Underreporting of energy intake in Brazilian women varies according to dietary assessment: a cross-sectional study using doubly labeled water.
OBJECTIVE
Underreporting of energy intake is prevalent in food surveys, but there is controversy about which dietary assessment method provides greater underreporting rates. Our objective is to compare validity of self-reported energy intake obtained by three dietary assessment methods with total energy expenditure (TEE) obtained by doubly labeled water (DLW) among Brazilian women.


METHODS
We used a cross-sectional study.


METHODS
Sixty-five females aged 18 to 57 years (28 normal-weight, 10 overweight, and 27 obese) were recruited from two universities to participate.


METHODS
TEE determined by DLW, energy intake estimated by three 24-hour recalls, 3-day food record, and a food frequency questionnaire (FFQ).


METHODS
Regression and analysis of variance with repeated measures compared TEE and energy intake values, and energy intake-to-TEE ratios and energy intake-TEE values between dietary assessment methods. Bland and Altman plots were provided for each method. chi(2) test compared proportion of underreporters between the methods.


RESULTS
Mean TEE was 2,622 kcal (standard deviation [SD]=490 kcal), while mean energy intake was 2,078 kcal (SD=430 kcal) for the diet recalls; 2,044 kcal (SD=479 kcal) for the food record and 1,984 kcal (SD=832 kcal) for the FFQ (all energy intake values significantly differed from TEE; P<0.0001). Bland and Altman plots indicated great dispersion, negative mean differences between measurements, and wide limits of agreement. Obese subjects underreported more than normal-weight subjects in the diet recalls and in the food records, but not in the FFQ. Years of education, income and ethnicity were associated with reporting accuracy.


CONCLUSIONS
The FFQ produced greater under- and overestimation of energy intake. Underreporting of energy intake is a serious and prevalent error in dietary self-reports provided by Brazilian women, as has been described in studies conducted in developed countries.
Scagliusi
Fernanda B
FB
Department of Nutrition, University of Sao Paulo, Sao Paulo, Brazil. fernanda.scagliusi@gmail.com
Ferriolli
Eduardo
E
Pfrimer
Karina
K
Laureano
Cibele
C
Cunha
Caroline Sanita
CS
Gualano
Bruno
B
Lourenço
Barbara Hatzlhoffer
BH
Lancha
Antonio Herbert
AH
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood / Q000652:urine; D001834:Body Water / Q000378:metabolism*; D001938:Brazil; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D003903:Deuterium; D015930:Diet Records; D002149:Energy Intake / Q000502:physiology*; D004734:Energy Metabolism / Q000502:physiology*; D005260:Female; D006801:Humans; D011939:Mental Recall; D008875:Middle Aged; D015596:Nutrition Assessment; D009765:Obesity / Q000523:psychology; D010103:Oxygen Isotopes; D012044:Regression Analysis; D012650:Self Disclosure; D011795:Surveys and Questionnaires / Q000592:standards; D013851:Thinness / Q000523:psychology; D055815:Young Adult
D015415:Biomarkers; D010103:Oxygen Isotopes; D003903:Deuterium