Improve Diet Quality Research Articles

Associations Between Engagement with the BitHabit Digital Lifestyle Intervention and Changes in Type 2 Diabetes Risk Factors.

Type 2 diabetes (T2D) can be prevented or delayed through a healthy lifestyle. Digital behavior change interventions (DBCIs) may offer cost-effective and scalable means to support lifestyle changes. This study investigated associations between user engagement with a habit-formation-based DBCI, the BitHabit app, and changes in T2D risk factors over 12 months in 963 participants at risk of T2D. User engagement was characterized by calculating use metrics from the BitHabit log data. User ratings were used as a subjective measure of engagement. The use metrics and user ratings were the strongest associated with improvements in diet quality. Weak positive associations were observed between the use metrics and changes in waist circumference and body mass index. No associations were found with changes in physical activity, fasting plasma glucose, or plasma glucose two hours after an oral glucose tolerance test. To conclude, increased use of the BitHabit app can have beneficial impacts on T2D risk factors, especially on diet quality.

Comparing the Effects of Consuming Almonds or Biscuits on Body Weight in Habitual Snackers: A 1-Year Randomized Controlled Trial

Background: Almonds are nutrient rich, providing a healthier alternative to many snacks. Studies report health benefits with regular almond consumption without adverse weight gain. However, most interventions have been relatively short or have included additional dietary advice. ObjectivesTaking a pragmatic approach, we compared consumption of almonds compared with biscuits on body weight and other health outcomes in a population of regular snackers of discretionary foods, hypothesizing the almonds will displace some of the less-healthful snacks in their current diets. MethodsWe randomly assigned 136 nonobese habitual discretionary snackers to receive almonds or biscuits daily for 1 y. These isocaloric snacks provided either 10% of participants’ total energy (TE) requirements or 1030 kJ (equivalent to 42.5 g almonds), whichever was greater. Anthropometry, blood biomarkers, diet, appetite, sleep, and physical activity were assessed at baseline, 3, 6, and 12 mo, and body composition and RMR at baseline and 12 mo. ResultsThe difference in changes for body weight from baseline to 12 mo was not statistically significant (geometric means: 67.1 and 69.5 kg for almonds and 66.3 and 66.3 kg for biscuits, P = 0.275). There were no statistically significant differences in changes for body composition or other nondietary outcomes (all P ≥ 0.112). Absolute intakes of protein; total, polyunsaturated, and monosaturated fat; fiber; vitamin E; calcium; copper; magnesium; phosphorous; and zinc, and % TE from total monounsaturated, and polyunsaturated fat statistically significantly increased from baseline (all P ≤ 0.033), whereas % TE from carbohydrate and sugar statistically significantly (both P ≤ 0.014) decreased from baseline, in the almond compared with the biscuit group. ConclusionsAlmonds can be incorporated into the diets of habitual snackers to improve diet quality, without evidence for changes in body weight, compared with a popular discretionary snack food. This trial was registered at the Australian New Zealand Clinical Trials Registry (https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375610&isReview=true), registration number ACTRN12618001758291.

Measuring changes in diet deprivation: New indicators and methods

Improving diet quality is an emerging development policy priority. Existing indicators emphasize the cost and affordability of healthy diets but have not attempted to measure how far households are from ideal diets or how policies may nudge them closer to them. We propose a new Reference Diet Deprivation (ReDD) index, estimated from household consumption survey data, that measures the incidence, breadth, and depth of diet deprivation across multiple food groups. While informative as a standalone measure, we demonstrate how the ReDD index can be integrated into an economic model to examine changes in diet quality under different policy or external shocks. Our Nigerian case study shows that productivity growth in the dairy, pulse & nut, fruit, and red meat value chains have more potential than staple crops to reduce diet deprivation. While these findings have implications for food and agricultural policy prioritization in Nigeria, the study more importantly demonstrates the usefulness of the ReDD index for assessing diet quality and examining the drivers of dietary change when used in conjunction with a simulation model.

