Traditional Self-Reported Dietary Instruments Are Prone to Inaccuracies and New Approaches Are Needed

Abstract

Background: Diet is a modifiable behavior that influences an individual's health. Because of this, diet assessment is an important component of public health surveillance, evaluating response to community health interventions, and monitoring individual compliance to medical interventions. Diet assessments are usually performed using one of three basic methods: diet recall, diet diaries, or food frequency questionnaires. Although these three assessment instruments have displayed a strong agreement between themselves, when reported intake is compared with intake measured using quantitative nutrient biomarkers, investigators have identified systematic misreporting errors for all three of these self-reported dietary instruments. Aims: This work aims to summarize the state of knowledge regarding misreporting and why it impedes diet-health research and to introduce advances in the collection and the treatment of dietary data. Methods: This work reviews and summarizes published data on misreporting and the recent efforts to reduce such errors. Results: The evidence demonstrates a strong and consistent systematic underreporting of energy intake (EIn) across adults and children studies. Underreporting of EIn has been found to increase with body mass index (BMI), and the differences between macronutrient reports indicate that not all foods are underreported equally. Protein is least underreported, but which specific foods are commonly underreported are not known. Conclusions: Because energy underreporting varies as a function of BMI, self-reported EIn should not be used for the study of energy balance in the study of obesity. The between-individual variability in the underreporting of self-reported intake of energy and other nutrients attenuates diet-disease relationships. Recent efforts to correct for underreporting have reduced misreporting of diet outcomes, but improvements have been incremental in nature and more research is needed to validate and extend these efforts.

A Simple Liking Survey Captures Behaviors Associated with Weight Loss in a Worksite Program among Women at Risk of Type 2 Diabetes

“…We support our hypothesis that the liking survey, particularly the assessment of food and beverage liking, would add to the ability to explain levels of weight loss in response to a worksite-based intervention. Dietary assessment tools used in experimental settings may fail in community-based settings, in part, because of participant burden and misreporting [2,3]. Our findings join others [21,36,37] to support liking surveys as dietary evaluation tools.…”

“…However, intake misreporting, particularly in overweight and obese individuals [2], challenges linking of dietary changes with weight loss [3]. Novel methods of capturing diet behaviors for intervention studies are needed [2]. This paper extends our research on reported food/beverage liking as a novel and valid measure of dietary behaviors [4][5][6] that is feasible in workplace settings [7][8][9] as a potential tool for dietary evaluation.…”

“…Dietary evaluation measures historically involve multiple dietary recalls/records and/or food frequency surveys to assess changes in energy intakes and diet quality [1]. However, intake misreporting, particularly in overweight and obese individuals [2], challenges linking of dietary changes with weight loss [3]. Novel methods of capturing diet behaviors for intervention studies are needed [2].…”

Retrospectively Estimating Energy Intake and Misreporting From a Qualitative Food Frequency Questionnaire: An Example Using Australian Cohort and National Survey Data

“…Assessment of individual-level misreporting compares the EI:TEE ratio to a percentage-based confidence limit (estimated using known measurement error and variance in estimated energy intake and total energy expenditure, and energy requirements). The pTEE method advocates a more stringent statistical cutoff (±1–1.5 SD) than the Goldberg method, intending to create a more biologically plausible sample where energy intake estimates are consistent with principles of energy physiology ( 18 , 53 ).…”

Associations among Food Security, School Meal Participation, and Students’ Diet Quality in the First School Nutrition and Meal Cost Study

“…Second, children and adolescents, like adults, may misreport their dietary intakes, either intentionally or because they are still undergoing cognitive development [ 28 ]. Several dietary recall validation studies have found children to accurately or slightly overreport their energy intakes, and younger children may report more accurately with parental assistance, but overweight or obese children and older children are more likely to underreport [ 28 , 29 ]. Third, some analyses were based on small sample sizes and may not be reliable; for example, few students attended schools that offered universal free meals.…”