Use of a Urinary Sugars Biomarker to Assess Measurement Error in Self-Reported Sugars Intake in the Nutrition and Physical Activity Assessment Study (NPAAS)

Abstract

Background Measurement error (ME) in self-reported sugars intake may be obscuring the association between sugars and cancer risk in nutritional epidemiologic studies. Methods We used 24-hour urinary sucrose and fructose as a predictive biomarker for total sugars, to assess ME in self-reported sugars intake. The Nutrition and Physical Activity Assessment Study (NPAAS) is a biomarker study within the Women’s Health Initiative (WHI) Observational Study, that includes 450 post-menopausal women aged 60–91. Food Frequency Questionnaires (FFQ), 4-day food records (4DFR) and three 24-h dietary recalls (24HRs) were collected along with sugars and energy dietary biomarkers. Results Using the biomarker, we found self-reported sugars to be substantially and roughly equally misreported across the FFQ, 4DFR and 24HR. All instruments were associated with considerable intake- and person-specific bias. Three 24HRs would provide the least attenuated risk estimate for sugars (attenuation factor, AF=0.57), followed by FFQ (AF=0.48), and 4DFR (AF=0.32), in studies of energy-adjusted sugars and disease risk. In calibration models, self-reports explained little variation in true intake (5–6% for absolute sugars; 7–18% for sugars density). Adding participants’ characteristics somewhat improved the percentage variation explained (16–18% for absolute sugars; 29–40% for sugars density). Conclusions None of the self-report instruments provided a good estimate of sugars intake, although overall 24HRs seemed to perform the best. Impact Assuming the calibrated sugars biomarker is unbiased, this analysis suggests that, measuring the biomarker in a subsample of the study population for calibration purposes may be necessary for obtaining unbiased risk estimates in cancer association studies.

Identifying biomarkers of dietary patterns by using metabolomics

“…These differences could be attributable to stronger correlations between food exposures and metabolites, or differences in self-reported food compared with nutrient measurement error properties. Urinary (as opposed to serum) biomarkers might better characterize intake of some of these nutrients (i.e., sucrose and fructose for sugars, and nitrogen for protein and sodium) (60,(67)(68)(69). The magnitudes of diet index-metabolite correlations were modest, but similar to previously reported findings (60).…”

Stable Isotope Ratios as Biomarkers of Diet for Health Research

“…Such studies will necessarily rely on self-reported dietary measures, and should use the best measures available (149), with the understanding that biomarker-diet relationships will be attenuated from their true associations. A recent study assessing measurement error in self-reported sugars intake found the least attenuation for multiple 24-hour recalls, followed by four-day food record, and finally FFQ (144), although all three measures were significantly misreported.…”

New markers of dietary added sugar intake

“…Both studies included large sample sizes of adults, and reported associations of biomarker values with self-reported sugar intake [31*,32]. Tasevska and colleagues [32] utilized a biomarker-based calibration equation to predict total sugar intake, and compared this to self-reported intake in a US sample. Kuhnle and colleagues [31*] collected spot urine samples from a UK sample.…”