Introduction to Human Nutrition

270 Introduction to Human Nutrition

identifi ed as overreporters, and those below 0.76 as
underreporters. In Figure 10.8, the same data are
expressed as EI:BMR and EE:BMR, and each respon-
dent is represented by the same symbol as in Figure
10.7. The line at EI:BMR = 1.05 indicates the Gold-
berg cut-off for n = 1 and PAL = 1.55, which has been
widely used to identify low energy reporters (LERs).
These data demonstrate that only about 50% of
underreporters (as defi ned by EI:EE = 0.76) are iden-
tifi ed as LERs. The second line at EI:BMR of 1.35 is
the Goldberg cut-off for n = 1 and PAL = 1.95. This
cut-off identifi es more of the underreporters, but also
includes some of the acceptable reporters. To improve
on identifi cation of underreporters it is necessary
to have information on physical activity to enable
respondents to be classifi ed into different levels of
activity and to calculate cut-offs appropriate for each
activity level.
While the ability to separate the food and nutrient
intake data of those with and without plausible energy
intakes is a very important step in the evaluation of
dietary intake data, it does have limitations.

● The equations for the estimation of BMR have
been derived for Western populations and their

application to other populations must be done with

caution.

● The ratio does not take differences in physical activ-

ity into account (Black, 2000).

● Using a single cut-off point to identify under-

reporters has been found to have poor sensitivity

for underreporting (fails to identify underreport-

ers), especially at high levels of energy intake (Black,

2000).

● Cut-off values differ among studies. Thus it is dif-

fi cult to select an appropriate value and to compare

studies.

● Cut-off values apply only to individuals in energy

balance. They cannot be applied to growing chil-

dren or to adults trying to lose weight (Gibson,

2005).

Characteristics of low energy reporters

A number of studies have examined the characteris-

tics of low energy reporters (LERs). Associations

between low energy reporting and a large number of

factors including high body weight, high BMI, obesity,

dieting, and awareness of body image were found in

every study that looked at these measures. Associations

20

15

10

5

0

Women

EI (MJ)

DLW EE (MJ)

UR

AR

OR

015 01520

Figure 10.7 Reported energy intake (EI) against energy expenditure
(EE) measured by doubly labeled water (DLW) in 264 women aged
18–90 years. The solid lines represent the 95% confi dence limits of
the expected agreement between EI and EE (±24%). UR, underreport-
ers; AR, acceptable reporters; OR, overreporters (after Black, 2000,
reproduced with permission).

3.0

2.5

2.0

1.5

1.0

0.5

0

EI:BMR

est

PAL (EE:BMRmeas)

1.0 1.5 2.0 2.5 3.0

UR

AR

OR

Figure 10.8 Energy intake–estimated basal metabolic rate (EI:BMRest)

against physical activity level [PAL; energy expenditure–measured

BMR (EE:BMRmeas)]. Respondents are designated as acceptable report-

ers (AR), overreporters (OR), or underreporters (UR) by the direct com-

parison of EI:EE. The horizontal lines indicate the lower Goldberg

cut-off for PAL = 1.55 and 1.95, 7 day records, and n = 1 (after Black,

2000, reproduced with permission).