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Total energy intake: implications for epidemiologic analyses.
Abstract
Associations between intake of specific nutrients and disease cannot be considered primary effects of diet if they are simply the result of differences between cases and noncases in body size, physical activity, and metabolic efficiency. Epidemiologic studies of diet and disease should therefore be directed at the effect of nutrient intakes independent of total caloric intake in most instances. This is not accomplished with nutrient density measures of dietary intake but can be achieved by employing nutrient intakes adjusted for caloric intake by regression analysis. While pitfalls in the manipulation and interpretation of energy intake data in epidemiologic studies have been emphasized, these considerations also highlight the usefulness of obtaining a measurement of total caloric intake. For instance, if a questionnaire obtained information on only cholesterol intake in a study of coronary heart disease, it is possible that no association with disease would be found even if a real positive effect of a high cholesterol diet existed, since the caloric intake of cases is likely to be less than that of noncases. Such a finding could be appropriately interpreted if an estimate of total caloric intake were available. The relationships between dietary factors and disease are complex. Even with carefully collected measures of intake, consideration of the biologic implications of various analytic approaches is needed to avoid misleading conclusions.
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“We adjusted the intakes of fruits and vegetables, omega-3 fatty acids, and salt (sodium) from NHANES for total energy intake using the residual method [4].”
From The Preventable Causes of Death in the United States: Comparative Risk Assessment of Dietary, Lifestyle, and Metabolic Risk Factors (2009) · cites this paper as [4]
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“Prior to statistical integration with GI symptoms, C-DHQ II data were adjusted for total caloric intake.”
From Adaptation to tolerate high doses of arabinoxylan is associated with fecal levels of Bifidobacterium longum (2024) · cites this paper as [71]
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Metadata
- Authors
- WILLETT, W., & STAMPFER, M. J.
- Affiliations
- Brigham and Women's Hospital (US)
- Corresponding author
- WILLETT, WALTER
- Venue
- American Journal of Epidemiology
- Publisher
- Oxford University Press (OUP)
- Published
- 1986-07
- Volume
- 124
- Issue
- 1
- Pages
- 17-27
- ISSN
- 0002-9262 (ISSN-L)
- 1476-6256
- OpenAlex
- W4292996332
- Cited by
- 2,751
- References
- 0
- Citations by year
- 2026: 56 · 2025: 83 · 2024: 92 · 2023: 112 · 2022: 135 · 2021: 133 · 2020: 92 · 2019: 104 · 2018: 98 · 2017: 94 · 2016: 95 · 2015: 77 · 2014: 90 · 2013: 106 · 2012: 93
- FWCI
- 16.97
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (HL-01018)
- National Cancer Institute (CA 26560, CA 23645)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutrition and Health Studies
- Keywords
- total energy intake, energy intake, nutrient intake, dietary assessment, nutrient density, coronary artery disease, cholesterol intake, body size, physical activity, metabolic efficiency, diet and disease
- MeSH terms
- Adult, Energy Intake, Coronary Disease, Diet Surveys, Dietary Fats, Epidemiologic Methods, Physical Exertion, Female, Humans, Male, Middle Aged, Neoplasms, Nutritional Physiological Phenomena, Surveys and Questionnaires, Regression Analysis
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