Controversy and Debate: Memory based Methods Paper 1: The Fatal Flaws of Food Frequency Questionnaires and other Memory-Based Dietary Assessment Methods

ArticleinJournal of Clinical Epidemiology 104 · August 2018with 194 Reads
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Abstract
There is an escalating debate over the value and validity of memory-based dietary assessment methods (M-BMs). Proponents argue that despite limitations, M-BMs such as food frequency questionnaires (FFQs), provide valid and valuable information about consumed foods and beverages, and therefore can be used to assess diet-disease relations and inform public policy. In fact, over the past 60 years thousands of research reports using these methods were published and used to populate the United States Department of Agriculture's National Evidence Library, inform public policy, and establish the Dietary Guidelines for Americans. Despite this impressive history, our position is that FFQs and other M-BMs are invalid and inadmissible for scientific research and cannot be employed in evidence-based policy making. Herein, we present the empirical evidence, and theoretic and philosophic perspectives that render M-BMs data both fatally flawed and pseudo-scientific. First, the use of M-BMs is founded upon two inter-related logical fallacies: a category error and reification. Second, human memory and recall are not valid instruments for scientific data collection. Third, in standard epidemiologic contexts, the measurement errors associated with self-reported data are non-falsifiable (i.e., pseudo-scientific) because there is no way to ascertain if the reported foods and beverages match the respondent's actual intake. Fourth, the assignment of nutrient and energy values to self-reported intake (i.e., the pseudo-quantification of qualitative/anecdotal data) is impermissible and violates the foundational tenets of measurement theory. Fifth, the proxy-estimates created via pseudo-quantification are physiologically implausible (i.e. meaningless numbers) and have little relation to actual nutrient and energy consumption. Finally, investigators engendered a fictional discourse on the health effects of dietary sugar, salt, fat and cholesterol when they failed to cite contrary evidence or address decades of research demonstrating the fatal measurement, analytic, and inferential flaws presented herein.

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      Ashkan Afshin
    • Dariush Mozaffarian
    Importance: Most studies of US dietary trends have evaluated major macronutrients or only a few dietary factors. Understanding trends in summary measures of diet quality for multiple individual foods and nutrients, and the corresponding disparities among population subgroups, is crucial to identify challenges and opportunities to improve dietary intake for all US adults. Objective: To characterize trends in overall diet quality and multiple dietary components related to major diseases among US adults, including by age, sex, race/ethnicity, education, and income. Design, setting, and participants: Repeated cross-sectional investigation using 24-hour dietary recalls in nationally representative samples including 33 932 noninstitutionalized US adults aged 20 years or older from 7 National Health and Nutrition Examination Survey (NHANES) cycles (1999-2012). The sample size per cycle ranged from 4237 to 5762. Exposures: Calendar year and population sociodemographic subgroups. Main outcomes and measures: Survey-weighted, energy-adjusted mean consumption and proportion meeting targets of the American Heart Association (AHA) 2020 continuous diet scores, AHA score components (primary: total fruits and vegetables, whole grains, fish and shellfish, sugar-sweetened beverages, and sodium; secondary: nuts, seeds, and legumes, processed meat, and saturated fat), and other individual food groups and nutrients. Results: Several overall dietary improvements were identified (P < .01 for trend for each). The AHA primary diet score (maximum of 50 points) improved from 19.0 to 21.2 (an improvement of 11.6%). The AHA secondary diet score (maximum of 80 points) improved from 35.1 to 38.5 (an improvement of 9.7%). Changes were attributable to increased consumption between 1999-2000 and 2011-2012 of whole grains (0.43 servings/d; 95% CI, 0.34-0.53 servings/d) and nuts or seeds (0.25 servings/d; 95% CI, 0.18-0.34 servings/d) (fish and shellfish intake also increased slightly) and to decreased consumption of sugar-sweetened beverages (0.49 servings/d; 95% CI, 0.28-0.70 servings/d). No significant trend was observed for other score components, including total fruits and vegetables, processed meat, saturated fat, or sodium. The estimated percentage of US adults with poor diets (defined as <40% adherence to the primary AHA diet score components) declined from 55.9% to 45.6%, whereas the percentage with intermediate diets (defined as 40% to 79.9% adherence to the primary AHA diet score components) increased from 43.5% to 52.9%. Other dietary trends included increased consumption of whole fruit (0.15 servings/d; 95% CI, 0.05-0.26 servings/d) and decreased consumption of 100% fruit juice (0.11 servings/d; 95% CI, 0.04-0.18 servings/d). Disparities in diet quality were observed by race/ethnicity, education, and income level; for example, the estimated percentage of non-Hispanic white adults with a poor diet significantly declined (53.9% to 42.8%), whereas similar improvements were not observed for non-Hispanic black or Mexican American adults. There was little evidence of reductions in these disparities and some evidence of worsening by income level. Conclusions and relevance: In nationally representative US surveys conducted between 1999 and 2012, several improvements in self-reported dietary habits were identified, with additional findings suggesting persistent or worsening disparities based on race/ethnicity, education level, and income level. These findings may inform discussions on emerging successes, areas for greater attention, and corresponding opportunities to improve the diets of individuals living in the United States.
