Dietary Energy Density Is Associated With Obesity and the Metabolic Syndrome in U.S. Adults

  1. Jason A. Mendoza, MD, MPH1,
  2. Adam Drewnowski, PHD2 and
  3. Dimitri A. Christakis, MD, MPH3
  1. 1Children's Nutrition Research Center and Academic General Pediatrics, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
  2. 2Center for Public Health Nutrition, Exploratory Center for Obesity Research, Departments of Medicine and Epidemiology, University of Washington, Seattle, Washington
  3. 3Child Health Institute and Department of Pediatrics, University of Washington and Children's Hospital and Regional Medical Center, Seattle, Washington
  1. Address correspondence and reprint requests to Jason A. Mendoza, MD, Children's Nutrition Research Center, 1100 Bates St., Rm 2036, Houston, TX 77030-2600. E-mail: jason.mendoza{at}


OBJECTIVE—Rising obesity rates have been linked to the consumption of energy-dense diets. We examined whether dietary energy density was associated with obesity and related disorders including insulin resistance and the metabolic syndrome.

RESEARCH DESIGN AND METHODS—We conducted a cross-sectional study using nationally representative data of U.S. adults ≥20 years of age from the 1999–2002 National Health and Nutrition Examination Survey (n = 9,688). Dietary energy density was calculated based on foods only. We used a series of multivariate linear regression models to determine the independent association between dietary energy density, obesity measures (BMI [in kilograms per meters squared] and waist circumference [in centimeters]), glycemia, or insulinemia. We used multivariate Poisson regression models to determine the independent association between dietary energy density and the metabolic syndrome as defined by the National Cholesterol and Education Program (Adult Treatment Panel III).

RESULTS—Dietary energy density was independently and significantly associated with higher BMI in women (β = 0.44 [95% CI 0.14–0.73]) and trended toward a significant association in men (β = 0.37 [−0.007 to 0.74], P = 0.054). Dietary energy density was associated with higher waist circumference in women (β = 1.11 [0.42–1.80]) and men (β = 1.33 [0.46–2.19]). Dietary energy density was also independently associated with elevated fasting insulin (β = 0.65 [0.18–1.12]) and the metabolic syndrome (prevalence ratio = 1.10 [95% CI 1.03–1.17]).

CONCLUSIONS—Dietary energy density is an independent predictor of obesity, elevated fasting insulin levels, and the metabolic syndrome in U.S. adults. Intervention studies to reduce dietary energy density are warranted.


  • Published ahead of print at on 17 January 2007. DOI: 10.2337/dc06-2188.

    A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

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    • Accepted January 4, 2007.
    • Received October 24, 2006.
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  1. Diabetes Care vol. 30 no. 4 974-979
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