Applying Recovery Biomarkers to Calibrate Self-Report Measures of Energy and Protein in the Hispanic Community Health Study/Study of Latinos

American Journal of Epidemiology © The Author 2015. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact Vol. 181, No. 12 DOI: 10.1093/aje/kwu468 Advance Access publication: May 20, 2015 Practice of Epidemiology Applying Recovery Biomarkers to Calibrate Self-Report Measures of Energy and Protein in the Hispanic Community Health Study/Study of Latinos Yasmin Mossavar-Rahmani*, Pamela A. Shaw, William W. Wong, Daniela Sotres-Alvarez, Marc D. Gellman, Linda Van Horn, Mark Stoutenberg, Martha L. Daviglus, Judith Wylie-Rosett, Anna Maria Siega-Riz, Fang-Shu Ou, and Ross L. Prentice Initially submitted July 18, 2014; accepted for publication December 18, 2014. We investigated measurement error in the self-reported diets of US Hispanics/Latinos, who are prone to obesity and related comorbidities, by background (Central American, Cuban, Dominican, Mexican, Puerto Rican, and South American) in 2010–2012. In 477 participants aged 18–74 years, doubly labeled water and urinary nitrogen were used as objective recovery biomarkers of energy and protein intakes. Self-report was captured from two 24hour dietary recalls. All measures were repeated in a subsample of 98 individuals. We examined the bias of dietary recalls and their associations with participant characteristics using generalized estimating equations. Energy intake was underestimated by 25.3% (men, 21.8%; women, 27.3%), and protein intake was underestimated by 18.5% (men, 14.7%; women, 20.7%). Protein density was overestimated by 10.7% (men, 11.3%; women, 10.1%). Higher body mass index and Hispanic/Latino background were associated with underestimation of energy (P < 0.05). For protein intake, higher body mass index, older age, nonsmoking, Spanish speaking, and Hispanic/Latino background were associated with underestimation (P < 0.05). Systematic underreporting of energy and protein intakes and overreporting of protein density were found to vary significantly by Hispanic/Latino background. We developed calibration equations that correct for subject-specific error in reporting that can be used to reduce bias in dietdisease association studies. biological markers; calibration equations; dietary measurement error; Hispanics/Latinos; 24-hour dietary recall; nutrition assessment Abbreviations: BMI, body mass index; DLW, doubly labeled water; HCHS, Hispanic Community Health Study; PABA, paraaminobenzoic acid; SOL, Study of Latinos; SOLNAS, Study of Latinos: Nutrition and Physical Activity Assessment Study. ment error of dietary self-report. Calibration equations using this strategy can improve assessment of diet and disease association by adjusting for self-reported intake measurement error (5, 9). For example, calibrated, but not uncalibrated, energy was positively correlated with total and site-specific cancer incidence and coronary heart disease incidence in postmenopausal US women (1, 10). Calibrated, but not uncalibrated, protein intake was also associated with diabetes risk in the same population (6). As part of the Study of Latinos: Nutrition and Physical Activity Assessment Study (SOLNAS), biomarker and self-report A growing body of research suggests that systematic bias and variability in self-reported dietary data can distort important associations between diet and disease (1–7). Although measurement error may relate to cultural differences or differences in the methodology of surveys (8), these biases have been relatively unexplored in the Hispanic/Latino population in the United States. Assessing objective recovery biomarkers such as doubly labeled water (DLW) and urinary nitrogen in combination with participant characteristics such as age, body mass index (weight (kg)/height (m)2), and background (2) helps to account for the systematic and random measure996 Am J Epidemiol. 2015;181(12):996–1007 * Correspondence to Dr. Yasmin Mossavar-Rahmani, Division of Health Promotion and Nutrition Research, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Block Building, Room 339, Bronx, NY 10461 (e-mail: ). Calibrating Dietary Intake by Using Biomarkers 997 measures of diet were collected in a subsample of the multicenter Hispanic Community Health Study (HCHS)/Study of Latinos (SOL) cohort to create estimates of calibrated energy and protein consumption. We also explored whether Hispanic/ Latino background (Central American, Cuban, Dominican, Mexican, Puerto Rican, and South American), in addition to other participant characteristics, influences the measurement error of dietary self-report. METHODS Study population HCHS/SOL Parent Study Baseline Visit Day 1 includes anthropometry, physical activity (GPAQ), and other questionnaires and in-person 24-hour dietary recall. Days 1–7 include Actical. Days 5–90 include 2nd 24-hour dietary recall by telephone. Visit 1 (n = 485) Informed consent Anthropometry Pre-DLW spot urine samples DLW dosing 2 post-DLW spot urine samples In-person 24-hour dietary recall Sedentary behavior and body image questionnaires Study protocol and procedures The DLW recovery biomarker was used to assess total energy expenditure over approximately a 2-week period (14). Visit 2 (n = 478) Visit 3 (n = 98) Visit 4 (n = 96) 12 days after SOLNAS visit 1 Reliability subsample Reliability subsample 5–7 months postSOLNAS visit 1 12 days after SOLNAS visit 3 Repeat procedures as in SOLNAS visit 1 plus instructions for Actical Repeat procedures as in SOLNAS visit 2 Bring 24-hour urine sample to visit Weight Fasting blood draw Fasting urine 1 spot urine sample Indirect calorimetry 2nd 24-hour dietary recall by telephone (5–90 days after visit 3) Collect Actical (7 days of wear) from participants 24-hour urine collection instructions Within 7 Months After Parent Study Visit Invitation letter and telephone screening for SOLNAS If Eligible and Willing to Enroll in SOLNAS Not Eligible Figure 1. Study of Latinos: Nutrition and Physical Activity Assessment Study (SOLNAS) procedures, 2010–2012. Invitation letter and telephone screening for SOLNAS occurred 12 months after the parent study visit for the San Diego site. DLW, doubly labeled water; GPAQ, Global Physical Activity Questionnaire; HCHS, Hispanic Community Health Study; SOL, Study of Latinos. Actical is an accelerometer that converts accelerations to a unit called “counts” over a given time period (1 minute) (Phillips Respironics, Bend, Oregon). Am J Epidemiol. 2015;181(12):996–1007 HCHS/SOL is a community-based cohort study of 16,415 self-identified Hispanic/Latino adults aged 18–74 years from (...truncated)