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Underreporting and overreporting of energy intake (EI) have been recognized as potential sources of bias. Dietary data mainly rely on proxy respondents, but little is known about the determinants of misreporting of EI among Latin American (LA) populations. This study was conducted using data from the multicenter Latin American Study of Nutrition and Health that consisted of information about sociodemographics, physical activity, and dietary intake from 9218 individuals aged 15 to 65 years who were living in urban areas in 8 LA countries (Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru, and Venezuela). Goldberg methodology was applied to classify the participants into categories of overreporter (OR), plausible reporter (PR), or underreporter (UR) of EI. Associations between misreporting and covariates were examined by the Kruskal-Wallis test, logistic regression, and linear regression. The prevalence of UR was 12.1% and OR was 14.1%. Costa Rica had the highest percentage of UR (24.4%) and the lowest of OR (7.3%), and Colombia had the lowest of UR (5.7%) and the highest of OR (22.4%). Furthermore, underreporters were more likely to be females from older groups with minimal education, white, physically active, overweight or obese, and living in Costa Rica. Overreporters were more likely to be younger, single, of low socioeconomic level, nonwhite, physically active, underweight or with normal weight, and from Colombia. The results demonstrated that sex, age, race, education status, and nationality seemed to influence the reporting behavior, which is essential to correctly interpreting potentially biased associations between diet and health outcomes, and improving nutritional interventions and public health policies. The ELANS was supported by a scientific grant from the Coca Cola Company and support from the Instituto Pensi/Hospital Infantil Sabara, International Life Science Institute of Argentina, Universidad de Costa Rica, Pontificia Universidad Católica de Chile, Pontificia Universidad Javeriana, Universidad Central de Venezuela (CENDES-UCV)/Fundación Bengoa, Universidad San Francisco de Quito, and Instituto de Investigación Nutricional de Peru. UCR::Vicerrectoría de Docencia::Salud::Facultad de Medicina::Escuela de Medicina

Background Little is known about breakfast habits of the Latin American (LA) population to support nutritional recommendations for a balanced breakfast in this region. Objective To evaluate the nutritional composition of breakfast in LA and to propose recommendations for a balanced breakfast. Design This multicenter cross-sectional study evaluated food and nutrient intake of nationally representative samples of urban populations of eight LA countries (Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru, and Venezuela) in 2014-2015. Participants/setting The sample comprised 8,714 participants from the Latin American Study of Nutrition and Health (ELANS), aged 15–65 years, randomly recruited according to geographical location, sex, age, and socioeconomic level. Main outcome measures Two 24-hour recalls were used to examine dietary intake. Breakfast consumers were stratified by tertiles of Nutrient-Rich Foods Index 9.3 (NRF9.3) to assess the overall diet quality of individuals. Nutrient intake at breakfast of those in the upper tertile of NRF9.3 pooled for the 8 countries was used as a reference for the development of recommendations for LA adolescents and adults. Statistical analyses:Comparison of food and nutrient intake of breakfast across NRF9.3 tertiles were analyzed using the Kruskal-Wallis rank sum test. Results Overall breakfast was an important contributor to protein, carbohydrate and B vitamin intakes, but also to added sugar, total and saturated fat intakes relative to daily intakes. Individuals in the upper NRF9.3 tertile had higher intake of key micronutrients such as calcium and potassium at breakfast when compared to other tertiles. White breads/rolls/tortillas were the most consumed food group (60%), followed by butter/margarine (40%) and coffee/tea without milk (34%-50%). Conclusions Breakfast contributed to the daily intake of B vitamins, protein and carbohydrates but also added sugar, and total and saturated fat intakes for all countries. The proposed recommendations support the nutrient density of existing highest-quality breakfast in the LA population while addressing concerns about nutrients to be encouraged or reduced.