The under-reporting of energy intake influences the dietary pattern reported by obese women in the waiting list for bariatric surgery

RAVELLI, Michele Novaes; SARTORI, Maria Márcia Pereira; CORRENTE, José Eduardo; RASERA JUNIOR, Irineu; SOUZA, Noa Pereira Prada de; OLIVEIRA, Maria Rita Marques de

doi:10.1590/1678-98652018000200009

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Brasil

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Sumário

ORIGINAL ARTICLES • Rev Nutr 31 (2) • Mar-Apr 2018 • https://doi.org/10.1590/1678-98652018000200009 copy

The under-reporting of energy intake influences the dietary pattern reported by obese women in the waiting list for bariatric surgery

A subnotificação do consumo energético influencia os resultados de padrão alimentar relatado por mulheres obesas na fila de espera para cirurgia bariátrica

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To verify the interference of the energy intake under-reporting in the determination of the dietary patterns and nutrient intakes reported by obese women in the waiting list for bariatric surgery.

Methods

The study included 412 women aged 20 to 45 years with a body mass index ranging from 35 to 60kg/m² who were on waiting list for bariatric surgery. Data from three reported food intake and physical activity, body weight, and height were used for estimating the reported energy intake, physical activity level, and resting energy expenditure. Subsequently, it was checked the biological plausibility of the reported energy intakes, classifying all participants as plausible reporters or under-reporters. Exploratory factor analysis was used to determine the participants’ dietary patterns. The Mann-Whitney test assessed the reported energy and nutrient intakes between plausible reporters and under-reporters groups. The Z-test assessed the variables of plausible reporters or under-reporters in relation to all participants of the study.

Results

Six dietary patterns were determined for all participants of study. After excluding information from under-reporting women, only two dietary patterns remained similar to those of all participants, while three other dietary patterns presented different conformations from food subgroups to plausible reporters. The reported energy intake did not present difference for the subgroups of fruits, leaf vegetables and vegetables. However, the energetic value reported for the other food subgroups was higher for the plausible reporters.

Conclusion

The under-reporting of energy intake influenced the determination of dietary patterns of obese women waiting for bariatric surgery.

Keywords
Energy intake; Dietary pattern; Multivariate analysis; Obesity.; Under-reporting

Groups of the Brazilian Food Guide (Ministry of Health, 2008)	Food group subgroups
Group 1 Grains, tubers, and roots.	Subgroup 1: Breads and grains (rice and respective preparations, maize, oat, cornmeal, popcorn, polenta, soups).
	Subgroup 2: Tubers and roots (potato and respective preparations, cassava, cassava flour, arracacia xanthorrhiza).
	Subgroup 3: Pasta (Pasta and sauces, pancake, lasagna).
Group 2 Fruits and vegetables.	Subgroup 4: Fruits (pineapple, banana, apple, watermelon, melon, strawberry, orange, papaya, grapes, kiwi, pear, guava, etc. and respective juices).
	Subgroup 5: Leaf vegetables (lettuce, watercress, chicory, arugula, kale, cabbage, etc.)
	Subgroup 6: Vegetables (pumpkin, zucchini, chayote, beets, carrots, okra, broccoli, cauliflower, eggplant, radish, tomato, etc).
Group 3 Beans and other high-protein plants.	Subgroup 7: Beans and other high-protein plants (pea, lentil, chickpea, soybean and derivatives, kidney beans (brown or black), bean stew, nuts).
Group 4 Meat and eggs, milk and dairy products.	Subgroup 8: Meat, seafood, and eggs (beef, poultry, pork, seafood, eggs and respective preparations).
Group 4 Meat and eggs, milk and dairy products.	Subgroup 9: Milk and dairy products (whole and low-fat cow milk, whole and low-fat yogurt, chocolate cow milk or coffee and cow milk containing sugar, fermented milk, and cheeses).
Group 5 Fat, sugar, and salt sources.	Subgroup 10: Fast foods (snacks, pizza, cheese roll, baked salty snacks, deep-fried salty snacks).
	Subgroup 11: Sweets (sandwich cookies, cookies, chocolate mix, sugar, cake with and without icing, mousse, homemade sweets, chocolate, ice cream, fruit preserves, etc.).
	Subgroup 12: Processed salty foods (cold cuts, sausages, mayonnaise, catchup, mustard, potato chips and other packaged snacks, etc.)
	Subgroup 13: Beverages (artificial or industrialized fruit juice, alcoholic beverages, soda, powdered drinks/coffee and teas containing sugar).

