Journal Article

Structure of Dietary Measurement Error: Results of the OPEN Biomarker Study

Victor Kipnis, Amy F. Subar, Douglas Midthune, Laurence S. Freedman, Rachel Ballard-Barbash, Richard P. Troiano, Sheila Bingham, Dale A. Schoeller, Arthur Schatzkin and Raymond J. Carroll

in American Journal of Epidemiology

Published on behalf of Johns Hopkins Bloomberg School of Public Health

Volume 158, issue 1, pages 14-21
Published in print July 2003 | ISSN: 0002-9262
Published online July 2003 | e-ISSN: 1476-6256 | DOI:
Structure of Dietary Measurement Error: Results of the OPEN Biomarker Study

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Multiple-day food records or 24-hour dietary recalls (24HRs) are commonly used as “reference” instruments to calibrate food frequency questionnaires (FFQs) and to adjust findings from nutritional epidemiologic studies for measurement error. Correct adjustment requires that the errors in the adopted reference instrument be independent of those in the FFQ and of true intake. The authors report data from the Observing Protein and Energy Nutrition (OPEN) Study, conducted from September 1999 to March 2000, in which valid reference biomarkers for energy (doubly labeled water) and protein (urinary nitrogen), together with a FFQ and 24HR, were observed in 484 healthy volunteers from Montgomery County, Maryland. Accounting for the reference biomarkers, the data suggest that the FFQ leads to severe attenuation in estimated disease relative risks for absolute protein or energy intake (a true relative risk of 2 would appear as 1.1 or smaller). For protein adjusted for energy intake by using either nutrient density or nutrient residuals, the attenuation is less severe (a relative risk of 2 would appear as approximately 1.3), lending weight to the use of energy adjustment. Using the 24HR as a reference instrument can seriously underestimate true attenuation (up to 60% for energy-adjusted protein). Results suggest that the interpretation of findings from FFQ-based epidemiologic studies of diet-disease associations needs to be reevaluated.

Keywords: bias (epidemiology); biological markers; diet; energy intake; epidemiologic methods; nutrition assessment; questionnaires; reference values; Abbreviations: DLW, doubly labeled water; FFQ, food frequency questionnaire; OPEN, Observing Protein and Energy Nutrition; 24HR, 24-hour dietary recall.

Journal Article.  6146 words. 

Subjects: Public Health and Epidemiology

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