European Journal of Nutrition

, Volume 54, Issue 1, pp 59–65 | Cite as

Dietary energy density is associated with obesity and other biomarkers of chronic disease in US adults

  • Jacqueline A. VernarelliEmail author
  • Diane C. Mitchell
  • Barbara J. Rolls
  • Terryl J. Hartman
Original Contribution



Given the current prevalence of obesity, it is important to identify dietary factors that may aid in disease prevention. The objective of the present study was to evaluate the association between consumption of an energy-dense diet and established markers factors for chronic disease, including body weight and measures of body fatness.


Data from a nationally representative sample of 9,551 adults ≥18 years who participated in the 2005–2008 National Health and Nutrition Examination Survey were analyzed. The association between dietary energy density (ED, energy per weight of food, kcal/g) and markers for obesity [including body mass index (BMI) and waist circumference (WC)], insulin insensitivity [including fasting glucose, insulin and homeostasis assessment model for insulin resistance (HOMA-IR)], and markers for inflammation was examined.


Dietary ED was positively associated with obesity in both men and women in multivariate models. Overall, obese adults had a significantly higher dietary ED than lean adults (p < 0.0001). Current smokers had significantly higher ED than non-smokers (2.00 vs. 1.75, p < 0.01), and it was determined that smoking status modified the relationship between ED and weight status in women (p interaction 0.03). In both sexes, there was a positive linear relationship between BMI and ED (p trend 0.01 and 0.0002, respectively); a linear trend between WC and ED was also observed in women (p trend <0.001) after adjusting for relevant cofactors. In women, ED was positively associated with HOMA-IR and fasting insulin; though, this relationship was not observed in men. No significant associations between ED and C-reactive protein were observed in either sex.


These findings support recent obesity and disease prevention recommendations to consume a diet low in ED.


Energy density NHANES Waist circumference BMI Obesity 



This study was supported in part by a Grant from American Institute of Cancer Research (10A078). We acknowledge the assistance provided by the Population Research Center at The Pennsylvania State University, which is supported by an infrastructure grant by the National Institutes of Health (2R24HD041025-11).


