title: Dietary energy density and obesity: how consumption patterns differ by body weight status.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  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.
  
  
  RESULTS
  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 lowand 23.3 %low), compared to men considered obese ((BMI > 30 kg/m2); 5.2 %very lowand 20.1low%; p-trends <0.001very low, 0.002low). 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 0.007very low, 0.004low). Men and women with obesity reported greater proportions of energy from high-ED foods (45.9 %men with obesityvs. 42.4 %lean men, 44.2 %women with obesityvs. 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.
  
  
  CONCLUSIONS
  Higher proportions of energy intake and food weight contributed by very low- and low-ED foods are associated with lower BMI (and WC).
authors.affiliation: Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, 16802, USA. jvernarelli@fairfield.edu.|Department of Biology, Fairfield University, 220 Bannow Science Center, Fairfield, CT, 06824, USA. jvernarelli@fairfield.edu.
authors.forename: Jacqueline A
authors.initials: JA
authors.lastname: Vernarelli
authors.affiliation: Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, 16802, USA.
authors.forename: Diane C
authors.initials: DC
authors.lastname: Mitchell
authors.affiliation: Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, 16802, USA.
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Rolls
authors.affiliation: Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, 16802, USA.|Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA.
authors.forename: Terryl J
authors.initials: TJ
authors.lastname: Hartman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D001835:Body Weight; D003430:Cross-Sectional Studies; D004032:Diet; D059305:Diet, High-Fat / Q000009:adverse effects; D002149:Energy Intake; D005260:Female; D005638:Fruit; D006801:Humans; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D009765:Obesity / Q000503:physiopathology*; D014675:Vegetables; D055105:Waist Circumference
keywords: Body mass index; Energy density; Fruits and vegetables; NHANES; Obesity; Waist circumference