reporting is Characteristic of Individuals Whether Over Time or by Different Assessment Methods

Abstract

Section snippets

The Studies

Statistics

Discussion

Applications

J Am Diet Assoc.

Am J Clin Nutr.

J Amer Diet Assoc.

Am J Clin Nutr.

Aust J Pub Health.

Am J Clin Nutr.

Nutr Res.

Appetite.

Am J Clin Nutr.

Am J Clin Nutr.

The energy expenditure and food intake of individual men

Br J Nutr.

Food intake in Antarctica

Br J Nutr.

Variability of nutrient intake over a 3-day period

J Amer Diet Assoc.

Critical evaluation of energy intake data using fundamental principles of energy physiology

1. Derivation of cut-off values to identify under-recording. Eur J Clin Nutr.

Critical evaluation of energy intake data using fundamental principles of energy physiology2. evaluating the results of dietary surveys

Eur J Ciin Nutr.

Contribution of dieting to the inverse association between energy intake and body mass index

Eur J Clin Nutr.

Determinants of energy balance and overweight in Finland, 1982 and 1992

Int J Obes.

Response rate with different distribution methods and reward, and reproducibility of a quantitative food frequency questionnaire

Eur J Clin Nutr.

Determinants and nature of dietary underreporting in a free-living populationThe fleurbaix laventie ville-sante (flvs) study

Int J Obes.

An evaluation of energy intake in the 1983 Australian National Dietary Survey of Adults

Eur J Clin Nutr.

Who are the “low energy reporters” in the dietary and nutritional survey of British adults?

Int J Epidemiol.

Characteristics of the low-energy reporters in a longitudinal national dietary survey

Br J Nutr.

Within-and between-subject variation in energy expenditure measured by doubly labelled waterImplications for assessing the validity of reported dietary energy intake

Eur J Clin Nutr.