Relationship between dietary energy density and dietary quality in overweight young children: a cross-sectional analysis.

BACKGROUND: Observational research has found that lower energy density (ED) diets are related to reduced intake of fat and greater intake of fruits and vegetables. No study has examined the relationship between dietary ED and dietary quality, as determined by the Healthy Eating Index-2005 (HEI), in children who are overweight and obese.

OBJECTIVE: Examine the relationship between dietary ED and HEI, determined from 3-d food records, in 156 children, aged 4-9 years, who had ≥85th percentile body mass index presenting for family-based obesity treatment.

METHOD: Dietary ED, in kcal/g, was calculated using two methods: food and all beverages consumed (food+bev) and food only consumed (food). For calculation of HEI, all components of the HEI were included except oils.

RESULTS: Participants were classified as consuming a low-ED, medium-ED or high-ED diet using tertile cut-off points with ED calculated using food and beverages_(food+bev) or food only_(food) . After controlling for group difference in child sex and race and parent sex, LOW_food+bev and LOW_food had significantly (P < 0.05) higher total HEI scores, and total fruit, total vegetable and saturated fat HEI scores than HIGH_food+bev and HIGH_food , with higher scores indicating greater quality.

CONCLUSIONS: Lower dietary ED is associated with higher dietary quality in children presenting for obesity treatment. Additional research investigating an ED prescription on dietary quality in children who are overweight or obese is needed to better understand this relationship.