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Nutritional Epidemiology

Dietary Evaluation and Attenuation of Relative Risk: Multiple Comparisons between Blood and Urinary Biomarkers, Food Frequency, and 24-Hour Recall Questionnaires: the DEARR Study¹

Iris Shai^*,,**,2, Bernard A. Rosner, Danit R. Shahar^,**, Hilel Vardi^**, Ayelet B. Azrad^,**, Ayala Kanfi, Dan Schwarzfuchs and Drora Fraser^,**

^* Harvard School of Public Health, Departments of Nutrition and Epidemiology, Boston, MA; S. Daniel Abraham International Center for Health and Nutrition, Ben-Gurion University of the Negev, Beer-Sheva, Israel; ^** Epidemiology and Health Services Evaluation Department, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Channing Laboratory, Harvard Medical School, Boston, MA; and The Nuclear Research Center, Department of Medicine, Dimona, Israel

²To whom correspondence should be addressed. E-mail: ishai{at}hsph.harvard.edu and irish{at}bgumail.bgu.ac.il.

Estimates of diet-disease relative risks (RRs) suffer from inaccuracies introduced by dietary measurement errors. Using the "method of triads," by which the validity coefficient (VC) of the dietary assessment method and "true" long-term intake could be estimated from 3 pairwise correlations between the FFQ, the reference method, and the biomarker, the authors evaluated the performance of a newly developed FFQ. Over a period of 13 mo (September 2000 to September 2001), 161 participants completed 3 FFQs and six 24-h recalls (24HRs), and supplied 2 blood samples and three 24-h urine collections. For protein, ß-carotene, and folic acid, the VCs of the FFQ with the "true intake" (0.77, 0.65, and 0.72, respectively) were relatively higher than the VCs of 24HRs (0.68, 0.60 and 0.39, respectively). Among the biomarkers, the VCs of serum ß-carotene and folic acid with the "true intake" (0.65 and 0.65) were higher than the VCs of urinary nitrogen and -tocopherol (0.44 and 0.34, respectively). The DEARR study showed that the newly developed FFQ is a valid and reproducible instrument for assessing dietary intake. The VCs obtained can be used for future adjustment of diet-disease RR estimates in this population.

KEY WORDS: • biomarkers • diet • dietary questionnaires • reproducibility and validity • true intake

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