Background: Dietary misreporting is the main limitation of dietary assessment and has been associated with body mass index in youth. However there are no prior studies assessing missreporting and cardiometabolic risk (CMR) in adolescence.
Objectives: The aim was to examine the associations between dietary misreporting and CMR factors in adolescents and to assess the potential bias on the association between CMR and energy intake (EI) driven by dietary misreporting.
Methods: Two 24-hour dietary recalls were obtained from 1,512 European adolescents (54.8% girls) aged 12.5-17.5 years. Physical activity was measured by accelerometry. Cut-offs suggested by Huang were applied to identify misreporters. Height, waist circumference (WC), sum of four skinfold thicknesses, diastolic (DBP) and systolic blood pressure (SBP), and cardiorespiratory fitness (CRF) were taken and serum triglycerides and total-/high-density lipoprotein cholesterol ratio (TC/HDL-c) were analyzed. A sex- and age-specific clustered CMR score (n=364) was computed. Associations were investigated by multilevel regression analyses adjusting for age, sex, center, socioeconomic status and physical activity.
Results: Under-reporting (24.8% adolescents) was significantly (p<0.05) associated with higher WC, waist-to-height ratio (WHeR) and sum of skinfold thickness whereas overreporting (23.4% adolescents) was significantly associated with lower WC, WHeR, sum of skinfold thickness and SBP. Associations between CMR factors and EI were significantly affected by misreporting considering various approaches. Significant positive associations became inverse after adjusting for misreporting for WC and WHeR. The opposite was true for sum of skinfold thickness, SBP and CMR score. Associations between EI and DBP and CRF did not remain significant after adjusting for misreporting.
Conclusions: CMR factors differed among misreporting groups and both abdominal and total fat mass indicators were more strongly associated with all forms of misreporting than BMI. Moreover, misreporting seems to bias EI and CMR associations in adolescents. Therefore, energy misreporting should be taken into account when examining diet-CMR associations.
© 2021 The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition.
- SPS Exercise, Nutrition and Health Sciences
- cardiometabolic risk
- energy misreporting
- HELENA study