Energy density of foods and beverages in the Australian food supply: influence of macronutrients and comparison to dietary intake

Objectives: The energy density (ED) of the diet is considered an important determinant of total energy intake and thus energy balance and weight change. We aimed to compare relationships between ED and macronutrient content in individual food and beverage items as well as population diet in a typical Western country. Design: Nutrient data for 3673 food items and 247 beverage items came from the Australian Food and Nutrient database (AusNut). Food and beverage intake data came from the 1995 Australian National Nutrition Survey (a 24-h dietary recall survey in 13 858 people over the age of 2). Relationships between ED and macronutrient and water content were analysed by linear regression with 95% prediction bands. Results: For both individual food items and population food intake, there was a positive relationship between ED and percent energy as fat and negative relationships between ED and percent energy as carbohydrate and percent water by weight. In all cases, there was close agreement between the slopes of the regression lines between food items and dietary intake. There were no clear relationships between ED and macronutrient content for beverage items. Carbohydrate (mostly sucrose) contributed 91, 47, and 25% of total energy for sugar-based, fat-based, and alcohol-based beverages respectively. Conclusions: The relationship between ED and fat content of foods holds true across both population diets and individual food items available in the food supply in a typical Western country such as Australia. As high-fat diets are associated with a high BMI, population measures with an overall aim of reducing the ED of diets may be effective in mediating the growing problem of overweight and obesity.

Two important exceptions to the relationship between energy density and fat content: food with reduced-fat claims and high-fat vegetable-based dishes

Objective: To test the hypothesis that many foods with reduced-fat (RF) claims are relatively energy-dense and that high-fat (HF) vegetable-based dishes are relatively energy-dilute.

Design: Nutrient data were collected from available foods in Melbourne supermarkets that had an RF claim and a full-fat (FF) equivalent. Nutrient analyses were also conducted on recipes for HF vegetable-based dishes that had more than 30% energy from fat but less than 10% from saturated fat. The dietary intake data (beverages removed) from the 1995 National Nutrition Survey were used for the reference relationships between energy density (ED) and percentage energy as fat and carbohydrate and percentage of water by weight.

Statistics: Linear regression modelled relationships of macronutrients and ED. Paired t-tests compared observed and predicted reductions in the ED of RF foods compared with FF equivalents.

Results: Both FF and RF foods were more energy-dense than the Australian diet and the HF vegetable-based dishes were less energy-dense. The Australian diet showed significant relationships with ED, which were positive for percentage energy as fat and negative for percentage energy as carbohydrate. There were no such relationships for the products with RF claims or for the HF vegetable-based dishes.

Conclusion: While, overall, a reduced-fat diet is relatively energy-dilute and is likely to protect against weight gain, there appear to be two important exceptions. A high intake of products with RF claims could lead to a relatively energy-dense diet and thus promote weight gain. Alternatively, a high intake of vegetable-based foods, even with substantial added fat, could reduce ED and protect against weight gain.

The effect of training in reduced energy density eating and food self-monitoring accuracy on weight loss maintenance

Background:
Failure to maintain weight losses in lifestyle change programs continues to be a major problem and warrants investigation of innovative approaches to weight control.
Objective:
The goal of this study was to compare two novel group interventions, both aimed at improving weight loss maintenance, with a control group.
Methods and Procedures:
A total of 103 women lost weight on a meal replacement–supplemented diet and were then randomized to one of three conditions for the 14-week maintenance phase: cognitive-behavioral treatment (CBT); CBT with an enhanced food monitoring accuracy (EFMA) program; or these two interventions plus a reduced energy density eating (REDE) program. Assessments were conducted periodically through an 18-month postintervention. Outcome measures included weight and self-reported dietary intake. Data were analyzed using completers only as well as baseline-carried-forward imputation.
Results:
Participants lost an average of 7.6 plusminus 2.6 kg during the weight loss phase and 1.8 plusminus 2.3 kg during the maintenance phase. Results do not suggest that the EFMA intervention was successful in improving food monitoring accuracy. The REDE group decreased the energy density (ED) of their diets more so than the other two groups. However, neither the REDE nor the EFMA condition showed any advantage in weight loss maintenance. All groups regained weight between 6- and 18-month follow-ups.
Discussion:
Although no incremental weight maintenance benefit was observed in the EFMA or EFMA + REDE groups, the improvement in the ED of the REDE group's diet, if shown to be sustainable in future studies, could have weight maintenance benefits.