General information	All Participants (n=412; 100%)					Plausible Reporters (n=157; 38%)					Under-reporters (n= 255; 62%)					p ^* * p<0.05 in the comparisons made by the Mann-Whitney test between energy intake plausible reporters and under-reporters.
General information	Mean	±	SD	Median	Quartiles	Mean	±	SD	Median	Quartiles	Mean	±	SD	Median	Quartiles
Age (years)	32	±	7	32	27 – 37	32	±	6	32	28 – 38	31	±	7	31	27 – 37	<0.313
BMI (kg/m²)	46.0	±	6.0	45.1	41.6 – 49.3	45.3	±	5.6	44.4	41.4 – 48.6	46.5	±	6.3	45.5	42.0 – 50.0	<0.102
TEE – DRI (kcal)	2902	±	382	2901	2637 – 3140	2775	±	339^†† †† = p≤0.01.	2744	2532 – 3009	2981	±	386^†† †† = p≤0.01.	2969	2714 – 3212	<0.001
REE (Kcal)	1884	±	191	1873	1748 – 2005	1849	±	191^† † Z-test of the all participants in relation to plausible reporters and under-reporters, where †=p≤0.05;	1849	1707 – 1981	1905	±	189	1885	1772 – 2035	<0.004
PAL – DRI	1.53	±	0.27	1.51	1.31 – 1.69	1.46	±	0.23^†† †† = p≤0.01.	1.45	1.27 – 1.62	1.58	±	0.27^†† †† = p≤0.01.	1.56	1.36 – 1.75	<0.001