  • Article
    Full-text available
    • Diana Maria Thomas
      Diana Maria Thomas
    • Nikhil Dhurandhar
      Nikhil Dhurandhar
    • Andrew W Brown
      Andrew W Brown
    • D B Allison
  • Article
    • Minami Sugimoto
      Minami Sugimoto
    • Keiko Asakura
    • Shizuko Masayasu
    • Satoshi Sasaki
    To investigate the hypothesis that misreporting observed in dietary assessments would be associated with nutrition knowledge and health consciousness, we compared the degree of misreporting between 99 female dietitians and 117 non-dietitians who worked at welfare facilities in Japan. Sodium, potassium, and protein intake were assessed by two 24-h urine collections, four-day semi-weighed dietary records, and two validated diet history questionnaires. Intake of these three nutrients measured by each method was compared. The ratio of self-reported intake to biomarker-based intake was used as an index of reporting accuracy, and compared between dietitians and non-dietitians. Pearson correlation coefficients between biomarker-based and self-reported intakes were also compared between dietary assessment methods within the same group, as well as between the two groups. The dietitians tended to under-report sodium and protein intake more severely than the non-dietitians, and over-reported potassium intake more obviously. However, the degree of misreporting did not significantly differ between the two groups. The correlation coefficients between biomarker-based and self-reported intakes were significantly lower with the two diet history questionnaires than with the diet record, particularly in the dietitians. In conclusion, misreporting was strongly suspected to be more severe among the dietitians, and the validity of the diet history questionnaires differed between the two groups and this result suggests that misreporting might be associated with higher nutrition knowledge and health consciousness.
  • Article
    • CN Ford
      CN Ford
    • Jennifer Poti
      Jennifer Poti
    • Shu Wen Ng
      Shu Wen Ng
    • Barry M Popkin
      Barry M Popkin
    Background: Taxing sugar-sweetened beverages (SSBs) has been proposed as a strategy to combat child obesity. Yet it is unclear how a tax on SSBs might influence the overall quality of diet in preschool children. Thus, we use simulated price increases and the 2010 Healthy Eating Index (HEI-2010) to explore the relationship between SSB taxes and diet quality in preschool children. Methods: Price and purchase data from the 2009-2012 Nielsen Homescan Panel and a two-part marginal effects model were used to estimate relative changes in purchases with a 20% increase in the price of SSBs. Demand elasticities were applied to dietary intake data for children ages 2-5 years from the National Health and Nutrition Examination Survey (2009-2010 and 2011-2012) to estimate the impact of a 20% SSB tax on dietary intake and quality (HEI-2010). Results: A 20% increase in the price of SSBs was associated with lower total caloric intake (-28 kcal d(-1) , p < 0.01), caloric intake from juice drinks (-20 kcal d(-1) , p < 0.01), added sugars (-4.1 servings d(-1) , p = 0.03), refined grains (-0.63 servings d(-1) , p < 0.01) and total meat (-0.56 servings d(-1) , p < 0.01). Beneficial decreases in empty calories and refined grains were offset by unfavourable changes in fatty acid profile, total protein, vegetables and fruit, such that total HEI scores (0-100 range) were not meaningfully changed with a 20% increase in SSB price (difference: -0.85, p < 0.01). Conclusions: A 20% tax on SSBs could decrease caloric intake, and intakes of added sugars and SSBs, but may not improve diet quality as an isolated intervention among US preschool children. Abbreviations: CPG, consumer-packaged goods; D, day; FPI, Food Price Index; FPL, federal poverty level; G, grams; HEI, Healthy Eating Index; kcal, kilocalories; RTE, ready-to-eat; SSBs, sugar-sweetened beverages; Y, year.
