Dietary underreporting by obese individuals--is it specific or non-specific?

OBJECTIVE: To examine the distribution of patterns of macronutrient density in relation to obesity. DESIGN: Cross sectional. SETTING: Denmark. SUBJECTS: 323 men and women aged 35-65 years, selected randomly from a larger population sample of Danish adults. MAIN OUTCOME MEASURE: Bias in dietary reporting of energy and protein intake in relation to percentage body fat, assessed by comparison of data from an interview on dietary intake with data estimated from 24 hour nitrogen output, validated by administering p-aminobenzoic acid, and estimated 24 hour energy expenditure. RESULTS: Degree of obesity was positively associated with underreporting of total energy and protein, whereas compared with total energy reported, protein was overreported by the obese subjects. CONCLUSION: Errors in dietary reporting of protein seem to occur disproportionately with respect to total energy, suggesting a differential reporting pattern of different foods. Although, on average, all subjects showed a greater underreporting of energy than of protein, this was most common in the obese subjects. Snack-type foods may be preferentially forgotten when obese people omit food items in dietary reporting. These results seem to agree with the general assumption that obese people tend to underreport fatty foods and foods rich in carbohydrates rather than underreport their total dietary intake. These results may have implications for the interpretation of studies of diet and comorbidities related to obesity.