Dietary Assessment Primer

Learn More about Misreporting

Misreporting in self-report dietary assessment is considered to be unavoidable and can include both under- and overreporting. More is known about [glossary term:] misreporting of energy; less is understood about the extent to which other individual foods and nutrients are misreported.

Energy [glossary term:] underreporting is considered to be present when reported intakes are substantially lower than true energy intakes. Energy overreporting is considered to be present when reported intakes are substantially higher than true energy intakes. Although energy underreporting appears to be common in developed countries, energy overreporting may be more common than underreporting in developing countries.

Various methods are used to determine the cut points by which a discrepancy in reported to estimated true energy intakes leads to classifying individuals as under- or overreporters. Energy misreporters are most accurately identified by the use of [glossary term:] doubly labeled water (DLW), a [glossary term:] recovery biomarker that accurately assesses energy expenditure in weight-stable individuals and is used as a surrogate for energy intake (Learn More about Biomarkers). However, DLW is expensive, burdensome, and reflects a limited time period (approximately two weeks). Less accurate but more accessible methods are often used, such as the Goldberg formula, which estimate energy expenditure based on height, weight, and, often, self-reported activity levels. Those above or below recommended cut points are identified as low- or high-energy reporters.

A limitation of the use of such methods is that [glossary term:] systematic bias may be introduced, in part, because true energy expenditure is unknown. Regardless of the method used, individuals identified as over- or underreporters are sometimes excluded from analyses. Alternatively, a sensitivity analysis can determine whether findings differ based on inclusion or exclusion of energy misreporters. Researchers should carefully review data and exercise caution in discarding data. It is important to consider that the application of cutoffs may result in the loss of a substantial number of study participants whose data contain no more [glossary term:] measurement error than those within the “acceptable” range of self-reported dietary data.

Energy underreporting has been shown to be associated with various personal characteristics, but most consistently with body mass index. Misreporting of other dietary components and foods generally has been shown to track with misreporting of energy, but not consistently. For example, some studies have show that sweets/desserts are prone to more underreporting than are fruits and vegetables.

For a variety of reasons related to inaccurate self-reporting of foods, beverages, and portion sizes, as well as to potential inaccuracies in nutrient database values, estimates of energy intake are commonly lower than expected. Because of this, the use of absolute energy estimates to represent accurate intakes, [glossary term:] means, or distributions of energy intake is discouraged (Learn More about Normal Distributions). Absolute energy estimates can be used, however, to create energy-adjusted nutrient and food group variables that have much less measurement error than estimates of absolute energy (see Key Concepts on Measurement Error and Learn More about Energy Adjustment). Another strategy for dealing with misreporting is the use of statistical modeling to correct for measurement error.

Efforts continue to reduce misreporting through improved methods of data collection and to mitigate its effects through improved analytic methods.

For More Information

Black AE. Critical evaluation of energy intake using the Goldberg cut-off for energy intake:basal metabolic rate. A practical guide to its calculation, use and limitations. Int J Obes Relat Metab Disord 2000 Sep;24(9):1119-30. [View Abstract]

Goldberg GR, Black AE, Jebb SA, Cole TJ, Murgatroyd PR, Coward WA, Prentice AM. Critical evaluation of energy intake data using fundamental principles of energy physiology: 1. Derivation of cut-off limits to identify under-recording. Eur J Clin Nutr 1991 Dec;45(12):569-81. Review. [View Abstract]

Harrison GG, Galal OM, Ibrahim N, Khorshid A, Stormer A, Leslie J, Saleh NT. Underreporting of food intake by dietary recall is not universal: a comparison of data from egyptian and american women. J Nutr 2000 Aug;130(8):2049-54. [View Abstract]

Kerr DA, Schap TRE, Johnson RK. Analysis, Presentation, and Interpretation of Dietary Data. Chapter 7 (pp 125-140) in Nutrition in the Prevention and Treatment of Disease. Third Edition. Coultson AM, Boushey CJ, Ferruzzi MG, ed. Elsevier Press: San Diego, CA. 2013.

Krebs-Smith SM, Graubard BI, Kahle LL, Subar AF, Cleveland LE, Ballard-Barbash R. Low energy reporters vs others: a comparison of reported food intakes. Eur J Clin Nutr 2000 Apr;54(4):281-7. [View Abstract]

Neuhouser ML, Tinker L, Shaw PA, Schoeller D, Bingham SA, Horn LV, Beresford SA, Caan B, Thomson C, Satterfield S, Kuller L, Heiss G, Smit E, Sarto G, Ockene J, Stefanick ML, Assaf A, Runswick S, Prentice RL. Use of recovery biomarkers to calibrate nutrient consumption self-reports in the Women's Health Initiative. Am J Epidemiol 2008 May 15;167(10):1247-59. [View Abstract]

Tooze JA, Krebs-Smith SM, Troiano RP, Subar AF. The accuracy of the Goldberg method for classifying misreporters of energy intake on a food frequency questionnaire and 24-h recalls: comparison with doubly labeled water. Eur J Clin Nutr 2012 May;66(5):569-76. [View Abstract]

Tooze JA, Subar AF, Thompson FE, Troiano R, Schatzkin A, Kipnis V. Psychosocial predictors of energy underreporting in a large doubly labeled water study. Am J Clin Nutr 2004 May;79(5):795-804. [View Abstract]