An energy-dense diet is cross-sectionally associated with an increased risk of overweight in male children, but not in female children, male adolescents, or female adolescents in Japan: the Ryukyus Child Health Study

Dietary Energy Density Is Associated with Biomarkers of Chronic Diseases-A Cross-Sectional Study of School-Aged Children in Rural Mexico

Background

Dietary energy density (DED) is associated with chronic disease markers in adults. However, results in children are still controversial.

Objective

To evaluate the DED of children and its association with obesity and biomarkers of chronic disease.

Methods

In this cross-sectional study, we recruited 284 children (6-10 y) from rural Mexico. Dietary intake was assessed using three 24-h recalls. DED was calculated for "foods only" (DEDfo) and for "foods and beverages" (DEDfb). Weight, height, and body fat percent (dual-energy X-ray absorptiometry) were measured. Inflammatory cytokines, lipid profile, leptin, and insulin resistance were determined from a fasting blood sample.

Results

DEDfo was 1.91 ± 0.36 kcal/g and DEDfb was 1.36 ± 0.31 kcal/g. Higher DEDfo and DEDfb were associated with higher risk to have insulin resistance [odds ratio (OR) = 3.92, 95% confidence interval (CI): 1.66, 9.22, P < 0.01; OR = 3.51, 95% CI: 1.25, 9.87, P = 0.02, respectively]. Higher DEDfo was associated with higher risk of higher leptin levels (OR = 3.17, 95% CI: 1.01, 10.23). Also, DEDfo and DEDfb were associated with higher concentrations of cholesterol (β = 11.67, 95% CI: 1.81, 19.53, P = 0.03; and β = 11.74, 95% CI: 2.69, 20.74 P = 0.01, respectively) and higher odds of having high insulin concentrations (OR = 2.52, 95% CI: 1.26, 5.06, P = 0.01; and OR = 2.95, 95% CI: 1.30, 6.70, P = 0.01). DEDfo and DEDfb were not associated with any measure of obesity and inflammatory cytokines in the adjusted models.

Conclusions

DED was associated with higher leptin and cholesterol concentrations, and having insulin resistance, but not with any measure of obesity or inflammation. Reducing DED may reduce risk of cardiovascular disease and improve insulin sensitivity in school-aged children.

A school-based nutrition education program involving children and their guardians in Japan: facilitation of guardian-child communication and reduction of nutrition knowledge disparity

Background

Since the risk of noncommunicable diseases is closely associated with dietary intake, it is important to establish healthy dietary habits in childhood. Although several dietary education programs for children have been attempted, their implementation at school was often difficult due to overcrowded study curricula. We developed a new program which included homework for children and guardians, and evaluated its effect. Determinants of the effect were also investigated.

Methods

The school-based nutrition education program including a 45-min lecture, a series of homework assignments involving children and guardians, and two handouts was implemented in 14 public primary schools in Japan. Seven schools each underwent the intervention in an alternating manner. Nutrition knowledge (percentage (%) of correct answers in the nutrition knowledge questionnaire) and attitude/behavior toward diet was evaluated three times (May (baseline), October, February) as outcomes. These factors and their changes following the intervention were assessed by linear mixed models to adjust for individual factors, with consideration to clustering of the participants and repeated measurements.

Results

In total, 2227 children aged 10–12 years and their guardians participated. All schools completed the program. Children’s nutrition knowledge level was significantly increased (8.7%, 95% confidence interval [7.7–9.7]) following the intervention. Communication between children and their guardians, which was positively related with nutrition knowledge, was facilitated by the intervention. The increase in nutrition knowledge was greater among children with a lower knowledge level at baseline.

Conclusions

This school-based nutrition education program was effective and feasible. Appropriate teaching materials for homework can reduce the burden on schools and facilitate communication between children and guardians. Public schools can be crucial venues for decreasing disparities in nutrition knowledge.

Trial registration

This study was registered as an intervention study in the UMIN Clinical Trials Registry (trial ID: UMIN000029252) on Sep 22, 2017.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12937-021-00751-z.

The association of dietary energy density and the risk of obesity, type 2 diabetes and metabolic syndrome: A systematic review and meta-analysis of observational studies

OBJECTIVES

There is a growing body of evidence linking dietary energy density (DED) with metabolic disorders like obesity, type 2 diabetes (T2D) and metabolic syndrome (MetS). However, according to our knowledge, there has been no systematic review and mate-analysis on T2D and MetS with DED. Therefore, this study aimed to investigate the association between DED with the risk of obesity, T2D and MetS in a systematic review and meta-analysis of observational studies.