  • Article
    Full-text available
    • Amy F Subar
    • Victor Kipnis
    • Richard P Troiano
    • Arthur Schatzkin
    This paper describes the Observing Protein and Energy Nutrition (OPEN) Study, conducted from September 1999 to March 2000. The purpose of the study was to assess dietary measurement error using two self-reported dietary instruments-the food frequency questionnaire (FFQ) and the 24-hour dietary recall (24HR)-and unbiased biomarkers of energy and protein intakes: doubly labeled water and urinary nitrogen. Participants were 484 men and women aged 40-69 years from Montgomery County, Maryland. Nine percent of men and 7% of women were defined as underreporters of both energy and protein intake on 24HRs; for FFQs, the comparable values were 35% for men and 23% for women. On average, men underreported energy intake compared with total energy expenditure by 12-14% on 24HRs and 31-36% on FFQs and underreported protein intake compared with a protein biomarker by 11-12% on 24HRs and 30-34% on FFQs. Women underreported energy intake on 24HRs by 16-20% and on FFQs by 34-38% and underreported protein intake by 11-15% on 24HRs and 27-32% on FFQs. There was little underreporting of the percentage of energy from protein for men or women. These findings have important implications for nutritional epidemiology and dietary surveillance.
  • Article
    • Edward Archer
      Edward Archer
    A lack of credible evidence for a relationship between socio-economic status and dietary patterns: a response to ‘Associations between socio-economic status and dietary patterns in US black and white adults’ - Volume 115 Issue 8 - Edward Archer
  • Book
    • E. Schrödinger
    • R. Penrose
    Nobel laureate Erwin Schrödinger was one of the most distinguished scientists of the twentieth century; his lectures on the history and philosophy of science are legendary. 'Nature and the Greeks' and 'Science and Humanism' makes available for the first time in many years the texts of two of Schrödinger's most famous lecture series. 'Nature and the Greeks' offers a comprehensive historical account of the twentieth-century scientific world picture, tracing modern science back to the earliest stages of Western philosophic thought. 'Science and Humanism' addresses some of the most fundamental questions of the century: what is the value of scientific research? And how do the achievements of modern science affect the relationship between material and spiritual matters? A foreword by Roger Penrose sets the lectures in a contemporary context, and affirms they are as relevant today as when they were first published.
  • Article
    • Edward Archer
      Edward Archer
    • Carl Lavie
      Carl Lavie
    • James O Hill
      James O Hill
    The debate on the relative contributions of presumptive etiologic factors in the development of obesity is becoming increasingly speculative, insular, and partisan. As the global prevalence of obesity continues to rise, the sheer volume of unfounded conjecture threatens to obscure well-established evidence. We posit that the failure to distinguish between causal factors and mere statistical associations engendered the proliferation of misleading and demonstrably false research programs and failed public health initiatives. Nevertheless, scientific progress necessitates the elimination of unsupported speculation via critical examinations of contrary evidence. Thus, the purpose of this review is to present a concise survey of potentially falsifying evidence for the major presumptive etiologic factors inclusive of 'diet', 'genes', physical activity, and non-physiologic factors from the social sciences. Herein, we advance two 'Fundamental Questions of Obesity' that provide a conceptually clear but challenging constraint on conjecture. First, why would an individual (i.e., human or non-human animal) habitually consume more calories than s/he expends? And second, why would the excess calories be stored predominantly as 'fat' rather than as lean tissue? We posit that the conceptual constraint presented by these questions in concert with the parallel trends in body-mass, adiposity, and metabolic diseases in both human and non-human mammals offer a unique opportunity to refute the oversimplification, causal reductionism, and unrestrained speculation that impede progress. We conclude this review with an attempt at consilience and present two novel paradigms, the 'Metabolic Tipping Point' and the 'Maternal Resources Hypothesis', that offer interdisciplinary explanatory narratives on the etiology of obesity and metabolic diseases across mammalian species.
