High Energy Density Foods Research Articles

Functional Magnetic Resonance Imaging (fMRI) of Neural Responses to Visual and Auditory Food Stimuli Pre and Post Roux-en-Y Gastric Bypass (RYGB) and Sleeve Gastrectomy (SG)

Of current obesity treatments, bariatric surgery induces the most weight loss. Given the marked increase in the number of bariatric surgeries performed, elucidating the mechanisms of action is a key research goal. We compared whole brain activation in response to high-energy dense (HED) vs. low-energy dense (LED) visual and auditory food cues before and approximately 4 months after Roux-en-Y Gastric Bypass (RYGB) (n = 16) and Sleeve Gastrectomy (SG) (n = 9). We included two control groups: a low-calorie diet weight loss group (WL) (n = 14) and a non-treatment group (NT) (n = 16). Relative to the control groups, the surgery groups showed increased dorsolateral prefrontal cortex (dlPFC) and decreased parahippocampal/fusiform gyrus (PHG/fusiform) activation in response to HED vs. LED, suggesting greater cognitive dietary inhibition and decreased rewarding effects and attention related to HED foods. dlPFC activation was significantly more increased in RYGB vs. SG. We also found that postprandial increases in GLP-1 concentrations (pre to postsurgery) correlated with postsurgical decreases in RYGB brain activity in the inferior temporal gyrus and the right middle occipital gyrus in addition to increases in the right medial prefrontal gyrus/paracingulate for HED > LED stimuli, suggesting involvement of these attention and inhibitory regions in satiety signaling postsurgery.

Understanding everyday strategies used to manage indulgent food consumption: A mixed-methods design

To maintain a healthy body weight or support weight loss efforts, dietary self-management must allow for the limitation of tempting high energy-dense foods. We were interested in people's implementation of day-to-day strategies in order to successfully manage their indulgent food and beverage consumption. Participants from the Swansea area, UK (N = 25; Mage = 37; 68% male) were divided into four focus groups. The average BMI was within the healthy range (23 kg/m2). Each group discussed the approaches that they used to manage their consumption of indulgent foods and drinks. Group discussions were then transcribed, thematically analysed and independently reviewed by a second researcher. In a follow-up phase, participants were asked to rate how often they used the identified strategies and to rate the perceived effectiveness of any that applied to them. The thematic analysis revealed four major themes: Exercise, Cognitive Strategies, Availability and Meal Formation. Variability in the frequency with which strategies were used and perceived as effective was evident. Notably, participants tended to use multiple strategies and even lean participants who did not identify themselves as ‘dieters’ none-the-less employed a variety of strategies to successfully manage their exposure to and consumption of tempting foods. The findings suggest that dietary advice could be improved by taking into account the strategies for managing indulgent food consumption that are frequently used by individuals, as well as those that are perceived as effective.

Relationship between dietary intake and obesity among a group of primary school-aged children in Cairo Governorate

Context Currently, childhood obesity has been growing at an alarming rate, and it is a common nutritional problem among children in developed countries as well as in developing countries. It has become one of the most serious public health challenges of the 21st century. Aim This study attempts to determine the relationship between dietary pattern and obesity among primary school children. Patients and methods This is a cross-sectional descriptive study involving 842 children (6–12 years old), comprising 389 boys and 453 girls. This study was carried out by using anthropometric data and dietary assessment (24 h recall) and food consumption pattern. Results The finding revealed that high-density foods were significantly associated with obesity. Obese children adequately took bodybuilding food. Preventive food was adequately taken, but some of them were within the recommended dietary allowance percentage, and others were less than recommended dietary allowance percentage. Conclusion We concluded that there was a positive correlation between the increased intake of high-energy dense food (fat and sugar) and obesity in the studied group.

Prudent-Active and Fast-Food-Sedentary Dietary-Lifestyle Patterns: The Association with Adiposity, Nutrition Knowledge and Sociodemographic Factors in Polish Teenagers-The ABC of Healthy Eating Project.