Food Groups (Kcal/day)	All Subjects (n=412; 100%)						Plausible Reporters (n=157; 38%)					Under-reporters (n= 255; 62%)
	Factor loadings (>\|0.400\|)						Factor loadings (>\|0.400\|)					Factor loadings (>\|0.400\|)
	1º Factor	2º Factor	3º Factor	4º Factor	5º Factor	6º Factor	1º Factor	2º Factor	3º Factor	4º Factor	5º Factor	1º Factor	2º Factor	3º Factor	4º Factor	5º Factor
Bread and grains	-0.283	-0.727	-0.008	-0.109	-0.079	-0.020	-0.054	0.693	-0.285	-0.004	-0.154	-0.042	-0.601	-0.114	-0.249	-0.338
Tubers and roots	-0.625	-0.042	-0.217	-0.163	-0.123	-0.040	-0.668	-0.075	-0.078	-0.100	-0.083	-0.070	-0.118	-0.142	-0.221	-0.646
Pasta	-0.107	-0.189	-0.753	-0.005	-0.155	-0.049	-0.282	-0.272	-0.117	-0.292	-0.541	-0.019	-0.390	-0.275	-0.081	-0.125
Fruits	-0.019	-0.071	-0.045	-0.018	-0.790	-0.133	-0.418	-0.162	-0.090	-0.585	-0.150	-0.584	-0.204	-0.087	-0.162	-0.068
Leaf vegetables	-0.170	-0.044	-0.048	-0.077	-0.074	-0.777	-0.034	-0.125	-0.526	-0.056	-0.137	-0.074	-0.206	-0.094	-0.595	-0.105
Vegetables	-0.210	-0.033	-0.106	-0.018	-0.313	-0.633	-0.621	-0.150	-0.053	-0.089	-0.102	-0.215	-0.063	-0.102	-0.651	-0.110
Beans and high-protein plants	-0.096	-0.841	-0.021	-0.123	-0.038	-0.054	-0.078	-0.861	-0.059	-0.017	-0.151	-0.047	-0.115	-0.165	-0.183	-0.733
Meats, seafood, and eggs	-0.6	-0.201	-0.175	-0.028	-0.281	-0.330	-0.427	-0.038	-0.436	-0.536	-0.018	-0.362	-0.444	-0.097	-0.521	-0.111
Milk and dairy products	-0.109	-0.265	-0.499	-0.181	-0.513	-0.165	-0.061	-0.170	-0.176	-0.392	-0.695	-0.168	-0.127	-0.792	-0.095	-0.098
Fast foods	-0.086	-0.039	-0.030	-0.858	-0.073	-0.031	-0.093	-0.023	-0.723	-0.173	-0.113	-0.474	-0.512	-0.029	-0.127	-0.156
Sweets	-0.173	-0.157	-0.595	-0.362	-0.161	-0.047	-0.033	-0.014	-0.344	-0.141	-0.616	-0.329	-0.110	-0.683	-0.109	-0.046
Processed salty foods	-0.663	-0.085	-0.112	-0.059	-0.068	-0.079	-0.446	-0.099	-0.291	-0.050	-0.094	-0.065	-0.504	-0.094	-0.119	-0.333
Beverages	-0.315	-0.080	-0.228	-0.593	-0.252	-0.042	-0.137	-0.069	-0.216	-0.654	-0.119	-0.772	-0.08	-0.159	-0.035	-0.069
Eigenvalues	-1.500	-1.400	-1.300	-1.300	-1.200	-1.200	-1.500	-1.400	-1.400	-1.400	-1.300	-1.500	-1.400	-1.300	-1.300	-1.300

Factors		All Participants		Plausible Reporters		Under-reporters
Factors		Dietary patterns	Variance (%)	Dietary patterns	Variance (%)	Dietary patterns	Variance (%)
1^st Factor		Tubers, meats, and processed foods	11.6	Tubers, fruits, vegetables, meats and processed food	11.6	Fruits, Fast foods and beverages	11.5
2^nd Factor		Bread, grains, and beans	11.0	Bread, grains, and beans	10.9	Breads, grains, meats, fast food and processed foods	10.6
3^rd Factor		Pasta, milk and dairy products and sweets	10.2	Leaf vegetables, meats and fast foods	10.7	Milk and dairy products and sweets	10.0
4^th Factor		Fast foods and beverages	10.1	Fruits, meats and beverages	10.5	Leaf vegetables, vegetables, and meats	09.8
5^th Factor		Fruits, milk, and dairy products	09.4	Pasta, milk and dairy products, and sweets	10.0	Tubers and beans	09.8
6^th Factor		Leaf vegetables and vegetables	09.1	-	-	-	-
Total variance (%)	61.4			53.7		51.7