Inclusive diets within planetary boundaries

Inclusive diets within planetary boundaries

Expanding Public and Private Partnerships to Improve Food Access for Families Enrolled in Supplemental Nutrition Programs

Food insecurity in the United States is a public health crisis and particularly impacts individuals in rural areas.1 Efforts to improve food access, including pilot programs to increase online ordering, have reduced food insecurity and improved diet quality for participants enrolled in supplemental nutrition programs.3,4 We discuss the nutritional and economic benefits of public and private partnerships that enhance the supplemental nutrition programs of the United States Department of Agriculture Food and Nutrition Service (eg, Special Supplemental Nutrition Program for Women, Infants, and Children; Supplemental Nutrition Assistance Program), and propose the expansion of technology and transportation resources through public and private partnerships to better address rural food insecurity.

Perspective: Seeing the Forest Through the Trees: The Importance of Food Matrix in Diet Quality and Human Health.

Poor nutrition is linked to morbidity and mortality globally. The nutrition transition toward diets composed of high amounts of ultraprocessed foods that are more refined, calorie-dense, and poor in nutrients is considered a factor in the rise of diet-related metabolic diseases in low- and middle-income countries. Historically, nutrition strategies aimed at mitigating metabolic diseases linked to suboptimal diets have targeted isolated nutrients such as fats; however, they overlook the complexity and importance of whole foods and food matrices, which can lead to unintended consequences such as avoidance of nutrient-dense foods. Dairy foods, such as milk, cheese, and yogurt, are underconsumed nutrient-dense foods that often fall in the cross-hairs of reductionist nutrition strategies because of their contribution of calories, saturated fat, and sodium to the diet. This article highlights dairy foods as an example for exploring the complex matrices of food, nutrients, and other bioactive components that are associated with improved nutrient status and reduced risk of metabolic diseases while considering a holistic approach to improving diet quality and human health.

Diet Quality and Nutritional Risk Based on the FIGO Nutrition Checklist among Greek Pregnant Women: A Cross-Sectional Routine Antenatal Care Study

The International Federation of Gynecology and Obstetrics (FIGO) nutrition checklist is a tool for everyday antenatal clinical practice, easy to use by most healthcare professionals, aiming to initiate a conversation regarding gestational weight gain (GWG) and nutrition and identify women who might require further assessment. The present cross-sectional study aimed to apply the FIGO nutrition checklist to pregnant women attending routine antenatal care and identify nutritional risk factors. Pregnant women (n = 200) were recruited from the outpatient pregnancy clinics of two hospitals in Thessaloniki and completed the checklist. The FIGO-diet quality score and the FIGO-nutritional risk score (NRS) were calculated. The results revealed that 99% of the women exhibited at least one nutritional risk factor based on the checklist. The median FIGO diet quality score of the sample was 4.0 (3.0–5.0), with 95% of the participants responding negatively to at least one question, indicating the need for improving diet quality. Improved diet quality was noted in cases of hyperemesis gravidarum and among those receiving vitamin D supplements. A large percentage of the participants (36%) exhibited five or more nutritional risk factors, as indicated by a total FIGO-NRS below 5. Women with low middle-upper arm circumference, indicative of protein-energy malnutrition (20.6% of the sample), exhibited more nutritional risk factors compared with the rest. On the other hand, being in the third trimester of pregnancy was associated with lower nutritional risk and, subsequently, better diet quality.

Does Internet use connect smallholder farmers to a healthy diet? Evidence from rural China.

Undernutrition and micronutrient malnutrition remain problems of significant magnitude among small-scale subsistence farmers, posing a serious threat to their health and well-being. Developing a healthy diet can effectively reduce this threat. Fortunately, the Internet can speed up the process. Based on survey data from 5,114 farm households in nine provinces in China, this study quantitatively assesses the impact of Internet use on the dietary quality of smallholder farmers using OLS regression models and PSM models. (1) Internet use can significantly contribute to dietary diversity and dietary rationality among smallholder farmers, thus optimizing their dietary structure. (2) Internet use significantly increased the average consumption amounts of milk and its products (2.9 g), fruits (21.5 g), eggs (7.5 g), and vegetables (27.1 g), while also decreasing the intake of salts (1.5 g) and oil (3.8 g). (3) The pull of internet use to improve diet quality is more significant for smallholder households with lower levels of education, older heads of households, and higher household incomes. (4) A possible mechanism is that Internet use increases household income and information access skills of rural residents, thus improving their dietary quality. In summary, governments should further promote Internet penetration in rural areas for health purposes.

