title: Dietary energy density is associated with obesity and other biomarkers of chronic disease in US adults.
abstract: OBJECTIVE
  Given the current prevalence of obesity, it is important to identify dietary factors that may aid in disease prevention. The objective of the present study was to evaluate the association between consumption of an energy-dense diet and established markers factors for chronic disease, including body weight and measures of body fatness.
  
  
  METHODS
  Data from a nationally representative sample of 9,551 adults ≥18 years who participated in the 2005-2008 National Health and Nutrition Examination Survey were analyzed. The association between dietary energy density (ED, energy per weight of food, kcal/g) and markers for obesity [including body mass index (BMI) and waist circumference (WC)], insulin insensitivity [including fasting glucose, insulin and homeostasis assessment model for insulin resistance (HOMA-IR)], and markers for inflammation was examined.
  
  
  RESULTS
  Dietary ED was positively associated with obesity in both men and women in multivariate models. Overall, obese adults had a significantly higher dietary ED than lean adults (p < 0.0001). Current smokers had significantly higher ED than non-smokers (2.00 vs. 1.75, p < 0.01), and it was determined that smoking status modified the relationship between ED and weight status in women (p interaction 0.03). In both sexes, there was a positive linear relationship between BMI and ED (p trend 0.01 and 0.0002, respectively); a linear trend between WC and ED was also observed in women (p trend <0.001) after adjusting for relevant cofactors. In women, ED was positively associated with HOMA-IR and fasting insulin; though, this relationship was not observed in men. No significant associations between ED and C-reactive protein were observed in either sex.
  
  
  CONCLUSIONS
  These findings support recent obesity and disease prevention recommendations to consume a diet low in ED.
authors.affiliation: Department of Nutritional Sciences, The Pennsylvania State University, 110 Chandlee Laboratory, University Park, PA, 16802, USA, jvern@psu.edu.
authors.forename: Jacqueline A
authors.initials: JA
authors.lastname: Vernarelli
authors.forename: Diane C
authors.initials: DC
authors.lastname: Mitchell
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Rolls
authors.forename: Terryl J
authors.initials: TJ
authors.lastname: Hartman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D004032:Diet / Q000009:adverse effects*; D002149:Energy Intake; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D009765:Obesity / Q000097:blood / Q000453:epidemiology / Q000209:etiology* / Q000276:immunology; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects; D014481:United States / Q000453:epidemiology; D055105:Waist Circumference; D055815:Young Adult
chemical_list: D015415:Biomarkers; D018836:Inflammation Mediators