  • Article
    • Edward Archer
      Edward Archer
    • Carl Lavie
      Carl Lavie
    • Gregory Pavela
    http://www.mayoclinicproceedings.org/article/S0025-6196(15)00797-1/fulltext
  • Article
    • R.C. Lewontin
  • Article
    Full-text available
    • Amy F Subar
    • Laurence Freedman
      Laurence Freedman
    • Janet A Tooze
      Janet A Tooze
    • Susan M Krebs-Smith
    Recent reports have asserted that, because of energy underreporting, dietary self-report data suffer from measurement error so great that findings that rely on them are of no value. This commentary considers the amassed evidence that shows that self-report dietary intake data can successfully be used to inform dietary guidance and public health policy. Topics discussed include what is known and what can be done about the measurement error inherent in data collected by using self-report dietary assessment instruments and the extent and magnitude of underreporting energy vs. other nutrients and food groups. Also discussed is the overall impact of energy underreporting on dietary surveillance and nutritional epidemiology. In conclusion, 7 specific recommendations for collecting, analyzing, and interpreting self-report dietary data are provided: 1) continue to collect self-report dietary intake data because they contain valuable, rich, and critical information about foods and beverages consumed by populations that can be used to inform nutrition policy and assess diet-disease associations; 2) do not use self-reported energy intake as a measure of true energy intake; 3) do use self-reported energy intake for energy adjustment of other self-reported dietary constituents to improve risk estimation in studies of diet-health associations; 4) acknowledge the limitations of self-report dietary data and analyze and interpret them appropriately; 5) design studies and conduct analyses that allow adjustment for measurement error; 6) design new epidemiologic studies to collect dietary data from both short-term (recalls or food records) and long-term (food-frequency questionnaires) instruments on the entire study population to allow for maximizing the strengths of each instrument; and 7) continue to develop, evaluate, and further expand methods of dietary assessment, including dietary biomarkers and methods using new technologies.
  • Article
    • Nina Teicholz
      Nina Teicholz
    It has a big impact on the diet of American citizens, and those of most Western nations, so why does the expert advice underpinning US government dietary guidelines not take account of all the relevant scientific evidence? Nina Teicholz reports
  • Article
    Full-text available
    • Henry Roediger
      Henry Roediger
    • Kathleen B McDermott
      Kathleen B McDermott
    Two experiments (modeled after J. Deese's 1959 study) revealed remarkable levels of false recall and false recognition in a list learning paradigm. In Experiment 1, subjects studied lists of 12 words (e.g., bed, rest, awake ); each list was composed of associates of 1 nonpresented word (e.g., sleep). On immediate free recall tests, the nonpresented associates were recalled 40% of the time and were later recognized with high confidence. In Experiment 2, a false recall rate of 55% was obtained with an expanded set of lists, and on a later recognition test, subjects produced false alarms to these items at a rate comparable to the hit rate. The act of recall enhanced later remembering of both studied and nonstudied material. The results reveal a powerful illusion of memory: People remember events that never happened.