METHODS

We searched all published studies according to the defined keywords up to march 2020 in the PubMed/Medline and Scopus databases. We excluded those that did not calculate DED for total intake, no observed association between obesity, T2D, MetS as the primary or one of the outcomes with DED, no reported odds ratio (OR), relative risk (RR) or hazard ratio (HR) estimates with 95% confidence intervals (CIs), studies in children under 2 years old, patients with cancer and pregnant women.

RESULTS

From 2282, after deleting the duplicates and irrelevant studies, we entered 58 articles ( 47 systematic reviews and 11 meta-analyse). We indicated an increased risk of T2D in relation to DED (OR: 1.25, 95% CI: 1.18-1.33, P < .001). But studies reviewed were inconsistent. All studies which examined the relationship between DED and MetS showed a positive relationship with an increased significant risk (OR: 1.59, 95% CI: 1.22-2.07, P < .001). Most articles reported a direct association between DED and obesity but the relationship between DED and risk of obesity was not significant (OR: 1.04, 95% CI: 0.92-1.17, P = .543).

CONCLUSION

In this systematic review and meta-analysis of observational studies, we found that the DED increased the risk of T2D and MetS but was not significant with the risk of obesity.

Dietary energy density is associated with body mass index-for-age in Mexican adolescents

Dietary energy density (DED) has been widely considered a risk factor for weight gain. In adolescents, however, the evidence is inconclusive, and in Mexico, the ways in which DED is associated with overweight and obesity are unknown. Our study analysed the association of DED with overweight or obesity (OW-O) in Mexican adolescents included in the National Health and Nutrition Survey 2012 (ENSANUT 2012). We analysed the data from a 7-day Food Frequency Questionnaire administered to 2,203 Mexican adolescents aged 12-19 years. DED was calculated excluding all beverages. Plausible and implausible reporters were identified based on the relationship between the reported energy intake and the estimated energy requirement. The association of DED with body mass index (BMI)-for-age and OW-O was analysed using multivariate statistical models restricted to plausible reporters. The combined prevalence of overweight and obesity was 35.4% in the complete sample and 27.8% in the sample of plausible reporters. Mean DED was 177 kcal/100 g, with higher DED in the north of the country. The proportion of plausible reporters was 38.5%. We found a positive association between high DED and the BMI-for-age z-score (β = 0.347; 95% CI [0.101, 0.594]; P = 0.006), controlling for sociodemographic and dietary variables, but no significant association with OW-O. It is necessary to consider the DED in the design and implementation of strategies to reduce energy density in the diets of young Mexicans.

Associations of dietary energy density with body composition and cardiometabolic risk in children with overweight and obesity: role of energy density calculations, under-reporting energy intake and physical activity

This study examined (1) the association of dietary energy density from solid (EDS) and solid plus liquids (EDSL) with adiposity and cardiometabolic risk factors (CRF) in children with overweight and obesity, (2) the effect of under-reporting on the mentioned associations and (3) whether the association between ED and body composition and CRF is influenced by levels of physical activity. In a cross-sectional design, 208 overweight and obese children (8–12-year-old; 111 boys) completed two non-consecutive 24 h recalls. ED was calculated using two different approaches: EDS and EDSL. Under-reporters were determined with the Goldberg method. Body composition, anthropometry and fasting blood sample measurements were performed. Moderate to vigorous physical activity (MVPA) was registered with accelerometers (7-d-register). Linear regressions were performed to evaluate the association of ED with the previously mentioned variables. Neither EDS nor EDSL were associated with body composition or CRF. However, when under-reporters were excluded, EDS was positively associated with BMI (P=0·019), body fat percentage (P=0·005), abdominal fat (P=0·008) and fat mass index (P=0·018), while EDSL was positively associated with body fat percentage (P=0·008) and fat mass index (P=0·026). When stratifying the group according to physical activity recommendations, the aforementioned associations were only maintained for non-compliers. Cluster analysis showed that the low-ED and high-MVPA group presented the healthiest profile for all adiposity and CRF. These findings could partly explain inconsistencies in literature, as we found that different ED calculations entail distinct results. Physical activity levels and excluding under-reporters greatly influence the associations between ED and adiposity in children with overweight and obesity.