A holistic approach to understanding the relationship between diet, lifestyle and obesity is a better approach than studying single factors. This study presents the clustering of dietary and lifestyle behaviours to determine the association of these dietary-lifestyle patterns (DLPs) with adiposity, nutrition knowledge, gender and sociodemographic factors in teenagers. The research was designed as a cross-sectional study with convenience sampling. The sample consisted of 1549 Polish students aged 11–13 years. DLPs were identified with cluster analysis. Logistic regression modelling with adjustment for confounders was applied. Three dietary-lifestyle patterns were identified: Prudent-Active (29.3% of the sample), Fast-food-Sedentary (13.8%) and notPrudent-notFast-food-lowActive (56.9%). Adherence to Prudent-Active pattern (reference: notPrudent-notFast-food-lowActive) was 29% or 49% lower in 12-year-old or 13-year-old teenagers than in 11-year-old teenagers, respectively, and higher by 57% or 2.4 times in the middle or the upper tertile than the bottom tertile of the nutrition knowledge score. To the contrary, adherence to Fast-food-Sedentary (reference: notPrudent-notFast-food-lowActive) was lower by 41% or 58% in the middle or the upper tertile than the bottom tertile of the nutrition knowledge score, respectively. In Prudent-Active, the chance of central obesity (waist-to-height ratio ≥0.5) was lower by 47% and overweight/obesity was lower by 38% or 33% (depending on which standard was used: International Obesity Task Force, 2012: BMI (body mass index)-for-age ≥ 25 kg/m2 or Polish standards, 2010: BMI-for-age ≥ 85th percentile) when compared with the notPrudent-notFast-food-lowActive pattern. In Fast-food-Sedentary, the chance of central obesity was 2.22 times higher than the Prudent-Active pattern. The study identified a set of characteristics that decreased the risk of general and central adiposity in teenagers, which includes health-promoting behaviours related to food, meal consumption and lifestyle. Avoiding high-energy dense foods is insufficient to prevent obesity, if physical activity and the consumption frequency of health-promoting foods are low and breakfast and a school meal are frequently skipped. The results highlight the importance of the nutrition knowledge of teenagers in shaping their health-promoting dietary habits and active lifestyle to decrease adiposity risk and negative aspects of lower family affluence which promotes unhealthy behaviours, both related to diet and lifestyle.

Can Reduced Intake Associated with Downsizing a High Energy Dense Meal Item be Offset by Increased Vegetable Variety in 3⁻5-year-old Children?

Large portions of energy dense foods promote overconsumption but offering small portions might lead to compensatory intake of other foods. Offering a variety of vegetables could help promote vegetable intake and offset the effect of reducing the portion size (PS) of a high energy dense (HED) food. Therefore, we tested the effect on intake of reducing the PS of a HED unit lunch item while varying the variety of the accompanying low energy dense (LED) vegetables. In a within-subjects design, 43 3–5-year-old pre-schoolers were served a lunch meal in their nursery on 8 occasions. Children were served a standard (100%) or downsized (60%) portion of a HED sandwich with a side of LED vegetables offered as a single (carrot, cherry tomato, cucumber) or variety (all 3 types) item. Reducing the PS of a HED sandwich reduced sandwich (g) (p < 0.001) and total meal intake (kcal) consumption (p = 0.001) without an increased intake of other foods in the meal (LED vegetables (p = 0.169); dessert (p = 0.835)). Offering a variety of vegetables, compared with a single vegetable, increased vegetable intake (g) (p = 0.003) across PS conditions. Downsizing and variety were effective strategies individually for altering pre-schoolers’ intakes of HED and LED meal items, however, using variety to offset HED downsizing was not supported in the present study.

