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Population studies of diet and obesity

Published online by Cambridge University Press:  09 March 2007

Lauren Lissner*
Affiliation:
Department of Internal Medicine, Göteborg University, Vasa Hospital, SE-41133, Gothenburg, Sweden
Berit L. Heitmann
Affiliation:
Unit for Dietary Studies, Copenhagen County Centre for Preventive Medicine, Glostrup University Hospital, Denmark
Calle Bengtsson
Affiliation:
Department of Primary Health Care, Göteborg University, Gothenburg, Sweden
*
*Corresponding author: L. Lissner, fax +46 31 7781704, email [email protected]
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Abstract

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Population-based research on diet, obesity and the metabolic syndrome is faced with accumulating evidence of biases that may profoundly affect results. One potential source of bias, which is often neglected in nutritional epidemiology, arises from self-selected study populations. Subjects who agree to participate in surveys may be at less risk of metabolic syndrome than those who refuse. Analogous to observations in adult populations, studies of schoolchildren have also yielded clear evidence of self-selection. Whether such selection patterns influence analytical results depends on how the biases relate to the dependent and independent variables being studied. Systematic dietary reporting error is another source of bias in studies of nutritional risk factors for disease. While obesity-related under-reporting bias is now well documented, less is known about whether specific foods and nutrients are disproportionately affected. However, two studies employing biomarkers for protein have suggested that obese subjects under-reported the proportion of energy from fat plus carbohydrate. This should alert epidemiologists to the possibility that a dual reporting bias may be present in studies of diet and disease: general under-reporting among obese subjects compounded by food-specific errors. In summary, biases due to self-selection and selective dietary under-reporting may produce consequences in epidemiological studies that are both unpredictable and complex. We conclude this review with recent findings involving dietary fat intake and regional adiposity in a population-based study of women. These preliminary results may have etiological relevance to the development of metabolic syndrome, but multiple biases of the type described previously may also be operating.

Type
Research Article
Copyright
Copyright © The Nutrition Society 2000

References

Bengtsson, C, Björkelund, C, Lapidus, L & Lissner, L (1993) Associations of serum lipid concentrations and obesity with mortality in women — 20 year follow up of participants in the prospective population study in Gothenburg, Sweden. British Medical Journal 307, 13851388.CrossRefGoogle ScholarPubMed
Bengtsson, C, Gredmark, T, Hallberg, L, Hällström, T, Isaksson, B, Lapidus, L, Lindquist, O, Lindstedt, S, Lurie, M, Nyström, E, Rybo, G, Samuelsson, S, Ranfsson, V & Sigurdsson, J (1989) The population study of women in Gothenburg 1980–81 — the third phase of a longitudinal study. Scandinavian Journal of Social Medicine 17, 141145.CrossRefGoogle ScholarPubMed
Berg, C, Jonsson, I, Conner, MT & Lissner, L (1998) Sources of bias in a dietary survey of children. European Journal of Clinical Nutrition 52, 663667.CrossRefGoogle Scholar
Hebert, J, Clemow, L, Pbert, L, Ockene, IS & Ockene, JK (1995) Social desirability bias in dietary self-report may compromise the validity of dietary intake measures. International Journal of Epidemiology 24, 389398.CrossRefGoogle ScholarPubMed
Heitmann, BL & Lissner, L (1995) Dietary under-reporting by obese individuals. Is it specific or nonspecific?. British Medical Journal 311, 986989.CrossRefGoogle ScholarPubMed
Heitmann, BL, Lissner, L, Sørensen, TIA & Bengtsson, C (1995) Dietary fat intake and weight gain in women genetically predisposed for obesity. American Journal of Clinical Nutrition 61, 12131217.CrossRefGoogle ScholarPubMed
Heitmann, BL, Lissner, L & Osler, M (2000) Do we eat less fat, or just report so?. International Journal of Obesity 24,.CrossRefGoogle ScholarPubMed
Hultén, B, Bengtsson, C & Isaksson, B (1990) Some errors in a longitudinal dietary survey revealed by the urine nitrogen test. European Journal of Clinical Nutrition 44, 169174.Google Scholar
Lissner, L, Heitmann, BL & Bengtsson, C (1997) Low-fat diets may prevent weight gain in sedentary women: prospective observations from the Population Study of Women in Göteborg. Obesity Research 5, 4348.CrossRefGoogle Scholar
Lissner, L, Heitmann, BL & Lindroos, AK (1998) Measuring intake in free-living humans: a question of bias. Proceedings of the Nutrition Society 57, 333339.CrossRefGoogle ScholarPubMed
Poppitt, SD, Swann, D, Black, AE & Prentice, AM (1998) Assessment of selective under-reporting of food intake by both obese and non-obese women in a metabolic facility. International Journal of Obesity 22, 303311.CrossRefGoogle Scholar
Radimer, KL & Harvey, PWJ (1998) Comparison of self-report of reduced fat and salt foods with sales and supply data. European Journal of Clinical Nutrition 52, 380382.CrossRefGoogle ScholarPubMed
Sonne-Holm, S, Sørensen, TIA, Jensen, G & Schnohr, P (1989) Influence of fatness, intelligence, education and sociodemographic factors on response rate in a health survey. Journal of Epidemiology and Community Health 43, 369374.CrossRefGoogle Scholar