Underreporting of energy, protein and potassium intake in relation to body mass index

BACKGROUND: Differential underreporting of dietary intake by subgroups of body mass index (BMI) will confound associations between dietary intake and BMI-related diseases. We estimated the magnitude of BMI-related underreporting for energy, protein, and potassium intake for the Dutch cohorts of the European Prospective Investigation into Cancer and Nutrition (EPIC).

METHODS: The study population consisted of 134 Dutch men and women, aged 21-71 years, who participated in a pilot of EPIC. Ratios of reported dietary intakes to biomarkers were used as measures for underreporting. Dietary intake was assessed by a food frequency questionnaire (FFQ) and repeated 24-hour dietary recalls. Biomarker for energy intake was calculated basal metabolic rate; for protein and potassium intake the biomarker was 24-hour urinary nitrogen and potassium excretion, respectively. The measures of underreporting were linearly regressed on BMI (in kg/m2).

RESULTS: Significant negative regression coefficients were observed when regressing energy ratio on BMI with adjustment for physical activity (FFQ: beta = -0.04 for men, beta = -0.02 for women; 24-hour recalls: beta = -0.03 for men, beta = -0.04 for women). In men, a significant negative regression coefficient (beta = -0.03) was observed when regressing protein ratio on BMI; for the recalls however only after adjustment for age and education (beta = -0.02). In women, negative regression coefficients were also obtained, but for the FFQ only after exclusion of dieting women (both FFQ and 24-hour recalls: beta = -0.02). According to the recalls, but not the FFQ, a significant negative regression coefficient (beta = -0.02) was observed among women when regressing potassium ratio on BMI.

CONCLUSIONS: In this Dutch population, BMI-dependent underreporting of 20-25% over the observed range of BMI is present for protein and energy, Further study on BMI-dependent underreporting of dietary intake in EPIC cohorts is warranted.