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Lipids and cardiovascular/metabolic health

The influence of adjustment for energy misreporting on relations of cake and cookie intake with cardiometabolic disease risk factors

European Journal of Clinical Nutrition volume 70, pages 1318–1324 (2016)Cite this article

Subjects

Abstract

Background/Objectives:

Previous cohort studies elucidated unexpected inverse relations of cake and cookie (CC) consumption with chronic disease risk. We assessed CC intake in relation to cardiometabolic disease risk factors in a well-phenotyped population with emphasis on misreporting as the potential driving force behind inverse relations.

Subjects/Methods:

In a cross-sectional EPIC-Potsdam sub-study individual usual CC intake was modeled by combining 24 h recall and food frequency questionnaire data. Cardiometabolic risk factors were anthropometry, blood lipids, blood pressure (BP), physical activity and fitness. Analysis of covariance models adjusted for (i) age/education/lifestyle and (ii) additionally for energy misreporting (ratio of energy intake over energy expenditure) were used to compute mean values of risk factors for quartiles of CC intake.

Results:

Adjustment for misreporting had considerable impact on relations of CC intake. Initial inverse links with anthropometry were reversed to direct associations. Misreporting adjustment also nullified inverse relations with triglycerides and with total cholesterol in women. Negligible associations with high density lipoprotein cholesterol turned inverse (men: cross-quartile difference (ΔQ4-Q1)=−1.7 mg/dl; women: ΔQ4-Q1=−3.6 mg/dl), so did fitness (men: ΔQ4-Q1=−1.2 ml/kg/min; women: ΔQ4-Q1=−0.9 ml/kg/min). Direct relations with total/low density lipoprotein cholesterol in men were not changed by misreporting (ΔQ4-Q1 max. 7.5 or 11.3 mg/dl). Reduced BP was observed in females with increased CC intake; only systolic BP remained relevant after misreporting adjustment (ΔQ4-Q1=−4.6 mmHg).

Conclusions:

The strong impact of energy misreporting on relations of CC intake with risk factors emphasizes a careful analysis and interpretation of nutritional data. We showed that apparent favorable relations of CC intake changed with a different model specification, highlighting proper modeling considerations when analyzing diet–disease relations.

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Acknowledgements

This study was partly funded by the German Federal Ministry of Education and Research (BMBF FKZ: 01ER0808). We thank the Human Study Centre (HSC) of the German Institute of Human Nutrition Potsdam-Rehbruecke, namely the trustee and the examination unit for collecting, the data hub for processing and the participants for providing the data, the biobank for processing the biological samples and the HSC head, Manuela Bergmann, for contributing to the study design and leading the underlying processes of data generation. We also thank the Ernst von Bergmann Klinikum Potsdam for conducting magnetic resonance tomography, the Division of Medical and Biological Informatics at the German Cancer Research Center for processing body composition data and the Institut für Medizinische Diagnostik Berlin - Potsdam for analyzing clinical blood parameters.

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Authors and Affiliations

  1. Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany

    M Gottschald, S Knüppel, H Boeing & B Buijsse

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  1. M Gottschald
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Correspondence to M Gottschald.

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Gottschald, M., Knüppel, S., Boeing, H. et al. The influence of adjustment for energy misreporting on relations of cake and cookie intake with cardiometabolic disease risk factors. Eur J Clin Nutr 70, 1318–1324 (2016). https://doi.org/10.1038/ejcn.2016.131

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