Diabetics Under Report Energy Intake in NHANES III Greater than Non-Diabetics

Abstract

Known factors associated with under-reporting energy intake (EI) include anthropometry, energy expenditure, psychological factors, smoking, and gender. There is insufficient information on the association between chronic disease status and under-reporting EI. Using NHANES III data from non-pregnant adults aged 20 years, reported EI was estimated from a single 24-hour dietary recall and compared with estimated basal metabolic rate (BMR est ) among 1503 diabetics and 17,010 non-diabetics. Multiple linear regression and logistic regression were performed to compare underreporting between diabetics and non-diabetics, and if it was associated with a hemoglobin A1c within diabetics.Using EI:BMR est < 0.9, male and female diabetics were 2.1 and 3.4 times as likely to under report EI compared to nondiabetics after controlling for weight, age, education, usual intake level, physical activity, tobacco and alcohol use. This greater under-reporting by diabetics could bias the association between diet and disease toward the null in epidemiological studies.Data examining the relationship between under-reporting EI and diabetic status are limited. One small study found under-reporting more prevalent among young type 1 diabetics [18]. No large studies have examined if an association between diabetic status and under-reporting exists.The current research was conducted using data from NHANES III to examine if an association between self-

Evaluation of different methods to handle misreporting in obesity research: evidence from the Canadian national nutrition survey

“…To our knowledge, this is the first study using a large-scale national survey data on adolescents and adults (self-reports) to compare seven different statistical approaches to counteract attenuation of risk estimates caused by misreporting. Consistent with previous studies on differential misreporting by weight and disease status ( 12 , 15 , 38 , 39 ) , under-reporters were more likely to be obese and have higher rates of chronic diseases compared with the plausible and over-reporters. In addition, our results showed strong evidence of selective misreporting in line with others ( 4 , 40 , 41 ) , where under-reporters reported significantly higher intakes of healthy foods – such as fibre, fruits and vegetables – and lower intakes of energy and energy-dense foods.…”

“…However, these authors did not consider the loss of statistical power that occurs as a result of excluding such large number of participants from the analyses and the fact that results would no longer be generalisable to the entire population, because misreporters have unique characteristics that are not shared by the plausible reporters (i.e. differential misreporting) ( 8 , 39 , 44 ) , as also clearly demonstrated in our study. In addition, extreme observations and outliers usually contain valuable information about the outcome of interest, and their exclusion may introduce an unknown bias ( 45 ) .…”

Diet and Acanthosis Nigricans over a Two-Year Period in Children of the Pacific Region

“…Thus, it is possible that parents who were informed about the presence of AN in their children and its relationship to diabetes may have under-reported their child’s added sugar intake at follow-up intake due to social desirability given they were participating in a study on childhood obesity [ 59 ]. A previous analysis of NHANES data indicated that adult men and women who self-identified with diabetes had 2.1 and 3.9 times greater risk, respectively, for underreporting energy intake [ 50 , 60 ]. Evidence that AN is associated with insulin resistance comes from several studies [ 25 , 27 , 61 , 62 ].…”