title: Dietary energy density: a mediator of depressive symptoms and abdominal obesity or independent predictor of abdominal obesity?
abstract: BACKGROUND
  In the U.S., Europe, and throughout the world, abdominal obesity prevalence is increasing. Depressive symptoms may contribute to abdominal obesity through the consumption of diets high in energy density.
  
  
  OBJECTIVE
  To test dietary energy density ([DED]; kilocalories/gram of food and beverages consumed) for an independent relationship with abdominal obesity or as a mediator between depressive symptoms and abdominal obesity.
  
  
  METHODS
  This cross-sectional study included 87 mid-life, overweight adults; 73.6% women; 50.6% African-American. Variables and measures: Beck depression inventory-II (BDI-II) to measure depressive symptoms; 3-day weighed food records to calculate DED; and waist circumference, an indicator of abdominal obesity. Hierarchical regression tested if DED explained waist circumference variance while controlling for depressive symptoms and consumed food and beverage weight. Three approaches tested DED as a mediator.
  
  
  RESULTS
  Nearly three-quarters of participants had abdominal obesity, and the mean waist circumference was 103.2 (SD 14.3) cm. Mean values: BDI-II was 8.67 (SD 8.34) which indicates that most participants experienced minimal depressive symptoms, and 21.8% reported mild to severe depressive symptoms (BDI-II ≥ 14); DED was 0.75 (SD 0.22) kilocalories/gram. Hierarchical regression showed an independent association between DED and waist circumference with DED explaining 7.0% of variance above that accounted for by BDI-II and food and beverage weight. DED did not mediate between depressive symptoms and abdominal obesity.
  
  
  CONCLUSIONS
  Depressive symptoms and DED were associated with elevated waist circumference, thus a comprehensive intervention aimed at improving depressive symptoms and decreasing DED to reduce waist circumference is warranted.
authors.affiliation: Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA. dgrossn@hotmail.com
authors.forename: Daurice A
authors.initials: DA
authors.lastname: Grossniklaus
authors.forename: Sandra B
authors.initials: SB
authors.lastname: Dunbar
authors.forename: Rebecca
authors.initials: R
authors.lastname: Gary
authors.forename: Beth C
authors.initials: BC
authors.lastname: Tohill
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Frediani
authors.forename: Melinda K
authors.initials: MK
authors.lastname: Higgins
mesh_terms: D000328:Adult; D017677:Age Distribution; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology* / Q000503:physiopathology; D004032:Diet; D002149:Energy Intake; D004734:Energy Metabolism / Q000502:physiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D056128:Obesity, Abdominal / Q000453:epidemiology* / Q000503:physiopathology* / Q000523:psychology; D011446:Prospective Studies; D012016:Reference Values; D012044:Regression Analysis; D018570:Risk Assessment; D017678:Sex Distribution; D055105:Waist Circumference