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Nutrition epidemiology: how do we know what they ate?
1Department of Community and Family Medicine, University of California, San Diego, La Jolla 92093-0607.
The American Journal of Clinical Nutrition
|July 1, 1991
Summary
Assessing dietary intake for disease risk is challenging. This review examines diet-assessment methods, finding no single best approach for epidemiological studies like those on osteoporosis.
Area of Science:
- Epidemiology
- Nutritional Science
- Public Health
Background:
- Diet is widely believed to influence disease risk, yet definitive proof is challenging.
- Epidemiological studies rely on various diet-assessment methods to investigate these links.
- Osteoporosis research, in particular, faces challenges in accurately measuring dietary calcium intake.
Purpose of the Study:
- To review the strengths and limitations of different diet-assessment methods.
- To evaluate the suitability of these methods for epidemiological research, especially for osteoporosis.
- To discuss factors that may obscure diet-disease associations.
Main Methods:
- Review of select diet-assessment techniques including direct observation, weighed food records, food histories, 24-hour recalls, and food frequency questionnaires.
- Analysis of method deficiencies such as cost, time, accuracy of recent vs. usual intake, recall bias, and seasonality.
- Consideration of how method limitations can lead to exposure misclassification.
Main Results:
- Direct observation and weighed food records are valuable for validating other methods.
- 24-hour recalls offer quantitative recent intake data but not usual intake.
- Food frequency questionnaires estimate usual diet better but are less quantitative and prone to recall/seasonality issues.
- No single diet-assessment method is universally superior.
Conclusions:
- The choice of diet-assessment method involves trade-offs between accuracy, cost, and feasibility.
- Limitations in diet assessment can lead to non-significant diet-disease findings.
- Despite methodological differences, studies on dietary calcium and osteoporotic fracture show consistent results, suggesting robustness or limitations in the research approach.