Associations between energy density and macronutrient composition in the diets of pre-school children: sugars vs. starch.

OBJECTIVE: To investigate the associations between energy density (ED) and macronutrient composition in the National Diet and Nutrition Survey of Children aged 1(1/2)-4(1/2) y, hypothesizing that high-ED diets tend to be high in sugars as well as fat.
DESIGN: Further analysis of data from a cross-sectional dietary survey of 1675 children with complete 4-day weighed dietary records. Differences in diet composition and food choice between children with diets of high, medium and low ED (defined as kJ/g of all food and drink) were identified. The possibility of confounding by water, or by soft drinks, was also explored in age-adjusted correlations.
RESULTS: High-ED diets (>3.7 kJ/g of total diet) were proportionately richer in fat and lower in carbohydrate, compared with diets of low ED (<2.9 kJ/g). In contrast to the hypothesis, high-ED diets were found to be proportionately lower in sugars, and higher in starch. Children with high-ED diets consumed more of a whole range of foods: meat, eggs, potatoes, cereal products, confectionery, sugar/preserves and savoury snacks, but consumed less soft drinks, water and fruit.
CONCLUSION: The inverse relationship observed between sugars and energy density may be partly attributable to the reciprocal relationship between sugars and fat, expressed as a proportion of energy. It may also reflect developing preferences in young childhood for a more adult-type, energy-dense, diet. Further work is required to verify ED/macronutrient relationships in other age groups, as the results have potential implications for obesity prevention and for food product development.