The Cardiometabolic Risk Profile of Underreporters of Energy Intake Differs from That of Adequate Reporters among Children at Risk of Obesity

• Published in: The Journal of nutrition Vol. 149; no. 1; pp. 123 - 130
• Main Authors: Suissa, Karine, Benedetti, Andrea, Henderson, Mélanie, Gray-Donald, Katherine, Paradis, Gilles
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2019; Oxford University Press; American Institute of Nutrition
• Subjects: 24-h recall; adiposity; Antihypertensives; Bias; Body mass index; Body size; cardiometabolic risk; Cardiovascular Diseases - etiology; Child; Children; Children & youth; children at risk; Cohort Studies; diabetes; Diabetes mellitus; Diet; diet recall; Diet Records; Dietary restrictions; dietitians; disease severity; Energy Intake; Epidemiology; Female; glycemic index; glycemic load; Health risks; household income; Humans; lifestyle; Male; men; misreporting; Nutrient deficiency; Nutrition; Obesity; Original; Parents; Pediatric Obesity; Physical activity; Quebec; questionnaires; regression analysis; Risk assessment; Risk Factors; risk profile; Surveys and Questionnaires; underreporting; waist circumference; Whites; women; youth; Quebec; energy intake; glycemic index; cardiometabolic risk; adiposity; QUALITY; EI; body mass index; BMR; misreporting; glycemic load; EI:BMR; 24-h recall; AR; children; underreporting; PAL; UR
• ISSN: 0022-3166; 1541-6100; 1541-6100
• DOI: 10.1093/jn/nxy209

Misreporting of energy intake (EI) in nutritional epidemiology is a concern because of information bias, and tends to occur differentially in obese compared with nonobese subjects. We examined characteristics of misreporters within a cohort of children with a parental history of obesity and the bias introduced by underreporting. The QUebec Adipose and Lifestyle InvesTigation in Youth (QUALITY) cohort included 630 Caucasian children aged 8–10 y at recruitment with ≥1 obese parent [body mass index (BMI; in kg/m2) >30 or waist circumference >102 cm (men), >88 cm (women)] and free of diabetes or severe illness. Children on antihypertensive medications or following a restricted diet were excluded. Child and parent characteristics were measured directly or by questionnaire. Three 24-h dietary recalls were administered by phone by a dietitian. Goldberg's cutoff method identified underreporters (URs). Logistic regression identified correlates of URs. We compared coefficients from linear regressions of BMI after 2 y on total EI at baseline 1) in all participants; 2) in adequate reporters (ARs) (excluding URs); 3) in all participants statistically adjusted for underreporting; 4) excluding URs using individual physical activity level (PAL)-specific cutoffs; and 5) in all participants statistically adjusted for underreporting using PAL-specific cutoffs. We identified 175 URs based on a calculated cutoff of 1.11. URs were older, had a higher BMI z score, and had poorer cardiometabolic health indicators. Parents of URs had a lower family income and higher BMI. Child BMI z score (OR: 3.07; 95% CI: 2.38, 3.97) and age (OR: 1.46/y; 95% CI: 1.14, 1.87/y) were the strongest correlates of underreporting. The association between BMI and total EI was null in all participants but became significantly positive after excluding URs (ß = 0.62/1000 kcal; 95% CI: 0.33, 0.92/1000 kcal) and after adjustment for URs (ß = 0.85/1000 kcal; 95% CI: 0.55, 1.06/1000 kcal). URs in 8- to 10-y-old children differed from ARs. Underreporting biases measurement of nutritional exposures and the assessment of exposure-outcome relations. Identifying URs and using an appropriate correction method is essential.