Literacy and Body Fatness are Associated with Underreporting of Energy Intake in US Low-Income Women Using the Multiple-Pass 24-hour Recall: A Doubly Labeled Water Study

doi:10.1016/S0002-8223(98)00263-6

Journal of the American Dietetic Association

Volume 98, Issue 10, October 1998, Pages 1136-1140

https://doi.org/10.1016/S0002-8223(98)00263-6 Get rights and content

Abstract

Objective The accuracy of the multiple-pass 24-hour recall method for estimating energy intake in low-income women in the United States was ascertained by comparing the method with measurements of total energy expenditure. The multiple-pass 24-hour recall is designed to provide respondents with multiple cues and opportunities to report their food intake. It consists of 3 distinct passes: the quick list, detailed description, and review. Predictors of energy intake misreporting (energy intake – total energy expenditure) in the sample were determined.

Design Four multiple-pass 24-hour recalls (2 in person, 2 by telephone) were obtained over a 14-day period to estimate energy intake. Total energy expenditure was measured over the same 14-day period using the doubly labeled water method. Body composition was measured using dual energy x-ray absorptiometry, and literacy was measured by the Wide Range Achievement Test (WRAT) for reading and spelling.

Subjects/settings Thirty-five low-income women between the ages of 19 and 46 years were tested at the General Clinical Research Center at the University of Vermont, Burlington. Low income was defined as a household income at or below 130% of the federal poverty level.

Statistical analysis Pearson product moment correlation coefficients, t tests, paired t tests, and stepwise multiple regression analysis were used to test the relationships among study variables.

Results Mean energy intake was significantly lower than mean total energy expenditure (2,197±607 vs 2,644±503 kcal, P=.001) and the correlation between the 2 measures was poor (r=.22, P=.20). Percentage body fat and the combined age-adjusted reading and spelling WRAT scores were the best predictors of misreporting of energy intake (R=.52, P=.006).

Conclusions The multiple-pass 24-hour recall did not generate a group measure of energy intake that was accurate or unbiased in this sample. Underreporting was strongly associated with increased body fatness. The ability to read and spell as measured by the WRAT improved the accuracy of the women's recall of their food intake.

Applications Dietetics professionals should take into consideration the problem of underreporting whenever conclusions are made about associations between diet and health and/or when evaluating the impact of food assistance programs on dietary intake. J Am Diet Assoc. 1998;98:1136–1140.

Section snippets

Sample

Thirty-five low-income women between the ages of 19 and 46 years residing in Burlington, Vt, and surrounding rural areas were recruited to participate in the study. Low income was defined as a monthly household income at or below 130% of the federal poverty level (13). This cutoff number was selected because it is the income eligibility cutoff point for the federal food stamp program. Thus, all the volunteers were eligible for food stamps, although participation in the program was not required.

Results

Table 1 presents a summary of the subjects’ characteristics. The mean change in subjects’ weight (mean=0.2 kg, range= −1.60 to 2.8 kg) over the 14-day period was not significantly different from zero (P=.2), which indicates that the group was weight stable during the study period. No difference was noted between the mean 2-day energy intake as estimated from the in-person recalls (2,173±656 kcal) and the mean 2-day energy intake as estimated from the telephone recalls (2,253±688 kcal) (P=.36).

Discussion

Two major findings are evident in this study. First, the multiple-pass 24-hour recall underestimated energy intake in this sample of weight-stable, low-income women. Second, percentage body fat and the ability to read and spell as measured by the WRAT were the best predictors of energy intake misreporting in the sample. These 2 variables had opposing effects on underreporting. Underreporting worsened as percentage body fat increased and was diminished as the WRAT scores improved.

The doubly

Applications

In this sample of low-income women, the multiple-pass 24-hour recall did not generate a group measure of energy intake that was accurate or unbiased. These findings, as well as those from the literature on dietary intake underreporting, raise serious challenges for nutrition professionals. It has become untenable for researchers to make conclusions about associations between diet and health unless the problem of underreporting is considered in the dietary survey data. Furthermore, evaluations

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Literacy and Body Fatness are Associated with Underreporting of Energy Intake in US Low-Income Women Using the Multiple-Pass 24-hour Recall: A Doubly Labeled Water Study

Abstract

Section snippets

Sample

Results

Discussion

Applications

J Am Diet Assoc.

Am J Clin Nutr.

J Am Diet Assoc.

Am J Clin Nutr.

Am J Clin Nutr.

J Nutr.

Am J Clin Nutr.

J Am Diet Assoc.

Am J Clin Nutr.

How accurate is self-reported dietary energy intake?

Nutr Rev.

Increasing prevalence of underreporting does not necessarily distort dietary surveys

Eur J Clin Nutr.

Who are the “low energy reporters” in the dietary and nutritional survey of British adults?

Int J Epidemiol.

Food intakes of US children and adolescents compared with recommendations

Pediatrics.

Characteristics of the low-energy reporters in a longitudinal national dietary survey

Br J Nutr.

High levels of energy expenditure in obese women

BMJ.

Discrepancy between self-reported and actual caloric intake and exercise in obese subjects

N Engl J Med.