  • Article
    Full-text available
    • Edward Archer
      Edward Archer
    • Carl Lavie
      Carl Lavie
    • Greg Pavela
      Greg Pavela
    The Scientific Report of the 2015 Dietary Guidelines Advisory Committee was primarily informed by memory-based dietary assessment methods (M-BMs) (eg, interviews and surveys). The reliance on M-BMs to inform dietary policy continues despite decades of unequivocal evidence that M-BM data bear little relation to actual energy and nutrient consumption. Data from M-BMs are defended as valid and valuable despite no empirical support and no examination of the foundational assumptions regarding the validity of human memory and retrospective recall in dietary assessment. We assert that uncritical faith in the validity and value of M-BMs has wasted substantial resources and constitutes the greatest impediment to scientific progress in obesity and nutrition research. Herein, we present evidence that M-BMs are fundamentally and fatally flawed owing to well-established scientific facts and analytic truths. First, the assumption that human memory can provide accurate or precise reproductions of past ingestive behavior is indisputably false. Second, M-BMs require participants to submit to protocols that mimic procedures known to induce false recall. Third, the subjective (ie, not publicly accessible) mental phenomena (ie, memories) from which M-BM data are derived cannot be independently observed, quantified, or falsified; as such, these data are pseudoscientific and inadmissible in scientific research. Fourth, the failure to objectively measure physical activity in analyses renders inferences regarding diet-health relationships equivocal. Given the overwhelming evidence in support of our position, we conclude that M-BM data cannot be used to inform national dietary guidelines and that the continued funding of M-BMs constitutes an unscientific and major misuse of research resources. Copyright © 2015 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
  • Article
    • Daniel L Schacter
      Daniel L Schacter
    • Joan Y Chiao
      Joan Y Chiao
    • Jason P Mitchell
    We examine the relation between memory and self by considering errors of memory. We draw on the idea that memory's imperfections can be classified into seven basic categories or “sins.” Three of the sins concern different types of forgetting (transience, absent-mindedness, and blocking), three concern different types of distortion (misattribution, suggestibility, and bias), and one concerns intrusive memories (persistence). We focus in particular on two of the distortion-related sins, misattribution and bias. By describing cognitive, neuropsychological, and neuroimaging studies that illuminate these memory sins, we consider how they might bear on the relation between memory and self.
  • Article
    • Edward Archer
      Edward Archer
    • Dale A Schoeller
    • John A Dawson
    • Steven B Heymsfield
      Steven B Heymsfield
  • Article
    Full-text available
    • Edward Archer
      Edward Archer
    • Steven N Blair
  • Article
    • Evan Cohen
    • Michael Cragg
      Michael Cragg
    • Jehan deFonseka
    • Bin Zhou
    For almost 50 y, the US National Health and Nutrition Examination Survey (NHANES) has measured the caloric consumption, and body heights and weights of Americans. The aim of this study was to determine, based on that data, how macronutrient consumption patterns and the weight and body mass index in the US adult population have evolved since the 1960s. We conducted the first comprehensive analysis of the NHANES data, documenting how macronutrient consumption patterns and the weight and body mass index in the US adult population have evolved since the 1960s. Americans in general have been following the nutrition advice that the American Heart Association and the US Departments of Agriculture and Health and Human Services have been issuing for more than 40 y: Consumption of fats has dropped from 45% to 34% with a corresponding increase in carbohydrate consumption from 39% to 51% of total caloric intake. In addition, from 1971 to 2011, average weight and body mass index have increased dramatically, with the percentage of overweight or obese Americans increasing from 42% in 1971 to 66% in 2011. Since 1971, the shift in macronutrient share from fat to carbohydrate is primarily due to an increase in absolute consumption of carbohydrate as opposed to a change in total fat consumption. General adherence to recommendations to reduce fat consumption has coincided with a substantial increase in obesity. Copyright © 2015 Elsevier Inc. All rights reserved.
