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  3. Are People Consuming The Diets They Say They Are Selfreported Versus Estimated Adherence To Low Carb
J Acad Nutr Diet in press

Are people consuming the diets they say they are? Self-reported versus estimated adherence to
low carbohydrate and low fat diets: National Health and Nutrition Examination Survey, 2007-2018.

July 11, 2024 at 12:00 AM

Kowalski C, Dustin D, Ilayan A, Johnson LK, Belury M, Conrad Z

BACKGROUND : Mischaracterization of dietary intake by patients and study participants is a common problem that presents challenges to clinical and public health approaches to improve diet quality, identify healthy eating patterns, and reduce the risk of chronic disease.

OBJECTIVE : This study examined participants' self-reported adherence to low carbohydrate and low fat diets compared to their estimated adherence using up to two 24-hour recalls.

DESIGN : This cross-sectional study acquired data on dietary intake from respondents in the National Health and Nutrition Examination Survey (NHANES) 2007-2018.

PARTICIPANTS/SETTING : This study included 30,219 respondents ≥20 y who had complete and reliable dietary data and were not pregnant or breastfeeding.

MAIN OUTCOME MEASURES : The main outcome was prevalence of self-reported and estimated adherence to low carbohydrate or low fat diet patterns.

STATISTICAL ANALYSES PERFORMED : Self-reported adherence to low carbohydrate or low fat diets was evaluated using responses to questionnaires. Estimated adherence to these diets was assessed using data from up to two 24-hour recalls and usual intake methodology developed by the National Cancer Institute.

RESULTS : Of the 1.4% of participants that reported being on a low carbohydrate diet, estimated adherence (<26% energy from carbohydrates) using 24-hour recalls was 4.1%, whereas estimated adherence among those that did not report following a low carbohydrate diet was <1% (P-difference=0.014). Of the 2.0% of participants who reported being on a low fat diet, estimated adherence (<30% energy from fat) was 23.0%, whereas estimated adherence among those that did not report following a low fat diet was 17.8% (P-difference=0.048).

CONCLUSIONS : This research demonstrates that most individuals mischaracterized their diet pattern when compared to up to two 24-hour recalls. These findings emphasize the need for clinicians and public health professionals to be cautious when interpreting individuals' self-reported diet patterns, and should aim to collect more detailed dietary data when possible.