Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Energy intake and sources of energy intake in the European Prospective Investigation into Cancer and Nutrition



To describe energy intake and its macronutrient and food sources among 27 regions in 10 countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study.


Between 1995 and 2000, 36 034 subjects aged 35–74 years were administered a standardized 24-h dietary recall. Intakes of macronutrients (g/day) and energy (kcal/day) were estimated using standardized national nutrient databases. Mean intakes were weighted by season and day of the week and were adjusted for age, height and weight, after stratification by gender. Extreme low- and high-energy reporters were identified using Goldberg's cutoff points (ratio of energy intake and estimated basal metabolic rate <0.88 or >2.72), and their effects on macronutrient and energy intakes were studied.


Low-energy reporting was more prevalent in women than in men. The exclusion of extreme-energy reporters substantially lowered the EPIC-wide range in mean energy intake from 2196–2877 to 2309–2866 kcal among men. For women, these ranges were 1659–2070 and 1873–2108 kcal. There was no north–south gradient in energy intake or in the prevalence of low-energy reporting. In most centres, cereals and cereal products were the largest contributors to energy intake. The food groups meat, dairy products and fats and oils were also important energy sources. In many centres, the highest mean energy intakes were observed on Saturdays.


These data highlight and quantify the variations and similarities in energy intake and sources of energy intake among 10 European countries. The prevalence of low-energy reporting indicates that the study of energy intake is hampered by the problem of underreporting.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others


  • Black AE, Cole TJ (2000). Within- and between-subject variation in energy expenditure measured by the doubly-labelled water technique: implications for validating reported dietary energy intake. Eur J Clin Nutr 54, 386–394.

    Article  CAS  Google Scholar 

  • Braam LA, Ocke MC, Bueno-de-Mesquita HB, Seidell JC (1998). Determinants of obesity-related underreporting of energy intake. Am J Epidemiol 147, 1081–1086.

    Article  CAS  Google Scholar 

  • Branca F, Nikogosian H, Lobstein T (eds). (2007). The Challenge of Obesity in the WHO European Region and the Strategies for Response. WHO Europe: Copenhagen.

    Google Scholar 

  • Brussaard JH, Johansson L, Kearney J (2002). Rationale and methods of the EFCOSUM project. Eur J Clin Nutr 56 (Suppl 2), S4–S7.

    Article  Google Scholar 

  • Brustad M, Skeie G, Braaten T, Slimani N, Lund E (2003). Comparison of telephone vs face-to-face interviews in the assessment of dietary intake by the 24 h recall EPIC SOFT program—the Norwegian Calibration Study. Eur J Clin Nutr 57, 107–113.

    Article  CAS  Google Scholar 

  • Cust AE, Skilton MR, van Bakel MME, Halkjær J, Olsen A, Agnoli C et al. (2009). Total dietary carbohydrate, sugar, starch and fibre intakes in the European Prospective Investigation into Cancer and Nutrition. Eur J Clin Nutr 63 (Suppl 4), S37–S60.

    Article  CAS  Google Scholar 

  • de Groot CP, van den Broek T, van Staveren W (1999). Energy intake and micronutrient intake in elderly Europeans: seeking the minimum requirement in the SENECA study. Age Ageing 28, 469–474.

    Article  CAS  Google Scholar 

  • Elmadfa I, Weichselbaum E (eds) (2005). European Nutrition and Health Report 2004. Forum Nutrition, vol. 58. Karger: Basel.

    Book  Google Scholar 

  • Ferrari P, Day NE, Boshuizen HC, Roddam A, Hoffmann K, Thiebaut A et al. (2008). The evaluation of the diet/disease relation in the EPIC study: considerations for the calibration and the disease models. Int J Epidemiol 37, 368–378.

    Article  Google Scholar 

  • Ferrari P, Kaaks R, Fahey MT, Slimani N, Day NE, Pera G et al. (2004). Within- and between-cohort variation in measured macronutrient intakes, taking account of measurement errors, in the European Prospective Investigation into Cancer and Nutrition study. Am J Epidemiol 160, 814–822.

    Article  Google Scholar 

  • Ferrari P, Roddam A, Fahey MT, Jenab M, Bamia C, Ocké M et al. (2009). A bivariate measurement error model for nitrogen and potassium intakes to evaluate the performance of regression calibration in the European Prospective Investigation into Cancer and Nutrition study. Eur J Clin Nutr 63 (Suppl 4), S179–S187.

