Associations between energy density and macronutrient composition in the diets of pre-school children: sugars vs....

To investigate the associations between energy density (ED) and macronutrient composition in the National Diet and Nutrition Survey of Children aged 1(1/2)-4(1/2) y, hypothesizing that high-ED diets tend to be high in sugars as well as fat.

Further analysis of data from a cross-sectional dietary survey of 1675 children with complete 4-day weighed dietary records. Differences in diet composition and food choice between children with diets of high, medium and low ED (defined as kJ/g of all food and drink) were identified. The possibility of confounding by water, or by soft drinks, was also explored in age-adjusted correlations.

High-ED diets (>3.7 kJ/g of total diet) were proportionately richer in fat and lower in carbohydrate, compared with diets of low ED (<2.9 kJ/g). In contrast to the hypothesis, high-ED diets were found to be proportionately lower in sugars, and higher in starch. Children with high-ED diets consumed more of a whole range of foods: meat, eggs, potatoes, cereal products, confectionery, sugar/preserves and savoury snacks, but consumed less soft drinks, water and fruit.

The inverse relationship observed between sugars and energy density may be partly attributable to the reciprocal relationship between sugars and fat, expressed as a proportion of energy. It may also reflect developing preferences in young childhood for a more adult-type, energy-dense, diet. Further work is required to verify ED/macronutrient relationships in other age groups, as the results have potential implications for obesity prevention and for food product development.