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Journal of the American College of Nutrition, Vol. 26, No. 4, 327-333 (2007)
Published by the American College of Nutrition

Low Energy Reporting Related to Lifestyle, Clinical, and Psychosocial Factors in a Randomly Selected Population Sample of Greek Adults: The ATTICA Study

Mary Yannakoulia, PhD, Demosthenes B. Panagiotakos, PhD, Christos Pitsavos, MD, PhD, Eirini Bathrellou, MSc, Christina Chrysohoou, MD, PhD, Yannis Skoumas, MD, PhD and Christodoulos Stefanadis, MD, PhD

Department of Nutrition and Dietetics, Harokopio University (M.Y., D.B.P., E.B.)
First Cardiology Clinic, School of Medicine, University of Athens (C.P., C.C., Y.S., C.S.), Athens, GREECE

Address reprint requests to: Mary Yannakoulia, PhD, Department of Nutrition and Dietetics, Harokopio University, El. Venizelou 70, Athens 17671, GREECE. E-mail: myiannak{at}hua.gr

Objective: Aim of the present study was to identify potential dietary, lifestyle, psychosocial and clinical correlates of underreporting in a population-based sample.

Methods: Following a random multistage sampling, 1514 men (46±13 years old) and 1528 women (45±13 years old) from the Attica area, in Greece, participated in this study. All participants underwent a standard assessment procedure that included clinical, psychosocial and lifestyle parameters. Food consumption was assessed through a validated semi-quantitative food frequency questionnaire. The ratio of energy intake to estimated basal metabolic rate (EI/BMR) and the Goldberg cut-off points were used for the classification of subjects as low energy reporters (LERs) and non-LERs.

Results: LERs represented 12.2% of the sample. This percentage was higher in obese subjects compared to overweight or normal weight (20.6 % vs. 9.9 % vs. 10.6 %, p = 0.05), as well as in women compared to men (14.6% vs. 9.9%, p<0.001). Data analysis was stratified by gender, since a significant interaction was observed between gender and LER group on several dietary parameters. Female LERs had higher Med Diet Score compared to non-LERs (30.6 ± 8.2, 95%CI 30.2–31.04 vs. 26.9 ± 6.3, 95%CI 26.05–27.7, p<0.001). Multiple regression analysis revealed that lower EI/BMR values were associated with younger age (p<0.001), higher BMI (p<0.001), presence of diabetes mellitus (p=0.012) and lower depression score (p=0.056) in women, whereas with younger age (p<0.001), higher BMI (p<0.001), higher education level (p=0.046) and higher anxiety score (p=0.08) in men.

Conclusion: Several psychosocial and clinical characteristics operate in low energy reporting in both genders. Nutrition-related professionals should be aware of these gender-specific trends in dietary assessment procedures.

Key words: underreporting, energy intake, overweight, diabetes, depression, anxiety






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