  1. 1.
    DiFranza JR, Wellman RJ (2005) A sensitization-homeostasis model of nicotine craving, withdrawal, and tolerance: integrating the clinical and basic science literature. Nicotine Tob Res 7(1):9–26. doi: 10.1080/14622200412331328538 CrossRefGoogle Scholar
  2. 2.
    Marmot M (2007) Food, nutrition, physical activity, and the prevention of cancer: a global perspective. World Cancer Research Fund/American Institute for Cancer Research, WashingtonGoogle Scholar
  3. 3.
    Rolls BJ (2009) The relationship between dietary energy density and energy intake. Physiol Behav 97(5):609–615. doi: 10.1016/j.physbeh.2009.03.011 CrossRefGoogle Scholar
  4. 4.
    Mendoza JA, Drewnowski A, Christakis DA (2007) Dietary energy density is associated with obesity and the metabolic syndrome in U.S. adults. Diabet Care 30(4):974–979. doi: 10.2337/dc06-2188 CrossRefGoogle Scholar
  5. 5.
    Ledikwe JH, Blanck HM, Kettel Khan L, Serdula MK, Seymour JD, Tohill BC, Rolls BJ (2006) Dietary energy density is associated with energy intake and weight status in US adults. Am J Clin Nutr 83(6):1362–1368Google Scholar
  6. 6.
    Kant AK, Graubard BI (2005) Energy density of diets reported by American adults: association with food group intake, nutrient intake, and body weight. Int J Obes (Lond) 29(8):950–956. doi: 10.1038/sj.ijo.0802980 CrossRefGoogle Scholar
  7. 7.
    Stookey JD (2001) Energy density, energy intake and weight status in a large free-living sample of Chinese adults: exploring the underlying roles of fat, protein, carbohydrate, fiber and water intakes. Eur J Clin Nutr 55(5):349–359. doi: 10.1038/sj.ejcn.1601163 CrossRefGoogle Scholar
  8. 8.
    Howarth NC, Murphy SP, Wilkens LR, Hankin JH, Kolonel LN (2006) Dietary energy density is associated with overweight status among 5 ethnic groups in the multiethnic cohort study. J Nutr 136(8):2243–2248Google Scholar
  9. 9.
    Hartman TJ, Albert PS, Zhang Z, Bagshaw D, Kris-Etherton PM, Ulbrecht J, Miller CK, Bobe G, Colburn NH, Lanza E (2010) Consumption of a legume-enriched, low-glycemic index diet is associated with biomarkers of insulin resistance and inflammation among men at risk for colorectal cancer. J Nutr 140(1):60–67. doi: 10.3945/jn.109.114249 CrossRefGoogle Scholar
  10. 10.
    Monzillo LU, Hamdy O (2003) Evaluation of insulin sensitivity in clinical practice and in research settings. Nutr Rev 61(12):397–412CrossRefGoogle Scholar
  11. 11.
    U.S. Department of Agriculture ARS, Beltsville Human Nutrition Research Center, Food Surveys Research Group (Beltsville, MD) and U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics (Hyattsville, MD). (2010) What We Eat in America, NHANES 2005-2008. U.S. Department of Agriculture. Accessed 1 April 2011
  12. 12.
    Flegal KM, Carroll MD, Ogden CL, Curtin LR (2010) Prevalence and trends in obesity among US adults, 1999-2008. JAMA 303(3):235–241. doi: 10.1001/jama.2009.2014 CrossRefGoogle Scholar
  13. 13.
    Vernarelli JA, Mitchell DC, Rolls BJ, Hartman TJ (2013) Methods for calculating dietary energy density in a nationally representative sample. Procedia Food Sci 2:68–74. doi: 10.1016/j.profoo.2013.04.011 CrossRefGoogle Scholar
  14. 14.
    Ledikwe JH, Blanck HM, Khan LK, Serdula MK, Seymour JD, Tohill BC, Rolls BJ (2005) Dietary energy density determined by eight calculation methods in a nationally representative United States population. J Nutr 135(2):273–278Google Scholar
  15. 15.
    Vernarelli JA, Mitchell DC, Hartman TJ, Rolls BJ (2011) Dietary energy density is associated with body weight status and vegetable intake in U.S. Children. J Nutr 141(12):2204–2210. doi: 10.3945/jn.111.146092 CrossRefGoogle Scholar
  16. 16.
    Johnson L, Wilks DC, Lindroos AK, Jebb SA (2009) Reflections from a systematic review of dietary energy density and weight gain: is the inclusion of drinks valid? Obes Rev 10(6):681–692. doi: 10.1111/j.1467-789X.2009.00580.x CrossRefGoogle Scholar
  17. 17.
    Ledikwe JH, Blanck HM, Khan LK, Serdula MK, Seymour JD, Tohill BC, Rolls BJ (2006) Low-energy-density diets are associated with high diet quality in adults in the United States. J Am Diet Assoc 106(8):1172–1180. doi: 10.1016/j.jada.2006.05.013 CrossRefGoogle Scholar
  18. 18.
    Schroder H, Marrugat J, Elosua R, Covas MI (2002) Tobacco and alcohol consumption: impact on other cardiovascular and cancer risk factors in a southern European Mediterranean population. Br J Nutr 88(3):273–281. doi: 10.1079/BJN2002655 CrossRefGoogle Scholar
  19. 19.
    Miller PE, Lesko SM, Muscat JE, Lazarus P, Hartman TJ (2010) Dietary patterns and colorectal adenoma and cancer risk: a review of the epidemiological evidence. Nutr Cancer 62(4):413–424. doi: 10.1080/01635580903407114 CrossRefGoogle Scholar
  20. 20.
    Perez-Escamilla R, Obbagy JE, Altman JM, Essery EV, McGrane MM, Wong YP, Spahn JM, Williams CL (2012) Dietary energy density and body weight in adults and children: a systematic review. J Acad Nutr Diet 112(5):671–684. doi: 10.1016/j.jand.2012.01.020 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Jacqueline A. Vernarelli
    • 1
    Email author
  • Diane C. Mitchell
    • 1
  • Barbara J. Rolls
    • 1
  • Terryl J. Hartman
    • 1
    • 2
  1. 1.Department of Nutritional SciencesThe Pennsylvania State UniversityUniversity ParkUSA
  2. 2.Department of Epidemiology, Rollins School of Public HealthEmory UniversityAtlantaUSA

Personalised recommendations