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. 2013 Oct 9;8(10):e76632.
doi: 10.1371/journal.pone.0076632. eCollection 2013.

Validity of U.S. nutritional surveillance:National Health and Nutrition Examination Survey caloric energy intake data, 1971-2010

Edward Archer  1 , Gregory A Hand, Steven N Blair
Affiliations

Validity of U.S. nutritional surveillance:National Health and Nutrition Examination Survey caloric energy intake data, 1971-2010

Edward Archer et al. PLoS One. .

Erratum in

Abstract

Importance: Methodological limitations compromise the validity of U.S. nutritional surveillance data and the empirical foundation for formulating dietary guidelines and public health policies.

Objectives: Evaluate the validity of the National Health and Nutrition Examination Survey (NHANES) caloric intake data throughout its history, and examine trends in the validity of caloric intake estimates as the NHANES dietary measurement protocols evolved.

Design: Validity of data from 28,993 men and 34,369 women, aged 20 to 74 years from NHANES I (1971-1974) through NHANES 2009-2010 was assessed by: calculating physiologically credible energy intake values as the ratio of reported energy intake (rEI) to estimated basal metabolic rate (BMR), and subtracting estimated total energy expenditure (TEE) from NHANES rEI to create 'disparity values'.

Main outcome measures: 1) Physiologically credible values expressed as the ratio rEI/BMR and 2) disparity values (rEI-TEE).

Results: The historical rEI/BMR values for men and women were 1.31 and 1.19, (95% CI: 1.30-1.32 and 1.18-1.20), respectively. The historical disparity values for men and women were -281 and -365 kilocalorie-per-day, (95% CI: -299, -264 and -378, -351), respectively. These results are indicative of significant under-reporting. The greatest mean disparity values were -716 kcal/day and -856 kcal/day for obese (i.e., ≥30 kg/m2) men and women, respectively.

Conclusions: Across the 39-year history of the NHANES, EI data on the majority of respondents (67.3% of women and 58.7% of men) were not physiologically plausible. Improvements in measurement protocols after NHANES II led to small decreases in underreporting, artifactual increases in rEI, but only trivial increases in validity in subsequent surveys. The confluence of these results and other methodological limitations suggest that the ability to estimate population trends in caloric intake and generate empirically supported public policy relevant to diet-health relationships from U.S. nutritional surveillance is extremely limited.

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Conflict of interest statement

Competing Interests: Dr. Gregory Hand has received consultancy fees from the National Institutes of Health (NIH) and grants from the NIH, and The Coca-Cola Company. Dr. James Hébert is supported by an Established Investigator Award in Cancer Prevention and Control from the Cancer Training Branch of the National Cancer Institute (K05 CA136975). Dr. Steven Blair receives book royalties (<$5,000/year) from Human Kinetics; honoraria for service on the Scientific/Medical Advisory Boards for Clarity, Technogym, Santech, and Jenny Craig; and honoraria for lectures and consultations from scientific, educational, and lay groups which are donated to the University of South Carolina or not-for-profit organizations. Dr. Blair is a consultant on research projects with the University of Texas-Southwestern Medical School and the University of Miami. During the past 5-year period Dr. Blair has received research grants from The Coca-Cola Company, the National Institutes of Health, and Department of Defense. Funding for the study was provided by an unrestricted research grant from The Coca-Cola Company. The sponsor of the study had no role in the study design, data collection, data analysis, data interpretation, or writing of the report, and does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Percent of plausible reporters (i.e., rEI/BMR >1.35) by sex from NHANES I to NHANES 2009–2010; U.S. Men and women (20–74 years).
See this image and copyright information in PMC

Comment in

References

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