Dietary energy density and obesity: how consumption patterns differ by body weight status

Recent public health messages have advised consumers to lower dietary energy density (ED) for weight management, but it is not known whether the proportion of the diet from low-ED foods is related to weight status. In a nationally representative sample of US adults, we evaluated whether the proportions of dietary energy intake contributed by low- and high-ED foods are associated with body mass index (BMI) and waist circumference (WC).

Data were from a cross-sectional sample of 9551 adults ≥18 years in the 2005-2008 National Health and Nutrition Examination Survey (NHANES). ED (kcal/g) was calculated for each food item reported during a 24-h dietary recall; individual foods were divided into five ED categories: very low ED (<0.6 kcal/g), low ED (0.6-1.5 kcal/g), medium ED (1.51-2.25 kcal/g), high ED (2.26-4.0 kcal/g), and very high ED (>4.0 kcal/g). The percentages of total energy and the food weight from each category were evaluated by BMI and WC after controlling for total energy intake and other covariates.

Men classified as lean (BMI < 25 kg/m²) reported consuming a greater proportion of total energy from very low- and low-ED foods (7.2 %_{very low} and 23.3 %_low), compared to men considered obese ((BMI > 30 kg/m²); 5.2 %_{very low} and 20.1_low %; p-trends <0.001_{very low}, 0.002_low). Similarly, women classified as lean reported intakes of very low-ED foods of 7.8 % (vs. 6.4 % for women with obesity) of total energy and low-ED foods of 24.7 % (vs. 21.5 % for women with obesity) of total energy (p-trends 0.007_{very low}, 0.004_low). Men and women with obesity reported greater proportions of energy from high-ED foods (45.9 %_{men with obesity} vs. 42.4 %_{lean men}, 44.2 %_{women with obesity} vs. 39.9 %_{lean women}) with significant statistical trends (men = 0.008, women = 0.0005). Similar patterns were observed for intakes of proportions of very low-, low-, and high-ED foods and WC.

Higher proportions of energy intake and food weight contributed by very low- and low-ED foods are associated with lower BMI (and WC).