Evaluation of different methods to handle misreporting in obesity research: evidence from the Canadian national nutrition survey

Abstract

The association of dietary exposures with health outcomes may be attenuated or reversed as a result of energy intake (EI) misreporting. This study evaluated several methods for dealing with implausible recalls when analysing the association between dietary factors and obesity. We examined data from 16 187 Canadians aged ≥12 years in the nationally representative Canadian Community Health Survey 2.2. Under-and over-reporting were defined as the ratio of EI:estimated energy requirement <0·7 and >1·42, respectively. Multinomial logistic regressiongeneralised logit model was conducted to test the utility of different methods for handling misreporting, including (a) adjusting for variables related to misreporting, (b) excluding misreported recalls, (c) adjusting for reporting groups (under-, plausible and over-reporters), (d) adjusting for propensity score and (e) stratifying the analyses by reporting groups. In the basic model, EI showed a negative association with overweight (OR 0·988; 95 % CI 0·979, 0·998) and obesity (OR 0·989; 95 % CI 0·977, 0·999). Similarly, the association between total energy density and overweight (OR 0·670; 95 % CI 0·487, 0·923) and obesity (OR 0·709; 95 % CI 0·495, 1·016) was inverse. Among all methods of handling misreporting, adjusting for the reporting status revealed the most satisfactory results, where a positive association between EI and overweight (OR 1·037; 95 % CI 1·019, 1·055) and obesity (OR 1·109; 95 % CI 1·082, 1·137) was observed (P < 0·0001), as well as direct positive associations between energy density and percentage energy from solid fats and added sugars with obesity (P < 0·05). The results of this study can help advance knowledge about the relationship between dietary variables and obesity and demonstrate to researchers and nutrition policy makers the importance of adjusting for recall plausibility in obesity research, which is highly relevant in light of global obesity epidemic.

Free and Added Sugar Consumption and Adherence to Guidelines: The UK National Diet and Nutrition Survey (2014/15–2015/16)

“…Like in all other surveys, the misreporting of foods high in sugar could affect the estimates of intake in this study. As a generally accepted limitation of subjective dietary assessment methods [34], misreporting can differentiate the results as individuals may alter their dietary pattern or misreport their food and drink intake, especially through underreporting foods perceived as unhealthy [35]. Therefore, it is possible that the dietary intake of added and free sugar intake may be higher than reported here.…”

Daily Snacking Occasions and Weight Status Among US Children Aged 1 to 5 Years

“…A “low active” level of physical activity (≥ 1.4 to < 1.6) was assumed for all children based on accelerometer data from NHANES 2003 to 2006 . Following the methods of Murakami and Livingstone , the EI/EER ratio was used as a covariate in analyses, as this approach has been shown to yield similar results to excluding implausible cases, without biasing sample selection ).…”

Exploring Diet Quality between Urban and Rural Dwelling Women of Reproductive Age

“…Consideration of plausible energy reporting strengthens the measured association between diet and health outcomes and reduces variability [36]. A common approach used to identify under and over-reporters in surveys is to compare each person’s basal metabolic rate (BMR) based on their age, sex and weight with their reported energy intake (EI) and apply Goldberg cut-off values to identify those with a plausible energy intake [37].…”