Energy density of meals and snacks in the British diet in relation to overall diet quality, BMI and waist circumference: findings from the National Diet and Nutrition Survey

Abstract

This cross-sectional study examined how energy density (ED) in meals and snacks is associated with overall diet quality, BMI and waist circumference (WC). On the basis of the data from 7-d weighed dietary record, all eating occasions were divided into meals or snacks based on time (meals: 06.00-10.00, 12.00-15.00 and 18.00-21.00 hours; snacks: others) or contribution to energy intake (EI) (meals: ≥15; snacks: <15 %) in 1451 British adults aged 19-64 years. Irrespective of the definition of meals and snacks, both meal ED and snack ED (kJ/g; calculated on the basis of solid food only) were inversely associated with overall diet quality assessed by the healthy diet indicator (regression coefficient (β) = − 0·29 to −0·21 and −0·07 to −0·04, respectively) and Mediterranean diet score (β = − 0·43 to −0·30 and −0·13 to −0·06, respectively) in both sexes (P ≤ 0·002), although the associations were stronger for meal ED. After adjustment for potential confounders, in both men and women, meal ED based on EI contribution showed positive associations with BMI (β = 0·34; 95 % CI 0·06, 0·62 and β = 0·31; 95 % CI 0·01, 0·61, respectively) and WC (β = 0·96; 95 % CI 0·27, 1·66 and β = 0·67; 95 % CI 0·04, 1·30, respectively). In addition, meal ED based on time was positively associated with WC in men (β = 0·59; 95 % CI 0·07, 1·10) and snack ED based on time was positively associated with BMI in women (β = 0·15; 95 % CI 0·04, 0·27). In analyses in which only acceptable EI reporters were included, similar results were obtained. In conclusion, the findings suggest stronger associations of meal ED with overall diet quality, BMI and WC compared with snack ED.

Adherence to the Mediterranean diet was positively associated with micronutrient adequacy and negatively associated with dietary energy density among adolescents

“…Our data showed a negative association between modified KIDMED scores and energy density, as a result of comparing energy densities among KIDMED groups (Table ) and the negative Spearman correlation between these two variables ( P < 0.001). We did not find other studies regarding the association between KIDMED scores and energy density; however, analysis of the British National Nutrition Survey demonstrated a similar negative association when the Mediterranean diet score and the Healthy Diet Indicator were utilised to assess the dietary quality in adults and children . Combining the results, the MD adherence, measured by the KIDMED index or the Mediterranean diet score, was associated with lower energy density.…”

“…However, the association between the modified KIDMED score and micronutrient intake/density is still heading in the same direction. Third, the present study did not differentiate over‐reporters, appropriate reporters and under‐reporters according to the gender, age and physical activity, which is a common way to correct reporting bias in dietary surveys . However, in the Mabat‐Youth Survey, the data collected from the field survey, which were considered inappropriate based on the data distribution, were not included in the analysis.…”

“…The former included all the solid or semi‐solid food and caloric beverages, excluding water, tea, coffee and artificially sweetened soft drinks . The latter included only solid and semi‐solid food, excluding any beverages (milk, juice, cola, soft drinks, beer, wine, tea, coffee and water) and soup .…”

Dietary energy density: Applying behavioural science to weight management

“…In addition to weight loss, reductions in energy density are associated with improved diet quality, indicating that this is a healthy strategy for weight management (Ledikwe et al . ; Murakami & Livingstone ). Nevertheless, it is clear that more data on the role of energy density in weight management are needed and could be obtained from secondary analyses of existing data.…”

“…Confirmation that lower-energy-dense diets are associated with lower bodyweight comes from several systematic reviews (Perez-Escamilla et al 2012;Karl & Roberts 2014;Rouhani et al 2016) and a meta-analysis (Stelmach-Mardas et al 2016). In addition to weight loss, reductions in energy density are associated with improved diet quality, indicating that this is a healthy strategy for weight management (Ledikwe et al 2006b;Murakami & Livingstone 2016). Nevertheless, it is clear that more data on the role of energy density in weight management are needed and could be obtained from secondary analyses of existing data.…”