Underreporting of food intake by dietary recall is not universal: A comparison of data from Egyptian and American women

Underreporting of dietary intake has been observed consistently in food con sumption surveys in affluent societies and in clinical studies in a variety of settings. Almost one third of quantitative 24-h recalls provided by adu lts in U.S. surveys appear to result in estimates that are biologically imp lausible. Underreporting has been linked to obesity in both the U.S. and Eu rope, with heavier individuals underreporting to a greater degree than lean persons. A relative dearth of data exists from developing countries and th ose in transition to address the question whether such underreporting is un iversal. We present the first data from a large survey of women in a rapidl y urbanizing developing country to address this question. More than 4500 ad ult women in Egypt provided quantitative 24-h recalls of food intake on the previous day in 1993-1994, and weights and heights were measured. We compa red the data, in terms of the ratio of reported energy intake to estimated basal metabolic rate, to data from 3010 women in the 1994-1996 U.S. Continu ing Survey of Food Intake by Individuals, on whom quantitative 24-h recalls were also conducted. The Egyptian women reported food intakes consistent w ith FAO/WHO recommendations for energy intakes for women of comparable acti vity levels, whereas the data for U.S. women showed underreporting consiste nt with other U.S. surveys. Only 10% of Egyptian women reported energy inta kes below accepted criteria for plausibility, compared with one third of Am erican women. We discuss: possible reasons for this difference, including c ultural and food supply differences, and methodological differences between the two surveys.