Evaluation of dietary assessment instruments against doubly labeled water, a biomarker of habitual energy intake

Epidemiological studies of diet and disease rely on the accurate determination of dietary intake and subsequent estimates of nutrient exposure. Although methodically developed and tested, the instruments most often used to collect self-reported intake data are subject to error. It had been assumed that this error was only random in nature; however, an increasing body of literature suggests that systematic error in the reporting of true dietary intake exists as well. Here, we review studies in which dietary intake by self report was determined while energy expenditure was simultaneously measured using the doubly labeled water (DLW) method. In seeking to establish the relative accuracy of each instrument to capture true habitual energy intake, we conclude that none of the self-reported intake instruments demonstrates greater accuracy against DLW. Instead, it is evident that the physical and psychological characteristics of study participants play a significant role in the underreporting bias observed in these studies. Further research is needed to identify underreporters and to determine how to account for this bias in studies of diet and health.