Chemical composition and tissue energy density of the cuttlefish (Sepia apama) and its assimilation efficiency by Diomedea albatrosses.

The cuttlefish Sepia apama Gray (Mollusca: Cephalopoda) is a seasonally abundant food resource exploited annually by moulting albatrosses throughout winter and early spring in the coastal waters of New South Wales, Australia. To assess its nutritional value as albatross forage, we analysed S. apama for water, lipid protein, ash contents, energy density and amino acid composition. Because albatrosses consistently consume S. apama parts preferentially in the order of head, viscera and mantle, we analysed these sections separately, but did not identify any nutritional basis for this selective feeding behaviour. The gross energy value of S. apama bodies was 20.9 kJ/g dry mass, but their high water content (>83%; cf <70% for fish) results in a relatively low energy density of 3.53 kJ/g. This may contribute to a need to take large meals, which subsequently degrade flight performance. Protein content was typically >75% dry mass, whereas fat content was only about 1%. Albatrosses feed on many species of cephalopods and teleost fish, and we found the amino acid composition of S. apama to be comparable to a range of species within these taxa. We used S. apama exclusively in feeding trials to estimate the energy assimilation efficiency for Diomedea albatrosses. We estimated their nitrogen-corrected apparent energy assimilation efficiency for consuming this prey to be 81.82 ± 0.72% and nitrogen retention as 2.90 ± 0.11 g N kg^-1 d^-1. Although S. apama has a high water content and relatively low energy density, its protein composition is otherwise comparable to other albatross prey species. Consequently, the large size and seasonal abundance of this prey should ensure that albatrosses remain replete and adequately nourished on this forage while undergoing moult.

Reducing the energy density of multiple meals decreases the energy intake of preschool-age children1,2,3

Background: The energy density (ED) of an entrée affects children's energy intake at a meal consumed ad libitum. However, the effects in children of changing the ED of meals over multiple days are unknown.

Objective: We aimed to test the effect of reducing the ED of multiple meals on the ad libitum energy intake of preschool-age children over 2 d.

Design: In this crossover study, 3- to 5-y-old children (n = 10 boys, 16 girls) were served manipulated breakfasts, lunches, and afternoon snacks 2 d/wk for 2 wk. Foods and beverages served at these meals during 1 wk were lower in ED than were those served during the other week. ED reductions were achieved by decreasing fat and sugar and by increasing fruit and vegetables. Dinner and an evening snack were sent home with children, but these meals did not vary in ED. The same 2-d menu was served in both conditions.

Results: Children consumed a consistent weight of foods and beverages over 2 d in both conditions, and therefore their energy consumption declined by 389 ± 72 kcal (14%) in the lower-ED condition, a significant decrease (P < 0.0001). Differences in energy intake were significant at breakfast on day 1, and they accumulated at manipulated meals over 2 d (P < 0.01). Intake of the nonmanipulated meals was similar between conditions.

Conclusions: Children's energy intake is influenced by the ED of foods and beverages served over multiple days. These results strengthen the evidence that reducing the ED of the diet is an effective strategy for moderating children's energy intake.

Reductions in entrée energy density increase children's vegetable intake and reduce energy intake

The energy density (ED; kcal/g) of an entrée influences children's energy intake (EI), but the effect of simultaneously changing both ED and portion size of an entrée on preschool children's EI is unknown. In this within-subject crossover study, 3- to 5-year-old children (30 boys, 31 girls) in a daycare facility were served a test lunch once/week for 4 weeks. The amount and type of vegetables and cheeses incorporated into the sauce of a pasta entrée were manipulated to create two versions that varied in ED by 25% (1.6 or 1.2 kcal/g). Across the weeks, each version of the entrée was served to the children in each of two portion sizes (400 or 300 g). Lunch, consumed ad libitum, also included carrots, applesauce, and milk. Decreasing ED of the entrée by 25% significantly (P < 0.0001) reduced children's EI of the entrée by 25% (63.1 8.3 kcal) and EI at lunch by 17% (60.7 8.9 kcal). Increasing the proportion of vegetables in the pasta entrée increased children's vegetable intake at lunch by half of a serving of vegetables (P < 0.01). Decreasing portion size of the entrée by 25% did not significantly affect children's total food intake or EI at lunch. Therefore, reducing the ED of a lunch entrée resulted in a reduction in children's EI from the entrée and from the meal in both portion size conditions. Decreasing ED by incorporating more vegetables into recipes is an effective way of reducing children's EI while increasing their vegetable intake.