Impact of price elasticity on the healthfulness of food choices by gender

Objective: To extend findings from experimental price elasticity studies by examining these effects in a field setting and identifying gender differences in purchasing behaviour in response to variations in the cost of lower energy-dense (ED) and higher ED foods. Setting: Data were collected from low- and median-income male and female grocery shoppers at a supermarket in the Western New York region. Design: Using a procedure adapted from experimental economics, participants were given a debit card in a grocery store setting and allowed to purchase any foods from two pricing conditions. Conditions were identical, except one had lower ED foods low priced, and the other had lower ED foods higher priced. The design was fully counterbalanced. Results: Overall, when lower ED foods were more expensive, fewer lower ED foods were purchased (95% confidence interval [CI]: −1.0, −.40). Gender differences revealed that men spent more money (in dollars) when higher ED foods were higher priced (95% CI: US$0.51, US$1.73) and women spent more money when lower ED foods were higher priced (95% CI: − US$2.21, − US$0.11). Furthermore, women, but not men, increased spending when lower ED foods were higher priced (95% CI: − US$2.85, − US$0.73). Conclusion: Higher costs for fruits and vegetables among consumers can adversely affect the purchase volume of these foods, with men being most susceptible to pricing manipulations. Results contribute to an understanding of how perceptions of price impact consumer choice and suggest that efforts aimed to increase the perceived value of health over cost should be tailored towards men.

Implicit and explicit evaluations of foods: The natural and transformed dimension

In Western societies, choosing what to eat can be a demanding task due to the excessive availability of food. To make our feeding decisions more complex, our explicit and implicit evaluations of foods may differ as they are multi-attribute stimuli. Previous research has focused on investigating implicit and explicit evaluations towards high and low energy dense foods, the main finding being that participants’ hunger level and dietary habits (restrained eating) modulate such evaluations. In the present study, we investigated whether normal-weight healthy individuals assigned different values to natural and transformed foods depending on implicit (assessed with the Implicit Association Test) or explicit measures (assessed with explicit ratings), and whether participants’ hunger level or dietary habits modulated the responses at both levels. Our results showed that while for natural foods implicit and explicit measures (healthiness) seemed to converge, dietary habits or hunger level did not affect such evaluations. For transformed foods, a dissociation between implicit and explicit measures (healthiness) seemed to emerge, along with a strong modulation of dietary habits and hunger level on the evaluations of such foods. Thus, these findings reveal how the type of food can modulate evaluations at both the implicit and explicit level and highlight a critical role of long-term health consequences and eating patterns in food evaluations.

Food commercials do not affect energy intake in a laboratory meal but do alter brain responses to visual food cues in children

Food commercials promote snack intake and alter food decision-making, yet the influence of exposure to food commercials on subsequent neural processing of food cues and intake at a meal is unclear. This study tested whether exposing children to food or toy commercials altered subsequent brain response to high- and low-energy dense food cues and influenced laboratory intake at a multi-item, ad libitum meal. Forty-one 7-9-year-old children (25 healthy weight; 16 with overweight/obesity) completed five visits as part of a within-subjects design where they consumed multi-item test-meals under three conditions: no exposure, food commercial exposure, and toy commercial exposure. On the fourth and fifth visits, functional magnetic resonance imaging (fMRI) was performed while children viewed low- and high-energy dense food images following exposure to either food or toy commercials. Linear mixed models tested for differences in meal energy intake by commercial condition. A whole-brain analysis was conducted to compare differences in response by commercial condition and child weight status. Meal intake did not differ by commercial condition (p = 0.40). Relative to toy commercials, food commercials reduced brain response to high-energy food stimuli in cognitive control regions, including bilateral superior temporal gyri, middle temporal gyrus, and inferior frontal gyrus. Commercial condition * weight status interactions were observed in orbitofrontal cortex, fusiform gyrus, and supramarginal gyrus. Children with overweight/obesity showed increased response in these regions to high-energy stimuli following food commercials. Food commercial exposure affected children's subsequent processing of food cues by reducing engagement of the prefrontal cortex, a region implicated in cognitive control. Even though food commercial exposure did not increase intake at a meal, the effect of reduced prefrontal cortical engagement on a broader range of consumption patterns warrants investigation.

Parent Instrumentality for Adolescent Eating and Activity.