    Article  CAS  Google Scholar 

  • Ferrari P, Slimani N, Ciampi A, Trichopoulou A, Naska A, Lauria C et al. (2002). Evaluation of under- and overreporting of energy intake in the 24-h diet recalls in the European Prospective Investigation into Cancer and Nutrition (EPIC). Public Health Nutr 5 (Suppl), S1329–S1345.

    Article  Google Scholar 

  • Goldberg GR, Black AE, Jebb SA, Cole TJ, Murgatroyd PR, Coward WA et al. (1991). Critical evaluation of energy intake data using fundamental principles of energy physiology: 1. Derivation of cut-off limits to identify under-recording. Eur J Clin Nutr 45, 569–581.

    CAS  PubMed  Google Scholar 

  • Haftenberger M, Schuit AJ, Tormo MJ, Boeing H, Wareham N, Bueno-de-Mesquita HB et al. (2002). Physical activity of subjects aged 50–64 years involved in the European Prospective Investigation into Cancer and Nutrition (EPIC). Public Health Nutr 5 (Suppl), S1163–S1176.

    Article  Google Scholar 

  • Halkjær J, Olsen A, Bjerregaard LJ, Deharveng G, Tjønneland A, Welch AA et al. (2009). Intake of total, animal and plant proteins and their food sources in 10 countries in the European Prospective Investigation into Cancer and Nutrition. Eur J Clin Nutr 63 (Suppl 4), S16–S36.

    Article  Google Scholar 

  • Heitmann BL, Lissner L (1995). Dietary underreporting by obese individuals—is it specific or non-specific? Br Med J 311, 986–989.

    Article  CAS  Google Scholar 

  • Kaaks R, Plummer M, Riboli E, Esteve J, van Staveren WA (1994). Adjustment for bias due to errors in exposure assessments in multicenter cohort studies on diet and cancer: a calibration approach. Am J Clin Nutr 59, S245–S250.

    Article  Google Scholar 

  • Kaaks R, Riboli E, van Staveren WA (1995). Calibration of dietary intake measurements in prospective cohort studies. Am J Epidemiol 142, 548–556.

    Article  CAS  Google Scholar 

  • Kipnis V, Subar AF, Midthune D, Freedman LS, Ballard-Barbash R, Troiano RP et al. (2003). Structure of dietary measurement error: results of the OPEN biomarker study. Am J Epidemiol 158, 14–21; discussion 22–26.

    Article  Google Scholar 

  • Linseisen J, Welch AA, Ocké M, Amiano P, Agnoli C, Ferrari P et al. (2009). Dietary fat intake in the European Prospective Investigation into Cancer and Nutrition: results from the 24-h dietary recalls. Eur J Clin Nutr 63 (Suppl 4), S61–S80.

    Article  CAS  Google Scholar 

  • Livingstone MB, Black AE (2003). Markers of the validity of reported energy intake. J Nutr 133 (Suppl 3), S895–S920.

    Article  Google Scholar 

  • Maurer J, Taren DL, Teixeira PJ, Thomson CA, Lohman TG, Going SB et al. (2006). The psychosocial and behavioral characteristics related to energy misreporting. Nutr Rev 64, 53–66.

    Article  Google Scholar 

  • Riboli E, Hunt KJ, Slimani N, Ferrari P, Norat T, Fahey M et al. (2002). European Prospective Investigation into Cancer and Nutrition (EPIC): study populations and data collection. Public Health Nutr 5 (Suppl), S1113–S1124.

    Article  Google Scholar 

  • Schofield WN (1985). Predicting basal metabolic rate; new standards and review of previous work. Hum Nutr Clin Nutr 39 (Suppl 1), S5–S41.

    Google Scholar 

  • Sieri S, Krogh V, Saieva C, Grobbee DE, Bergmann M, Rohrmann S et al. (2009). Alcohol consumption patterns, diet and body weight in 10 European countries. Eur J Clin Nutr 63 (Suppl 4), S81–S100.

    Article  CAS  Google Scholar 

  • Slimani N, Bingham S, Runswick S, Ferrari P, Day NE, Welch AA et al. (2003). 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 study. Cancer Epidemiol Biomarkers Prev 12, 784–795.

    PubMed  Google Scholar 

  • Slimani N, Deharveng G, Charrondière RU, van Kappel AL, Ocké MC, Welch A et al. (1999). Structure of the standardized computerized 24-h diet recall interview used as reference method in the 22 centers participating in the EPIC project. Comput Methods Programs Biomed 58, 251–266.