  • Article
    Full-text available
    • Carla I. Mercado
    • Mary E Cogswell
    • Amy L Valderrama
    • Alicia Carriquiry
      Alicia Carriquiry
    Limited data are available on the accuracy of 24-h dietary recalls used to monitor US sodium and potassium intakes. We examined the difference in usual sodium and potassium intakes estimated from 24-h dietary recalls and urine collections. We used data from a cross-sectional study in 402 participants aged 18-39 y (∼50% African American) in the Washington, DC, metropolitan area in 2011. We estimated means and percentiles of usual intakes of daily dietary sodium (dNa) and potassium (dK) and 24-h urine excretion of sodium (uNa) and potassium (uK). We examined Spearman's correlations and differences between estimates from dietary and urine measures. Multiple linear regressions were used to evaluate the factors associated with the difference between dietary and urine measures. Mean differences between diet and urine estimates were higher in men [dNa - uNa (95% CI) = 936.8 (787.1, 1086.5) mg/d and dK - uK = 571.3 (448.3, 694.3) mg/d] than in women [dNa - uNa (95% CI) = 108.3 (11.1, 205.4) mg/d and dK - uK = 163.4 (85.3, 241.5 mg/d)]. Percentile distributions of diet and urine estimates for sodium and potassium differed for men. Spearman's correlations between measures were 0.16 for men and 0.25 for women for sodium and 0.39 for men and 0.29 for women for potassium. Urinary creatinine, total caloric intake, and percentages of nutrient intake from mixed dishes were independently and consistently associated with the differences between diet and urine estimates of sodium and potassium intake. For men, body mass index was also associated. Race was associated with differences in estimates of potassium intake. Low correlations and differences between dietary and urinary sodium or potassium may be due to measurement error in one or both estimates. Future analyses using these methods to assess sodium and potassium intake in relation to health outcomes may consider stratifying by factors associated with the differences in estimates from these methods. This trial was registered at clinicaltrials.gov as NCT01631240. © 2015 American Society for Nutrition.
  • Article
    • Sylvia Rowe
      Sylvia Rowe
    • Nick Alexander
      Nick Alexander
    The article’s authors describe recent movement in science communications and research to embrace a broader approach than has been utilized previously in reaching understanding of modern, complex issues facing scientists, policy makers, and the public today, such as obesity and climate change. Referring to what social anthropologists have called “distanciation,” “disembedding,” and “unresolved trust issues,” between scientists and the public, the authors cite recent calls by academicians, policy analysts, and health professionals for a greater scientific inclusionary focus to research and communication. They argue that the physical sciences alone may not describe the food and lifestyle behaviors or the food system that have led to alarming increases in noncommunicable diseases such as diabetes, obesity, and other modern health conditions. They point to increasing participation by experts in the social sciences and humanities in conferences, research, and communications, regarding contemporary critical nutrition and health issues, a move to transdisciplinarity.
  • Article
    Full-text available
    • Dale A Schoeller
    • Lindsay Orcholski
    • Amy Luke
    • Jacob Plange-Rhule
      Jacob Plange-Rhule
    Studies on the role of diet in the development of chronic diseases often rely on self-report surveys of dietary intake. Unfortunately, many validity studies have demonstrated that self-reported dietary intake is subject to systematic under-reporting, although the vast majority of such studies have been conducted in industrialised countries. The aim of the present study was to investigate whether or not systematic reporting error exists among the individuals of African ancestry (n 324) in five countries distributed across the Human Development Index (HDI) scale, a UN statistic devised to rank countries on non-income factors plus economic indicators. Using two 24 h dietary recalls to assess energy intake and the doubly labelled water method to assess total energy expenditure, we calculated the difference between these two values ((self-report - expenditure/expenditure) × 100) to identify under-reporting of habitual energy intake in selected communities in Ghana, South Africa, Seychelles, Jamaica and the USA. Under-reporting of habitual energy intake was observed in all the five countries. The South African cohort exhibited the highest mean under-reporting ( - 52·1 % of energy) compared with the cohorts of Ghana ( - 22·5 %), Jamaica ( - 17·9 %), Seychelles ( - 25·0 %) and the USA ( - 18·5 %). BMI was the most consistent predictor of under-reporting compared with other predictors. In conclusion, there is substantial under-reporting of dietary energy intake in populations across the whole range of the HDI, and this systematic reporting error increases according to the BMI of an individual.
