Dietary energy density and successful weight loss maintenance

Research shows a positive relationship between dietary energy density (ED) and body mass index (BMI), but dietary ED of weight loss maintainers is unknown. This preliminary investigation was a secondary data analysis that compared self-reported dietary ED and food group servings consumed in overweight adults (OW: BMI=27-45kg/m(2)), normal weight adults (NW: BMI=19-24.9 kg/m(2)), and weight loss maintainers (WLM: current BMI=19-24.9kg/m(2) [lost≥10% of maximum body weight and maintained loss for ≥5years]) participating in 2 studies, with data collected from July 2006 to March 2007. Three 24-h phone dietary recalls from 287 participants (OW=97, NW=85, WLM=105) assessed self-reported dietary intake. ED (kcal/g) was calculated by three methods (food+all beverages except water [F+AB], food+caloric beverages [F+CB], and food only [FO]). Differences in self-reported consumption of dietary ED, food group servings, energy, grams of food/beverages, fat, and fiber were assessed using one-way MANCOVA, adjusting for age, sex, and weekly energy expenditure from self-reported physical activity. ED, calculated by all three methods, was significantly lower in WLM than in NW or OW (FO: WLM=1.39±0.45kcal/g; NW=1.60±0.43 kcal/g; OW=1.83±0.42 kcal/g). Self-reported daily servings of vegetables and whole grains consumed were significantly higher in WLM compared to NW and OW (vegetables: WLM=4.9±3.1 servings/day; NW=3.9±2.0 servings/day; OW=3.4±1.7 servings/day; whole grains: WLM=2.2±1.8 servings/day; NW=1.4±1.2 servings/day; OW=1.3±1.3 servings/day). WLM self-reported consuming significantly less energy from fat and more fiber than the other two groups. Self-reported energy intake per day was significantly lower in WLM than OW, and WLM self-reported consuming significantly more grams of food/beverages per day than OW. These preliminary findings suggest that consuming a diet lower in ED, characterized by greater intake of vegetables and whole grains, may aid with weight loss maintenance and should be further tested in prospective randomized controlled trials.     

Dietary energy density is associated with energy intake and weight status in US adults

BACKGROUND: Laboratory-based investigations indicate that the consumption of foods with a low energy density (kcal/g) decreases energy intake. Although low-energy-dense diets are recommended for weight management, relations between energy density, energy intake, and weight status have not been clearly shown in free-living persons. OBJECTIVES: A representative US sample was used to determine whether dietary energy density is associated with energy intake, the weight of food consumed, and body weight and to explore the influence of food choices (fruit, vegetable, and fat consumption) on energy density and body weight. DESIGN: A cross-sectional survey of adults (n = 7356) from the 1994-1996 Continuing Survey of Food Intakes by Individuals and two 24-h dietary recalls were used. RESULTS: Men and women with a low-energy-dense diet had lower energy intakes (approximately 425 and 275 kcal/d less, respectively) than did those with a high-energy-dense diet, even though they consumed more food (approximately 400 and 300 g/d more, respectively). Normal-weight persons had diets with a lower energy density than did obese persons. Persons with a high fruit and vegetable intake had the lowest energy density values and the lowest obesity prevalence. CONCLUSIONS: Adults consuming a low-energy-dense diet are likely to consume more food (by weight) but to have a lower energy intake than do those consuming a higher-energy-dense diet. The energy density of a variety of dietary patterns, including higher-fat diets, can be lowered by adding fruit and vegetables. Our findings support the hypothesis that a relation exists between the consumption of an energy-dense diet and obesity and provide evidence of the importance of fruit and vegetable consumption for weight management.     

