Debunking the High Cost of Healthy Diets: Consumer Behavior Predicts Dietary Energy Density in a Nationally Representative Sample of US Adults

Dietary Energy Density ◽

The Relationship

Purpose: Dietary energy density (ED; kcal/g) is an established marker for diet quality and a risk factor for obesity. Previous studies have suggested that low-ED diets cost more than high-ED diets, adding an economic contribution to the obesity epidemic. This study evaluated the relationship between consumer behavior (money spent on food) and dietary energy density in a nationally representative sample of US adults. Design, Setting and Subjects: Data from 10,622 adult participants in the 2013-2016 NHANES were used for this study. The NHANES is a large cross-sectional survey conducted by the CDC and NCHS. Measures: Consumer behavior was evaluated by examining total dollars spent on food, as well as dollars spent at various categories of food stores & restaurants. Dietary ED was calculated using multiple methods. Analysis: Multivariate regression models were then used to evaluate the relationship between consumer behavior, defined as money spent in four categories (groceries, take-out, dining out, other food purchases) and dietary energy density. Results: Low-ED diets did not cost more than high-ED diets overall, though low-ED diets contained more servings of fruits (1.6 vs 0.4), vegetables (2.2 vs 0.9) and fiber (21 vs 13g), and fewer added sugars (15 vs. 18 tsp), solid fats (28 vs 39g), all p’s < 0.01. Differences in spending patterns were identified. A positive linear trend between money spent on fast food/takeout and dietary energy density (p < 0.001) was observed. Additionally, individuals in the lowest quartile of ED spent more at grocery stores per person than individuals in the highest quartile of ED ($182 vs. $150 p = 0.04). Conclusion: Spending pattern and consumer choices are associated with dietary ED in this cross-sectional analysis of a nationally representative population sample. Identifying eating behaviors associated with diets high in energy density may inform future investigations that intervene on dietary habit for promotion of healthy eating and prevention of weight gain.

Consumption of Ultra-Processed Food and Its Association with Sociodemographic Characteristics and Diet Quality in a Representative Sample of French Adults

Nutrients ◽

10.3390/nu13020682 ◽

2021 ◽

Vol 13 (2) ◽

pp. 682

Author(s):

Giovanna Calixto Andrade ◽

Chantal Julia ◽

Valérie Deschamps ◽

Bernard Srour ◽

Serge Hercberg ◽

...

Keyword(s):

Energy Density ◽

Representative Sample ◽

Saturated Fat ◽

Free Sugar ◽

Sociodemographic Characteristics ◽

Dietary Energy ◽

Processed Food ◽

Food Groups ◽

Cross Sectional ◽

The present study aims to describe ultra-processed food (UPF) consumption in a representative sample of French adults and to evaluate the association between UPF consumption and socioeconomic characteristics and nutritional profile of the diet. This is a cross-sectional study using food consumption data from the Étude Nationale Nutrition Santé (ENNS), conducted with 2642 participants (18–74 years old), between February 2006 and March 2007 in France. Dietary data were collected through three 24-h dietary recalls. All food and beverages were classified according to the NOVA classification. The energy contribution of NOVA food groups to total energy intake was presented by categories of sociodemographic characteristics. Linear and logistic regression models were used to estimate the association between the percentage of UPF in the diet with nutritional indicators. The mean daily energy consumption of the adult French population was 2111 kcal, of which 31.1% came from UPF. This percentage was higher among younger individuals, and in the urban area, and lower among individuals with incomplete high school and individuals who were retired. The consumption of UPF was positively associated with the dietary energy density and the dietary contents of total carbohydrates, free sugar, and total and saturated fat, as well as with inadequate dietary energy density, saturated fat, free sugar, and fiber intakes.

Eat Better, Run Longer? Dietary Energy Density Is Associated with Cardiovascular Fitness Level in a Nationally Representative Sample of Adolescents (P16-030-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz050.p16-030-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Cited By ~ 1

Author(s):

Jacqueline Vernarelli ◽

Rebecca DiSarro

Keyword(s):

