Use of a urinary sugars biomarker to assess measurement error in self-reported sugars intake in the nutrition and physical activity assessment study (NPAAS).

Publication Type:

Journal Article


Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, Volume 23, Issue 12, p.2874-83 (2014)


2014, Aged, Carbohydrates, Center-Authored Paper, Diet Surveys, Energy Intake, Female, Humans, Immune Monitoring Core Facility, Middle Aged, Motor Activity, Nutrition Assessment Core Facility, Nutritional Status, Prevention Center Core Facility, Prospective Studies, Public Health Sciences Division, Self Report, Specimen Processing Core Facility, Surveys and Questionnaires


BACKGROUND: Measurement error in self-reported sugars intake may be obscuring the association between sugars and cancer risk in nutritional epidemiologic studies. METHODS: We used 24-hour urinary sucrose and fructose as a predictive biomarker for total sugars, to assess measurement error in self-reported sugars intake. The Nutrition and Physical Activity Assessment Study (NPAAS) is a biomarker study within the Women's Health Initiative (WHI) Observational Study that includes 450 postmenopausal women ages 60 to 91 years. Food Frequency Questionnaires (FFQ), four-day food records (4DFR), and three 24-hour dietary recalls (24HRs) were collected along with sugars and energy dietary biomarkers. RESULTS: Using the biomarker, we found self-reported sugars to be substantially and roughly equally misreported across the FFQ, 4DFR, and 24HR. All instruments were associated with considerable intake- and person-specific bias. Three 24HRs would provide the least attenuated risk estimate for sugars (attenuation factor, AF = 0.57), followed by FFQ (AF = 0.48) and 4DFR (AF = 0.32), in studies of energy-adjusted sugars and disease risk. In calibration models, self-reports explained little variation in true intake (5%-6% for absolute sugars and 7%-18% for sugars density). Adding participants' characteristics somewhat improved the percentage variation explained (16%-18% for absolute sugars and 29%-40% for sugars density). CONCLUSIONS: None of the self-report instruments provided a good estimate of sugars intake, although overall 24HRs seemed to perform the best. IMPACT: Assuming the calibrated sugars biomarker is unbiased, this analysis suggests that measuring the biomarker in a subsample of the study population for calibration purposes may be necessary for obtaining unbiased risk estimates in cancer association studies.