Doubly labelled water–calibration approach attenuates the underestimation of energy intake calculated from self-reported dietary assessment data in Japanese older adults
Abstract Objective: Self-reported energy intake (EI) estimation may incur systematic errors that could be attenuated through biomarker calibration. We aimed to confirm whether calibrated EI was comparable to total energy expenditure (TEE) measured using the doubly labelled water (DLW) technique. Design: Cross-sectional study. Setting: General older population from the Kyoto–Kameoka Study, Japan. Participants: This study included sub- and main cohorts of 72 and 8,058 participants aged ≥65 years, respectively. EI was evaluated using a validated FFQ, and calibrated EI was obtained using a previously developed equation based on the DLW method. TEE was considered representative of true EI and also measured using the DLW method. We used a Wilcoxon signed-rank test and correlation analysis to compare the uncalibrated and calibrated EI with TEE. Results: In the sub-cohort, the median TEE, uncalibrated EI, and calibrated EI were 8,559 kJ, 7,088 kJ, and 9,269 kJ, respectively. The uncalibrated EI was significantly lower than the TEE (median difference = −1,847 kJ; interquartile range [IQR]: −2,785 to −1,096), although the calibrated EI was not (median difference = 463 kJ; IQR: −330 to 1,541). The uncalibrated (r = 0.275) and calibrated EI (r = 0.517) significantly correlated with TEE. The reproducibility was higher for calibrated EI (interclass correlation coefficient [ICC] = 0.982) than for uncalibrated EI (ICC = 0.637). Similar findings were observed when stratifying the sample by sex. For medians, uncalibrated EI was lower (˜17%) than calibrated EI in the main cohort. Conclusions: Biomarker calibration may improve the accuracy of self-reported dietary intake estimation.