Maturitas 69 (2011) 63–68 Contents lists available at ScienceDirect Maturitas journal homepage: www.elsevier.com/locate/maturitas Correlates of low dietary energy reporting in free-living elderly: The MEDIS study Mary Yannakoulia a , Stefanos Tyrovolas a , George Pounis a , Akis Zeimbekis b , Foteini Anastasiou c , Vassiliki Bountziouka a , Katia Voutsa a , Efthimios Gotsis a , George Metallinos a , Christos Lionis c , Evangelos Polychronopoulos a , Demosthenes Panagiotakos a,∗ a Department of Nutrition Science - Dietetics, Harokopio University, Athens, Greece b Health Center of Kalloni, General Hospital of Mitilini, Lesvos, Greece c Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece article info Article history: Received 6 September 2010 Received in revised form 18 January 2011 Accepted 25 January 2011 Keywords: Dietary assessment Misreporting Low energy reporting Mediterranean diet Elderly abstract Objectives: To evaluate the prevalence of low energy reporting (LER) and associations between LER and lifestyle, psychological and clinical parameters, in elderly people living in eastern Mediterranean islands. Methods: 1190 men and women, aged 65–100 years, participated in this cross-sectional study. Socio- demographic, clinical and lifestyle characteristics were recorded for the study participants. Among others, the ratio of energy intake to estimated basal metabolic rate (EI/BMR) was calculated and was used for the assessment of LER. Results: Prevalence of LER was 47.7%. Lower EI/BMR (i.e., higher risk for LER) was associated with older age (p = 0.001), male sex (p < 0.001), higher body mass index (BMI; p = 0.04), lower adherence to the Mediterranean diet (p < 0.001) and non-current smoking (p = 0.007). The sex-specific analysis revealed that, lower EI/BMR values were associated with lower adherence to the Mediterranean diet and being non-current smoker in both men and women (p ≤ 0.05), as well as with older age (p = 0.01), higher BMI (p = 0.02) and hypercholesterolemia (p = 0.02), only in women. Conclusion: In elderly, several clinical and lifestyle factors seem to be related to LER, and they should be taken into account in their nutritional assessment. © 2011 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Accurate assessment of the dietary intake is essential for evaluating nutritional status and undertaking preventive and/or therapeutic measures. A few methods can be used alone or in combination for the dietary assessment [1]. Available evidence indicates that, regardless of the method used, there is a substantial degree of under- or low-reporting of the usual food intake, a phe- nomenon described as low energy reporting (LER) [2–4]. Several factors have been extensively studied in relation to LER, like sex and obesity status [5–9], with women and overweight individuals being more prone to underreport. Dieting, specific eating behaviours, psy- chological characteristics and physical activity parameters have also been evaluated in relation to their effect on LER [9,10]. With regard to socioeconomic characteristics, there is also inconsistency among studies regarding their effect [8,11–14]. Although LER has been recognized to increase with age or to be more prevalent among older people [5–7], few studies have specifically focused on the elderly [15–20]. People of older age ∗ Corresponding author at: 46 Paleon Polemiston St., Glyfada, 166 74 Attica, Greece. Tel.: +30 210 9603116; fax: +30 210 9600719. E-mail address: D.b.Panagiotakos@usa.net (D. Panagiotakos). may be particularly prone to non-accurately reporting their dietary intake due to lower motivation, cognitive impairments, physical and social limitations and health problems [21–23]. Recognizing lifestyle and psychological factors associated with LER in the elderly would improve the quality of the dietary data obtained, and thus the assessment of energy imbalances, known to be associated with higher rates of limitation, chronic disease, and mortality [24,25]. Most studies so far exploring LER in the elderly refer to populations with “westernized” lifestyle habits. The lifestyle factors influencing the accuracy of underreporting may not be different compared to corresponding adult populations. Thus, it would be interesting and novel to evaluate the prevalence of dietary misreporting in popu- lations that maintain, at least, part of their traditional way of living, including dietary habits, and, to recognize associations between mis-reporting and socio-economic, psychological and clinical mea- sures. The older inhabitants of the Greek islands and Cyprus provide such as a population sample. They were studied in early 1960s, where the Seven Countries Study investigators [26] enrolled peo- ple from two Mediterranean islands (Crete and Corfu) and revealed, among other findings, the protective role of the Mediterranean diet on cardiovascular disease. Under this perspective, the aim of the present work was to eval- uate the prevalence of LER, as well as associations between LER and various dietary, lifestyle, psychological and clinical parame- 0378-5122/$ – see front matter © 2011 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.maturitas.2011.01.016