Dietary Energy Density and Its Association with Overweight or Obesity in Adolescents: A Systematic Review of Observational Studies

Dietary energy density (DED) has been identified as a crucial dietary factor in body weight control, in that higher DED has been associated with weight gain. To our knowledge, no review studies have explained this association specifically in adolescents. The aim of this study was to describe the association of DED with overweight or obesity (OW/O) in adolescents, as derived from observational studies. We conducted a systematic search of the MEDLINE/PubMed and Science Direct databases, including studies published between January 2000 and December 2017. We selected the studies that included adolescents (aged 10⁻19 years) and contained DED-related information and anthropometric measurements of OW/O. From 1149 candidate studies, 30 were selected, though only 12 met all the inclusion criteria. Of these, only four found a positive association between DED and certain OW/O indicators, six found no association and two showed an inverse association with weight gain. These studies differed in several aspects such as design, DED calculation method and dietary assessment tool, leading to inconsistent results. Methodological differences found among the examined studies did not allow us to establish a clear conclusion of this association. Evidence in adolescents was also poor. New, standardized methodological approaches should be considered in future studies.

Associations between dietary energy density and obesity: A systematic review and meta-analysis of observational studies

OBJECTIVE

Although many studies have shown an association between dietary energy density (DED) and obesity, there has been no systematic review and meta-analysis on this topic. Therefore, the objective of this study was to qualitatively and quantitatively review and summarize the literature on association between DED and obesity.

METHODS

We searched titles, abstracts, and keywords of articles indexed in ScienceDirect, ProQuest, MEDLINE, and Google Scholar databases until January 2015 to identify eligible studies. We excluded studies that did not examine DED for whole diet and studies that included patients with cancer, pregnant women, the elderly (>60 y old), and children (<2 y old). There were no language or publication date restrictions.

RESULTS

Of the 37 studies included in this review, most articles reported a direct association between DED and obesity. We performed a meta-analysis on 23 of these studies. In comparison with the lowest NTILE of DED, subjects in the highest NTILE of DED had significant weight gain (2.26 kg, 95% confidence interval [CI]: 1.00-3.53), greater adjusted mean body mass index (BMI) (0.50 kg/m(2), 95% CI: 0.02-0.98 for males and 0.85 kg/m(2), 95% CI: 0.51-1.19 for females), and risk of excess adiposity (odds ratio [OR]: 1.27, 95% CI: 1.04-1.55). We did not observe significant associations between DED and risk of elevated BMI (OR: 1.13, 95% CI: 1.00-1.27) and abdominal obesity (OR: 1.17, 95% CI: 0.19-7.38). We found no evidence of publication bias.

CONCLUSION

The present review showed that DED was directly associated with risk of excess adiposity, higher weight change, and BMI. Lower DED should be considered a prevention strategy for obesity.

The Cross-Sectional Association of Energy Intake and Dietary Energy Density with Body Composition of Children in Southwest China

OBJECTIVE

We examined whether dietary energy intake (EI) and dietary energy density (ED) were cross-sectionally associated with body composition of children living in Southwest China.

DESIGN AND METHODS

Multivariate regression analyses were performed on three day, 24 h dietary recall data and information on potential confounders from 1207 participants aged 8-14 years. EI was calculated from all foods and drinks and ED was classified into five categories. Body mass index (BMI) z-scores, percentage of body fat (%BF), fat mass index (FMI), fat-free mass index (FFMI) and ratio of waist to hip circumference (WHR) were used to describe body composition.

RESULTS

Boys with higher total EI had higher BMI z-scores, %BF, and FMI than boys with lower total EI both before and after measurements were adjusted for confounders (age, fiber intake, physical activity, the timing of adding complementary foods, paternal education level and maternal BMI) (p ≤ 0.04). However, EI was not associated with body composition in girls. Dietary ED, in any category, was not associated with body composition in either gender.

CONCLUSIONS

Dietary ED was not associated with body composition of children in Southwest China, while dietary EI in boys, not girls, was positively associated with body composition. Reducing dietary energy intake may help to prevent obesity and related diseases in later life among boys living in Southwest China.

The Influence on Population Weight Gain and Obesity of the Macronutrient Composition and Energy Density of the Food Supply

Rates of overweight and obesity have increased dramatically in all regions of the world over the last few decades. Almost all of the world's population now has ubiquitous access to low-cost, but highly-processed, energy-dense, nutrient-poor food products. These changes in the food supply, rather than decreases in physical activity, are most likely the primary driver of population weight gain and obesity. To-date, the majority of prevention efforts focus on personalised approaches targeting individuals. Population-wide food supply interventions addressing sodium and trans fat reduction have proven highly effective and comparable efforts are now required to target obesity. The evidence suggests that strategies focusing upon reducing the energy density and portion size of foods will be more effective than those targeting specific macronutrients. Government leadership, clearly specified targets, accountability and transparency will be the key to achieving the food supply changes required to address the global obesity epidemic.