Elsevier

Annals of Epidemiology

Volume 12, Issue 8, November 2002, Pages 577-586
Annals of Epidemiology

Original reports
Systematic Errors in Middle-Aged Women's Estimates of Energy Intake: Comparing Three Self-Report Measures to Total Energy Expenditure from Doubly Labeled Water

https://doi.org/10.1016/S1047-2797(01)00297-6Get rights and content

Abstract

PURPOSE: To evaluate energy intake (EI) derived from a food frequency questionnaire (FFQ), seven-day dietary recall (7DDR), and seven 24-hour dietary recall interviews (24HR) for reporting errors associated with social desirability and social approval. METHODS: The FFQ and 7DDR were administered once before and once after a 14-day metabolic period during which total energy expenditure was determined using the doubly labeled water method (TEEdlw). Seven 24HR were conducted over the 14-day period. Data obtained from 80 healthy women (mean age = 49.1 years) were fit to linear regression models in which the EI estimates were the dependent variables and estimates of social desirability and social approval traits, body mass index [weight (kg)/ height (m)2], and TEEdlw were fit as independent variables. RESULTS: indicated that in college-educated women there was an underestimate associated with social desirability on the FFQ (-42.24 kcal/day/point on the social desirability scale; 95% CI:–75.48, -9.00). For college-educated women with an average social desirability score (∼17 points) this would equal an underestimate of 507 kcal/day compared to women with the minimum score (4 points). The 7DDR was associated with a differential effect of social approval when comparing by education; i.e., there was a difference of 36.35 kcal/day/point between the two groups (-14.69 in women with ≥college and 21.66 in women with <college) (95% CI: 10.25, 62.45). CONCLUSIONS: Social desirability and social approval distort energy intake estimates from structured questionnaires, in a manner that appears to vary by educational status. Results observed have important implications for subject recruitment, data collection, and for methods of detection and control of biases in epidemiologic studies.

Section snippets

Selected Abbreviations and Acronyms

24HR = 24-hour diet recall interview

7DDR = seven-day dietary recall

BMI = body mass index [weight (kg)/ height (m)2]

BRFSS = Behavioral Risk Factor Surveillance System

CI = confidence interval

DLW = doubly labeled water

EI = energy intake

FFQ = food frequency questionnaire

FM = fat mass

FFM = fat-free mass

FQ = food quotient

LTPA = leisure-time physical activity

MCSD = Marlowe-Crowne Social Desirability scale

METS = metabolic equivalents (equal to 1 kcal/ kg body mass)

MLAM = Martin-Larsen Approval

Subjects/Methods of Recruitment

Eighty-one women aged 40 to 65 years were recruited for the study between June and October 1997 from two main sources, the University of Massachusetts —Memorial Medical Center and the general population of Worcester and surrounding communities. In the Medical Center community, recruitment was done by posting flyers in the hospital and by advertising in the hospital newsletter. Other subjects were recruited via local newspaper advertisements. Eligible women were free of major medical conditions,

Results

Descriptive statistics for the 80 subjects used in this report are shown in Table 1, Table 2. Most women were White, non-Hispanic, reflecting the Worcester, MA population in general. Slightly more than half were premenopausal. They were well educated, predominantly sedentary in their leisure-time, and non-smoking. Two women had values from both the FFQ and 7DDR that exceeded the nominal upper limit of EI. Additionally, one woman exceeded the nominal upper limit of EI on the FFQ and one on the

Discussion

Two of the most common sources of response bias studied in the psychological literature are social approval and social desirability. Social desirability, the tendency of an individual to convey an image in keeping with social norms and to avoid criticism in a “testing” situation 39, 40 was hypothesized, a priori, to be associated with underestimation of EI as reported by women using structured dietary assessment questionnaires 1, 2. In general, high scorers on the MCSD are far more likely to

Acknowledgements

This work was supported by National Institute of Diabetes and Digestive and Kidney Diseases grant DK 52079-02 to the University of Massachusetts Medical School (J.R. Hebert, P.I.).

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