Dietary energy density is associated with body weight status and vegetable intake in U.S. children

Abstract

The objective was to determine the relationship between dietary energy density (ED; kcal/g) and measured weight status in children. The present study used data from a nationally representative sample of 2442 children between 2 and 8 y old who participated in the 2001-2004 NHANES. Survey measures included 24-h dietary recall data, measurement of MyPyramid servings of various food groups, and anthropometry. The relationship among dietary ED, body weight status as calculated using the 2000 CDC growth charts, and food intake was evaluated using quartiles of ED. Additionally, other dietary characteristics associated with ED among children are described. Specific survey procedures were used in the analysis to account for sample weights, unequal selection probability, and the clustered design of the NHANES sample. In this sample, dietary ED was positively associated with body weight status in U.S. children aged 2-8 y. Obese children had a higher dietary ED than lean children (2.08 ± 0.03 vs. 1.93 ± 0.05; P = 0.02). Diets high in ED were also found to be associated with greater intakes of energy and added sugars, more energy from fat; and significantly lower intake of fruits and vegetables. Interventions that lower dietary ED by means of increasing fruit and vegetable intake and decreasing fat consumption may be an effective strategy for reducing childhood obesity.

FIGURE 1

Dietary ED by body weight status in children aged 2–8 y (NHANES 2001–2004). Total unweighted n = 2442. Values are means ± SE. Means adjusted for age in months, sex, race, socioeconomic status, physical activity, and survey cycle. Specific survey procedures were applied to account for sample weights and complex survey design. Means without a common letter differ, P < 0.05. *Dietary ED, ED (kcal/g), calculated using only food, excluding all beverages. **Lean, overweight, and obese defined using CDC cutpoints base on BMI percentile. Lean, <85th percentile; overweight, 85–95th percentile; obese, >95th percentile (19). ED, energy density.

FIGURE 2

Fruit and vegetable intake by ED quartile in children aged 2–8 y (NHANES 2001–2004). Total unweighted n = 2442. Data are adjusted mean ± SE. Means without a common letter differ, P < 0.05; significance was calculated using age and fruit/vegetable classification category. Intake was adjusted for age, sex, race, socioeconomic status (as measured by family PIR) physical activity, and survey cycle. *Servings/d is based on USDA dietary guidelines for vegetables measured in cup equivalents (12). **Dietary ED calculated kcal/g. Quartiles of ED were calculated using food only. ED, energy density; PIR, poverty:income ratio.