Validity of U.S. nutritional surveillance: National Health and Nutrition Examination Survey caloric energy intake data, 1971–2010

Summary

This analysis examined the validity of energy intake data from the National Health and Nutrition Examination Survey spanning 1971–2010 across 63,362 respondents aged 20–74 years. Using physiological benchmarks (rEI/BMR ratios and rEI–TEE disparity values), the authors found significant and persistent under-reporting of caloric intake, with mean disparities of −281 kcal/day for men and −365 kcal/day for women; under-reporting was most pronounced in obese respondents (−716 and −856 kcal/day respectively). The authors conclude that methodological limitations render the majority of NHANES energy intake data unsuitable for estimating population-level trends or informing evidence-based dietary policy.

Regional applicability

Whilst this study is specific to the United States NHANES survey, it raises important questions about the reliability of dietary surveillance methodology that may apply to the UK's National Diet and Nutrition Survey (NDNS) and other countries' nutrition monitoring systems. The findings suggest that under-reporting of energy intake is a persistent methodological challenge in self-reported dietary assessment globally, with implications for the empirical foundation of dietary guidelines and public health nutrition policy internationally.

Key measures

Reported energy intake (rEI) to estimated basal metabolic rate (BMR) ratio; disparity values (rEI minus total energy expenditure); proportion of respondents with physiologically implausible energy intake data

Outcomes reported

The study assessed the physiological plausibility of reported energy intake data from NHANES across 39 years, finding widespread under-reporting of caloric intake when compared to estimated basal metabolic rate and total energy expenditure. Results indicated that 67.3% of women and 58.7% of men reported energy intake values that were not physiologically credible.

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