Prospective study of dietary energy density and weight gain in women

BACKGROUND: Little is known about the long-term effects of dietary energy density (ED) on weight gain. OBJECTIVE: The objective was to assess the long-term relation between changes in dietary ED and age-related weight gain. DESIGN: We conducted a prospective study of 50 026 women (x +/- SD age: 36.5 +/- 4.6 y) in the Nurses' Health Study II followed from 1991 to 1999. Dietary ED and body weight were ascertained in 1991, 1995, and 1999. Total dietary ED was calculated by dividing each subject's daily energy intake (kcal) by the reported weight (g) of all foods consumed. RESULTS: Dietary ED was positively correlated with saturated fat (r = 0.16), trans fat (r = 0.15), and the glycemic index (r = 0.16), but was inversely correlated with vegetable protein (r = -0.30), vegetables (r = -0.27), and fruit (r = -0.17). ED was not significantly correlated with total fat intake as a percentage of energy (r = 0.08). Women who increased their dietary ED during follow-up the most (5th quintile) had a significantly greater multivariate-adjusted weight gain than did those who decreased their dietary ED (1st quintile) (8-y time period: 6.42 kg compared with 4.57 kg; P for trend < 0.001). However, the amount of weight change over time varied considerably according to the ED values of individual foods and beverages. CONCLUSION: A high dietary ED reflects a dietary pattern higher in saturated and trans fats and refined carbohydrates. Increases in dietary ED were associated with greater weight gain among middle-aged women during 8 y of follow-up. However, public health recommendations cannot be made simply on the basis of ED values of individual foods and beverages.     

Changes in dietary intake after diagnosis of breast cancer

OBJECTIVE: To quantify change in intake of kilocalories, macronutrients, and fruit and vegetable servings after diagnosis of breast cancer, and to correlate these changes with subject characteristics and with self-reported global change in dietary patterns. DESIGN: Food frequency questionnaires were completed by women newly diagnosed with breast cancer shortly after diagnosis. They were asked to recall intake 1 year before diagnosis. Two years after the initial interview another food frequency questionnaire was completed recalling intake during the previous year. At the 2-year follow-up interview women were also asked if they had changed their intake of fruit, vegetables, and fat since diagnosis. SUBJECTS/SETTING: Two hundred sixty New Mexico women with newly diagnosed breast cancer between July 1997 and March 1999. ANALYSIS: Two-year change scores for kilocalories, macronutrients, and fruit and vegetable servings were calculated and tested for difference from zero using paired t tests or Wilcoxon signed rank tests. Subjects' characteristics were related to change in kilocalories and linear regression was used to determine the relative importance of these characteristics. Amount of change in fruit and vegetable servings and fat intake were calculated using food frequency data for women who reported increasing their intake of fruits and vegetables or decreasing their intake of fat after diagnosis. RESULTS: Small but significant decreases in intake of total energy and macronutrients were found 2 years postdiagnosis, with younger women reporting the greatest decreases. Fat as a percentage of diet increased over this period. There was no change in mean intake of fruit and vegetable servings. There is agreement between change as measured by food frequency questionnaire and change reported by more global questions on dietary habits; however, the amount of change measured was small. Women reporting an increase in fruit and vegetable intake postdiagnosis described an increase of one-quarter serving of fruit and one-third serving of vegetables per day. CONCLUSIONS: Breast cancer diagnosis results in modest dietary changes. Small changes in fruit and vegetable consumption suggest that efforts are needed to encourage increased consumption of these foods.     

Sex differences in fruit and vegetable intake in older adults

Fruits and vegetables are important components of a healthy diet, but intakes in most Western countries are well below the recommended five servings a day. Men in particular are eating too little. The aim of this study is to understand the processes underlying this gender difference. Fruit and vegetable intake, nutrition knowledge, taste preferences, attitudes to fruit and vegetable intake, and dieting status, were assessed in a simple questionnaire in 1,024 older adults attending population-based cancer screening across the UK. The results confirmed the pattern of men consuming fewer servings of fruit and vegetables daily than women (2.52 vs 3.47; p<0.01). Fewer men than women knew the current recommendations for fruit and vegetable intake, and fewer were aware of the links between fruit and vegetable consumption and disease prevention. Women rated their liking for vegetables but not fruit higher, and there were no differences in attitudes. Men were less likely to be dieting to lose weight. Multivariate analysis showed that the gender difference in intake was substantially attenuated by controlling for nutrition knowledge. There were no significant attenuating effects of preferences, attitudes or dieting status. These results indicate that men's poorer nutrition knowledge explains a significant part of their lower intake of fruit and vegetables.     

