Plausible Reports of Energy Intake May Predict Body Mass Index in Pre-Adolescent Girls

Abstract

Inaccurate reporting of energy intake makes it difficult to study the associations between diet and weight status. This study examined reported energy intake at age 9 years as a predictor of girls' body mass index (BMI) at age 11 years, before and after adjusting for parents' BMI and girls' pubertal status. This prospective, observational cohort study included 177 non-Hispanic white girls and their parents. When the subjects were 9 years of age, three 24-hour recalls were used to categorize girls as plausible or implausible over-reporters and under-reporters based on previously published methods. Height and weight was measured to calculate BMI. Linear and hierarchical regression analyses were used to predict girls' BMI. Results revealed that girls who under-reported had significantly higher BMIs than plausible and overreporters. Among the total sample and among implausible reporters, reported energy intake was not a significant predictor of BMI; however, among plausible reporters, reported energy intake explained 14% of the variance in BMI and remained a significant predictor after adjusting for parental BMI and girls' pubertal status. Systematic bias related to underreporting in dietary data can obscure relationships with weight status, even among young girls. A relatively simple analytical procedure can be used to identify the magnitude and nature of reporting bias in dietary data.Obesity and overweight are due to an imbalance between energy intake and energy expenditure, in which intake exceeds expenditure (1). Among youth, previous research has failed to consistently reveal positive relations between reported energy intake and weight status (2-4). This has led to the conclusion that low energy expenditure, rather than excessive energy intake, is responsible for weight gain and an increase in overweight among adolescents (2). However, failure to note relations between reported energy intake and weight status may be due to bias in reporting dietary intake. Doubly labeled water studies reveal weight-related reporting bias among older children and adults, with heavier children under-reporting to a greater extent than thinner children (5-9).Although doubly labeled water studies provide clear evidence for bias in reporting of energy intake (9-12), it is expensive and laboratory-based, which is not feasible for use in screening most studies. Recently, Huang and colleagues developed screening procedures, using the logic developed in the use of doubly labeled water studies, to allow the classification of individuals as plausible, under-reporters, and over-reporters (13,14) The purpose of this research was to examine the extent to which girls' reported energy intake assessed at age 9 years predicted girls' body mass index (BMI) at age 11 years, before and after adjusting for pubertal status and parent BMI. Girls were classified as plausible or implausible under-reporters and over-reporters, based on the method of Huang and colleagues (15), to test the hypothesis that (1) under-reporters would be heavier than ...

Energy Underreporting in African-American Girls: A Longitudinal Analysis

“…22,28,39,57,58 Our results support previous reports that overweight status is a predictor of diet underreporting in African-American girls.…”

“…8 Predictors of dietary underreporting in children have not been well elucidated, but similar to adults, overweight status and increasing age appear to be the strongest and most consistent predictors. 8,22,[26][27][28][29][30] several issues are crucial for understanding the utility and accuracy of dietary assessment. For example, what is the prevalence of dietary underreporting in the same cohort over time?…”

Diet–obesity associations in children: approaches to counteract attenuation caused by misreporting

“…A recent study reported that not excluding implausible reports resulted in weak, nonsignificant or even misleading associations between BMI and diet (9) , whereas Nielsen and Adair stated that examining all data but stratifying by level of intake may be more informative for population nutrient intake than exclusion of misreports (8) . Savage et al found a significant association between BMI and reported EI in the PR of preadolescent girls, but neither in the total study group nor when analysing only misreports (combining UdR and OvR into one group) (36) . This agrees with our results for the total study group (basic model).…”

Components of the Diet Associated with Child Adiposity: A Cross-Sectional Study

“…Elimination of implausible data led to a severe loss of data (48%). In addition, this study design lacked reference information about actual intake (e.g., from observation), consistent with other studies in which the Huang method was used [18,23,29,30,68,71]. Collecting such data, however, is not feasible in large-sample studies.…”

“…However, research among youth has not consistently supported this seemingly intuitive relationship [10,[13][14][15][16]. In fact, some research has failed to detect the fundamental direct association between total EI and body mass [16][17][18][19] or confusingly found the inverse [16,20]. Until components of the diet that directly influence adiposity are identified, interventions may continue to be misguided, thus ineffective, in preventing childhood obesity.…”