Reducing the energy density of an entrée decreases children’s energy intake at lunch

Background: Strategies need to be developed to reduce preschool children’s energy intake.

Objective: To test the effect of reducing the energy density of an entrée on children’s ad libitum energy intake.

Subjects: Subjects were 2- to 5-year-old children (37 boys and 40 girls) in a university day-care facility.

Intervention: In this within-subjects crossover study, children were served a test lunch once per week for 6 weeks. Two versions of a macaroni and cheese entrée were formulated to differ in energy density while maintaining similar palatability. Each version was served to children three times. The higher-energy-density entrée had 2.0 kcal/g and the other entrée was 30% lower in energy density. Lunch, consumed ad libitum, also included broccoli, applesauce, and milk.

Main outcome measures: Food intake and energy intake were measured.

Statistical analyses: A mixed linear model tested effect of energy density of the entrée on food intake and energy intake. Results are reported as mean±standard error.

Results: Decreasing the energy density of the entrée by 30% significantly (P<0.0001) reduced children’s energy intake from the entrée by 25% (72.3±8.3 kcal) and total lunch energy intake by 18% (71.8±7.9 kcal). Children consumed significantly more of the lower-energy-density entrée (10.1±4.2 g; P<0.05). Children’s sex-specific body mass index–for-age percentiles did not affect the relationship between energy density of the entrée and children’s intakes.

Conclusions: Decreasing the energy density of a lunch entrée resulted in a reduction in children’s energy intake from the entrée and from the total meal. Reducing the energy density of foods may be an effective strategy to moderate children’s energy intake.

The influence on population weight gain and obesity of the macronutrient composition and energy density of the food supply

Rates of overweight and obesity have increased dramatically in all regions of the world over the last few decades. Almost all of the world's population now has ubiquitous access to low-cost, but highly-processed, energy-dense, nutrient-poor food products. These changes in the food supply, rather than decreases in physical activity, are most likely the primary driver of population weight gain and obesity. To-date, the majority of prevention efforts focus on personalised approaches targeting individuals. Population-wide food supply interventions addressing sodium and trans fat reduction have proven highly effective and comparable efforts are now required to target obesity. The evidence suggests that strategies focusing upon reducing the energy density and portion size of foods will be more effective than those targeting specific macronutrients. Government leadership, clearly specified targets, accountability and transparency will be the key to achieving the food supply changes required to address the global obesity epidemic.

The ultimate food energy guide

This is the third book in Garry Egger's new series of books based on his 'Professor Trim's Medically Supervised Weight Loss Program', a unique medically-based program being endorsed by GPs throughout Australia.In the same vein as Garry Egger and Rosemary Stanton's previously published fat and fibre counters, The Ultimate Energy Guide will provide a comprehensive listing of hundreds of Australian food products broken down by 'energy density', the hottest new topic in weight control research. Regulating the energy density of food that is consumed has begun to supersede previous medical arguments about fat or carbohydrate content as the pivotal factor in weight loss. This will be a quick reference listing which can be used in conjunction with the Becoming Gutless or Becoming Slim weight loss books for men and women respectively.