Assessment of the effect of fat-modified foods on diet quality in adults, 19 to 50 years, using data from the Continuing Survey of Food Intake by Individuals

Fat-reduction strategies and the role of fat-modified foods in the US diet were assessed using a nationally representative survey: the 1996 US Department of Agriculture Continuing Survey of Food Intakes by Individuals. A sample of 878 men and 853 women was included. The sample was divided into low fat and high fat based on the Dietary Guideline's cutoff poin of 30% or less of energy from total fat. The survey sample was further stratified in nonusers, low-users or high-users of fat-modified foods. Approximately 10% of 7,000 foods were classified as fat-modified. There was a 400 to 500 kcal difference in energy intake of individuals consuming low-fat compared with high-fat diets. Adults who were users of fat-modified foods consumed more nutrient-dense diets, with higher intakes of vitamin A, folate, and iron. Not all fat-reduction strategies were equally effective in reducing fat and maintaining nutrient intake. Nonusers of fat-modified foods who consumed a low-fat diet tended to do so by substituting carbohydrate, in part from carbonated beverages, for fat. Both men and women consuming a low-fat diet had lower average BMIs; this difference between individuals consuming low-fat vs high-fat diets was significant for women who were high-users of fat-modified foods. The data suggest that a low-fat diet with high use of fat-modified foods may be one strategy for achieving adequate nutrient intake while maintaining weight in the desirable BMI range of 19 to 25.     

The role of added sugars in the diet quality of children and adolescents

OBJECTIVE: The associations between added sugars intake and consumption of vitamins, minerals and servings of foods in the USDA Food Guide Pyramid were examined. METHODS: Data from the USDA 1994-96 Continuing Survey of Food Intakes by Individuals were used in multivariate regression analyses to assess the statistical and practical significance of added sugars intake for diet and nutrient adequacy. RESULTS: The association of added sugars with consumption of vitamins, minerals and servings of foods in the USDA Food Guide Pyramid was usually statistically significant. For the model of all individuals over two years of age, individuals who consume more added sugars are predicted to consume more grains, lean meat and iron and to consume fewer vegetables and fruits and less dairy, vitamin A, calcium and folates. Children who consume more added sugars are predicted to consume more grains, vitamin C, iron and folates and to consume less dairy. Adolescents who consume more added sugars are predicted to consume more grains, vitamin C and iron and less fruit. CONCLUSION: The associations, whether positive or negative, however, were always small from either a practical perspective or in comparison to the associations of other sources of energy.     

Telephone counseling promotes dietary change in healthy adults: results of a pilot trial

Telephone counseling is increasingly reported to be an effective behavior change strategy, but more studies in broader populations are needed. This uncontrolled pilot trial investigated whether a 3-month/eight-call telephone counseling intervention could promote dietary changes associated with reduced chronic disease risk in adults consuming <5.0 servings of vegetables and fruits daily. Between 2002 and 2004, 97 adults (mean age 46 years; range 21 to 84 years) completed the intervention and a follow-up assessment at 6 months. Approximately half were of nonwhite ethnicity (53%). The majority were women (95%) and had never had cancer (89%). The intervention promoted daily intakes of three to five vegetable servings, two to four fruit servings, and three whole-grain and/or beans/legumes servings. Average total daily intake of vegetables, fruits, whole grains, beans/legumes, fiber, and fat were assessed at baseline and at 6 months, each by a set of three 24-hour recalls. Plasma carotenoids were measured on a subsample (n=41) as an objective biomarker of vegetable and fruit intake. Change in mean self-reported dietary intake (ie, vegetables, fruit, whole grains, beans/legumes, fiber, and fat) and plasma carotenoids were compared by paired t tests. The intervention was associated with a significant (P<0.001) increase in vegetable servings per day (baseline 2.1 servings per day, 6 months 3.5 servings per day; 67% increase), fruit servings per day (baseline 1.4 servings per day, 6 months 2.4 servings per day; 71% increase), and whole-grain and/or bean servings per day (baseline 1.0 serving per day, 6 months 1.4 servings per day; 40% increase). These changes were corroborated by a significant (P<0.001) increase in total plasma carotenoids. This 3-month/eight-call telephone counseling intervention was associated with dietary change in healthy adults consuming fewer than five servings per day of vegetables and fruit at study entry.     

