Using enhanced regression calibration to combine dietary intake estimates from 24 h recall and FFQ reduces bias in diet–disease associations

Objective: To illustrate the impact of combining 24 h recall (24hR) and FFQ estimates using regression calibration (RC) and enhanced regression calibration (ERC) on diet–disease associations. Setting: Wageningen area, the Netherlands, 2011–2013. Design: Five approaches for obtaining self-reported dietary intake estimates of protein and K were compared: (i) uncorrected FFQ intakes (FFQ); (ii) uncorrected average of two 24hR ( $\overline {\rm R}$ ); (iii) average of FFQ and $\overline {\rm R}$ ( ${\overline {\rm F}}\,\overline {\rm R}}$ ); (iv) RC from regression of 24hR v . FFQ; and (v) ERC by adding individual random effects to the RC approach. Empirical attenuation factors (AF) were derived by regression of urinary biomarker measurements v . the resulting intake estimates. Participants: Data of 236 individuals collected within the National Dietary Assessment Reference Database. Results: Both FFQ and 24hR dietary intake estimates were measured with substantial error. Using statistical techniques to correct for measurement error (i.e. RC and ERC) reduced bias in diet–disease associations as indicated by their AF approaching 1 (RC 1·14, ERC 0·95 for protein; RC 1·28, ERC 1·34 for K). The larger sd and narrower 95% CI of AF obtained with ERC compared with RC indicated that using ERC has more power than using RC. However, the difference in AF between RC and ERC was not statistically significant, indicating no significantly better de-attenuation by using ERC compared with RC. AF larger than 1, observed for the ERC for K, indicated possible overcorrection. Conclusions: Our study highlights the potential of combining FFQ and 24hR data. Using RC and ERC resulted in less biased associations for protein and K.