Methodologic and statistical considerations regarding use of biomarkers of nutritional exposure in epidemiology

In nutritional epidemiology, accurate quantification of nutritional exposure is critical. Even moderate flaws in measurement can lead to sizeable distortions in estimations of the effects of exposure. In many situations, this will lead to inaccurate direct estimation of exposure effects. In others, it will make it difficult to control for the confounding effects of nutritional exposure. Biomarkers offer important opportunities to advance research in nutritional epidemiology; their objectivity and potentially greater accuracy give them the potential to substantially lessen distortions that might result from imperfect measurements. Clearly, the accuracy of biomarkers as indicators of nutritional exposure is critical to their value. It is likely that establishing the accuracy of biomarkers will require some reference to self-reports, even if those reports are not as accurate as the biomarkers they are used to test. The goal of this paper is to describe aspects of accuracy-reproducibility, reliability and validity-as they apply to biomarkers in nutritional epidemiology.