  • Article
    • Ambika Satija
      Ambika Satija
    • Edward Yu
    • Walter C Willett
    • Frank B Hu
    Nutritional epidemiology has recently been criticized on several fronts, including the inability to measure diet accurately, and for its reliance on observational studies to address etiologic questions. In addition, several recent meta-analyses with serious methodologic flaws have arrived at erroneous or misleading conclusions, reigniting controversy over formerly settled debates. All of this has raised questions regarding the ability of nutritional epidemiologic studies to inform policy. These criticisms, to a large degree, stem from a misunderstanding of the methodologic issues of the field and the inappropriate use of the drug trial paradigm in nutrition research. The exposure of interest in nutritional epidemiology is human diet, which is a complex system of interacting components that cumulatively affect health. Consequently, nutritional epidemiology constantly faces a unique set of challenges and continually develops specific methodologies to address these. Misunderstanding these issues can lead to the nonconstructive and sometimes naive criticisms we see today. This article aims to clarify common misunderstandings of nutritional epidemiology, address challenges to the field, and discuss the utility of nutritional science in guiding policy by focusing on 5 broad questions commonly asked of the field. © 2015 American Society for Nutrition.
  • Article
    • Nicholas Rescher
      Nicholas Rescher
    • Karl R. Popper
    • Norwood R. Hanson
  • Article
    Full-text available
    • Nikhil Dhurandhar
      Nikhil Dhurandhar
    • Andrew W Brown
      Andrew W Brown
    • D B Allison
    • D A Schoeller
    Energy intake (EI) and physical activity energy expenditure (PAEE) are key modifiable determinants of energy balance, traditionally assessed by self-report despite its repeated demonstration of considerable inaccuracies. We argue here that it is time to move from the common view that self-reports of EI and PAEE are imperfect, but nevertheless deserving of use, to a view commensurate with the evidence that self-reports of EI and PAEE are so poor that they are wholly unacceptable for scientific research on EI and PAEE. While new strategies for objectively determining energy balance are in their infancy, it is unacceptable to use decidedly inaccurate instruments, which may misguide health care policies, future research, and clinical judgment. The scientific and medical communities should discontinue reliance on self-reported EI and PAEE. Researchers and sponsors should develop objective measures of energy balance.International Journal of Obesity accepted article preview online, 13 November 2014. doi:10.1038/ijo.2014.199.
  • Article
    • Jinan Banna
      Jinan Banna
    • Marie Kainoa Fialkowski
      Marie Kainoa Fialkowski
    • Marilyn S Townsend
      Marilyn S Townsend
    Misreporting of dietary intake affects the validity of data collected and conclusions drawn in studies exploring diet and health outcomes. One consequence of misreporting is biological implausibility. Little is known regarding how accounting for biological implausibility of reported intake affects nutrient intake estimates in Hispanics, a rapidly growing demographic in the United States. Our study explores the effect of accounting for plausibility on nutrient intake estimates in a sample of Mexican-American women in northern California in 2008. Nutrient intakes are compared with Dietary Reference Intake recommendations, and intakes of Mexican-American women in a national survey are presented as a reference. Eighty-two women provided three 24-hour recalls. Reported energy intakes were classified as biologically plausible or implausible using the reported energy intakes to total energy expenditure cutoff of <0.76 or >1.24, with low-active physical activity levels used to estimate total energy expenditure. Differences in the means of nutrient intakes between implausible (n=36) and plausible (n=46) reporters of energy intake were examined by bivariate linear regression. Estimated energy, protein, cholesterol, dietary fiber, and vitamin E intakes were significantly higher in plausible reporters than implausible. There was a significant difference between the proportions of plausible vs implausible reporters meeting recommendations for several nutrients, with a larger proportion of plausible reporters meeting recommendations. Further research related to misreporting in Hispanic populations is warranted to explore the causes and effects of misreporting in studies measuring dietary intake, as well as actions to be taken to prevent or account for this issue.
