Energy intake (EI) is the foundation of the diet, because all other nutrients must be provided within the quantity of food needed to fulfill the energy requirement. Thus if total EI is underestimated, it is probable that the intakes of other nutrients are also underestimated. Under conditions of weight stability, EI equals energy expenditure (EE). Because at the group level weight may be regarded as stable in the timescale of a dietary assessment, the validity of reported EI can be evaluated by comparing it with either measured EE or an estimate of the energy requirement of the population. This paper provides the first comprehensive review of studies in which EI was reported and EE was measured using the doubly labeled water technique. These conclusively demonstrate widespread bias to the underestimation of EI. Because energy requirements of populations or individuals can be conveniently expressed as multiples of the basal metabolic rate (BMR), EE:BMR, reported EI may also be expressed as EI:BMR for comparison. Values of EI:BMR falling below the 95% confidence limit of agreement between these two measures signify the presence of underreporting. A formula for calculating the lower 95% confidence limit was proposed by Goldberg et al. (the Goldberg cutoff). It has been used by numerous authors to identify individual underreporters in different dietary databases to explore the variables associated with underreporting. These studies are also comprehensively reviewed. They explore the characteristics of underreporters and the biases in estimating nutrient intake and in describing meal patterns associated with underreporting. This review also examines some of the problems for the interpretation of data introduced by underreporting and particularly by variable underreporting across subjects. Future directions for research are identified.
Total free living energy expenditure was compared in lean and obese women by the new doubly labelled water method and partitioned into basal metabolism and thermogenesis plus activity by whole body calorimetry. Average energy expenditure was significantly higher in the obese group (10-22 versus 7-99 MJ/day (2445 versus 1911 kcal/day); p<0-001) resulting from an increase in the energy cost of both basal metabolism and physical activity. Self recorded energy intakes were accurate in the lean subjects but underestimated expenditure by 3-5 MJ/day (837 kcal/day) in the obese group. Basal metabolic rate and energy expenditure on thermogenesis plus activity were identical in the two groups when corrected for differences in fat free mass and total body mass.In the obese women in this series there was no evidence that their obesity was caused by a metabolic or behavioural defect resulting in reduced energy expenditure.
Results from analysis of 24 h urine collections, verified for completeness with para-amino benzoic acid, and blood samples collected over 1 year were compared with 16 d weighed records of all food consumed collected over the year, and with results from 24 h recalls, food-frequency questionnaires and estimated food records in 160 women. Using the weighed records, individuals were sorted into quintiles of the distribution of the urine N excreti0n:dietary N intake ratio (UN:DN). UN exceeded DN in the top quintile of this ratio; mean ratio UN:DN = 1.13. Individuals in this top quintile were heavier, had significantly greater body mass indices, were reportedly more restrained eaters, had significantly lower energy intake:basal metabolic rate ratios (EI:BMR), and had correlated ratios of UN:DN and EI : BMR (r -0.62). Those in the top quintile reported lower intakes of energy and energy-yielding nutrients, Ca, fats, cakes, breakfast cereals, milk and sugars than individuals in the other quintiles but not lower intakes of non-starch polysaccharides, vitamin C, vegetables, potatoes or meat. Correlations between dietary intake from weighed records and 24 h urine K were 0.74 and 0.82, and between dietary vitamin C and &carotene and plasma vitamin C and &carotene 0.86 and 0.48. Correlations between dietary N intake from weighed records and 24 h urine excretion were high (0-78-0.87). Those between N from estimated food records and urine N were r 0-60-0.70. Correlations between urine N and 24 h recalls and food-frequency questionnaires were in the order of 0.01 to 0.5. Despite problems of underreporting in overweight individuals in 20% of this sample, weighed records remained the most accurate method of dietary assessment, and only an estimated 7 d diary was able to approach this accuracy. Dietary assessment methods: Urine nitrogen: Dietary nitrogenThe validity of measurements of dietary intake in free-living individuals is difficult to assess because all methods rely on information given by the subjects themselves, which may not be correct. In an attempt to determine objective measures for validating dietary assessments, the search has begun for analytes of biological specimens that closely reflect dietary intake, but which do not rely on reports of food consumption (Isaksson, 1980;Bingham, 1987). In individuals in energy and N balance, urine N as assessed from 8 d of complete 24 h urine available at https://www.cambridge.org/core/terms. https://doi
Energy intakes assessed by 7-d weighted dietary records (EI-WDRs) and diet histories (EI-DHs) were compared with concurrent estimates of total energy expenditure (TEE) by the doubly labeled water method in 78 subjects aged 3-18 y. EI-WDRs were not obtained from the 3- and 5-y-old subjects. EI-WDRs in the 7- and 9-y-old children were 108 +/- 25% (n = 12) and 97 +/- 15% (n = 12), respectively, of corresponding TEE values showing good agreement. However in the 12-, 15-, and 18-y-old subjects EI-WDR averaged 89 +/- 12% (n = 12), 78 +/- 18% (n = 12), and 73 +/- 25% (n = 10), respectively, of corresponding TEE values. The difference was greater than or equal to 20% in 13 adolescents. Mean EI-DHs were 114 +/- 19% (3 y), 111 +/- 19% (5 y), 111 +/- 23% (7 y), 106 +/- 9% (9 y), 114 +/- 17% (12 y), 101 +/- 21% (15 y), and 98 +/- 21% (18 y) of TEE estimates. Differences were significant in the 3-, 9-, and 12-y-old subjects. Results suggest that 7-d EI-WDRs tend to underestimate food intake of adolescents. Although EI-DHs were biased towards overestimation in most age groups and individual measurements lacked precision, EI-DHs were more representative of habitual intake than were EI-WDRs.
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