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Am J Clin Nutr. 2003 Jul;78(1):84-90.

Associations between diet and the metabolic syndrome vary with the validity of dietary intake data.

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  • 1Division of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.



Underreporting is a common problem in dietary surveys. Few studies have shown the implication of this when investigating diet-disease relations.


We investigated how underreporting affects the associations between dietary factors and the metabolic syndrome.


Dietary intake measured with a 7-d food record, fasting insulin concentrations, and other variables of the metabolic syndrome were assessed in a cross-sectional study of 301 healthy men aged 63 y. Biological markers for intakes of protein, sodium, and potassium were measured in 24-h urine samples. Underreporters (URs, n = 88) were identified by Goldberg's equation, which compares energy intake with energy expenditure, both expressed as multiples of the basal metabolic rate. Physical activity level was estimated, and individual cutoffs were calculated.


The URs had higher nutrient and food densities in their diet than did the non-URs, which suggested that they followed a healthier diet. The URs had a higher prevalence of the metabolic syndrome than did the non-URs (18% and 9%, respectively; P = 0.029). The biological markers confirmed a low validity of the dietary data in the URs. The correlations between fasting insulin concentrations, a central component of the metabolic syndrome, and the intakes of polyunsaturated fats, n-6 fats, and fat from milk products were stronger in the URs than in the non-URs, which indicates that inaccurate data can introduce spurious associations.


The association between diet and fasting insulin differed between URs and non-URs in this study of 301 healthy men aged 63 y. If URs are not identified and excluded or treated separately in studies in nutritional epidemiology, spurious diet-disease relations may be reported.

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