Objective versus Self-Reported Energy Intake Changes During Low-Carbohydrate and Low-Fat Diets

Abstract

ObjectiveTo examine objective versus self-reported energy intake changes ({Delta}EI) during a 12-month diet intervention.\n\nMethodsWe calculated {Delta}EI in subjects who participated in a 1-year randomized low-carbohydrate versus low-fat diet trial using repeated body weight measurements as inputs to an objective mathematical model ({Delta}EIModel) and compared these values with self-reported energy intake changes assessed by repeated 24-hr recalls ({Delta}EI24hrRecall).\n\nResults{Delta}EI24hrRecall indicated a relatively persistent state of calorie restriction [≥]500 kcal/d throughout the year with no significant differences between diets. {Delta}EIModel demonstrated large early decreases in calorie intake >800 kcal/d followed by an exponential return to approximately 100 kcal/d below baseline at the end of the year. The low-carbohydrate diet resulted in {Delta}EIModel that was 162{+/-}53 kcal/d lower than the low-fat diet over the first 3 months (p=0.002), but no significant diet differences were found at later times. Weight loss at 12 months was significantly related to {Delta}EIModel at all time intervals for both diets (p<0.0001).\n\nConclusionsSelf-reported measurements of {Delta}EI were inaccurate. Model-based calculations of {Delta}EI found that instructions to follow the low-carbohydrate diet resulted in greater calorie restriction than the low-fat diet in the early phases of the intervention, but these diet differences were not sustained.\n\nWhat is already known about this subject?O_LIDiet assessments that rely on self-report, such as 24hr dietary recall, are known to underestimate actual energy intake as measured by doubly labeled water. However, it is possible that repeated self-reported measurements could accurately detect changes in energy intake over time if the absolute bias of self-reported of measurements is approximately constant for each subject.\nC_LI\n\nWhat this study addsO_LIWe compared energy intake changes measured using repeated 24hr dietary recall measurements collected over the course of the 1-year Diet Intervention Examining The Factors Interacting with Treatment Success (DIETFITS) trial versus energy intake changes calculated using repeated body weight measurements as inputs to a validated mathematical model.\nC_LIO_LIWhereas self-reported measurements indicated a relatively persistent state of calorie restriction, objective model-based measurements demonstrated a large early calorie restriction followed by an exponential rise in energy intake towards the pre-intervention baseline.\nC_LIO_LIModel-based calculations, but not self-reported measurements, found that low-carbohydrate diets led to significantly greater early decreases in energy intake compared to low-fat diets, but long-term energy intake changes were not significantly different.\nC_LI