Patterns of fruit, vegetable, and milk consumption among smoking and nonsmoking female teens

BACKGROUND: The increase in teenage smoking, and the fact that concern about body weight is given as a reason for smoking initiation by girls, suggest that food intake may be compromised in female teens who smoke. Daily consumption of a variety of foods is important due to the health-protective constituents they contain. Few studies have documented how smoking and the consumption of fruits, vegetables, and milk may be associated in female teens. METHODS: This study examined the relationship of smoking and the consumption of fruit, fruit juice, vegetables, and milk in ninth- to twelfth-grade Caucasian (n=2797), African-American (n=2196), and Hispanic (n=2052) female teens. Data from the Youth Behavior Risk Survey (1999) were analyzed with SUDAAN software, using logistic regression models. RESULTS: Smoking was significantly associated with decreased odds of consuming milk at 0.74 (95% confidence interval [CI], 0.55-0.98); fruit, 0.70 (95% CI, 0.54-0.92); fruit juice, 0.74 (95% CI, 0.56-0.98); and vegetables, 0.75 (95% CI, 0.63-0.89) among Caucasian female teens, and with decreased odds of consuming fruit juice among Hispanic female teens at 0.59 (95% CI, 0.40-0.89). For each significant food variable, a dose-response relationship was detected with significantly more females consuming each food at lower smoking levels and significantly fewer doing so at the highest level (p<0.05). By contrast, African-American female teen smokers tended to consume higher levels of the specified food/beverages than nonsmokers, but this relationship was not statistically significant. IMPLICATIONS: This study establishes a smoking/food intake interaction for the specific foods tested, in an adolescent female population. Compromising the intake of healthy foods and their protective nutrients leaves young women more vulnerable to the serious health consequences of smoking. These results underscore the need for young women to be educated on the importance of eating maximum servings of fruits and vegetables and dairy products, such as milk, particularly if they smoke or are at risk for smoking initiation. The study also underscores the need to culturally tailor programs according to differences in smoking initiation and eating/dieting behaviors.     

Vegetable and fruit food frequency questionnaire serves as a proxy for quantified intake

BACKGROUND: Public health practitioners need valid tools to survey trends in dietary intake. The Rapid Risk Factor Surveillance System (RRFSS) includes an optional six-item vegetable and fruit intake food frequency questionnaire (FFQ) module. Our objectives were 1) to compare reported vegetable and fruit consumption from the FFQ to quantified servings (portions) defined by Canada's Food Guide to Healthy Eating and ascertained by a reference method, and 2) to compare the FFQ with the reference method for their classification of the proportion of respondents consuming five or more servings of vegetables and fruit per day. METHODS: Dietitians administered 24-hour recalls to each of 174 adult respondents who had completed the FFQ as part of the RRFSS. Recalls were conducted over the telephone on three separate occasions using an adaptation of the multiple pass method. RESULTS: The mean total intake of vegetables and fruit for the group was 4.6 times/day from the FFQ versus 4.8 servings/day from the recalls (paired t-test; p = 0.92). Thirty-seven percent of respondents were classified as consuming five or more times/day by the FFQ versus 35% by the 24-hour recall servings. CONCLUSION: The FFQ tool can be used as a proxy for quantified intake of vegetable and fruit consumption.     

Energy density of foods and beverages in the Australian food supply: influence of macronutrients and comparison to dietary intake

OBJECTIVES: The energy density (ED) of the diet is considered an important determinant of total energy intake and thus energy balance and weight change. We aimed to compare relationships between ED and macronutrient content in individual food and beverage items as well as population diet in a typical Western country. DESIGN: Nutrient data for 3673 food items and 247 beverage items came from the Australian Food and Nutrient database (AusNut). Food and beverage intake data came from the 1995 Australian National Nutrition Survey (a 24-h dietary recall survey in 13 858 people over the age of 2). Relationships between ED and macronutrient and water content were analysed by linear regression with 95% prediction bands. RESULTS: For both individual food items and population food intake, there was a positive relationship between ED and percent energy as fat and negative relationships between ED and percent energy as carbohydrate and percent water by weight. In all cases, there was close agreement between the slopes of the regression lines between food items and dietary intake. There were no clear relationships between ED and macronutrient content for beverage items. Carbohydrate (mostly sucrose) contributed 91, 47, and 25% of total energy for sugar-based, fat-based, and alcohol-based beverages respectively. CONCLUSIONS: The relationship between ED and fat content of foods holds true across both population diets and individual food items available in the food supply in a typical Western country such as Australia. As high-fat diets are associated with a high BMI, population measures with an overall aim of reducing the ED of diets may be effective in mediating the growing problem of overweight and obesity.     