How much environmental burden does the shifting to nutritional diet bring? Evidence of dietary transformation in rural China

There is a rapid increase in demand for higher quality and healthier diets in less developed regions such as rural areas. Given the large disparity in nutrition levels between urban and rural areas, such demands are justified and should be pursued. However, little attention has been paid to the environmental consequences of rural diet change and the solutions that follow. With its large scale of rural population and the rapid development of rural areas due to the implementation of Rural Revitalization National Strategy, China is taken as a typical example to explore the environmental impacts of rural dietary improvement. A framework for evaluating water footprints, carbon footprints, and ecological footprints is established, and four scenarios are presented based on increased rural income and a reduction in urban-rural imbalance. The findings revealed a significant improvement in diet quality with increasing income, decreasing urban-rural disparities, and compensating for insufficient food consumption (total deviation decreases from 69% to an average of 38%). However, such improvements would significantly increase the environmental burden, with water footprints ranging from 24% to 71%, carbon footprints ranging from 5% to 46%, and ecological footprints ranging from 20% to 122%. The primary reason is increased consumption of dairy products, meat, and aquatic products. As a result, when developing national dietary guidelines, environmental indicators should be considered alongside nutrition and health metrics.

Effect of Mobile Health Interventions on Lifestyle and Anthropometric Characteristics of Uncontrolled Hypertensive Participants: Secondary Analyses of a Randomized Controlled Trial.

Our objective was to evaluate the effect of a mobile health (mHealth) intervention on lifestyle adherence and anthropometric characteristics among individuals with uncontrolled hypertension. We performed a randomized controlled trial (ClinicalTrials.gov NCT03005470) where all participants received lifestyle counseling at baseline and were randomly allocated to receive (1) an automatic oscillometric device to measure and register blood pressure (BP) via a mobile application, (2) personalized text messages to stimulate lifestyle changes, (3) both mHealth interventions, or (4) usual clinical treatment (UCT) without technology (control). The outcomes were achieved for at least four of five lifestyle goals (weight loss, not smoking, physical activity, moderate or stopping alcohol consumption, and improving diet quality) and improved anthropometric characteristics at six months. mHealth groups were pooled for the analysis. Among 231 randomized participants (187 in the mHealth group and 45 in the control group), the mean age was 55.4 ± 9.5 years, and 51.9% were men. At six months, achieving at least four of five lifestyle goals was 2.51 times more likely (95% CI: 1.26; 5.00, p = 0.009) to be achieved among participants receiving mHealth interventions. The between-group difference reached clinically relevant, but marginally significant, reduction in body fat (-4.05 kg 95% CI: -8.14; 0.03, p = 0.052), segmental trunk fat (-1.69 kg 95% CI: -3.50; 0.12, p = 0.067), and WC (-4.36 cm 95% CI: -8.81; 0.082, p = 0.054), favoring the intervention group. In conclusion, a six-month lifestyle intervention supported by application-based BP monitoring and text messages significantly improves adherence to lifestyle goals and is likely to reduce some anthropometric characteristics in comparison with the control without technology support.

Differences in Adherence to American Heart Association's Life's Essential 8, Diet Quality, and Weight Loss Strategies Between Those With and Without Recent Clinically Significant Weight Loss in a Nationally Representative Sample of US Adults.

Background The American Heart Association defines ideal cardiovascular health based on 8 risk factors (Life's Essential 8 [LE8]); a high LE8 score (range 0-100) reflects greater adherence to their recommendations. Weight status influences cardiovascular health, yet individuals may use detrimental diet and weight loss strategies to improve weight status. We assessed differences in LE8 adherence, diet quality, and weight loss strategies between those with and without a recent history of clinically significant weight loss (CSWL). Methods and Results Data from 2007 to 2016 National Health and Nutrition Examination Survey questionnaires, clinical measures, and 24-hour dietary recalls were assessed to determine LE8 adherence, diet quality (Healthy Eating Index), and weight loss strategies between adults with: (1) intentional CSWL ≥5%; and (2) non-CSWL <5%, weight maintenance, or weight gain over the past 12 months using ANCOVA and chi-square tests. Those with CSWL demonstrated higher scores for diet quality (P=0.014), physical activity (P<0.001), and blood lipids (P<0.001). Those without CSWL reported lower BMI (P<0.001). There were no differences in total LE8 cardiovascular health scores between those with and without CSWL. More individuals with CSWL reported weight loss strategies of exercising (P=0.016); those without CSWL reported skipping meals (P=0.002) and using prescription diet pills (P<0.001). Conclusions Greater adherence to the LE8 recommendations was observed among individuals with CSWL, although overall LE8 scores were low. Future research should address the implementation of evidence-based strategies that improve diet quality while promoting optimal cardiovascular health among those with intent to lose weight.