Parent-adolescent interactions have health implications for adolescents. Parents can be instrumental to healthy eating by purchasing fruits and vegetables or refraining from purchasing hedonic (low nutrient, high energy-dense) foods. Parents can be instrumental to healthy activity by modeling exercise behavior or discouraging sedentary activities. This research leverages theory on goal pursuit within relationships to investigate whether parents are instrumental to adolescents' eating and activity. Using a national sample of 1,556 parent-adolescent dyads, we conducted dyadic analyses to examine whether parent instrumentality (both parent-perceived and adolescent-perceived) for healthy behaviors was associated with adolescent engagement in those behaviors. We examined whether the link between parent instrumentality and adolescent BMI was mediated by parent instrumentality. We also explored whether parent instrumentality was associated with parent behaviors and parent BMI. Greater adolescent-perceived parent instrumentality was associated with greater fruit and vegetable consumption and physical activity, and lower sedentariness. Parent-perceived parent instrumentality was associated with greater adolescent fruit and vegetable consumption, less hedonic eating, and more activity. Mediation modeling suggests that adolescent BMI is partially attributable to parent instrumentality for activity. Instrumental parents also engage in healthier behaviors, some of which in turn are associated with lower parent BMI. Findings have implications for the promotion of healthy eating and activity patterns among adolescents. Parental instrumentality for behavior may be an important target for interventions to improve adolescent health, and interventions may be most successful in facilitating adolescent behavior change if they target both parent- and adolescent-perceived parent instrumentality.

Predictors of portion size of high energy density foods in children and adolescents: evidence from the UK National Diet and Nutrition Survey

Predictors of portion size of high energy density foods in children and adolescents: evidence from the UK National Diet and Nutrition Survey

Neural correlates of familial obesity risk and overweight in adolescence

Abstract Background Rates of adolescent obesity and overweight are high. The offspring of overweight parents are at increased risk of becoming obese later in life. Investigating neural correlates of familial obesity risk and current overweight status in adolescence could help identify biomarkers that predict future obesity and that may serve as novel targets for obesity interventions. Objective Our primary aim was to use functional MRI to compare neural responses to words denoting high or low energy density (ED) foods and non-foods, in currently lean adolescents at higher compared with lower familial risk for obesity, and in overweight compared with lean adolescents. Secondary aims were to assess group differences in subjective appetite when viewing food and non-food words, and in objective ad libitum intake of high-ED foods in a laboratory setting. Design We recruited 36 adolescents (14-19y), of whom 10 were (obese/overweight “ overweight ”), 16 lean with obese/overweight mothers (lean high-risk, “ lean-HR” ), and 10 lean with lean mothers (lean low-risk, “ lean-LR” ). All underwent fMRI scanning while they viewed words representing high-ED foods, low-ED foods, or non-foods, and provided appetitive ratings in response to each word stimulus. They then consumed a multi-item ad libitum buffet meal. Results Food compared with non-food words activated a distributed emotion/reward system including insula and pregenual anterior cingulate cortex (ACC). Participants who were at increasing risk for obesity exhibited progressively weaker activation of an attentional/regulatory system including dorsolateral prefrontal cortex (PFC), dorsal ACC, and basal ganglia nuclei (activation was greatest in lean-LR, intermediate in lean-HR, and weakest in the overweight group). These group differences were most apparent for neural responses to high-compared with low-ED foods. Lean-HR (compared with lean-LR and overweight) adolescents reported greater desire for high-ED foods. Meal intake was greatest for the overweight, then lean-HR, then lean-LR groups. Conclusions Adolescents at higher obesity risk exhibited reduced neural responses to high-ED food cues in a neural system that subserves attention and self-regulation. They also reported heightened appetitive responses to high-ED cues. Interventions that promote the capacity for self-regulation could prevent youth who have a familial predisposition for obesity from translating risk into reality.

