Comparison of self-reported dietary intakes from the Automated Self-Administered 24-h recall, 4-d food records, and food-frequency questionnaires against recovery biomarkers

Authors: PARK, YIKYUNG - Washington University School Of Medicine; DODD, KEVIN - National Cancer Institute (NCI, NIH); KIPNIS, VICTOR - National Cancer Institute (NCI, NIH); THOMPSON, FRANCES - National Cancer Institute (NCI, NIH); POTISCHMAN, NANCY - National Cancer Institute (NCI, NIH); SCHOELLER, DALE - University Of Wisconsin; Baer, David; MIDTHUNE, DOUGLAS - National Cancer Institute (NCI, NIH); TROIANO, RICK - National Cancer Institute (NCI, NIH); BOWLES, HEATHER - National Cancer Institute (NCI, NIH); SUBAR, AMY - National Cancer Institute (NCI, NIH)

Submitted to: The American Journal of Clinical Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 10/17/2017
Publication Date: 1/26/2018
Citation: Park, Y., Dodd, K., Kipnis, V., Thompson, F.E., Potischman, N., Schoeller, D.A., Baer, D.J., Midthune, D., Troiano, R., Bowles, H., Subar, A.F. 2018. Comparison of self-reported dietary intakes from the Automated Self-Administered 24-h recall, 4-d food records, and food-frequency questionnaires against recovery biomarkers. American Journal of Clinical Nutrition. 107:80-93. https://doi.org/10.1093/ajcn/nqx002.
DOI: https://doi.org/10.1093/ajcn/nqx002

Interpretive Summary: Nutritional epidemiologic studies have made significant contributions to identifying the association between diet-disease. However, the quality of evidence from these studies has been criticized, in part, due to methodological limitations, one of which is measurement error inherent in all self-reported dietary intakes. These is limited evidence for the validity of dietary intakes assessed by self-reported dietary assessment tools such as 24-hour recalls including the Automated Self-Administered 24-hour recall (ASA24), food records, and food frequency questionnaires (FFQs) against recovery biomarkers. The objective of this study was to evaluate and compare dietary intakes of multiple self-assessment methods as compared to biological biomarkers of intake (also called recovery biomarkers), including urinary nitrogen, sodium and potassium. Over 12 months, 530 men and 545 women, 50-74 years of age, were asked to complete multiple dietary self-assessment tools and collect urine samples for measurement of recovery biomarkers. Absolute and density-based energy-adjusted nutrient intakes were calculated and under- and over-reporting of self-report against biomarkers was evaluated. Absolute nutrient intakes assessed by all self-reported dietary assessment instruments were systematically lower than those based on recovery biomarkers, with reporting being worse for energy than other nutrients. On average, compared to the energy biomarker, self-reported energy intake was underestimated by 17%-19% on ASA24s, 18%-21% on 4DFRs, and 29%-34% on FFQs. Under-reporting was more prevalent on FFQs than ASA24s and 4DFRs and among obese individuals. Mean protein and sodium densities on ASA24s, 4DFRs, and FFQs were similar to biomarker values, but potassium density on FFQs was 26%-40% higher than biomarker values leading to a substantial increase in the prevalence of over-reporting compared to absolute potassium intake. Although misreporting is present in all self-report dietary assessment tools, multiple ASA24s and a 4DFR provide the best estimates of absolute dietary intakes, outperforming FFQs. Energy adjustment improves estimates for FFQs for protein and sodium but not for potassium. ASA24 is a feasible means to collect high-quality dietary data in epidemiologic and clinical studies. These data are important scientist involved in dietary assessment, public health professional, and individuals interested in self-assessing their diet.

Technical Abstract: A limited number of studies have evaluated self-reported dietary intakes against objective recovery biomarkers. The aim was to compare dietary intakes of multiple Automated Self-Administered 24-h recalls (ASA24s), 4-d food records (4DFRs), and food-frequency questionnaires (FFQs) against recovery biomarkers and to estimate the prevalence of under- and overreporting. Over 12 mo, 530 men and 545 women, aged 50–74 y, were asked to complete 6 ASA24s (2011 version), 2 unweighed 4DFRs, 2 FFQs, two 24-h urine collections (biomarkers for protein, potassium, and sodium intakes), and 1 administration of doubly labeled water (biomarker for energy intake). Absolute and density-based energy-adjusted nutrient intakes were calculated. The prevalence of under- and overreporting of self-report against biomarkers was estimated. Ninety-two percent of men and 87% of women completed =3 ASA24s (mean ASA24s completed: 5.4 and 5.1 for men and women, respectively). Absolute intakes of energy, protein, potassium, and sodium assessed by all self-reported instruments were systematically lower than those from recovery biomarkers, with underreporting greater for energy than for other nutrients. On average, compared with the energy biomarker, intake was underestimated by 15–17% on ASA24s, 18–21% on 4DFRs, and 29–34% on FFQs. Underreporting was more prevalent on FFQs than on ASA24s and 4DFRs and among obese individuals. Mean protein and sodium densities on ASA24s, 4DFRs, and FFQs were similar to biomarker values, but potassium density on FFQs was 26–40% higher, leading to a substantial increase in the prevalence of overreporting compared with absolute potassium intake. Although misreporting is present in all self-report dietary assessment tools, multiple ASA24s and a 4DFR provided the best estimates of absolute dietary intakes for these few nutrients and outperformed FFQs. Energy adjustment improved estimates from FFQs for protein and sodium but not for potassium. The ASA24, which now can be used to collect both recalls and records, is a feasible means to collect dietary data for nutrition research.