Improvement of Diet after an Early Nutritional Intervention in Pediatric Oncology

Pediatric cancer survivors may experience cardiometabolic sequelae over the course of their lives as a result of the treatments they have received. While nutrition consists of an actionable target for cardiometabolic health, few nutritional interventions have been documented in this population. This study assessed the changes in diet during a one-year nutritional intervention for children and adolescents undergoing cancer treatments and the participants' anthropometric and cardiometabolic profiles. A total of 36 children and adolescents (mean age: 7.9 years, 52.8% male) newly diagnosed with cancer (50% leukemia) and their parents underwent a one-year individualized nutrition intervention. The mean number of follow-up visits with the dietitian during the intervention was 4.72 ± 1.06. Between the initial and one-year assessments, there was an improvement in diet quality reflected by the Diet Quality Index (5.22 ± 9.95, p = 0.003). Similarly, the proportion of participants with moderate and good adherence (vs. low adherence) to the Healthy Diet Index score almost tripled after one year of intervention (14% vs. 39%, p = 0.012). In parallel, there was an increase in the mean z-scores for weight (0.29 ± 0.70, p = 0.019) and BMI (0.50 ± 0.88, p = 0.002), and in the mean levels of HDL-C (0.27 ± 0.37 mmol/L, p = 0.002) and 25-hydroxy vitamin D (14.5 ± 28.1 mmol/L, p = 0.03). Overall, this study supports that a one-year nutritional intervention deployed early after a pediatric cancer diagnosis is associated with an improvement in the diets of children and adolescents.

Snacking Consumption among Adults in the United States: A Scoping Review.

Snacks are a staple of the American diet, contributing to approximately 20% of energy intake. Most U.S. adults consume one to three snacks/day, yet few reviews have focused on snacking among this population. This scoping review was conducted to characterize snacks and snacking occasions among U.S. adults to further inform healthy eating practices. The protocol was prepared following the PRISMA-Extension for Scoping Reviews. Three web databases were used to identify articles using snacking or eating occasions as primary or secondary outcomes among U.S. adults. A search strategy was developed using subject headings, truncation, and phrase searching in the title and abstract of articles published between 2010 and 2022. A two-stage, multi-step screening process identified 31 of 4795 publications as meeting the inclusion criteria. Findings included identification of snacking themes, e.g., cues and motivations; diet composition; and weight management. Food quality, time of consumption, and convenience emerged as characteristics of snacking; time of day was found to influence food choice. Snacks contribute to or detract from a healthy diet. Strategic selection of healthy snack options can improve diet quality. Applied to nutrition education, this information can help strengthen programs or policies, ultimately contributing to health and wellbeing.

Effect of a dietary intervention based on the Mediterranean diet on the quality of life of patients recovered from depression: Analysis of the PREDIDEP randomized trial

IntroductionThere is substantial evidence supporting that improving diet quality leads to improved health-related quality of life (HRQoL). Our major aim was to assess the effectiveness of a Mediterranean diet–based nutritional intervention to improve HRQoL in the context of a secondary prevention trial of depression. Secondarily to assess its effectiveness among adults aged 60 or more years. MethodsThe PREDIDEP study is a 2-year multicentre, randomized, single-blinded nutritional trial. At baseline and at 1-year and 2-year follow-up, SF-36 health survey questionnaire was collected to evaluate participants' HRQoL (total and specific range for each of the 8 dimensions: 0 to 100 points). Mixed effect linear models were used to assess changes in HRQoL according to adherence to the Mediterranean diet. The trial was registered at ClinicalTrials.govNCT03081065. ResultsAfter 2 years of intervention, the Mediterranean Diet intervention group compared to control group (without nutritional intervention, only usual clinical care) showed an improvement in some dimensions of HRQoL such as Mental Health (7.22; 95 % CI = 2.22–12.22) (between-group difference: 6.79; 95 % CI −0.14–13.73, p = 0.055); Vitality (9.51; 95 % CI = 4.00–15.03) (between-group difference: 9.00; 95 % CI 1.75–16.25, p = 0.020); Mental Summary Component (2.83; 95 % CI = 0.55–5.11) (between-group difference: 1.17; 95 % CI = −1.96–4.30, p = 0.462); and General Health (10.70; 95 % CI = 5.58–15.81) (between-group difference: 6.20; 95 % CI = −0.89–13.28, p = 0.086). Similar results were observed for participants aged 60 or more years. ConclusionThe intervention based on Mediterranean diet in patients with previous depression seems to be effective in improving HRQoL, especially the mental dimensions. This effect is also observed among participants aged 60 or more years.

