Journal
CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION
Volume 23, Issue 12, Pages 2874-2883Publisher
AMER ASSOC CANCER RESEARCH
DOI: 10.1158/1055-9965.EPI-14-0594
Keywords
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Funding
- Intramural Research Program of the National Cancer Institute, NIH
- National Cancer Institute [R01 CA119171-04A1]
- National Heart, Lung, and Blood Institute, NIH
- U.S. Department of Health and Human Services [HHSN268201100046C, HHSN268201100001C, HHSN268201100002C, HHSN268201100003C, HHSN268201100004C, HHSN271201100004C]
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Background: Measurement error in self- reported sugars intake may be obscuring the association between sugars and cancer risk in nutritional epidemiologic studies. Methods: We used 24-hour urinary sucrose and fructose as a predictive biomarker for total sugars, to assess measurement error in self-reported sugars intake. The Nutrition and Physical Activity Assessment Study (NPAAS) is a biomarker study within the Women's Health Initiative (WHI) Observational Study that includes 450 postmenopausal women ages 60 to 91 years. Food Frequency Questionnaires (FFQ), four-day food records (4DFR), and three 24-hour dietaryrecalls (24HRs) were collected along with sugars and energy dietary biomarkers. Results: Using the biomarker, we found self-reported sugars to be substantially and roughly equally misreported across the FFQ, 4DFR, and 24HR. All instruments were associated with considerable intake-and person-specific bias. Three 24HRs would provide the least attenuated risk estimate for sugars (attenuation factor, AF = 0.57), followed by FFQ (AF = 0.48) and 4DFR (AF = 0.32), in studies of energy-adjusted sugars and disease risk. In calibration models, self-reports explained little variation in true intake (5%-6% for absolute sugars and 7%-18% for sugars density). Adding participants' characteristics somewhat improved the percentage variation explained (16%-18% for absolute sugars and 29%-40% for sugars density). Conclusions: None of the self-report instruments provided a good estimate of sugars intake, although overall 24HRs seemed to perform the best. Impact: Assuming the calibrated sugars biomarker is unbiased, this analysis suggests that measuring the biomarker in a subsample of the study population for calibration purposes may be necessary for obtaining unbiased risk estimates in cancer association studies. (C) 2014 AACR.
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