    Article  CAS  Google Scholar 

  • Slimani N, Deharveng G, Unwin I, Southgate DA, Vignat J, Skeie G et al. (2007). The EPIC nutrient database project (ENDB): a first attempt to standardize nutrient databases across the 10 European countries participating in the EPIC study. Eur J Clin Nutr 61, 1037–1056.

    Article  CAS  Google Scholar 

  • Slimani N, Ferrari P, Ocke M, Welch A, Boeing H, van Liere M et al. (2000). Standardization of the 24-h diet recall calibration method used in the European Prospective Investigation into Cancer and Nutrition (EPIC): general concepts and preliminary results. Eur J Clin Nutr 54, 900–917.

    Article  CAS  Google Scholar 

  • Slimani N, Kaaks R, Ferrari P, Casagrande C, Clavel-Chapelon F, Lotze G et al. (2002). European Prospective Investigation into Cancer and Nutrition (EPIC) calibration study: rationale, design and population characteristics. Public Health Nutr 5 (Suppl), S1125–S1145.

    Article  Google Scholar 

  • Swinburn BA, Caterson I, Seidell JC, James WP (2004). Diet, nutrition and the prevention of excess weight gain and obesity. Public Health Nutr 7, 123–146.

    CAS  PubMed  Google Scholar 

  • WHO/FAO (2003). Diet, Nutrition and the Prevention of Chronic Diseases (Report of a Joint WHO/FAO Expert Consultation). WHO Technical Report 916. World Health Organization: Geneva.

Download references


The work described in this paper was carried out with the financial support of the European Commission: Public Health and Consumer Protection Directorate 1993–2004; of the Research Directorate-General 2005; Ligue contre le Cancer (France); Société 3M (France); Mutuelle Générale de l'Education Nationale; Institut National de la Santé et de la Recherche Médicale (INSERM); Institut Gustave Roussy; German Cancer Aid; German Cancer Research Center; German Federal Ministry of Education and Research; Danish Cancer Society; Health Research Fund (FIS) of the Spanish Ministry of Health; Spanish Regional Governments of Andalucía, Asturias, Basque Country, Murcia and Navarra and the Catalan Institute of Oncology; and ISCIII RETIC (RD06/0020), Spain; Cancer Research UK; Medical Research Council, UK; the Stroke Association, UK; British Heart Foundation; Department of Health, UK; Food Standards Agency, UK; the Wellcome Trust, UK; Greek Ministry of Health; Hellenic Health Foundation; Italian Association for Research on Cancer; Italian National Research Council, Regione Sicilia (Sicilian government); Associazione Iblea per la Ricerca Epidemiologica—ONLUS (Hyblean association for epidemiological research, NPO); Dutch Ministry of Health, Welfare and Sport; Dutch Prevention Funds; LK Research Funds; Dutch ZON (Zorg Onderzoek Nederland); World Cancer Research Fund (WCRF); Swedish Cancer Society; Swedish Research Council; Regional Government of Skane and the County Council of Vasterbotten, Sweden; Norwegian Cancer Society; the Norwegian Research Council; and the Norwegian Foundation for Health and Rehabilitation. We thank Sarah Somerville, Nicole Suty and Karima Abdedayem for assistance with editing and Kimberley Bouckaert and Heinz Freisling for technical assistance.

Author information

Authors and Affiliations


Corresponding author

Correspondence to M C Ocké.

Additional information

Guarantor: MC Ocké.Contributors: MO carried out statistical analysis, prepared tables and figures and wrote the paper, taking into account comments from all co-authors. NS was the overall coordinator of this project and of the EPIC nutritional databases (ENDB) project. MO, NS, NL, SG, SB, PF, SS, VB, JL and EW were members of the writing group and gave input on statistical analysis, drafting of the paper and interpretation of results. The other co-authors were local EPIC collaborators involved in the collection of data, and in documenting, compiling and evaluating the subset of their national nutrient databases used in the ENDB. ER is the overall coordinator of the EPIC study. All co-authors provided comments and suggestions on the paper and approved the final version.



Table A1

Table a1 Minimally adjusteda mean daily intakes of total energy (kcal) by centre ordered from south to north, gender and age group

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ocké, M., Larrañaga, N., Grioni, S. et al. Energy intake and sources of energy intake in the European Prospective Investigation into Cancer and Nutrition. Eur J Clin Nutr 63 (Suppl 4), S3–S15 (2009).

Download citation

  • Published:

  • Issue Date:

  • DOI:


This article is cited by


Quick links