Current and emerging medications for the management of obesity in adults.

Current and emerging medications for the management of obesity in adults.

Free sugar intake from snacks and beverages in Canadian preschool- and toddler-aged children: a cross-sectional study

BackgroundExcess consumption of free sugar (FS) increases the risk of dental caries and unhealthy weight gain. However, the contribution of snacks and beverages to young children’s FS intake is not well understood. The purpose of this study was to determine FS intake from snacks and beverages among preschool-aged Canadian children.MethodsThis cross-sectional study examined baseline data from 267 children 1.5 to 5 y enrolled in the Guelph Family Health Study. Dietary assessment was completed over a 24-h period using ASA24-Canada-2016 to, 1) estimate the proportion of children whose FS intake from snacks and beverages consumed exceeded 5% total energy intake (TE) and 10% TE, and 2) identify the top snack and beverage sources of FS.ResultsFS contributed 10.6 ± 6.9% TE (mean ± SD). 30 and 8% of children consumed ≥ 5% TE and ≥ 10% TE from snack FS, respectively. Furthermore, 17 and 7% of children consumed ≥ 5% TE and ≥ 10% TE from beverages FS, respectively. Snacks and beverages accounted for 49 ± 30.9% of FS energy. Top snack sources of FS (% children, children’s %TE from FS) were bakery products (55%, 2.4%), candy and sweet condiments (21%, 3.0%), and sugar-containing beverages (20%, 4.1%). Top sugar-containing beverage sources of FS (48%, 5.3%) were 100% fruit juice (22%, 4.6%) and flavored milk (11%, 3.1%).ConclusionsSnacks and beverages contributed nearly half of FS intake among a sample of young children in Canada. Thus, long-term monitoring of snacking behavior and consumption of FS is warranted. These findings may help inform nutritional strategies and public policies to improve diet quality and FS intake in preschool-aged children.Trial registrationThe Clinical Trial Registry number is NCT02939261 from clinicaltrials.gov. Date of Registration: October 20, 2016.

The Global Diet Quality Score predicts diet quality of women of reproductive age in Addis Ababa, Ethiopia.

Improving diet quality is recognised as a double-duty action that can simultaneously address multiple forms of malnutrition. This study aimed to assess diet quality among non-pregnant non-lactating women of reproductive age (WRA) in Addis Ababa, Ethiopia. A 1-d quantitative 24 h recall was conducted among 653 non-pregnant/non-lactating women. Diet quality, assessed using the women dietary diversity score (WDDS), the Global Diet Quality Score (GDQS) and the Nova 4 classification reflecting consumption of ultra-processed foods (UPF), was compared. The proportion that meets the minimum dietary diversity for women (MDD-W) was estimated. The average MDD-W score was 2·6 (sd 0·9), with only 3 % of women meeting the MDD-W (≥ 5 food groups). Consumption of wholegrain and legumes was high, but UPF were also consumed by 9 % of the women. GDQS was positively associated with WDDS, age and skipping breakfast and was negatively associated with eating out of home and UPF consumption (P < 0·05). The multivariate regression model showed that GDQS (total) was not associated with wealth but was significantly associated with both UPF and WDDS (P < 0·001). Unlike UPF and WDDS alone, GDQS was able to predict both nutrient adequacy and unhealthy dietary practices. The diet quality of WRA in Addis Ababa is low in diversity, possibly exposing them to higher risk of nutrient inadequacy and non-communicable diseases as reflected by the low GDQS. Understanding what drives food and dietary choices in urban settings is urgently needed.

