Women's Health Initiative Dietary Modification Trial: Update and Application of Biomarker Calibration to Self-Report Measures of Diet and Physical Activity

Evidence has been accruing that self-reported dietary intake underestimates actual intake. Particularly noteworthy is that overweight and obese persons may systematically under-report energy intake. Women who, at Women's Health Initiative (WHI) enrollment during 1993-1998, were in their 50s under-reported energy intake to a greater degree than women who were in their 70s, and there is some evidence that Black or Hispanic women may underreport energy intake to a greater degree than White women. Protein intake was also under-reported although to a lesser extent than energy, which resulted in a modest overestimation of protein density. This chapter describes the calibration studies and the subsequent efforts to relate calibrated intakes to disease risk specifically cardiovascular disease, diabetes and cancer as well as aging-related indicators such as frailty and renal function. It concludes by describing future avenues of investigation.