The “price” of health: Fruit and vegetable costs differentially affect purchase volume by gender

The purpose of this study was to extend findings that experimental cost manipulations influence purchasing behavior by examining these effects in a field setting and identify gender differences in purchasing behavior in response to variations in the cost of lower energy dense (ED) and higher ED foods. Using a counterbalanced procedure adapted from experimental economics, low- and median- income male and female grocery shoppers at a regional supermarket were given a debit card and allowed to purchase any foods from 2 tables. Tables were identical, except one had lower ED foods low priced; the other had lower ED foods higher priced. Results showed that when lower ED foods were more expensive, fewer lower ED foods were purchased overall (95% CI -1.0, -.40), with men spending more money (in dollars) when high calorie foods were higher priced (95% CI $0.51, $1.73); however, women, but not men, increased spending when low calorie foods were higher priced (95% CI -$2.85, -$0.73). Overall, the results contribute to an understanding of how perceptions of price impact consumer choice and suggest that efforts aimed to increase the perceived value of health over cost should be tailored towards men.

Understanding the science of portion control and the art of downsizing.

Offering large portions of high-energy-dense (HED) foods increases overall intake in children and adults. This is known as the portion size effect (PSE). It is robust, reliable and enduring. Over time, the PSE may facilitate overeating and ultimately positive energy balance. Therefore, it is important to understand what drives the PSE and what might be done to counter the effects of an environment promoting large portions, especially in children. Explanations for the PSE are many and diverse, ranging from consumer error in estimating portion size to simple heuristics such as cleaning the plate or eating in accordance with consumption norms. However, individual characteristics and hedonic processes influence the PSE, suggesting a more complex explanation than error or heuristics. Here PSE studies are reviewed to identify interventions that can be used to downsize portions of HED foods, with a focus on children who are still learning about social norms for portion size. Although the scientific evidence for the PSE is robust, there is still a need for creative downsizing solutions to facilitate portion control as children and adolescents establish their eating habits.

A Low Energy–Dense Diet in the Context of a Weight-Management Program Affects Appetite Control in Overweight and Obese Women

BackgroundLow energy–dense (LED) foods reduce energy intake (EI); whether this effect is sustained over time and during weight loss is unknown.ObjectiveThis trial examined the effects of LED compared with high energy–dense (HED) meals on appetite, EI, and control over eating in the laboratory and during a weight-management program that encourages unrestricted intake of LED foods [Slimming World, UK (SW)] compared with a self-led Standard Care program [NHS weight-loss plan (SC)].MethodsOverweight and obese women [n = 96; mean ± SD age: 41.03 ± 12.61 y; mean ± SD body mass index (in kg/m2): 34.00 ± 3.61] were recruited from the SW or SC programs. Primary outcomes included appetite, food preferences (liking and wanting for LED and HED foods), cravings, and evening meal EI (LED, HED) in response to calorie-matched LED (≤0.8 kcal/g) and HED (≥2.5 kcal/g) breakfast and lunch meals. Probe-day tests were conducted at weeks 3 and 4 and repeated at weeks 12 and 13 in a within-day crossover design. Secondary outcomes, including body weight and program experience, were measured from weeks 1 to 14 in a parallel-group design. Dietary compliance was monitored with the use of weighed food diaries at weeks 3 and 12.ResultsIntention-to-treat (ITT) and completers analyses showed that the SW group lost more weight than the SC group [ITT: −5.9% (95% CI: −4.7%, –7.2%) compared with −3.5% (−2.3%, −4.8%), P < 0.05; completers: −6.2% (−4.8%, −7.6%) compared with 3.9% (−2.5%, −5.2%), P < 0.05]. The SW group reported greater control over eating and more motivation to continue the program compared with the SC group. LED meals increased sensations of fullness and reduced hunger on probe days (P < 0.001). Total-day EI was 1057 ± 73 kcal less (95% CI: 912, 1203 kcal; 36%) under LED compared with HED conditions (P < .001). Liking for LED and HED foods and wanting for HED foods were lower before lunch under LED compared with HED conditions, and liking decreased to a greater extent after the LED lunch. The SW group reported fewer cravings under LED compared with HED conditions (P < 0.05). On probe days, appetite and EI outcomes did not differ between weeks 3 and 12 or between the SW and SC groups.ConclusionLED meals improve appetite control in women attempting weight loss and the effect is sustainable. Consumption of LED meals likely contributed to weight loss in the SW program. This study was registered at clinicaltrials.gov as NCT02012426.

