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      Adjustment for total energy intake in epidemiologic studies

      1 , 1 , 1

      The American Journal of Clinical Nutrition

      Oxford University Press (OUP)

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          Abstract

          In epidemiologic studies, total energy intake is often related to disease risk because of associations between physical activity or body size and the probability of disease. In theory, differences in disease incidence may also be related to metabolic efficiency and therefore to total energy intake. Because intakes of most specific nutrients, particularly macronutrients, are correlated with total energy intake, they may be noncausally associated with disease as a result of confounding by total energy intake. In addition, extraneous variation in nutrient intake resulting from variation in total energy intake that is unrelated to disease risk may weaken associations. Furthermore, individuals or populations must alter their intake of specific nutrients primarily by altering the composition of their diets rather than by changing their total energy intake, unless physical activity or body weight are changed substantially. Thus, adjustment for total energy intake is usually appropriate in epidemiologic studies to control for confounding, reduce extraneous variation, and predict the effect of dietary interventions. Failure to account for total energy intake can obscure associations between nutrient intakes and disease risk or even reverse the direction of association. Several disease-risk models and formulations of these models are available to account for energy intake in epidemiologic analyses, including adjustment of nutrient intakes for total energy intake by regression analysis and addition of total energy to a model with the nutrient density (nutrient divided by energy).

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          Author and article information

          Journal
          The American Journal of Clinical Nutrition
          Oxford University Press (OUP)
          0002-9165
          1938-3207
          April 1997
          April 01 1997
          April 1997
          April 01 1997
          : 65
          : 4
          : 1220S-1228S
          Affiliations
          [1 ] Department of Nutrition and Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA.
          10.1093/ajcn/65.4.1220S
          9094926
          © 1997

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