Increasing fruits and vegetables in midlife women: a feasibility study

The positive link between bone health and fruit/vegetable consumption has been attributed to the lower renal acid load of a diet high in alkaline-forming fruit/vegetables. Other important dietary determinants of bone health include micronutrients and bioactives found in fruit/vegetables. We hypothesized that increased intake of fruit/vegetables to 9 or more servings a day would lower net endogenous acid production (NEAP) significantly (~20 mEq/d) and increase urine pH (0.5 pH units). This 8-week feasibility study investigated if 21 midlife women (age, 40-65 years) currently consuming 5 or less servings a day of fruit/vegetables could increase their intake to 9 or more servings a day to substantially lower NEAP and include specific vegetables daily. Three-day diet diaries were completed at baseline and the end of the study and assessed for NEAP (estimated) and number of servings from all food groups. Urine pH dipsticks were provided for the participants to assess and record their fasting urine pH daily (second void). Seventy-six percent of women achieved the study aim, which was to increase to 9 or more servings of fruit/vegetables for at least 5 d/wk. There was a reduction in the number of bread/cereal servings. Net endogenous acid production (estimated) was reduced significantly, with a mean urine pH increase of 0.68 pH units (95% confidence interval, 0.46-1.14); however, daily urine pH measures showed high variability. This study demonstrated that a group of midlife women can change their diet for 8 weeks by significantly increasing fruit/vegetable servings and include specific “bone friendly” vegetables daily, resulting in a significant decrease in estimated dietary NEAP and an increase in urine pH.     

Low-energy-density diets are associated with high diet quality in adults in the United States

OBJECTIVE: This study investigated food choices made by individuals consuming diets differing in energy density and explores relationships between energy density and diet quality. DESIGN: Cross-sectional, nationally representative survey. SUBJECTS: 7,500 adults (older than 19 years) in the 1994-1996 Continuing Survey of Food Intakes by Individuals. STATISTICAL ANALYSIS: Energy density values were calculated from reported food intake. Subjects were classified as consuming a low-energy-density diet, medium-energy-density diet, or high-energy-density diet using tertile cutoffs. For each group, the percentage consuming various foods/beverages and the mean amount of foods/beverages they consumed was determined along with mean nutrient intakes. RESULTS: Compared with participants consuming a high-energy-density diet, those with a low-energy-density diet had a lower energy intake but consumed more food, by weight, from most food groups. A low-energy-density diet included a relatively high proportion of foods high in micronutrients and water and low in fat, such as fruits and vegetables. Subjects with a low-energy-density diet consumed fewer (nonwater) beverages such as caloric carbonated beverages. They also consumed less fat and had higher intakes of several important micronutrients, including vitamins A, C, and B-6, folate, iron, calcium, and potassium. CONCLUSIONS: These analyses further demonstrate the beneficial effects of a low-energy-density diet, which was associated with lower energy intakes, higher food intakes, and higher diet quality than a high-energy-density diet. To achieve a low-energy-density diet, individuals should be encouraged to eat a variety of fruits and vegetables as well as low-fat/reduced-fat, nutrient-dense, and/or water-rich grains, dairy products, and meats/meat alternatives.     

Dietary Energy Density and Weight Regulation

Dietary energy density (ED) has been suggested as an important determinant of energy intake and, therefore, energy regulation. This review summarizes published studies on the effects of dietary ED on hunger, satiety, energy intake, and body weight in healthy individuals, and compares the relative effects of ED manipulated by dietary fat only, fat and fiber, water, and type of sweetener. In short-term studies, consumption of low-ED foods promotes satiety, reduces hunger, and decreases energy intake with no marked differences between different dietary manipulations used to change ED. In addition, low-ED diets promote moderate weight loss in long-term studies. In studies lasting longer than 6 months, weight loss was more than three times as great in individuals consuming diets both low in fat and high in fiber compared with diets only low in fat (−3.4 kg versus -1.0 kg). Combined, these studies suggest that diets low in fat and high in fiber may be the most effective low-ED diets for promoting weight loss. Further research is needed on the effects of dietary ED by changing water or sweetener content.     

