The European prospective investigation into cancer, nutrition and health (EPIC) (original) (raw)
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European Journal of Clinical Nutrition, 2000
Objectives: Despite increasing interest in the concept of calibration in dietary surveys, there is still little experience in the use and standardization of a common reference dietary method, especially in international studies. In this paper, we present the general theoretical framework and the approaches developed to standardize the computer-assisted 24 h diet recall method (EPIC-SOFT) used to collect about 37 000 24-h dietary recall measurements (24-HDR) from the 10 countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC). In addition, an analysis of variance was performed to examine the level of standardization of EPIC-SOFT across the 90 interviewers involved in the study. Methods: The analysis of variance used a random effects model in which mean energy intake per interviewer was used as the dependent variable, while age, body mass index (BMI), energy requirement, week day, season, special diet, special day, physical activity and the EPIC-SOFT version were used as independent variables. The analysis was performed separately for men and women. Results: The results show no statistical difference between interviewers in all countries for men and ®ve out of eight countries for women, after adjustment for physical activity and the EPIC-SOFT program version used, and the exclusion of one interviewer in Germany (for men), and one in Denmark (for women). These results showed an interviewer effect in certain countries and a signi®cant difference between gender, suggesting an underlying respondent's effect due to the higher under-reporting among women that was consistently observed in EPIC. However, the actual difference between interviewer and country mean energy intakes is about 10%. Furthermore, no statistical differences in mean energy intakes were observed across centres from the same country, except in Italy and Germany for men, and France and Spain for women, where the populations were recruited from areas scattered throughout the countries. Conclusion: Despite these encouraging results and the efforts to standardize the 24-HDR interview method, conscious or unconscious behaviour of respondents andaor interviewer bias cannot be prevented entirely. Further evaluation of the reliability of EPIC-SOFT measurements will be conducted through validation against independent biological markers (nitrogen, potassium).
American Journal of Epidemiology, 2004
Multicenter epidemiologic studies provide a unique opportunity to evaluate the association between exposure and disease at the individual and the aggregate levels. The two components can eventually be pooled to corroborate each other, using weights proportional to the intraclass correlation coefficient (ICC), which expresses the amount of between-cohort variability in the exposure variable compared with the total. The greater the ICC, the more the overall estimate will reflect the between-cohort component. Dietary measurements are affected by measurement errors, particularly within a cohort. In 1992-2000, the variability of macronutrient intake distribution before and after calibration for measurement error in the European Prospective Investigation into Cancer and Nutrition was evaluated. A two-level, random-effects model was used. Evaluation of macronutrient densities revealed that energy has a considerable effect on the calibration model, leading to ICC values larger than those for the absolute intakes. Given the shrinkage of the within-center variability, a sizable increase in the ICC was observed for protein in men and women (0.48 and 0.54, respectively) and carbohydrates in men (0.41). Results suggest that the effect of calibration on macronutrient intake variability is greater for the within-cohort component, thus increasing the relative importance of the between-cohort component. After calibration, the two components had a similar weight. This observation has important implications for the analysis of multicenter studies because the between-cohort component provides a large part of the overall heterogeneity.
Public Health Nutrition, 2016
ObjectiveTo characterize meal patterns across ten European countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) calibration study.DesignCross-sectional study utilizing dietary data collected through a standardized 24 h diet recall during 1995–2000. Eleven predefined intake occasions across a 24 h period were assessed during the interview. In the present descriptive report, meal patterns were analysed in terms of daily number of intake occasions, the proportion reporting each intake occasion and the energy contributions from each intake occasion.SettingTwenty-seven centres across ten European countries.SubjectsWomen (64 %) and men (36 %) aged 35–74 years (n36 020).ResultsPronounced differences in meal patterns emerged both across centres within the same country and across different countries, with a trend for fewer intake occasions per day in Mediterranean countries compared with central and northern Europe. Differences were also found fo...
Journal of the Academy of Nutrition and Dietetics, 2012
assessment is to evaluate usual food and nutrient intakes of population groups relative to dietary recommendations. The usual intake reflects the long-run average of daily intake 1 and its reliable estimation based on short-term dietary assessment methods is an important challenge for investigators. Although 24-hour recall and food records are useful for providing detailed dietary data regarding types and amounts of food items consumed, 2,3 it is recognized that a single recall or food record is not sufficient to reproduce the usual food and nutrient intakes by individuals or groups due to normal dayto-day fluctuation of intake, also know as within-person variation. 4 For many dietary constituents, the excessive withinperson variation can lead to serious problems in data analysis, 2,5,6 such as, biased prevalence estimates of inadequate nutrient intake in the population when using standards for nutrient adequacy. 2,7 Considering that administering several 24-hour per individual in large epidemiologic studies is difficult, because it is time-consuming, costly, and respondent burdensome, several statistical methods were developed in the last years 7-9 to adjust for the within-person variation and to estimate usual intake, as the National Cancer Institute (NCI) method. 7 The NCI method provides advantages over previously proposed methods, by accounting for the correlation between probability of consumption and amount consumed and its ability to provide estimates for subpopulations through the incorporation of covariates into the model. 7 Also, this method is suitable for estimating the usual intake of episodically-con-ABSTRACT Background Statistical methods for estimating usual intake require at least two shortterm dietary measurements in a subsample of the target population. However, the percentage of individuals with a second dietary measurement (replication rate) may influence the precision of estimates, such as percentiles and proportions of individuals below cutoffs of intake. Objective To investigate the precision of the usual food intake estimates using different replication rates and different sample sizes.
