American Journal of Epidemiology

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Am J Epidemiol 2003; 158:14-21.
Copyright © 2003 by Johns Hopkins Bloomberg School of Public Health

PRACTICE OF EPIDEMIOLOGY

Structure of Dietary Measurement Error: Results of the OPEN Biomarker Study

Victor Kipnis¹ , Amy F. Subar², Douglas Midthune¹, Laurence S. Freedman^3,4, Rachel Ballard-Barbash², Richard P. Troiano², Sheila Bingham⁵, Dale A. Schoeller⁶, Arthur Schatzkin⁷ and Raymond J. Carroll⁸

¹ Biometry Research Group, Division of Cancer Prevention, National Cancer Institute, Bethesda, MD.
² Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD.
³ Department of Mathematics, Statistics and Computer Science, Bar Ilan University, Ramat Gan, Israel.
⁴ Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel.
⁵ Medical Research Council, Dunn Human Nutrition Unit, Cambridge, United Kingdom.
⁶ Department of Nutritional Sciences, University of Wisconsin, Madison, WI.
⁷ Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD.
⁸ Department of Statistics, Texas A&M University, College Station, TX.

Multiple-day food records or 24-hour dietary recalls (24HRs) are commonly used as "reference" instruments to calibrate food frequency questionnaires (FFQs) and to adjust findings from nutritional epidemiologic studies for measurement error. Correct adjustment requires that the errors in the adopted reference instrument be independent of those in the FFQ and of true intake. The authors report data from the Observing Protein and Energy Nutrition (OPEN) Study, conducted from September 1999 to March 2000, in which valid reference biomarkers for energy (doubly labeled water) and protein (urinary nitrogen), together with a FFQ and 24HR, were observed in 484 healthy volunteers from Montgomery County, Maryland. Accounting for the reference biomarkers, the data suggest that the FFQ leads to severe attenuation in estimated disease relative risks for absolute protein or energy intake (a true relative risk of 2 would appear as 1.1 or smaller). For protein adjusted for energy intake by using either nutrient density or nutrient residuals, the attenuation is less severe (a relative risk of 2 would appear as approximately 1.3), lending weight to the use of energy adjustment. Using the 24HR as a reference instrument can seriously underestimate true attenuation (up to 60% for energy-adjusted protein). Results suggest that the interpretation of findings from FFQ-based epidemiologic studies of diet-disease associations needs to be reevaluated.

bias (epidemiology); biological markers; diet; energy intake; epidemiologic methods; nutrition assessment; questionnaires; reference values

Abbreviations: Abbreviations: DLW, doubly labeled water; FFQ, food frequency questionnaire; OPEN, Observing Protein and Energy Nutrition; 24HR, 24-hour dietary recall.

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Related articles in Am. J. Epidemiol.:

Using Intake Biomarkers to Evaluate the Extent of Dietary Misreporting in a Large Sample of Adults: The OPEN Study

Amy F. Subar, Victor Kipnis, Richard P. Troiano, Douglas Midthune, Dale A. Schoeller, Sheila Bingham, Carolyn O. Sharbaugh, Jillian Trabulsi, Shirley Runswick, Rachel Ballard-Barbash, Joel Sunshine, and Arthur Schatzkin
Am. J. Epidemiol. 2003 158: 1-13. [Abstract] [FREE Full Text]  

Invited Commentary: OPEN Questions

Walter Willett
Am. J. Epidemiol. 2003 158: 22-24. [Extract] [FREE Full Text]  

Kipnis et al. Respond to "OPEN Questions"

Victor Kipnis, Amy F. Subar, Arthur Schatzkin, Douglas Midthune, Richard P. Troiano, Dale A. Schoeller, Sheila Bingham, and Laurence S. Freedman
Am. J. Epidemiol. 2003 158: 25-26. [Extract] [FREE Full Text]  

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				R. L. Prentice, W. C. Willett, P. Greenwald, D. Alberts, L. Bernstein, N. F. Boyd, T. Byers, S. K. Clinton, G. Fraser, L. Freedman, et al. Nutrition and Physical Activity and Chronic Disease Prevention: Research Strategies and Recommendations J Natl Cancer Inst, September 1, 2004; 96(17): 1276 - 1287. [Abstract] [Full Text] [PDF]

				L. S. Freedman, D. Midthune, R. J. Carroll, S. Krebs-Smith, A. F. Subar, R. P. Troiano, K. Dodd, A. Schatzkin, P. Ferrari, and V. Kipnis Adjustments to Improve the Estimation of Usual Dietary Intake Distributions in the Population J. Nutr., July 1, 2004; 134(7): 1836 - 1843. [Abstract] [Full Text]

				K. Hoffmann, M. B. Schulze, A. Schienkiewitz, U. Nothlings, and H. Boeing Application of a New Statistical Method to Derive Dietary Patterns in Nutritional Epidemiology Am. J. Epidemiol., May 15, 2004; 159(10): 935 - 944. [Abstract] [Full Text] [PDF]

				J. P. Pierce, V. A. Newman, S. W. Flatt, S. Faerber, C. L. Rock, L. Natarajan, B. J. Caan, E. B. Gold, K. A. Hollenbach, L. Wasserman, et al. Telephone Counseling Intervention Increases Intakes of Micronutrient- and Phytochemical-Rich Vegetables, Fruit and Fiber in Breast Cancer Survivors J. Nutr., February 1, 2004; 134(2): 452 - 458. [Abstract] [Full Text] [PDF]

				A. Schatzkin, V. Kipnis, R. J Carroll, D. Midthune, A. F Subar, S. Bingham, D. A Schoeller, R. P Troiano, and L. S Freedman A comparison of a food frequency questionnaire with a 24-hour recall for use in an epidemiological cohort study: results from the biomarker-based Observing Protein and Energy Nutrition (OPEN) study Int. J. Epidemiol., December 1, 2003; 32(6): 1054 - 1062. [Abstract] [Full Text] [PDF]

				J. Satia-Abouta, J. A. Galanko, J. D. Potter, A. Ammerman, C. F. Martin, and R. S. Sandler Associations of Total Energy and Macronutrients with Colon Cancer Risk in African Americans and Whites: Results from the North Carolina Colon Cancer Study Am. J. Epidemiol., November 15, 2003; 158(10): 951 - 962. [Abstract] [Full Text] [PDF]

				A. F. Subar, V. Kipnis, R. P. Troiano, D. Midthune, D. A. Schoeller, S. Bingham, C. O. Sharbaugh, J. Trabulsi, S. Runswick, R. Ballard-Barbash, et al. Using Intake Biomarkers to Evaluate the Extent of Dietary Misreporting in a Large Sample of Adults: The OPEN Study Am. J. Epidemiol., July 1, 2003; 158(1): 1 - 13. [Abstract] [Full Text] [PDF]

				W. Willett Invited Commentary: OPEN Questions Am. J. Epidemiol., July 1, 2003; 158(1): 22 - 24. [Full Text] [PDF]

				V. Kipnis, A. F. Subar, A. Schatzkin, D. Midthune, R. P. Troiano, D. A. Schoeller, S. Bingham, and L. S. Freedman Kipnis et al. Respond to "OPEN Questions" Am. J. Epidemiol., July 1, 2003; 158(1): 25 - 26. [Full Text] [PDF]

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