Energy adjustment of nutrient intakes is preferable to adjustment using body weight and physical activity in epidemiological analyses

Objective Adjustment for body weight and physical activity has been suggested as an alternative to adjusting for reported energy intake in nutritional epidemiology. We examined which of these approaches would yield stronger correlations between nutrients and their biomarkers. Design A cross-sectional study in which dietary fatty acids, carotenoids and retinol were adjusted for reported energy intake and, separately, for weight and physical activity using the residual method. Correlations between adjusted nutrients and their biomarkers were examined. Setting USA. Subjects Cases and controls from a nested case-control study of erythrocyte fatty acids and CHD (n 442) and of plasma carotenoids and retinol and breast cancer (n 1254). Results Correlations between intakes and plasma levels of trans-fatty acids were 0 center dot 30 (energy-adjusted) and 0 center dot 16 (weight- and activity-adjusted); for erythrocyte levels, the corresponding correlations were 0 center dot 37 and 0 center dot 25. Energy-adjusted intakes of linoleic acid and alpha-linolenic acid were more strongly correlated with their respective biomarkers than weight- and activity-adjusted intakes, but the differences were not significant except for linoleic acid (erythrocyte). Weight- and activity-adjusted DHA intake was slightly more strongly correlated with its plasma biomarker than energy-adjusted intake (0 center dot 37 v. 0 center dot 34). Neither method made a difference for DHA (erythrocyte), carotenoids and retinol. Conclusions The effect of energy adjustment depends on the nutrient under investigation, and adjustment for energy calculated from the same questionnaire used to estimate nutrient intakes improves the correlation of some nutrients with their biomarkers appreciably. For the nutrients examined, adjustment using weight and physical activity had at most a small effect on these correlations.