Effect of Energy Under-Reporting on Secular Trends of Dietary Patterns in a Mediterranean Population

Abstract

BackgroundDiet is an important factor in the prevention of chronic diseases. Analysis of secular trends of dietary patterns can be biased by energy under-reporting. Therefore, the objective of the present study was to analyse the impact of energy under-reporting on dietary patterns and secular trends in dietary patterns defined by cluster analysis.Design and methodsTwo cross-sectional population-based surveys were conducted in Spain, in 2000 and 2005, with 3058 and 6352 participants, respectively, aged 25 to 74 years. Validated questionnaire was used to collect dietary data. Cluster analysis was run separately for all participants, plausible energy reporters (PER), and energy under-reporters (EUR) to define dietary patterns.ResultsThree clusters, “healthy”, “mixed” and “western”, were identified for both surveys. The “mixed” cluster was the predominant cluster in both surveys. Excluding EUR reduced the proportion of the “mixed” cluster up to 6.40% in the 2000 survey; this caused secular trend increase in the prevalence of the “mixed” pattern. Cross-classification analysis of all participants and PER’ data showed substantial agreement in cluster assignments: 68.7% in 2000 and 84.4% in 2005. Excluding EUR did not cause meaningful (≥15%) changes in the “healthy” pattern. It provoked changes in consumption of some food groups in the “mixed” and “western” patterns: mainly decreases of unhealthy foods within the 2000 and increases of unhealthy foods within the 2005 surveys. Secular trend effects of EUR were similar to those within the 2005 survey. Excluding EUR reversed the direction of secular trends in consumption of several food groups in PER in the “mixed” and “western” patterns.ConclusionsEUR affected distribution of participants between dietary patterns within and between surveys, secular trends in food group consumption and amount of food consumed in all, but not in the “healthy” pattern. Our findings emphasize threats from energy under-reporting in dietary data analysis.

The effect of under-reporting of energy intake on dietary patterns and on the associations between dietary patterns and self-reported chronic disease in women aged 50–69 years

“…Studies using the DLW method have clearly shown that all dietary assessment methods tend to underestimate EI to various degrees (57)(58)(59) . Previous studies have reported prevalence of low energy reporting ranging from 10 to 60 % depending on the dietary assessment method, the reference method used to identify low energy reporters and the characteristics of the study population (4,11,58,(60)(61)(62)(63)(64)(65)(66)(67)(68)(69)(70)(71)(72) . In the revised Goldberg cut-off equations (10) , the individual's physical activity is taken into account.…”

“…A few studies have investigated the effect of under-reporting on empirically derived dietary patterns (11)(12)(13)(14)(15)(16)(17)(18) ; four studies have reported that the composition of food groups that significantly contributed to the dietary patterns remained relatively unchanged after removal of low energy reporters (11,(13)(14)(15) . One study found that the number of dietary patterns differed between plausible reporters and all reporters (12) .…”

A healthy dietary pattern associates with a lower risk of a first clinical diagnosis of central nervous system demyelination

“…A further limitation of our study is the widely acknowledged under-reporting of energy intake from self-reported dietary assessment methods 23 . It is well-known that energy underreporting of foods is selective, with unhealthy and snack foods more likely to be forgotten during dietary reporting 31,32 . Although this may potentially bias the analysis of dietary patterns, it is likely that recall error in our study was similar for case and control participants.…”

The under-reporting of energy intake influences the dietary pattern reported by obese women in the waiting list for bariatric surgery

“…The influence of underreporting of energy intake on dietary patterns determined by the clusters method were more prevalent in groups described as healthy [33,34] and the exclusion of these individuals did not alter the contribution of the food group in the description of the cluster. However, by excluding under-reporters, the patterns described as mixed and western showed a high consumption of unhealthy food groups such as sausages, white bread, pastry, soft drinks and fast foods by plausible reporting participants [34].…”

“…While the exclusion of information of a high percentage of under-reporting patients contributed to a new conformation of dietary patterns, the exclusion of a low percentage of under-reporting patients (16.3%) did not induce variations in the definition of dietary patterns, but in different contributions from certain food subgroups described in plausible reporters patterns [32]. The influence of underreporting of energy intake on dietary patterns determined by the clusters method were more prevalent in groups described as healthy [33,34] and the exclusion of these individuals did not alter the contribution of the food group in the description of the cluster. However, by excluding under-reporters, the patterns described as mixed and western showed a high consumption of unhealthy food groups such as sausages, white bread, pastry, soft drinks and fast foods by plausible reporting participants [34].…”