International Journal of Epidemiology, 1997
Several ongoing cohort studies in Europe and US use different dietary assessment methods to increase our knowledge about diet and disease relationships concerning cardiovascular disease, osteoporosis and cancer. Diet history methods and food frequency questionnaires are commonly used methods to measure usual food intake in case-control studies and cohort studies. However, misclassification imposed by the methods limit the possibilities of collecting reliable data on dietary intake. The validity of the dietary methods depends on several components, like accurate estimations of frequency and portion sizes, the quality of food composition data bases used, and data collection procedure; all components which are crucial for interpretation of the dietary results. If the food list does not include commonly consumed food items in the chosen study population, or dietary methods with predefined questions are used, the sample characteristics must be homogeneous for several factors like gender, age, ethnicity and social 1071
Public Health Nutrition, 2002
Objective: To describe the diversity in dietary patterns existing across centres/regions participating in the European Prospective Investigation into Cancer and Nutrition (EPIC). Design and setting: Single 24-hour dietary recall measurements were obtained by means of standardised face-to-face interviews using the EPIC-SOFT software. These have been used to present a graphic multi-dimensional comparison of the adjusted mean consumption of 22 food groups. Subjects: In total, 35 955 men and women, aged 35-74 years, participating in the EPIC nested calibration study. Results: Although wide differences were observed across centres, the countries participating in EPIC are characterised by specific dietary patterns. Overall, Italy and Greece have a dietary pattern characterised by plant foods (except potatoes) and a lower consumption of animal and processed foods, compared with the other EPIC countries. France and particularly Spain have more heterogeneous dietary patterns, with a relatively high consumption of both plant foods and animal products. Apart from characteristics specific to vegetarian groups, the UK 'health-conscious' group shares with the UK general population a relatively high consumption of tea, sauces, cakes, soft drinks (women), margarine and butter. In contrast, the diet in the Nordic countries, The Netherlands, Germany and the UK general population is relatively high in potatoes and animal, processed and sweetened/refined foods, with proportions varying across countries/centres. In these countries, consumption of vegetables and fruit is similar to, or below, the overall EPIC means, and is low for legumes and vegetable oils. Overall, dietary patterns were similar for men and women, although there were large gender differences for certain food groups. Conclusions: There are considerable differences in food group consumption and dietary patterns among the EPIC study populations. This large heterogeneity should be an advantage when investigating the relationship between diet and cancer and formulating new aetiological hypotheses related to dietary patterns and disease.
British Journal of Nutrition, 2013
The aim of the present study was to describe the energy, nutrient and crude v. disaggregated food intake measured using 7 d diet diaries (7dDD) for the full baseline Norfolk cohort recruited for the European Prospective Investigation into Cancer (EPIC-Norfolk) study, with emphasis on methodological issues. The first data collection took place between 1993 and 1998 in Norfolk, East Anglia (UK). Of the 30 445 men and women, aged 40-79 years, registered with a general practitioner invited to participate in the study, 25 639 came for a health examination and were asked to complete a 7dDD. Data from diaries with data recorded for at least 1 d were obtained for 99 % members of the cohort; 10 354 (89•8 %) of the men and 12 779 (91•5 %) of the women completed the diet diaries for all 7 d. Mean energy intake (EI) was 9•44 (SD 2•22) MJ/d and 7•15 (SD 1•66) MJ/d, respectively. EI remained approximately stable across the days, but there was apparent under-reporting among the participants, especially among those with BMI. 25 kg/m 2. Micronutrient density was higher among women than among men. In conclusion, under-reporting is an issue, but not more so than that found in national surveys. How foods were grouped (crude or disaggregated) made a difference to the estimates obtained, and comparison of intakes showed wide limits of agreement. The choice of variables influences estimates obtained from the food group data; while this may not alter the ranking of individuals within studies, this issue may be relevant when comparing absolute food intakes between studies.
Public Health Nutrition, 2001
Background and objective: A new data-entry system (DINER ± Data Into Nutrients for Epidemiological Research) for food record methods has been devised for the European Prospective Investigation into Cancer (EPIC) cohort study of 25 000 men and women in Norfolk. DINER has been developed to address the problems of efficiency and consistency of data entry, comparability of data, maximising information and future flexibility in large long-term population studies of diet and disease that use record methods to assess dietary intakes. DINER captures more detail than traditional systems and enables provision of new variables for specific food types or groups. The system has been designed to be fully flexible and easy to update. Analysis of consistency of data entry was tested in a group of 3525 participants entered by 25 coders. Results: A food list of 9000 food items and values for 24 000 portion sizes have been incorporated into the database, using information from the 5979 diaries coded since 1995. Analysis of consistency of entry indicated that this has largely been achieved. The effect of coders in a multivariate regression model was significant only if the three coders involved in early use of the program were included P , 0X013X Conclusions: The development of DINER has facilitated the use of more accurate record methods in large-scale epidemiological studies of diet and disease. Furthermore, the retention of original information as an extensive food list allows greater flexibility in later analyses of data of multiple dietary hypotheses.