Fruit and vegetable availability enables adolescent consumption that exceeds national average

The availability of fruit, juice, and vegetables (FJV) in home and school settings is positively associated with adolescent fruit and vegetable consumption. Less is known, however, about the influence on youths' consumption of the availability of FJV in community-based settings. This study examined fruit and vegetable consumption in a sample of 156 African American adolescents (mean age, 11.89 years; range, 10-14 years; 55% female) who were provided with 3 servings each of FJV (9 servings daily) for 3 consecutive days during summer camp programming in New York City youth services agencies. It was hypothesized that youths' mean intake (measured via direct observation) would exceed the mean intake of 3.6 daily servings found among similarly aged youths in the US population given the consistently high number of servings of FJV offered. Intake differences by sex, age, and meal were also examined. Youths' mean (SD) intake of 5.41 (1.51) daily servings was higher than the population mean intake of 3.6 daily servings (P < .001). Youths aged 10 years had higher intake than did youths aged 11, 12, and 13 years. Youths' FJV intake was lower at lunch than at breakfast and dinner meals. Across meals, youths consumed more juice than fruit or vegetables. Increasing the availability of FJV in community-based settings is a promising strategy for enabling fruit and vegetable consumption among African American adolescents. Youths may also benefit from intervention to prevent age-related declines in intake, increase consumption of FJV at lunch meals, and encourage higher consumption of vegetables and fruit.     

Defining and measuring stages of change for dietary behaviors: readiness to meet fruit, vegetable, and grain guidelines among Chinese Singaporeans

OBJECTIVE: To assess the ability of 2 algorithms to classify people by stage of change for consuming the recommended servings of grains (cereal foods) and total fruit and vegetables. DESIGN: Assessment of stage involved an objective behavioral measure in the form of a self-administered food frequency questionnaire, followed by a brief telephone interview to assess intentions of subjects to increase intake to meet the recommended servings. Validity of the stage classification was assessed by comparison with three 24-hour dietary recalls. SUBJECTS: One hundred and one Singaporean Chinese subjects (mean age = 38.7; 51% men) were recruited from 716 respondents who had taken part in a survey investigating factors influencing consumption of grains, fruit, and vegetables. STATISTICAL ANALYSES PERFORMED: Differences in mean intake by diet recalls across the stages were investigated using analysis of variance. Sensitivity, specificity, and predictive values of the algorithms were also determined. RESULTS: There were significant increases across the stages in mean intake of grains (men: F(2,48) = 20.30, P < .001; women: F(2,47) = 23.39, P < .0001), and total fruit and vegetables (men: F(2,48) = 30.29, P < .005; women: F(2,47) = 37.29, P < .0001). Based on diet recalls for grains intake, the algorithms classified 89% of subjects having inadequate intakes into the preaction stages, and 75% of those having adequate intakes into the action or maintenance stages. For fruit and vegetables, 93% of subjects having inadequate intakes were classified into the preaction stages, and 76% of those having adequate intakes were classified into the action or maintenance stages. CONCLUSION: Algorithms developed to assess stages of change for food-based rather than nutrient goals, and which include an objective assessment of intake, appear to improve the accuracy of stage classifications.     

The role of dietary fat in body fatness: evidence from a preliminary meta-analysis of ad libitum low-fat dietary intervention studies

