title: Diet-obesity associations in children: approaches to counteract attenuation caused by misreporting.
abstract: OBJECTIVE
  Measurement errors in dietary data lead to attenuated estimates of associations between dietary exposures and health outcomes. The present study aimed to compare and evaluate different approaches of handling implausible reports by exemplary analysis of the association between dietary intakes (total energy, soft drinks, fruits/vegetables) and overweight/obesity in children.
  
  
  METHODS
  Cross-sectional multicentre study.
  
  
  METHODS
  Kindergartens/schools from eight European countries participating in the IDEFICS Study.
  
  
  METHODS
  Children (n 5357) aged 2-9 years who provided one 24 h dietary recall and complete covariate information.
  
  
  RESULTS
  The 24 h recalls were classified into three reporting groups according to adapted Goldberg cut-offs: under-report, plausible report or over-report. In the basic logistic multilevel model (adjusted for age and sex, including study centre as random effect), the dietary exposures showed no significant association with overweight/obesity (energy intake: OR=0·996 (95 % CI 0·983, 1·010); soft drinks: OR = 0·999 (95 % CI 0·986, 1·013)) and revealed even a positive association for fruits/vegetables (OR = 1·009 (95 % CI 1·001, 1·018)). When adding the reporting group (dummy variables) and a propensity score for misreporting as adjustment terms, associations became significant for energy intake as well as soft drinks (energy: OR = 1·074 (95 % CI 1·053, 1·096); soft drinks: OR = 1·015 (95 % CI 1·000, 1·031)) and the association between fruits/vegetables and overweight/obesity pointed to the reverse direction compared with the basic model (OR = 0·993 (95 % CI 0·984, 1·002)).
  
  
  CONCLUSIONS
  Associations between dietary exposures and health outcomes are strongly affected or even masked by measurement errors. In the present analysis consideration of the reporting group and inclusion of a propensity score for misreporting turned out to be useful tools to counteract attenuation of effect estimates.
authors.affiliation: BIPS - Institute for Epidemiology and Prevention Research, Achterstrasse 30, 28359 Bremen, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Börnhorst
authors.forename: Inge
authors.initials: I
authors.lastname: Huybrechts
authors.forename: Antje
authors.initials: A
authors.lastname: Hebestreit
authors.forename: Barbara
authors.initials: B
authors.lastname: Vanaelst
authors.forename: Dénes
authors.initials: D
authors.lastname: Molnár
authors.forename: Silvia
authors.initials: S
authors.lastname: Bel-Serrat
authors.forename: Theodora
authors.initials: T
authors.lastname: Mouratidou
authors.forename: Luis A
authors.initials: LA
authors.lastname: Moreno
authors.forename: Valeria
authors.initials: V
authors.lastname: Pala
authors.forename: Marge
authors.initials: M
authors.lastname: Eha
authors.forename: Yiannis A
authors.initials: YA
authors.lastname: Kourides
authors.forename: Alfonso
authors.initials: A
authors.lastname: Siani
authors.forename: Gabriele
authors.initials: G
authors.lastname: Eiben
authors.forename: Iris
authors.initials: I
authors.lastname: Pigeot
mesh_terms: D015982:Bias; D002253:Carbonated Beverages; D002648:Child; D002675:Child, Preschool; D004032:Diet / Q000009:adverse effects; D015930:Diet Records; D002149:Energy Intake; D005060:Europe; D005260:Female; D005638:Fruit; D006801:Humans; D016015:Logistic Models; D008297:Male; D011939:Mental Recall; D009765:Obesity / Q000209:etiology*; D016017:Odds Ratio; D050177:Overweight / Q000209:etiology; D057566:Self Report; D014675:Vegetables