Comparison of self-reported dietary intakes from the Automated Self-Administered 24-h recall, 4-d food records, and food-frequency questionnaires against recovery biomarkers

Am J Clin Nutr. 2018 Jan 1;107(1):80-93. doi: 10.1093/ajcn/nqx002.


Background: A limited number of studies have evaluated self-reported dietary intakes against objective recovery biomarkers.

Objective: The aim was to compare dietary intakes of multiple Automated Self-Administered 24-h recalls (ASA24s), 4-d food records (4DFRs), and food-frequency questionnaires (FFQs) against recovery biomarkers and to estimate the prevalence of under- and overreporting.

Design: Over 12 mo, 530 men and 545 women, aged 50-74 y, were asked to complete 6 ASA24s (2011 version), 2 unweighed 4DFRs, 2 FFQs, two 24-h urine collections (biomarkers for protein, potassium, and sodium intakes), and 1 administration of doubly labeled water (biomarker for energy intake). Absolute and density-based energy-adjusted nutrient intakes were calculated. The prevalence of under- and overreporting of self-report against biomarkers was estimated.

Results: Ninety-two percent of men and 87% of women completed ≥3 ASA24s (mean ASA24s completed: 5.4 and 5.1 for men and women, respectively). Absolute intakes of energy, protein, potassium, and sodium assessed by all self-reported instruments were systematically lower than those from recovery biomarkers, with underreporting greater for energy than for other nutrients. On average, compared with the energy biomarker, intake was underestimated by 15-17% on ASA24s, 18-21% on 4DFRs, and 29-34% on FFQs. Underreporting was more prevalent on FFQs than on ASA24s and 4DFRs and among obese individuals. Mean protein and sodium densities on ASA24s, 4DFRs, and FFQs were similar to biomarker values, but potassium density on FFQs was 26-40% higher, leading to a substantial increase in the prevalence of overreporting compared with absolute potassium intake.

Conclusions: Although misreporting is present in all self-report dietary assessment tools, multiple ASA24s and a 4DFR provided the best estimates of absolute dietary intakes for these few nutrients and outperformed FFQs. Energy adjustment improved estimates from FFQs for protein and sodium but not for potassium. The ASA24, which now can be used to collect both recalls and records, is a feasible means to collect dietary data for nutrition research.

Keywords: 24-h recalls; 4-d food records, under-reporting, and overreporting; dietary assessment, food-frequency questionnaire, recovery biomarker.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Biomarkers / urine*
  • Body Mass Index
  • Diet Records*
  • Diet*
  • Exercise
  • Female
  • Humans
  • Male
  • Mental Recall*
  • Middle Aged
  • Nitrogen / urine
  • Nutrition Assessment
  • Potassium / urine
  • Self Report
  • Sodium / urine
  • Surveys and Questionnaires


  • Biomarkers
  • Sodium
  • Nitrogen
  • Potassium