Who Underreports Dietary Intake in a Dietary Recall?: Evidence From the Second National Health and Nutrition Examination Survey

The present study sought to identify the presence and degree of apparent underreporting of dietary intake in 11,663 participants in the Second National Health and Nutrition Examination Survey (NHANES II). Self-reported dietary intake was compared with estimated basal metabolic rate. Underreporting was based on cutoff limits that identified plausible levels of energy expenditure for adult individuals. Results indicated that up to 31% of adults in this sample may have underreported dietary intake. Those individuals at greatest risk of underreporting were less well educated and heavier. The Sex × Race interaction indicated that for both ethnic categories, women were more likely to underreport than men, but the difference between men and women was greater among Caucasian participants. It is concluded that such factors as reduced energy needs, deliberate falsification, and measurement error inherent in dietary assessment contribute to apparent underreporting, and this occurs in a large percentage of dietary data.