Dietary energy density as a marker of dietary quality in Swedish children and adolescents: the European Youth Heart Study.

OBJECTIVE: To investigate if dietary energy density is associated with measures of dietary quality (food group, micronutrient and macronutrient intakes) in children and adolescents. SUBJECTS/
METHODS: In all, 551 children (mean age 9.6 years, 52% girls) and 569 adolescents (15.5 years, 55% girls), sampled from schools in Sweden, completed a single 24-h dietary recall. Dietary energy density (kJ/g) was calculated as the energy from all food consumed divided by the weight of all food consumed. Beverages were excluded from the calculation. Food and micronutrient intakes were adjusted for energy intake. A one-way analysis of variance (ANOVA) was used to test for differences in food group and nutrient intakes across age- and gender-specific tertiles of energy density. Discriminant analysis was used to confirm the groupings formed by tertiles.
RESULTS: Subjects with low-energy-density diets were significantly more likely to consume fruits, vegetables, pasta, rice, potatoes and cereals and less likely to consume sweetened drinks, sweets and chocolate. After energy adjustment, their intakes of many foods recommended in the Swedish food-based dietary guidelines were higher and intakes of nutrient-poor foods were lower. The macronutrient energy profile (% energy) of low-energy-density diets was closest to the recommended level. Low-energy-density diets contained greater amounts of most micronutrients. Discriminant analysis confirmed the existence of heterogeneous dietary patterns and the likelihood of correct classification by energy density in 65% of cases.
CONCLUSIONS: Lower dietary energy density is associated with better dietary quality in children and adolescents. Energy density has advantages over other whole diet analysis methods and may be suitable as a simple proxy of diet quality.