Sustaining dietary changes for preventing obesity and diabetes: lessons learned from the successes of other epidemic control programs

A degree of success has been achieved in controlling several epidemics of infectious and non-infectious causes of death in countries, such as, Australia and New Zealand. Using the epidemiological triad (host, vector, environment) as a model, the key components of the control of these epidemics have been identified and compared to the current status of interventions to prevent obesity and its main disease consequence, type 2 diabetes. Reductions in mortality from tobacco, cardiovascular diseases, road crashes, cervical cancer and sudden infant death syndrome have been achieved by addressing all corners of the triad. Similarly, prevention programs have minimized the mortality from HIV AIDS and melanoma mortality rates are no longer rising. The main lessons learned from these prevention programs that could be applied to the obesity/diabetes epidemic are: taking a more comprehensive approach by increasing the environmental (mainly policy-based) initiatives; increasing the 'dose' of interventions through greater investment in programs; exploring opportunities to further influence the energy density of manufactured foods (one of the main vectors for increased energy intake); developing and communicating specific, action messages; and developing a stronger advocacy voice so that there is greater professional, public and political support for action. Successes in the other epidemics have been achieved in the face of substantial barriers within individuals, society, the private sector and government. The barriers for preventing obesity/diabetes are no less formidable, but the strategies for surmounting them have been well tested in other epidemics.

Effect of fat replacement by insulin or lupin-kernal fibre on sausage patty acceptability, post-meal perceptions of satiety and food intake in men

The present study examined whether replacing fat with inulin or lupin-kernel fibre influenced palatability, perceptions of satiety, and food intake in thirty-three healthy men (mean age 52 years, BMI 27·4 kg/m²), using a within-subject design. On separate occasions, after fasting overnight, the participants consumed a breakfast consisting primarily of either a full-fat sausage patty (FFP) or a reduced-fat patty containing inulin (INP) or lupin-kernel fibre (LKP). Breakfast variants were alike in mass, protein and carbohydrate content; however the INP and LKP breakfasts were 36 and 37 % lower in fat and 15 and 17 % lower in energy density respectively compared with the FFP breakfast. The participants rated their satiety before breakfast then evaluated patty acceptability. Satiety was rated immediately after consuming the breakfast, then over the subsequent 4·5 h whilst fasting. Food consumed until the end of the following day was recorded. All patties were rated above ‘neither acceptable or unacceptable’, however the INP rated lower for general acceptability (P=0·039) and the LKP lower for flavour (P=0·023) than the FFP. The LKP breakfast rated more satiating than the INP (P=0·010) and FFP (P=0·016) breakfasts. Total fat intake was 18 g lower on the day of the INP (P=0·035) and 26 g lower on the day of the LKP breakfast (P=0·013) than the FFP breakfast day. Energy intake was lower (1521 kJ) only on the day of the INP breakfast (P=0·039). Both inulin and lupin-kernel fibre appear to have potential as fat replacers in meat products and for reducing fat and energy intake in men.

Maintenance of traditional cultural orientation is associated with lower rates of obesity and sedentary behaviours among African migrant children to Australia

Background: Migrants from developing to developed countries rapidly develop more obesity than the host population. While the effects of socio-economic status on obesity are well established, the influence of cultural factors, including acculturation, is not known.

Objective: To examine the association between acculturation and obesity and its risk factors among African migrant children in Australia.

Design and participants: A cross-sectional study using a non-probability sample of 3- to 12-year-old sub-Saharan African migrant children. A bidimensional model of strength of affiliation with African and Australian cultures was used to divide the sample into four cultural orientations: traditional (African), assimilated (Australian), integrated (both) and marginalized (neither).

Main outcome measures: Body mass index (BMI), leisure-time physical activity (PA) and sedentary behaviours (SBs) and energy density of food.

Results: In all, 18.4% (95% confidence interval (CI): 14–23%) were overweight and 8.6% (95% CI: 6–12%) were obese. After adjustment for confounders, integrated (ß=1.1; P<0.05) and marginalized ß(=1.4; P<0.01) children had higher BMI than traditional children. However, integrated children had significantly higher time engaged in both PA (ß=46.9, P<0.01) and SBs (ß=43.0, P<0.05) than their traditional counterparts. In comparison with traditional children, assimilated children were more sedentary (ß=57.5, P<0.01) while marginalization was associated with increased consumption of energy-dense foods (ß=42.0, P<0.05).

Conclusions: Maintenance of traditional orientation was associated with lower rates of obesity and SBs. Health promotion programs and frameworks need to be rooted in traditional values and habits to maintain and reinforce traditional dietary and PA habits, as well as identify the marginalized clusters and address their needs.