Abstract MP64: Impact of a Vegan Diet Compared to Omnivorous Diet on Blood Lipids and Weight Among Identical Twins: The Twins Nutrition Study (TwiNS) Randomized Controlled Trial

Introduction: Vegan diets, where animal- and all their by-products are excluded from the diet, have gained popularity. Growing evidence suggests potential cardiovascular benefits of vegan diets due to improvements in diet quality (i.e., higher consumption of vegetables, fruits whole grains, nuts, legumes, and seeds). Methods: The TwiNS randomized controlled trial examined the cardiometabolic impact of a healthy vegan diet compared to a healthy omnivorous diet (NCT05297825). These diets were examined in 22 pairs of identical twins, where one twin followed the vegan diet, and the other twin followed the omnivorous diet for 8 weeks. Diet specific meals were provided via a meal delivery service from baseline through week 4, and during weeks 5-8 participants prepared their own diet appropriate meals and snacks. The primary outcome was difference in LDL cholesterol from baseline to week 8. Secondary outcome measures included change in triglycerides, HDL-cholesterol and body weight. Adherence to study diets, ease/difficulty in following the diets, participant energy levels, and sense of wellbeing were also measured. A linear mixed model was used to investigate a difference in the change in primary and secondary outcomes from baseline and included a random effect for twin pair, to account for the correlation between identical twins. Results: Participants were generally healthy adults, average age 39.6 years, primarily non-Hispanic White, and had an average BMI of 26.2. On average, twins randomized to the healthy vegan diet had decreased their LDL-cholesterol more after 8 weeks compared to twins on the healthy omnivorous diet (-15.2 vs. -2.3mg/dL, 95% CI: 4.3-24.8). Participants on the healthy vegan diet also had decreased their body weight more after 8 weeks (-1.9 vs. -0.29 kg, 95% CI: 0.9-3.0). No significant differences were observed between the vegan and omnivorous diets for secondary outcomes of triglycerides or HDL-C. Conclusion: This study contributes to growing evidence that vegan diets may offer a protective cardiometabolic advantage compared to a healthy, omnivorous diet. Further analyses of the TwINS trial will examine changes to the gut microbiome (i.e., microbial diversity), inflammatory markers, and other health factors.

Abstract P301: Diet Quality and Frailty in Israeli Adults 65 Years or Older

Background: Frailty represents a transition state between successful aging and disability. Nutrition may promote successful aging. However, only a few studies explicitly examined the association between overall diet quality and frailty in the oldest old age group. Methods: We studied an older adult (65+) cohort that participated in the Israeli National Health and Nutrition Survey of Older Adults in 2005-2006 (T1, N=1,799). Survivors of T1 were contacted, and from 2017-2019, an extensive interview and a functional assessment were conducted (T2) among 604 past participants. A 24-hour dietary recall, assessed at T1, was used to calculate the healthy eating index (HEI-2015), a measure of diet quality used to assess how well a set of foods aligns with key recommendations. A frailty index (FI) based on accumulation of deficits was developed and comprised 33 variables, including clinical, functional, and cognitive measures. A threshold of ≥ 0.26 was used to define frailty. Frail participants at T1 were excluded from the analysis (n=125). Logistic regression models were constructed to assess the association of HEI-2015 with frailty incidence. Inverse probability weighting was used to minimize attrition bias. Results: Among the 479 T2 participants analyzed (mean [SD], age 84 [5] years, 50% women), 225 (46%) were classified as frail. Frail participants were older, less educated, with a lower household income and a higher comorbidity burden at baseline than non-frail subjects. After adjustment for sociodemographic and lifestyle factors, a higher HEI-2015 score was associated with decreased odds of incident frailty [odds ratio, 0.56 (95% CI: (0.35-0.90), for the upper tertile; 0.68, (95% CI: 0.42-1.09), for the middle tertile, compared with the lower tertile ( P for trend = .005). A spline analysis supported a linear decline in frailty with increasing HEI-2015 scores (Figure). Conclusion: In this cohort study of oldest-old participants, improved diet quality was inversely associated with frailty incidence in a dose-dependent manner.

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

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: &amp;#916;-0.1 kcal/g vs. STANDARD: &amp;#916;+0.1 kcal/g, p = 0.12) or food only (LOW-ED: &amp;#916;-0.2 kcal/g vs. STANDARD: &amp;#916;+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: &amp;#916;-98 kcals vs. STANDARD: &amp;#916;+212 kcals, p = 0.04), but not when using ITT (LOW-ED: &amp;#916;+5 kcals vs. STANDARD: &amp;#916;+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.