Negative urgency moderates reactivity to laboratory stress inductions.

Impulsive personality traits refer to a group of self-reported dispositions about self-regulatory capacity, several of which have been linked to diverse forms of psychopathology. One of these is negative urgency (NUR), the propensity to act out when experiencing negative emotions, which has been linked to substance use disorders and eating disorders. However, few laboratory studies have investigated the extent to which self-reported NUR relates to an individual's in vivo emotional and behavioral responses. Harmonizing two archival data sets on alcohol and high-energy-dense (HED) food motivation, the current study investigated NUR as a moderator of reactivity to stressful situations elicited by two commonly used stress manipulations, the Trier Social Stress Test and a stress imagery induction. A sample of 148 adults was assessed for NUR, severity of alcohol misuse or binge eating, and measures of negative affect and psychophysiological arousal (i.e., heart rate and blood pressure) prior to and following one of the two manipulations. In addition, a behavioral multiple-choice procedure assessing the relative reinforcing value of alcohol or HED foods followed the manipulations. As predicted, NUR positively moderated the effects of stress induction on self-reported negative affect and relative reinforcing value, although not arousal. Individuals exhibiting elevated NUR also exhibited greater alcohol misuse, although not greater binge eating severity. These findings provide in vivo validation of the construct of NUR and its measurement using the UPPS-P Impulsive Behavior Scale. More broadly, these findings inform the understanding of deficits that are characteristic of self-regulatory disorders. (PsycINFO Database Record

Reinforcing value and hypothetical behavioral economic demand for food and their relation to BMI

Food is a primary reinforcer, and food reinforcement is related to obesity. The reinforcing value of food can be measured by establishing how hard someone will work to get food on progressive-ratio schedules. An alternative way to measure food reinforcement is a hypothetical purchase task which creates behavioral economic demand curves. This paper studies whether reinforcing value and hypothetical behavioral demand approaches are assessing the same or unique aspects of food reinforcement for low (LED) and high (HED) energy density foods using a combination of analytic approaches in females of varying BMI. Results showed absolute reinforcing value for LED and HED foods and relative reinforcing value were related to demand intensity (r's = 0.20–0.30, p's < 0.01), and demand elasticity (r's = 0.17–0.22, p's < 0.05). Correlations between demographic, BMI and restraint, disinhibition and hunger variables with the two measures of food reinforcement were different. Finally, the two measures provided unique contributions to predicting BMI. Potential reasons for differences between the reinforcing value and hypothetical purchase tasks were actual responding versus hypothetical purchasing, choice of reinforcers versus purchasing of individual foods in the demand task, and the differential role of effort in the two tasks. Examples of how a better understanding of food reinforcement may be useful to prevent or treat obesity are discussed, including engaging in alternative non-food reinforcers as substitutes for food, such as crafts or socializing in a non-food environment, and reducing the value of immediate food reinforcers by episodic future thinking.

Downsizing portions of high energy-dense snack food and sugar-sweetened beverages in adolescents: The Smart Snacking study

Downsizing portions of high energy-dense snack food and sugar-sweetened beverages in adolescents: The Smart Snacking study

The portion size effect and overconsumption – towards downsizing solutions for children and adolescents

AbstractPortion sizes of foods offered to consumers have increased at the same time as overweight and obesity levels have risen. It has been suggested that large portions of high energy density (HED) foods increase total energy intake and that this is not compensated for in the short‐ to medium‐term, potentially promoting weight gain. In the laboratory setting, offering large portions of HED foods increases overall energy intake in both children and adults. This phenomenon is known as the portion size effect (PSE), and it is robust, reliable and enduring. The possible impact of the PSE is that large portions served over time may facilitate overeating and could contribute to overweight and obesity. Explanations for the PSE vary from simple heuristics, such as the tendency to clear the plate, to more complex biobehavioural processes, including individual differences in susceptibility to external food cues through eating traits. Consumers may eat in accordance with available consumption norms or eat opportunistically when large portions are made available. An obvious solution to the PSE is to ‘downsize’ HED meal items and snacks, but whether this strategy is acceptable or feasible is not clear. In adults, the effects of downsizing are mixed and for children and adolescents, as yet unclear. The contention is that for those who are still learning about social norms and appropriate portions, there remains the potential to counter the PSE through downsizing strategies.

