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Group Level Validation of Protein Intakes Estimated by 24-Hour Diet Recall and Dietary Questionnaires against 24-Hour Urinary Nitrogen in the European Prospective Investigation into Cancer and Nutrition (EPIC) Calibration Study¹

Unit of Nutrition and Cancer, IARC-WHO, 69372 Lyon Cedex 08, France [N. S., P. F., E. R.]; Medical Research Council Dunn Human Nutrition Unit, Cambridge CB2 2XY, United Kingdom [S. B., S. R.]; Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom CB1 8RN [N. E. D., A. A. W.]; Cancer Research UK Epidemiology Unit, Oxford OX2 6HE, United Kingdom [T. J. K.]; Division of Clinical Epidemiology, German Cancer Research Center, 69120 Heidelberg, Germany [A. B. M.]; German Institute of Human Nutrition, 14558 Potsdam-Rehbrücke, Germany [H. B.]; Epidemiology Unit, Istituto Nazionale dei Tumori, 20133 Milan, Italy [S. S.]; Institute for Scientific Interchange Foundation, Torino, Italy [F. V.]; Epidemiology Unit, Centro per lo Studio e la Provenzione Oncologia, Florence, Italy [D. P.]; Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy [S. P.]; Cancer Registry, Azienda Ospedaliera "Civile - M.P. Arezzo," Ragusa, Italy [R. T.]; Department for Chronic Diseases Epidemiology, National Institute for Public Health and the Environment, 3720 BA Bilthoven, the Netherlands [B. B-d-M., M. C. O.]; Institut National de la Santé et de la Recherche Médicale, Institute Gustave Roussy, 94800 Villejuif, France [F. C-C.]; Department of Hygiene and Epidemiology, University of Athens Medical School, Athens 11527, Greece [A. T.]; and Department of Human Nutrition and Epidemiology, Wageningen Agricultural University, 6700 EV Wageningen, the Netherlands [W. A. v. S.]

A calibration approach was developed to correct for systematic between-cohort dietary measurement errors in the European Prospective Investigation into Cancer and Nutrition (EPIC), a large multicenter cohort study. To validate the 24-h diet recalls (24-HDRs) as reference measurements for between-cohort calibration, we estimated the agreement between center mean nitrogen (N) and total energy intakes and mean 24-h urinary N. Similar analyses using N and energy intake data from different dietary questionnaires (DQs) used at study baseline were conducted to estimate the effect of the calibration approach. This study was conducted between 1995 and 1999, and involved 1103 volunteers of both genders from 12 centers participating in European Prospective Investigation into Cancer and Nutrition. Pearson’s correlation coefficients were weighted for study center sample size. When both genders were considered together (n = 22), the correlation coefficients between the center mean log-transformed urinary estimates and the center mean log-transformed dietary N estimates from the 24-HDRs were 0.86 and 0.94 after exclusion of outliers. The corresponding correlation with the DQs was 0.53. When center mean total energy intakes were regressed on center mean urinary N, the correlation remained slightly higher with 24-HDRs (0.91; 0.95 after exclusion of outliers) than DQs (0.86). When stratified by gender, these correlations were systematically higher in men than women with both dietary methods. The ß regression coefficients were not significantly different from 1 when mean N (or total energy intakes) from 24-HDR or DQ were regressed on urinary estimates, except with N from 24-HDRs in men and, in most cases, after adjustment for age, body mass index, and sex with both genders together. This suggests that overall the systematic bias across centers is of uniform magnitude. Although relatively high correlations were observed between urinary N and both dietary methods in men, the errors in DQs tend to vary in both directions (under- and over-reporting) in contrast with 24-HDRs in women. This observation may have implications on the dietary measurement error characteristics and support the potential benefit of between-cohort calibration.

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