Chronic Disease ◽

Energy Density ◽

Dietary Intake ◽

Representative Sample ◽

Cardiovascular Fitness ◽

Dietary Energy ◽

Fitness Level ◽

Dietary Energy Density ◽

Fitness Levels

Abstract Objectives Obesity during childhood and adolescence is a risk factor for several types of chronic disease in adulthood. Researchers have identified dietary energy density (ED, kcal/g) and sedentary behavior as risk factors for obesity during adulthood, but little is known about the relationship between diet and measured cardiovascular fitness levels. The 2012 National Health and Nutrition Examination Survey National Youth Fitness Survey (NNYFS) collected data on dietary intake, physical activity and fitness levels in a nationally representative sample of US adolescents. The objective of this study was to determine the association between eating patterns, specifically dietary energy density, and physical fitness in a nationally representative sample of youth. Methods Using data from NHANES National Youth Fitness Survey, the association between dietary energy density (ED, kcal/g) and cardiovascular fitness level was evaluated. During the NNYFS, cardiovascular fitness was assessed in adolescents aged 12–15y. Dietary intake information was collected using 24-hour recall, and assessment of diet quality involved calculation of dietary energy density. Cardiovascular fitness level was categorized based on gender-age specific cut-points of estimated VO2max. All data were analyzed using SAS 9.4 survey procedures to account for the unequal sampling probability and complex survey design of the NHANES. Results We observed a significant positive association between dietary energy density and cardiovascular fitness level after controlling for age, sex, race, and household income. Children with cardiovascular fitness levels categorized as “high risk” had significantly higher dietary energy density than children in the “healthy fitness zone” (1.82 vs 1.97, P = 0.04). Conclusions These findings expand on previous work from our group indicating that dietary energy density is associated with obesity in children and that diet in early childhood corresponds with development of physical characteristics that are associated with fitness ability. Interventions that aim to lower dietary energy density in adolescence may aid in the reduction of chronic disease risk during adulthood. Funding Sources None. Supporting Tables, Images and/or Graphs

Dietary energy density: estimates, trends and dietary determinants for a nationally representative sample of the Irish population (aged 5–90 years)

British Journal Of Nutrition ◽

10.1017/s0007114514003420 ◽

2014 ◽

Vol 113 (1) ◽

pp. 172-180 ◽

Cited By ~ 8

Author(s):

Laura O'Connor ◽

Janette Walton ◽

Albert Flynn

Keyword(s):

Energy Density ◽

Representative Sample ◽

Inverse Association ◽

Dietary Energy ◽

Age Group ◽

Irish Population ◽

Fresh Meat ◽

Breakfast Cereals ◽

Higher dietary energy density (DED) has been reported to be associated with weight gain, obesity and poorer dietary quality, yet nationally representative estimates that would allow tracking of secular trends and inter-country comparisons are limited. The aims of the present study were to calculate DED estimates for the Irish population and to identify dietary determinants of DED. Weighed/semi-weighed food records from three cross-sectional surveys (the National Children's Food Survey, the National Teens’ Food Survey and the National Adult Nutrition Survey) were collated to estimate habitual dietary intakes for a nationally representative sample of the Irish population, aged 5–90 years (n2535). DED estimates, calculated using the total diet method, the food only method and a novel method, including foods and solids in beverages, were 3·70 (sd1·09), 7·58 (sd1·72) and 8·40 (sd1·88) kJ/g, respectively. Determinants of DED did not vary by the calculation method used. Variation in the intakes of fruit, vegetables and sugar-sweetened beverages (SSB) across consumer groups contributed to the largest variance in DED estimates, followed by variation in the intakes of potatoes, fresh meat, bread, chips, ready-to-eat breakfast cereals, and confectionery. DED estimates were inversely associated with age group and consistently lower for females than for males. The inverse association of DED with age group was explained by higher intakes of vegetables, fruit, fish, potatoes, fresh meat and brown bread and lower intakes of SSB, chocolate confectionery, ready-to-eat breakfast cereals and savoury snacks in older age groups. Females consumed, on average, 1·5 times more fruit and vegetables combined when compared with males, largely explaining the sex differences in DED estimates. Current DED estimates for adults were similar to those calculated in a previous survey, carried out 10 years earlier. These estimates and determinants serve as a baseline for comparison for other works and public health campaigns.

Methods for Calculating Dietary Energy Density in a Nationally Representative Sample

Procedia Food Science ◽

10.1016/j.profoo.2013.04.011 ◽

2013 ◽

Vol 2 ◽

pp. 68-74 ◽

Cited By ~ 27

Author(s):

Jacqueline A. Vernarelli ◽

Diane C. Mitchell ◽

Barbara J. Rolls ◽

Terryl J. Hartman

Keyword(s):

Energy Density ◽

Representative Sample ◽

Dietary Energy ◽

Evaluating the Relationship Between Adolescent Fatherhood and Routine Health Care in a Nationally Representative Sample: A Descriptive, Cross-Sectional Study

Journal of Pediatric Health Care ◽

10.1016/j.pedhc.2020.09.003 ◽

2020 ◽

Author(s):

Alicia Boykin ◽

Kelley Jones ◽

Elizabeth Miller

Keyword(s):

Health Care ◽

Representative Sample ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

The Relationship ◽

Adolescent Fatherhood

Personality Factors and Sick Leave Days. Evidence from a Nationally Representative Longitudinal Study in Germany.

