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Nutritional Epidemiology

A Debriefing Session with a Nutritionist Can Improve Dietary Assessment Using Food Diaries¹

Marie M. Cantwell^*,,2, Amy E. Millen^**, Raymond Carroll, Beth L. Mittl, Sigurd Hermansen, Louise A. Brinton and Nancy Potischman^#

^* Laboratory of Biosystems and Cancer, Center Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD; Cancer Prevention Fellowship Program, Division Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda MD; ^** Department of Social and Preventive Medicine, University at Buffalo, Buffalo, NY; Department of Statistics, Texas A & M University, College Station, TX; Westat, Incorporated, Rockville, MD; Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD; and ^# Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD

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

The objective of the current study was to evaluate the effect of a debriefing call on nutrient intake estimates using two 3-d food diaries among women participating in the Women's Health and Interview Study (WISH) Diet Validation Study. Subjects were 207 women with complete data and six 24-h recalls (24-HR) by telephone over 8 mo followed by two 3-d food diaries during the next 4 mo. Nutrient intake was assessed using the food diaries before and after a debriefing session by telephone. The purpose of the debriefing call was to obtain more detailed information on the types and amounts of fat in the diet. However, due to the ubiquitous nature of fat in the diet, the debriefing involved providing more specific detail on many aspects of the diet. There was a significant difference in macronutrient and micronutrient intake estimates after the debriefing. Estimates of protein, carbohydrate, and fiber intake were significantly higher and total fat, monounsaturated fat, saturated fat, vitamin A, vitamin C, -tocopherol, folic acid, and calcium intake were significantly lower after the debriefing (P < 0.05). The limits of agreement between the food diaries before and after the debriefing were especially large for total fat intake, which could be under- or overestimated by 15 g/d. The debriefing call improved attenuation coefficients associated with measurement error for vitamin C, folic acid, iron, tocopherol, vitamin A, and calcium estimates. A hypothetical relative risk (RR) = 2.0 could be attenuated to 1.16 for folic acid intake assessed without a debriefing but to only 1.61 with a debriefing. Depending on the nutrients of interest, the inclusion of a debriefing can reduce the potential attenuation of RR in studies evaluating diet disease associations.

KEY WORDS: • food diaries • dietary assessment • attenuation