Submitted to: Diabetes Care
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 12/1/2006
Publication Date: 4/1/2007
Citation: Mendoza, J.A., Drewnowski, A., Christakis, D.A. 2007. Dietary energy density is associated with obesity and the metabolic syndrome in U.S. adults. Diabetes Care. 30(4):974-979. Interpretive Summary: Obesity is increasing and has been linked to eating energy-dense diets, i.e., foods that have high calories per the amount of the food. This study examined whether eating energy-dense foods was related to obesity and related disorders among adults from the National Health and Nutrition Examination Survey, 1999-2002. Among women, the higher the energy density, the higher the body mass index. This relationship was similar in men, although of borderline significance. For both women and men, energy-dense diets were related to greater waist circumference, insulin resistance, and to the metabolic syndrome. This report confirmed that energy dense diets were related to obesity in U.S. Adults. It was also the first to report the relationship between energy dense diets, insulin resistance, and the metabolic syndrome.
Technical Abstract: Rising obesity rates have been linked to the consumption of energy-dense diets. We examined whether dietary energy density was associated with obesity and related disorders, including insulin resistance and the metabolic syndrome. We conducted a cross-sectional study using nationally representative data of U.S. adults > or =20 years of age from the 1999-2002 National Health and Nutrition Examination Survey (n = 9,688). Dietary energy density was calculated based on foods only. We used a series of multivariate linear regression models to determine the independent association between dietary energy density, obesity measures (BMI [in kilograms per meters squared] and waist circumference [in centimeters]), glycemia, or insulinemia. We used multivariate Poisson regression models to determine the independent association between dietary energy density and the metabolic syndrome as defined by the National Cholesterol and Education Program (Adult Treatment Panel III). Dietary energy density was independently and significantly associated with higher BMI in women (beta = 0.44 [95% CI 0.14-0.73]) and trended toward a significant association in men (beta = 0.37 [-0.007 to 0.74], P = 0.054). Dietary energy density was associated with higher waist circumference in women (beta = 1.11 [0.42-1.80]) and men (beta = 1.33 [0.46-2.19]). Dietary energy density was also independently associated with elevated fasting insulin (beta = 0.65 [0.18-1.12]) and the metabolic syndrome (prevalence ratio = 1.10 [95% CI 1.03-1.17]). Dietary energy density is an independent predictor of obesity, elevated fasting insulin levels, and the metabolic syndrome in U.S. adults. Intervention studies to reduce dietary energy density are warranted.