The role of high-fat diets in weight gain and obesity has been questioned because of inconsistent reports in the literature concerning the efficacy of ad libitum low-fat diets to reduce body weight. We conducted a meta-analysis of weight loss occurring on ad libitum low-fat diets in intervention trials, and analysed the relationship between initial body weight and weight loss. We selected controlled trials lasting more than 2 months comparing ad libitum low-fat diets with a control group consuming their habitual diet or a medium-fat diet ad libitum published from 1966 to 1998. Data were included from 16 trials with a duration of 2-12 months, involving 1728 individuals. No trials on obese subjects fulfilled the inclusion criteria. The weighted difference in weight loss between intervention and control groups was 2.55 kg (95% CI, 1.5-3.5; P < 0.0001). Weight loss was positively and independently related to pre-treatment body weight (r = 0.52, P < 0.05) and to reduction in the percentage of energy as fat (0.37 kg/%, P < 0.005) in unweighted analysis. Extrapolated to a BMI of about 30 kg/m2 and assuming a 10% reduction in dietary fat, the predicted weight loss would be 4.4 kg (95% CI, 2.0 to -6.8 kg). Because weight loss was not the primary aim in 12 of the 16 studies, it is unlikely that voluntary energy restriction contributed to the weight loss. Although there is no evidence that a high intake of simple sugars contributes to passive overconsumption, carbohydrate foods with a low glycaemic index may be more satiating and exert more beneficial effects on insulin resistance and cardiovascular risk factors. Moreover, an increase in protein content up to 25% of total energy may also contribute to reducing total energy intake. In conclusion, a low-fat diet, high in protein and fibre-rich carbohydrates, mainly from different vegetables, fruits and whole grains, is highly satiating for fewer calories than fatty foods. This diet composition provides good sources of vitamins, minerals, trace elements and fibre, and may have the most beneficial effect on blood lipids and blood-pressure levels. A reduction in dietary fat without restriction of total energy intake prevents weight gain in subjects of normal weight and produces a weight loss in overweight subjects, which is highly relevant for public health.     

A comparison of three methods of determination of energy density of elite figure skaters

Dietary energy density (kcal/g) is defined as available dietary energy per unit weight or volume of food. The consumption of energy-dense foods has been associated with increased obesity risk and with excessive weight gain. The objectives of this study were to compare how dietary energy density, calculated using three different methods relates to food choices and nutrient composition of the diets of elite figure skaters. Participants were 159 elite figure skaters attending training camps. Mean age was 18.4 y for boys (n = 79) and 15.9 y for girls (n = 80). Heights and weights were measured to calculate body-mass indices (BMI). Dietary intakes were based on 3-d food records analyzed using the Nutritionist IV program. Mean energy intakes were 2326 kcal/d for boys and 1545 kcal/d for girls. Dietary energy density,,based on foods and caloric beverages only, was 1.0 kcal/g. Dietary ED was positively associated with percent energy from fat and negatively with percent energy from sugar. The main sources of dietary energy in this group were baked goods, cereals, regular soda, low-fat milk, fruit juices, bagels and pizza. Percent energy from fast foods was associated with higher dietary energy density, whereas percent energy from dairy products, soft drinks, vegetables, and fruit was associated with lower dietary energy density. These results are consistent with past observations; higher energy density diets were higher in fat. In contrast, there was a negative relationship between sugar content and energy density of the diet.     

Design of a Mediterranean Exchange List Diet Implemented by Telephone Counseling

A Greek-Mediterranean dietary pattern has two distinct aspects that differ relative to average intakes in the United States: a high intake of monounsaturated fats and a high intake of fruit and vegetables. The purpose of the study was to develop and test an exchange list Greek-Mediterranean diet that could be used in future clinical trials of breast cancer prevention. A total of 69 women, ages 25 to 59 years, were randomized to either continue their own usual diet or follow an intervention diet for 6 months during 2004 through 2005. Intervention goals were to decrease usual fat intakes by about half and to replace those fats with olive oil and other high–monounsaturated fatty acid foods; increase fruit and vegetable intakes to 7 to 9 servings/day, depending on energy intake; and consume at least one serving per day each of culinary herbs and allium vegetables. Registered dietitians provided exchange goals and individualized telephone counseling, and diets were self-selected using a Mediterranean exchange list developed specifically for this study. Changes in diet were assessed by 7-day food records. Results demonstrated that counseling using the Mediterranean exchange list was effective for large dietary changes relative to the nonintervention group. Repeated measures analysis of variance indicated a statistically significant 48% increase in dietary monounsaturated fat with no appreciable change in total fat intake, and a significant increase in fruit and vegetable intake from 4.0 to 8.6 servings/day (P < 0.05).