Diabetics Under Report Energy Intake in NHANES III Greater than Non-Diabetics

Michael E. Broyles, Robin Harris, Douglas L. Taren*
Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA

© 2008 Broyles et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 North Martin Ave, PO Box 245163, Tucson, Arizona 85724, USA;


Known factors associated with under-reporting energy intake (EI) include anthropometry, energy expenditure, psychological factors, smoking, and gender. There is insufficient information on the association between chronic disease status and under-reporting EI. Using NHANES III data from non-pregnant adults aged ≥ 20 years, reported EI was estimated from a single 24-hour dietary recall and compared with estimated basal metabolic rate (BMRest) among 1503 diabetics and 17,010 non-diabetics. Multiple linear regression and logistic regression were performed to compare underreporting between diabetics and non-diabetics, and if it was associated with a hemoglobin A1c within diabetics.

Using EI:BMRest < 0.9, male and female diabetics were 2.1 and 3.4 times as likely to under report EI compared to nondiabetics after controlling for weight, age, education, usual intake level, physical activity, tobacco and alcohol use. This greater under-reporting by diabetics could bias the association between diet and disease toward the null in epidemiological studies.

Keywords: Dietary methods, 24-hour recalls, Energy intake, Diabetes, NHANES, Bias, Epidemiology.