Abstract P616: Implementing a Dietary Energy Density Intervention in Preschool Children

Abstract

Introduction: The preschool years have been identified as a critical time to intervene on energy balance behaviors to halt the progression of obesity. In children, strategies for achieving physical activity recommendations are well established. Less clear are strategies for implementing an optimal dietary approach—one that maintains a healthy body weight and improves diet quality. Energy density (ED), the amount of energy per unit weight of food (kcal/g), may be a promising dietary approach. Hypothesis: We tested the hypothesis that a lower ED dietary approach will lower ED and energy intake and demonstrate better maintenance of body mass index (BMI z-score) than standard dietary recommendations in young children at risk for obesity. Methods: Thirty-six preschool children (3.5±1.1 years; 52.8% female; 52.8% White; 16.7% Hispanic or Latino; BMI percentile 56.8±22.2) and their parent (35.4±6.2 years; 86.1% female; 55.6% White; 13.9% Hispanic or Latino; BMI 38.2±5.4 kg/m 2 ) participated in a 6-month, 14-session, family-based behavioral intervention. Participants were randomized to a low-ED dietary approach (consume ≥10 foods/day with an ED ≤1.0 kcal/g and ≤2 foods/day with an ED ≥ 3.0 kcal/g; LOW-ED), or standard dietary recommendations (meet recommended daily servings of fruits, vegetables, and whole grains; STANDARD). Both interventions had physical activity goals of 60 minutes/day for children and 150 minutes/week for adults. Dietary and anthropometric assessments occurred at baseline and 6-months. Completer and intent-to-treat (ITT) analyses, with outliers removed, used repeated measures general linear mixed models to examine child change in ED (calculated as both all foods and beverages and food only), kcals, and BMI z-score from baseline to 6 months. Results: ITT analyses showed that the change in ED did not differ between the LOW-ED condition and STANDARD condition when calculated as for foods and beverages (LOW-ED: Δ-0.1 kcal/g vs. STANDARD: Δ+0.1 kcal/g, p = 0.12) or food only (LOW-ED: Δ-0.2 kcal/g vs. STANDARD: Δ+0.1 kcal/g, p = 0.06). There was a significant time by condition interaction with kcals/d decreasing in LOW-ED and increasing in STANDARD over time for completers (LOW-ED: Δ-98 kcals vs. STANDARD: Δ+212 kcals, p = 0.04), but not when using ITT (LOW-ED: Δ+5 kcals vs. STANDARD: Δ+211 kcals, p = 0.09). Under ITT BMI z-score had a main effect of time, with both LOW-ED and STANDARD conditions significantly increasing over time (p=0.03). Conclusion: In conclusion, these data suggest a LOW-ED dietary approach is an alternative way to lower ED and energy intake in young children at risk for obesity.