Fourth-Grade Children’s Reporting Accuracy for Amounts Eaten at School-Provided Meals: Insight from a Reporting-Error-Sensitive Analytic Approach Applied to Validation Study Data

Abstract

Background Validation studies that have directly assessed reporting accuracy for amounts eaten have provided results in various ways. Objective To analyze amount categories of a reporting-error-sensitive approach for insight concerning reporting accuracy for amounts eaten. Design For a cross-sectional validation study, children were observed eating school-provided breakfast and lunch, and randomized to one of eight 24-hour recall conditions (two retention intervals [short; long] crossed with four prompts [forward; meal-name; open; reverse]). Participants/setting Data collected during three school years (2011–2012 to 2013–2014) on 455 children from ten schools (four districts) in a southern USA state. Main outcome measures Items were classified as matches [observed and reported], omissions [observed but unreported], or intrusions [unobserved but reported]. Within amount categories (matches [corresponding, over-reported, under-reported], intrusions [over-reported], omissions [under-reported]), item-amounts were converted to kilocalories. Statistical analyses performed A multilevel model was fit with food-level explanatory variables (amount category, meal) and child-level explanatory variables (retention interval, prompt, sex, race/ethnicity). T-tests on three contrasts investigated inaccuracy differences. Results Inaccuracy differed by amount category (P<0.001; largest to smallest—omission, intrusion, under-reported match, over-reported match), meal (P=0.01; larger for breakfast), retention interval (P=0.003; larger for long), sex (P=0.004; larger for boys), race/ethnicity (P=0.045; largest for non-Hispanic Whites), and amount category-×-meal interaction (P=0.046). Over-reported amounts were larger for intrusions than over-reported matches (P<0.0001). Under-reported amounts were larger for omissions than under-reported matches (P<0.0001). Overall under-reported amounts (from omissions and under-reported matches) exceeded overall over-reported amounts (from intrusions and over-reported matches) (P<0.003). Conclusions Amount categories provide a standard way to analyze validation-study data on reporting accuracy for amounts eaten, and compare results across studies. Multilevel analytic models reflecting the data structure are recommended for inference. To enhance reporting accuracy for amounts eaten, focus on increasing reports of correct items, thereby yielding more matches with fewer intrusions and omissions.

Validity of Interviewer-Administered 24-h Dietary Recalls in Older Korean Women: A Pilot Study

“…We assessed the accuracy of the food items consumed and portion sizes reported by the participants by comparing them to the actual intake of food items and portion sizes. Using previously established definitions [ 16 , 17 ], we determined whether the reported food items matched those provided (matches). Exclusions (i.e., items consumed but not reported) and intrusions (i.e., items reported but not consumed) were also identified.…”

“…The high inaccuracy of portion size estimates in this study may be due to the lack of assistance from food guides/models or interviewer. In addition, although the accuracy of 24-h recalls for nutrients may be important, its meaningfulness has recently been challenged [ 16 , 17 ]. As dietary patterns have become a large area of interest, understanding the reporting accuracy of foods is essential.…”