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By Norman J. Temple, Ted Wilson, David R. Jacobs Jr.

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Extra resources for Nutritional Health: Strategies for Disease Prevention (Nutrition and Health)

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ENERGY ADJUSTMENT The concept of energy density and the optimal approach to expressing the levels of intakes, particularly of macronutrients (protein, fat, and carbohydrate), has been debated for many years. The prevailing view suggests that the relevant measure of exposure for macronutrients is the intake relative to energy intake, rather than a simple measure of absolute intake. One reason for expressing macronutrient intake relative to energy intake is that it makes it easier to compare intakes across different levels of energy intake, for example, men and women and different ages.

This assumption should always be tested before using biological markers to infer dietary intake. A particular issue to consider is that most markers do not provide a measure of absolute intake, only the relative ranking of intakes. Although the technical errors of measurement (repeatability) of markers may be smaller, the marker may not be a relevant measure of the dietary exposure of interest. For a biological marker to be a useful indicator of exposure it must be sensitively and specifically related to dietary intake across the range of intakes in the population under study.

Measuring dietary exposure in nutritional epidemiological studies. Nutr Res Rev 1995; 5:165–178. 8. Kipnis V, Midthune D, Freedman L, et al. Bias in dietary-report instruments and its implications for nutritional epidemiology. Public Health Nutr 2002; 5:915–923. 9. Freedman LS, Fainberg V, Kipnis V, Midthune D, Carroll RJ. A new method for dealing with measurement error in explanatory variables of regression models. Biometrics 2004; 60:172–181. 10. Kipnis V, Subar AF, Midthune D, et al. Structure of dietary measurement error: results of the OPEN biomarker study.

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