Dietary energy density is associated with body mass index‐for‐age in Mexican adolescents

Abstract

Dietary energy density (DED) has been widely considered a risk factor for weight gain. In adolescents, however, the evidence is inconclusive, and in Mexico, the ways in which DED is associated with overweight and obesity are unknown. Our study analysed the association of DED with overweight or obesity (OW-O) in Mexican adolescents included in the National Health and Nutrition Survey 2012 (ENSANUT 2012). We analysed the data from a 7-day Food Frequency Questionnaire administered to 2,203 Mexican adolescents aged 12-19 years. DED was calculated excluding all beverages. Plausible and implausible reporters were identified based on the relationship between the reported energy intake and the estimated energy requirement. The association of DED with body mass index (BMI)-for-age and OW-O was analysed using multivariate statistical models restricted to plausible reporters. The combined prevalence of overweight and obesity was 35.4% in the complete sample and 27.8% in the sample of plausible reporters. Mean DED was 177 kcal/100 g, with higher DED in the north of the country. The proportion of plausible reporters was 38.5%. We found a positive association between high DED and the BMI-for-age z-score (β = 0.347; 95% CI [0.101, 0.594]; P = 0.006), controlling for sociodemographic and dietary variables, but no significant association with OW-O. It is necessary to consider the DED in the design and implementation of strategies to reduce energy density in the diets of young Mexicans.

Dietary Patterns and the Double Burden of Malnutrition in Mexican Adolescents: Results from ENSANUT-2006

“…After adjusting for EI:BMR ratio, the direction of the associations between dietary patterns and overweight–obesity and stunting radically changed. Given the inverse correlation between BAZ and EI:BMR ratio (−0.13, p < 0.01), this may be due to underreporting of energy intake by subjects with high BAZ, which has also been suggested by a previous study in Mexican adolescents [52].…”

Animal Protein Intake Is Associated with General Adiposity in Adolescents: The Teen Food and Development Study

“…Past investigations examined possible mechanisms on how animal protein intake can potentially increase the risk of obesity. Although unlikely to be the single contributor to obesity, red meat and its products are energy-dense foods and this could explain their association with overweight/obesity [14,32]. Meats are frequently consumed in the western diet, particularly by adolescents, and therefore, the magnitude of the effect on their health can potentially be significant.…”

“…The development of obesity is multifactorial [13]: In general, imbalances in the diet, e.g., energy-dense diet. Several investigations on factors that contribute to childhood and adolescent obesity have focused on dietary factors [14][15][16][17][18] or habits [19][20][21][22][23]. One macronutrient that is particularly critical for normal growth and development of adolescents is protein [24], but its role in obesity development is still controversial.…”

Dietary Energy Density and Its Association with Overweight or Obesity in Adolescents: A Systematic Review of Observational Studies

“…In this age range, underreporting generally provides lower intakes of snacks and energy-dense foods than plausible reports [ 51 ] because adolescents tend to easily forget and/or omit foods they consume [ 51 ]. Moreover, it has been documented that the exclusion of non-plausible reporters can improve the magnitude of dietary (including DED) associations with obesity [ 52 , 53 ]. Likewise, some studies have indicated that associations tend to be stronger when under-reporters are excluded from analysis or this variable is introduced as a covariate [ 52 , 53 , 54 ].…”

“…Moreover, it has been documented that the exclusion of non-plausible reporters can improve the magnitude of dietary (including DED) associations with obesity [ 52 , 53 ]. Likewise, some studies have indicated that associations tend to be stronger when under-reporters are excluded from analysis or this variable is introduced as a covariate [ 52 , 53 , 54 ].…”