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17031089 ◽

2020 ◽

Vol 17 (3) ◽

pp. 1089

Author(s):

Yulia I. Raynik ◽

Hans-Helmut König ◽

André Hajek

Keyword(s):

Sick Leave ◽

Representative Sample ◽

Fixed Effects ◽

Personality Factors ◽

Cross Sectional ◽

Private Households ◽

Longitudinal Association ◽

Underlying Mechanisms ◽

The Relationship

Background: The question of whether employees’ sickness absence from the workplace depends on personality has been researched. Existing evidence mostly stems from cross-sectional studies, mainly showing that personality factors were not associated with the number of sick leave days, except for neuroticism, which was positively associated with sick leave days. Based on the above, it remains an under researched question whether intraindividual changes in personality factors are associated with changes in sick leave days. Thus, based on a nationally representative sample, the current study aimed to investigate the relationship between personality factors and sick leave days longitudinally based on a nationally representative sample of individuals in Germany. Methods: The present study used data from the German Socio-Economic Panel (GSOEP), a longitudinal survey of private households in Germany. Information from the years 2005, 2009, 2013 were used. The Big Five Inventory-GSOEP (BFI-S) was used to measure personality. Sick leave days in the preceding year were recorded. Poisson fixed effects regressions were used. Results: Adjusting for potential confounders, regressions showed that increases in neuroticism were associated with increased sick leave days. The longitudinal association between extraversion and sick leave days was marginally significant (p < 0.10). Other personality factors were not significantly associated with sick leave days. In addition, sick leave days increased with worsening self-rated health, presence of severe disability and increasing age. Conclusions: The findings of the current study highlight the association between neuroticism and sick leave days longitudinally. Further research is required to elucidate the underlying mechanisms.

Energy density of the diets of Japanese adults in relation to food and nutrient intake and general and abdominal obesity: a cross-sectional analysis from the 2012 National Health and Nutrition Survey, Japan

British Journal Of Nutrition ◽

10.1017/s0007114516004451 ◽

2017 ◽

Vol 117 (1) ◽

pp. 161-169 ◽

Cited By ~ 19

Author(s):

Kentaro Murakami ◽

M. Barbara E. Livingstone ◽

Hitomi Okubo ◽

Satoshi Sasaki

Keyword(s):

Energy Density ◽

Abdominal Obesity ◽

Nutrient Intake ◽

Dietary Energy ◽

Nutrition Survey ◽

Cross Sectional ◽

Health And Nutrition ◽

Japanese Adults ◽

Food And Nutrient Intake ◽

AbstractThe associations of dietary energy density with dietary intake and obesity have been largely unexplored in non-Western populations. The present cross-sectional study examined the associations using data from the 2012 National Health and Nutrition Survey, Japan. Dietary intake was assessed using a 1-d semi-weighed dietary record in 15 618 Japanese adults aged ≥20 years. Mean dietary energy density (calculated on the basis of foods only) was 5·98 (sd 1·20) kJ/g in men and 5·72 (sd 1·16) kJ/g in women. Dietary energy density was positively associated with intakes of bread, noodles (only men), meat, fats and oils, and sugar and confectionery but inversely with intakes of white rice (only men), potatoes, pulses, vegetables, fruits, and fish and shellfish. For nutrient intake, dietary energy density was positively associated with total fat and SFA but inversely associated with all other nutrients examined such as protein, carbohydrate, alcohol (only women), dietary fibre, and several vitamins and minerals, including Na. After adjustment for potential confounding factors, dietary energy density was positively associated with abdominal obesity (waist circumference ≥80 cm) in women (adjusted prevalence ratio between the extreme tertiles 1·07; 95 % CI 1·02, 1·12; Pfor trend=0·003). Dietary energy density was also positively but non-significantly associated with general obesity (BMI≥25 kg/m2) in women (Pfor trend=0·08). There were no such associations in men. In conclusion, lower energy density of the diets of Japanese adults was associated with favourable food and nutrient intake patterns, except for higher Na, and, in only women, a lower prevalence of abdominal obesity.

The Relationship between Insufficient Sleep and Self-Rated Health in a Nationally Representative Sample

Journal of Environmental and Public Health ◽

10.1155/2012/518263 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 23

Author(s):

Sarah Dee Geiger ◽

Charumathi Sabanayagam ◽

Anoop Shankar

Keyword(s):

Representative Sample ◽

Positive Association ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Insufficient Sleep ◽

Self Rated Health ◽

Increased Risk ◽

Adjusted Model ◽

The Relationship

Reduced sleep has been found to be associated with increased risk of diabetes mellitus, hypertension, cardiovascular disease (CVD), and mortality. Self-rated health (SRH) has been shown to be a predictor of CVD and mortality. However, study of the association between insufficient sleep and SRH is limited. We examined participants >18 years of age (n=377, 160) from a representative, cross-sectional survey (2008 BRFSS). Self-reported insufficient sleep in the previous 30 days was categorized into six groups. The outcome was poor SRH. We calculated odds ratios ((OR) (95% confidence interval (CI)) of increasing categories of insufficient rest/sleep, taking zero days of insufficient sleep as the referent category. We found a positive association between increasing categories of insufficient sleep and poor SRH, independent of relevant covariates. In the multivariable-adjusted model, compared to 0 days insufficient sleep, the OR (95% CI) of poor SRH was 1.03 (0.97–1.10) for 1–6 days, 1.45 (1.34–1.57) for 7–13 days, 2.12 (1.97–2.27) for 14–20 days, 2.32 (2.09–2.58) for 21–29 days, and and 2.71 (2.53–2.90) for 30 days of insufficient sleep in the prior 30 days (P-trend <0.0001). In a nationally representative sample, increasing categories of insufficient sleep were associated with poor SRH.