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ARS Home » Northeast Area » Beltsville, Maryland (BHNRC) » Beltsville Human Nutrition Research Center » Food Surveys Research Group » Research » Publications at this Location » Publication #354831
Title: Evaluation of measurement error in 24-hour dietary recall for assessing sodium and potassium intake among U.S. adults - National Health and Nutrition Examination Survey (NHANES), 2014

Author
item PUTHIERY, VA - Centers For Disease Control And Prevention (CDC) - United States
item DODD, KEVIN - National Cancer Institute (NCI, NIH)
item ZHAO, LIXIA - Centers For Disease Control And Prevention (CDC) - United States
item THOMPSON-PAUL, ANGELA - Centers For Disease Control And Prevention (CDC) - United States
item MERCADO, CARLA - Centers For Disease Control And Prevention (CDC) - United States
item TERRY, ANA - Centers For Disease Control And Prevention (CDC) - United States
item JACKSON, SANDRA - Centers For Disease Control And Prevention (CDC) - United States
item WANG, CHIA-YIH - Centers For Disease Control And Prevention (CDC) - United States
item LORIA, CATHERINE - National Cancer Institute (NCI, NIH)
item Moshfegh, Alanna
item Rhodes, Donna
item COGSWELL, MARY - Centers For Disease Control And Prevention (CDC) - United States

Submitted to: The American Journal of Clinical Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 3/4/2019
Publication Date: 4/26/2019
Citation: Puthiery, V., Dodd, K.W., Zhao, L., Thompson-Paul, A.M., Mercado, C.I., Terry, A.L., Jackson, S.L., Wang, C., Loria, C.M., Moshfegh, A.J., Rhodes, D.G., Cogswell, M.E. 2019. Evaluation of measurement error in 24-hour dietary recall for assessing sodium and potassium intake among U.S. adults - National Health and Nutrition Examination Survey (NHANES), 2014. American Journal of Clinical Nutrition. https://doi.org/10.1093/ajcn/nqz044.
DOI: https://doi.org/10.1093/ajcn/nqz044

Interpretive Summary: The objective of this study was to evaluate the measurement error in sodium and potassium intake as assessed with the 24-hour dietary recalls (24HDR) compared with 24-hour urinary excretions (24HUE) in a national sample of U.S. adults. Data were analyzed from 776 non-pregnant, noninstitutionalized U.S. adults aged 20–69 years who completed up-to-two 24HUE and 24HDR measures in the 2014 National Health and Nutrition Examination Survey. The findings from this study suggest that, compared with 24HUE, the 24HDR as used in NHANES is an unbiased measure for estimating mean sodium but yielded higher mean potassium intakes for the U.S. population overall and by sex. Furthermore, mean potassium intake, as assessed with 24HDR when compared to 24HUE, varied by race which may reflect underestimation of potassium intake using 24HUE for some population subgroups. These results will be beneficial for researchers and public health officials to understand the potential strengths and bias of associations of health outcomes with both sodium and potassium intakes assessed by 24HDR.

Technical Abstract: Understanding measurement error in sodium and potassium intake is essential for assessing population mean intake and studying associations with health outcomes. The objective of this research is to compare sodium and potassium intake derived from 24-hour dietary recalls (24HDR), with intake derived from 24-hour urinary excretions (24HUE). Data were analyzed from 776 non-pregnant, noninstitutionalized U.S. adults aged 20–69 years who completed up-to-two 24HUE and 24HDR measures in the 2014 National Health and Nutrition Examination Survey. Mean bias was estimated as the sum of differences between individual mean 24HDR and 24HUE measurements. Correlations and attenuation factors were estimated using the Kipnis joint mixed effects model accounting for within-person day-to-day variability in sodium excretion. The attenuation factor reflects the degree to which true associations between long-term intake (estimated with 24HUEs) and a hypothetical health outcome would be approximated using a single 24HDR: values near 1 indicate close approximation and near 0 indicate bias toward null. Estimates are reported for sodium, potassium, and the sodium:potassium (Na/K) ratio. Model parameters can be used to estimate correlations/attenuation factors when multiple 24HDRs are available. Overall, mean bias for sodium was -51 mg (95% confidence interval [CI]: -235, 134), for potassium 469 mg (CI: 368, 570), and for Na/K -0.38 (CI:-0.52, -0.245). Using one 24HDR, the attenuation factor for sodium was 0.14 (CI: 0.08, 0.21), for potassium 0.19 (CI: 0.11, 0.26), and for the Na/K 0.24 (CI: 0.12, 0.37). Correlation for sodium was 0.27 (CI: 0.16, 0.39), for potassium 0.35 (CI: 0.25, 0.45), and for Na/K 0.27 (CI: 0.12, 0.42). Compared with 24HUE, using 24HDR is unbiased for assessing population mean sodium intake but yielded higher mean potassium intake measurements. Due to attenuation, studies of association with health outcomes that use a single 24HDR to assess sodium and potassium intake may be strongly biased toward the null.