Observational Epidemiologic Studies of Nutrition and Cancer: The Next Generation (with Better Observation)

• Published in: Cancer epidemiology, biomarkers & prevention Vol. 18; no. 4; pp. 1026 - 1032
• Main Authors: SCHATZKIN, Arthur, SUBAR, Amy F, MOORE, Steven, PARK, Yikyung, POTISCHMAN, Nancy, THOMPSON, Frances E, LEITZMANN, Michael, HOLLENBECK, Albert, MORRISSEY, Kerry Grace, KIPNIS, Victor
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA American Association for Cancer Research 01-04-2009
• Subjects: Biological and medical sciences; Diet; Epidemiologic Studies; Humans; Medical sciences; Neoplasms - epidemiology; Neoplasms - etiology; Neoplasms - prevention & control; Nutritive Value; Tumors; Observational study; Cancerology; Nutrition; Diet; Observation; Malignant tumor; Epidemiology; Public health; Feeding; Cancer
• ISSN: 1055-9965; 1538-7755
• DOI: 10.1158/1055-9965.EPI-08-1129

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 24HRs in large epidemiologic studies, however, has up to now been prohibitive. In that context,
we suggest that Internet-based 24HRs, 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 24HRs into large epidemiologic studies may help advance our understanding
of the nutritional determinants of cancer. (Cancer Epidemiol Biomarkers Prev 2009;18(4):1026–32)