  • Article
    • A. M. Armstrong
    • Anita Macdonald
      Anita Macdonald
    • Ian Booth
      Ian Booth
    • David A. Booth
      David A. Booth
    The aims of this study were to investigate the types of error made after intervals of 1 to 8 days in reporting foods recorded as eaten over a 24-hour period and to examine ways of improving memory for foods eaten. For Study 1, male and female university staff and student volunteers were instructed to keep a record of all dietary intake for a 24-hour period and to return after 1, 2, 4 or 8 days to report orally the recorded day's intake using a standard protocol for dietary recall. In Study 2, 67 similar volunteers returned at 4 days after recording and orally reported foods eaten using the standard protocol or one of three protocols with added prompts used in a ‘cognitive interview’, namely context reinstatement, repeating the recall or recalling again in the reverse temporal sequence. Oral report of food items was compared with the written record for the number of correct food items and errors of omission, intrusion, description and quantity as a ratio of the recorded items. The number of foods remembered correctly declined with increasing time after recording. Omissions of food items increased after 4 and 8 days and may be attributed to confusion from intervening days. In contrast, intrusion errors were made at all recall intervals, indicating confusion between the recorded day's intake and usual diet. This type of error could make an otherwise correct report in the 24-hour recall approach to dietary assessment more representative of the individual's usual intake. Neither of the repeat recall procedures reduced errors. However, reinstatement of the context of eating occasions may have potential for improving the accuracy of reports of foods eaten in the past, as in dietary assessments that rely on memory. Copyright © 2000 John Wiley & Sons, Ltd.
  • Article
    Full-text available
    • James R Hebert
      James R Hebert
    • Thomas G Hurley
      Thomas G Hurley
    • Susan E Steck
      Susan E Steck
    • Edward A Frongillo
    Dietary assessment has long been known to be challenged by measurement error. A substantial amount of literature on methods for determining the effects of error on causal inference has accumulated over the past decades. These methods have unrealized potential for improving the validity of data collected for research studies and national nutritional surveillance, primarily through the NHANES. Recently, the validity of dietary data has been called into question. Arguments against using dietary data to assess diet–health relations or to inform the nutrition policy debate are subject to flaws that fall into 2 broad areas: 1) ignorance or isunderstanding of methodologic issues; and 2) faulty logic in drawing inferences. Nine specific issues are identified in these arguments, indicating insufficient grasp of themethods used for assessing diet and designing nutritional epidemiologic studies. These include a narrow operationalization of validity, failure to properly account for sources of error, and large, unsubstantiated jumps to policy implications. Recent attacks on the inadequacy of 24-h recall–derived data from the NHANES are uninformative regarding effects on estimating risk of health outcomes and on inferences to inform the diet-related health policy debate. Despite errors, for many purposes and inmany contexts, these dietary data have proven to be useful in addressing important research and policy questions. Similarly, structured instruments, such as the food frequency questionnaire, which is the mainstay of epidemiologic literature, can provide useful data when errors are measured and considered in analyses. Adv. Nutr. 5: 447–455, 2014.
  • Article
    Full-text available
    • Laurence Freedman
      Laurence Freedman
    • John M Commins
    • Walter Willett
    • James E Moler
    We pooled data from 5 large validation studies of dietary self-report instruments that used recovery biomarkers as references to clarify the measurement properties of food frequency questionnaires (FFQs) and 24-hour recalls. The studies were conducted in widely differing US adult populations from 1999 to 2009. We report on total energy, protein, and protein density intakes. Results were similar across sexes, but there was heterogeneity across studies. Using a FFQ, the average correlation coefficients for reported versus true intakes for energy, protein, and protein density were 0.21, 0.29, and 0.41, respectively. Using a single 24-hour recall, the coefficients were 0.26, 0.40, and 0.36, respectively, for the same nutrients and rose to 0.31, 0.49, and 0.46 when three 24-hour recalls were averaged. The average rate of under-reporting of energy intake was 28% with a FFQ and 15% with a single 24-hour recall, but the percentages were lower for protein. Personal characteristics related to under-reporting were body mass index, educational level, and age. Calibration equations for true intake that included personal characteristics provided improved prediction. This project establishes that FFQs have stronger correlations with truth for protein density than for absolute protein intake, that the use of multiple 24-hour recalls substantially increases the correlations when compared with a single 24-hour recall, and that body mass index strongly predicts under-reporting of energy and protein intakes.