Energy Adjustment Does Not Control for Differential Recall Bias in Nutritional Epidemiology

It has been stated that energy adjustment can control for recall bias in case-control studies. Simulation of recall bias and cases and controls in a nutritional survey of German adults was conducted to examine its impact on five dietary effects, (adding a macronutrient, substituting one macronutrien...

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Bibliographic Details
Published in:Journal of clinical epidemiology 1998-05, Vol.51 (5), p.393-398
Main Authors: Bellach, Baerbel, Kohlmeier, Lenore
Format: Article
Language:English
Subjects:
Adult
Bias
Biological and medical sciences
energy adjustment
Energy Intake
Epidemiology
General aspects
Germany
Humans
Logistic Models
measurement error
Medical sciences
Mental Recall
Methodology
Models, Statistical
Nutrition Assessment
Nutritional epidemiology
Nutritional Status
Public health. Hygiene
Public health. Hygiene-occupational medicine
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Summary:It has been stated that energy adjustment can control for recall bias in case-control studies. Simulation of recall bias and cases and controls in a nutritional survey of German adults was conducted to examine its impact on five dietary effects, (adding a macronutrient, substituting one macronutrient for another, adding a macronutrient while keeping the other energy sources constant, and changing the macronutrient to energy ratio through addition or substitution) using various energy adjustment models. If energy adjustment were an effective means of correcting measurement error, the energy adjusted dietary effects, after a subtraction of energy and fat intake, should equal those in the original data set. Simulation of differential under-reporting of fat and energy intake by cases but not controls showed this to dramatically impact all five considered dietary effects, even after energy adjustment. The influence of the assumed recall bias on the different effects depends on the error type structure, inflating an odds ration of 1.8 to as much as 12.3 or reducing it to 0.45 when 100 kcal of fat was substituted for 100 kcal of other macronutrients. Although energy adjustment may serve many functions, it cannot correct for differential error. Depending upon the nature of the hypothesized effect and the error type, energy adjustment may also distort risk ratios in the presence of non-differential bias. The concern that cases and controls report their energy intakes with different degrees of error remains a critical consideration that must be addressed through improved measurements, and not energy adjustment under any of the currently used models.
ISSN:0895-4356
1878-5921
DOI:10.1016/S0895-4356(97)00302-8