Impact of non-dietary nutrients intake on misclassification in the estimation of nutrient intake in epidemiologic study

Background: Few previous epidemiologic studies have evaluated the effects of non-dietary nutrient intake, such as supplements, over the counter (OTC) drugs, and prescription drugs containing vitamins or minerals, in examining the relationship between dietary factors and health outcomes. Methods: To examine the influence of the non-dietary intake of vitamins and calcium on the estimation of nutrient intake, we conducted a cross-sectional study with 1,168 community-dwelling Japanese subjects aged 70 years or older in 2002. The subjects were asked to bring their non-dietary nutrient sources to the examining site. The dietary and non-dietary intakes of vitamins B1, C, E and calcium were obtained and the subjects were grouped into quartiles according to their dietary intake and their dietary plus non-dietary intake. The degree of agreement between these two classifications was examined to estimate the degree of misclassification. Results: Among the subjects who were classified into the highest intake category for vitamin E with dietary intake plus non-dietary nutrient intake, 34.2 % were misclassified into lower category with dietary intake alone. Similarly, intake of vitamin B1, vitamin C and calcium were misclassified 28.8%, 18.8 %, 6.2 %, respectively. Conclusions: Our data suggest that estimation of vitamin intake from dietary sources alone would yield a maximum misclassification of one-third, which would lead to misleading conclusions being drawn from epidemiologic studies. In contrast, the degree of misclassification for calcium may be relatively small.