Journal Article

Underreporting of energy, protein and potassium intake in relation to body mass index

DW Heerstrass, MC Ocké, HB Bueno-de-Mesquita, PHM Peeters and JC Seidall

in International Journal of Epidemiology

Published on behalf of International Epidemiological Association

Volume 27, issue 2, pages 186-193
Published in print April 1998 | ISSN: 0300-5771
Published online April 1998 | e-ISSN: 1464-3685 | DOI:
Underreporting of energy, protein and potassium intake in relation to body mass index

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Differential underreporting of dietary intake by subgroups of body mass index (BMJ) will confound associations between dietary intake and BMI-related diseases. We estimated the magnitude of BMI-related underreporting for energy,. protein, and potassium intake for the Dutch cohorts of the European Prospective Investigation into Cancer and Nutrition (EPIC).


The study population consisted of 134 Dutch men and women, aged 21–71 years, who participated in a pilot of EPIC. Ratios of reported dietary intakes to biomarkers were used as measures for underreporting. Dietary intake was assessed by a food frequency questionnaire (FFQ) and repeated 24-hour dietary recalls. Biomarker for energy intake was calculated basal metabolic rate; for protein and potassium intake the biomarker was 24-hour urinary nitrogen and potassium excretion, respectively. The measures of underreporting were linearly regressed on BMJ (in kg/m2).


Significant negative regression coefficients were observed when regressing energy ratio on BMI with adjustment for physical activity (FFQ: β = −0.04 for men, β = −0.02 for women; 24-hour recalls: β = −0.03 for men, β = −0.04 for women). In men, a significant negative regression coefficient (β = −0.03) was observed when regressing protein ratio on BMI; for the recalls however only after adjustment for age and education (β = −0.02). In women, negative regression coefficients were also obtained, but for the FFQ only after exclusion of dieting women (both FFQ and 24-hour recalls: β = −0.02). According to the recalls, but not the FFQ, a significant negative regression coefficient (β = −0.02) was observed among women when regressing potassium ratio on BMI.


In this Dutch population. BMI-dependent underreporting of 20–25% over the observed range of BMI is present for protein and energy. Further study on BMI-dependent underreporting of dietary intake in EPIC cohorts is warranted. Underreporting, body mass index, energy intake, protein intake, potassium intake, measurement error

Keywords: Underreporting; body mass index; energy intake; protein intake; potassium intake; measurement error

Journal Article.  0 words. 

Subjects: Public Health and Epidemiology

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