Food Subgroups	All Participants (n=412; 100%)					Plausible Reporters (n=157; 38%)					Under-reporters (n=255; 62%)					p ^* * <0.05 according to the Mann-Whitney test between reported energy intake for plausible reporters and under-reporters;
	Energy (kcal/day)					Energy (kcal/day)					Energy (kcal/day)
	Mean	±	SD	Median	Quartiles	Mean	±	SD	Median	Quartiles	Mean	±	SD	Median	Quartiles
Bread and grains	385	±	192	367	240 -486	475	±	209^†† †† =p≤0.01.	457	321 – 612	330	±	157^†† †† =p≤0.01.	307	220 – 414	<0.001
Tubers and roots	83	±	120	40	0 – 114	117	±	146^†† †† =p≤0.01.	70	17 – 163	62	±	95^†† †† =p≤0.01.	25	0 – 88	<0.001
Pasta	85	±	116	40	0 - 133	104	±	128^† † Z-test of all participants in relation to the plausible reporters and under-reporters, where †=p≤0.05;	64	0 – 161	74	±	106	32	0 – 107	<0.020
Fruits	65	±	73	44	0 – 104	74	±	83	50	0 – 120	59	±	65	40	0 – 95	<0.170
Leaf vegetables	5	±	8	3	0 – 8	5	±	7	3	0 – 8	6	±	9	4	0 – 7	<0.750
Vegetables	13	±	22	9	2 – 17	15	±	21	9	2 – 18	12	±	22	7	1 – 15	<0.060
Beans and high-protein plants	94	±	112	62	22 – 121	127	±	132^†† †† =p≤0.01.	85	28 – 182	74	±	92^†† †† =p≤0.01.	49	21 – 91	<0.001
Meats, seafood, and eggs	383	±	235	340	219 – 520	497	±	269^†† †† =p≤0.01.	458	306 – 640	314	±	178^†† †† =p≤0.01.	279	195 – 430	<0.001
Milk and dairy products	127	±	130	107	48 – 174	167	±	174^†† †† =p≤0.01.	136	76 – 211	103	±	84^†† †† =p≤0.01.	93	40 – 148	<0.001
Fast foods	119	±	174	46	0 – 171	161	±	214^†† †† =p≤0.01.	88	0 – 226	94	±	138^†† †† =p≤0.01.	28	0 – 134	<0.010
Sweets	301	±	341	209	80 – 391	503	±	429^†† †† =p≤0.01.	412	228 – 646	176	±	185^†† †† =p≤0.01.	132	41 – 253	<0.001
Processed salty foods	188	±	172	142	71 – 258	259	±	217^†† †† =p≤0.01.	191	95 – 356	144	±	118^†† †† =p≤0.01.	123	52 – 201	<0.001
Beverages	161	±	154	118	63 – 204	229	±	196,	162	99 – 301	120	±	103^†† †† =p≤0.01.	98	50 – 155	<0.001
Energy and Nutrients	Mean	±	SD	Median	Quartiles	Mean	±	SD	Median	Quartiles	Mean	±	SD	Median	Quartiles	p ^* * <0.05 according to the Mann-Whitney test between reported energy intake for plausible reporters and under-reporters;
Reported energy intake (Kcal)	1984	±	646	1863	1543 – 2276	2563	±	611^†† †† =p≤0.01.	2474	2081 – 2912	1629	±	334^†† †† =p≤0.01.	1616	1410 – 1856	<0.001
Carbohydrates (g)	226	±	85	209	165 – 263	295	±	88^†† †† =p≤0.01.	282	234 – 346	183	±	46^†† †† =p≤0.01.	180	150 – 213	<0.001
Proteins (g)	99	±	28	93	80 – 114	119	±	28^†† †† =p≤0.01.	117	100 – 133	86	±	18^†† †† =p≤0.01.	86	74 – 96	<0.001
Fats (g)	76	±	26	71	59 – 88	97	±	27^†† †† =p≤0.01.	93	81 – 112	63	±	14^†† †† =p≤0.01.	62	54 – 72	<0.001
Fibers (g)	16	±	7	15	12 – 19	20	±	8^†† †† =p≤0.01.	18	15 – 22	14	±	4^†† †† =p≤0.01.	13	11 – 16	<0.001
Calcium (mg)	629	±	312	570	438 – 745	789	±	398^†† †† =p≤0.01.	703	553– 892	530	±	185^†† †† =p≤0.01.	506	400 – 644	<0.001
Vitamin C (mg)	81	±	42	69	53 – 96	88	±	49	73	58 – 105	77	±	37	65	52 – 90	<0.004

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[1] Correspondência para/Correspondence to MNRAVELLI. E-mail: <michellenovaesr@hotmail.com>.