Mediterranean Diet Index (KIDMED) Adherence, Socioeconomic Determinants, and Nutritional Status of Portuguese Children: The Eat Mediterranean Program

Background: Despite its health benefits, adherence to the Mediterranean diet (MD) has been decreasing, particularly in young generations and in Mediterranean regions, including Portugal. Socioeconomic and lifestyle factors have been shown to influence children and adolescents’ eating habits. This study aimed to assess the association between socioeconomic factors and children’s nutritional status with the MD adherence using the Eat Mediterranean (EM) program. Methods: Participant’s BMI and adherence to the MD diet was assessed at baseline and after the intervention. Data regarding socioeconomic status and KIDMED Index were collected using a family record form. The intervention consisted of various educational sessions addressing the principles and promoting a Mediterranean dietary pattern in schools belonging to two municipalities in the central area of Portugal. A total of 1,772 participants (from preschool to secondary school) met the inclusion criteria for the study. Results: At the end of the program, the adherence to the MD diet improved significantly with participants increasing their adherence to an optimal diet by 17.6%. Daily intake of foods belonging to the MD diet also increased significantly, and the intake of high energy density foods decreased. Mother’s educational level and household income were significantly (p < 0.0001) associated with optimal MD adherence by participants, in both stages. Nutritional status was not associated with the KIDMED Index. Discussion: The EM program showed to be effective in increasing MD adherence in this study population since optimal MD adherence was reported in most participants at the end of the EM program. Household income and mother’s educational level were positively associated with the diet quality of the children and adolescents.

Increasing low-energy-dense foods and decreasing high-energy-dense foods differently influence weight loss trial outcomes.

Although reducing energy density (ED) enhances weight loss, it is unclear whether all dietary strategies that reduce ED are comparable, hindering effective ED guidelines for obesity treatment. This study examined how changes in number of low-energy-dense (LED) (<4.186 kJ/1.0 kcal g-1) and high-energy-dense (HED) (>12.56 kJ/3.0 kcal g-1) foods consumed affected dietary ED and weight loss within an 18-month weight loss trial. This secondary analysis examined data from participants randomized to an energy-restricted lifestyle intervention or lifestyle intervention plus limited non-nutrient dense, energy-dense food variety (n=183). Number of daily LED and HED foods consumed was calculated from three, 24-h dietary recalls and anthropometrics were measured at 0, 6 and 18 months. Multivariable-adjusted generalized linear models and repeated-measures mixed linear models examined associations between 6-month changes in number of LED and HED foods and changes in ED, body mass index (BMI), and percent weight loss at 6 and 18 months. Among mostly female (58%), White (92%) participants aged 51.9 years following an energy-restricted diet, increasing number of LED foods or decreasing number of HED foods consumed was associated with 6- and 18-month reductions in ED (β=-0.25 to -0.38 kJ g-1 (-0.06 to -0.09 kcal g-1), P<0.001). Only increasing number of LED foods consumed was associated with 6- and 18-month reductions in BMI (β=-0.16 to -0.2 kg m-2, P<0.05) and 6-month reductions in percent weight loss (β=-0.5%, P<0.05). Participants consuming ⩽2 HED foods per day and ⩾6.6 LED foods per day experienced better weight loss outcomes at 6- and 18-month than participants only consuming ⩽2 HED foods per day. Despite similar reductions in ED from reducing number of HED foods or increasing number of LED foods consumed, only increasing number of LED foods related to weight loss. This provides preliminary evidence that methods used to reduce dietary ED may differentially influence weight loss trajectories. Randomized controlled trials are needed to inform ED recommendations for weight loss.