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
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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