Schatzkin Arthur, Subar Amy F, Moore Steven, Park Yikyung, Potischman Nancy, Thompson Frances E, Leitzmann Michael, Hollenbeck Albert, Morrissey Kerry Grace, Kipnis Victor
National Cancer Institute, Bethseda, MD, USA.
Cancer Epidemiol Biomarkers Prev. 2009 Apr;18(4):1026-32. doi: 10.1158/1055-9965.EPI-08-1129. Epub 2009 Mar 31.
It would be of enormous public health importance if diet and physical activity, both modifiable behavioral factors, were causally related to cancer. Nevertheless, the nutritional epidemiology of cancer remains problematic, in part because of persistent concerns that standard questionnaires measure diet and physical activity with too much error. We present a new strategy for addressing this measurement error problem. First, as background, we note that food frequency and physical activity questionnaires require respondents to report "typical" diet or activity over the previous year or longer. Multiple 24-hour recalls (24HR), based on reporting only the previous day's behavior, offer potential cognitive advantages over the questionnaires, and biomarker evidence suggests the 24-hour dietary recall is more accurate than the food frequency questionnaire. The expense involved in administering multiple 24 HRs in large epidemiologic studies, however, has up to now been prohibitive. In that context, we suggest that Internet-based 24 HRs, for both diet and physical activity, represent a practical and cost-effective approach for incorporating multiple recalls in large epidemiologic studies. We discuss (1) recent efforts to develop such Internet-based instruments and their accompanying software support systems; (2) ongoing studies to evaluate the feasibility of using these new instruments in cohort studies; (3) additional investigations to gauge the accuracy of the Internet-based recalls vis-à-vis standard instruments and biomarkers; and (4) new statistical approaches for combining the new instruments with standard assessment tools and biomarkers The incorporation of Internet-based 24 HRs into large epidemiologic studies may help advance our understanding of the nutritional determinants of cancer.
如果饮食和身体活动这两个可改变的行为因素与癌症存在因果关系，那将对公众健康具有极其重大的意义。然而，癌症的营养流行病学仍然存在问题，部分原因是人们一直担心标准问卷在测量饮食和身体活动时存在过多误差。我们提出了一种解决这一测量误差问题的新策略。首先，作为背景，我们注意到食物频率和身体活动问卷要求受访者报告前一年或更长时间内的“典型”饮食或活动情况。基于仅报告前一天行为的多次24小时膳食回顾（24HR），相对于问卷而言具有潜在的认知优势，而且生物标志物证据表明24小时膳食回顾比食物频率问卷更准确。然而，在大型流行病学研究中实施多次24HR所涉及的费用迄今为止一直过高。在此背景下，我们认为基于互联网的饮食和身体活动24HR是在大型流行病学研究中纳入多次回顾的一种实用且具有成本效益的方法。我们讨论了：（1）近期开发此类基于互联网的工具及其配套软件支持系统的努力；（2）正在进行的评估在队列研究中使用这些新工具可行性的研究；（3）进一步调查以衡量基于互联网的回顾相对于标准工具和生物标志物的准确性；以及（4）将新工具与标准评估工具和生物标志物相结合的新统计方法。将基于互联网的24HR纳入大型流行病学研究可能有助于推进我们对癌症营养决定因素的理解。
