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Nutritional Methodology

Adjustments to Improve the Estimation of Usual Dietary Intake Distributions in the Population¹

Laurence S. Freedman, Douglas Midthune^*, Raymond J. Carroll, Sue Krebs-Smith^**, Amy F. Subar^**, Richard P. Troiano^**, Kevin Dodd^**, Arthur Schatzkin, Pietro Ferrari and Victor Kipnis^*,2

Department of Mathematics, Statistics and Computer Science, Bar Ilan University, Ramat Gan, Israel, and Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel; ^* Biometry Research Group, Division of Cancer Prevention, National Cancer Institute, Bethesda, MD Department of Statistics, Texas A&M University, College Station, TX; ^** Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD; Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD; and International Agency for Research into Cancer, Lyon, France

²To whom correspondence should be addressed. E-mail: victor_kipnis{at}nih.gov.

We reexamined the current practice in estimating the distribution of usual dietary nutrient intakes from population surveys when using self-report dietary instruments, particularly the 24-h recall (24HR), in light of the new data from the Observing Protein and Energy Nutrition Study. In this study, reference biomarkers for energy (doubly labeled water) and protein [urinary nitrogen (UN)], together with multiple FFQs and 24HRs, were administered to 484 healthy volunteers. By using the reference biomarkers to estimate the distributions for energy and protein, the data confirmed previous reports that FFQs generally do not give an accurate impression of the distribution of usual dietary intake. The traditional method applied to 24HRs performed poorly because of underestimating the mean and overestimating the SD of the usual energy and protein intake distributions, and, although the National Research Council and the Iowa State University methods generally give better estimates of the shape of the distribution, they did not improve the estimates of the mean (10–15% underestimation for energy and 6–7% underestimation for protein). Results for urinary potassium, a putative biomarker for potassium intake, and reported potassium intake did not display this underestimation and may reflect either differential underreporting of foods or inadequacy of the potassium biomarker. A large controlled feeding study is required to validate conclusively the potassium biomarker. For energy intake, adjusting its 24HR-based distribution by using the UN biomarker appeared to capture the usual intake distribution quite accurately. Incorporating UN assessments into nutritional surveys, therefore, deserves serious consideration.

KEY WORDS: • biological markers • energy intake • nutrition assessment • questionnaires • reference values • underreporting • surveillance

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