# Dietary Energy Density Is Associated with Biomarkers of Chronic Diseases—A Cross-Sectional Study of School-Aged Children in Rural Mexico

## TL;DR

This study shows that higher dietary energy density in children from rural Mexico is linked to increased risk of insulin resistance and higher cholesterol levels, but not obesity or inflammation.

## Contribution

The study provides new evidence on the association between dietary energy density and biomarkers of chronic disease in school-aged children.

## Key findings

- Higher dietary energy density was associated with increased odds of insulin resistance and higher leptin levels.
- Both dietary energy density measures were linked to higher cholesterol concentrations.
- No significant associations were found between dietary energy density and obesity or inflammatory cytokines.

## Abstract

Dietary energy density (DED) is associated with chronic disease markers in adults. However, results in children are still controversial.

To evaluate the DED of children and its association with obesity and biomarkers of chronic disease.

In this cross-sectional study, we recruited 284 children (6–10 y) from rural Mexico. Dietary intake was assessed using three 24-h recalls. DED was calculated for “foods only” (DEDfo) and for “foods and beverages” (DEDfb). Weight, height, and body fat percent (dual-energy X-ray absorptiometry) were measured. Inflammatory cytokines, lipid profile, leptin, and insulin resistance were determined from a fasting blood sample.

DEDfo was 1.91 ± 0.36 kcal/g and DEDfb was 1.36 ± 0.31 kcal/g. Higher DEDfo and DEDfb were associated with higher risk to have insulin resistance [odds ratio (OR) = 3.92, 95% confidence interval (CI): 1.66, 9.22, P < 0.01; OR = 3.51, 95% CI: 1.25, 9.87, P = 0.02, respectively]. Higher DEDfo was associated with higher risk of higher leptin levels (OR = 3.17, 95% CI: 1.01, 10.23). Also, DEDfo and DEDfb were associated with higher concentrations of cholesterol (β = 11.67, 95% CI: 1.81, 19.53, P = 0.03; and β = 11.74, 95% CI: 2.69, 20.74 P = 0.01, respectively) and higher odds of having high insulin concentrations (OR = 2.52, 95% CI: 1.26, 5.06, P = 0.01; and OR = 2.95, 95% CI: 1.30, 6.70, P = 0.01). DEDfo and DEDfb were not associated with any measure of obesity and inflammatory cytokines in the adjusted models.

DED was associated with higher leptin and cholesterol concentrations, and having insulin resistance, but not with any measure of obesity or inflammation. Reducing DED may reduce risk of cardiovascular disease and improve insulin sensitivity in school-aged children.