A comparison of self-reported energy intake with total energy expenditure estimated by accelerometer and basal metabolic rate in African-American women with type 2 diabetes.
OBJECTIVE
This study assesses the validity of dietary data from African-American women with type 2 diabetes by comparing reported energy intake (EI) with total energy expenditure (TEE) estimated by an accelerometer and basal metabolic rate (BMR).


METHODS
EI of 200 African-American women was assessed by three telephone-administered 24-h diet recalls using a multiple-pass approach. Physical activity was measured over a 7-day period by accelerometer, which also provided an estimate of TEE. Underreporting of EI was determined by using cutoffs for EI-to-TEE and EI-to-BMR ratios.


RESULTS
Participants, on average, were 59 years of age, with a BMI of 35.7, 10.5 years of diagnosed diabetes, and 10.7 years of education. Mean EI was 1,299 kcal/day; mean EI-to-TEE and EI-to-BMR ratios were 0.65 and 0.88, respectively. Among the 185 subjects with complete dietary data, 81% (n=150) were classified as energy underreporters using the EI-to-TEE ratio cutoff; 58% (n=107) were classified as energy underreporters using the EI-to-BMR ratio. Energy underreporters had significantly lower reported fat, higher protein, but similar carbohydrate intakes compared with non-underreporters. The EI-to-TEE ratio was not significantly associated with any demographic variables or following a diet for diabetes, but it was inversely associated with BMI (r=-0.37, P<0.0001). In a multivariate model, demographic variables, BMI, and following a diet for diabetes explained 16% of the variance in the EI-to-TEE ratio, with the latter two variables being the only significant predictors (inversely associated).


CONCLUSIONS
Widespread energy underreporting among this group of overweight African-American women with type 2 diabetes severely compromised the validity of self-reported dietary data.
Department of Nutrition, Schools of Public Health and Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-8140, USA. carmen_samuel@unc.edu
Carmen D
CD
Samuel-Hodge
Louise M
LM
Fernandez
Carlos F
CF
Henríquez-Roldán
Larry F
LF
Johnston
Thomas C
TC
Keyserling
D001741:Black or African American; D001481:Basal Metabolism; D015992:Body Mass Index; D001835:Body Weight; D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism*; D015930:Diet Records; D002149:Energy Intake; D004734:Energy Metabolism; D005260:Female; D006801:Humans; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009043:Motor Activity; D015203:Reproducibility of Results