DED, defined as the ratio of energy intake (EI) to food weight, is receiving increased attention reflecting recent reports of its associations with elevated risks for obesity and T2DM in general populations. However, only a few studies have investigated the associations between DED and metabolic variables in patients with established diabetes, which led us to analyze the association between DED and obesity in Japanese patients with T2DM. Cross-sectionally investigated were 1,576 outpatients with T2DM (men 60.8%) who attended 26 clinics having diabetes specialists. Dietary habits were obtained by the Food Frequency Questionnaire based on food groups (FFQg). DED (kcal/g) was calculated by dividing EI (kcal) from foods (excluding beverages) by these food weights (g) and was categorized into tertiles (low (L), <1.36; medium (M), 1.36-1.53; high (H), ≥1.54). We compared nutritional intake between groups by ANCOVA. Multivariate logistic regression model was used to estimate adjusted odds ratios for obesity (BMI≥25) in each tertile and per 1 kcal/g of DED, together with tests of combined tertiles of DED and EI. Both EI (kcal) (L, 1692; M, 1787; H, 1862, p for trend< 0.001) and the fat-energy ratio (%) (L, 28.5; M, 29.5; H, 30.7, p for trend< 0.001) were positively associated according to tertiles of DED. Adjusted odds ratios for obesity were also significantly increased according to tertiles of DED (L, ref; M, 1.33(95% CI:1.01-1.75); H, 1.76(1.32-2.36), p for trend< 0.001) and 4.29(2.38-7.73) per 1 kcal/g of DED. Possibility of obesity was significantly higher for patients in the top tertile of DED regardless of EI but was not significant for those in the bottom tertile regardless of EI.

In conclusion, higher DED, which is related to higher fat intake, was strongly associated with a greater chance of having obesity in T2DM patients regardless of EI. Therefore, DED is critical in assessing diet quality and has clinical relevance in obesity management of patients with T2DM.


Y. Takeda: None. K. Fujihara: None. S.Y. Morikawa: None. C. Horikawa: None. M. Hatta: None. D. Ishii: None. R. Hirasawa: None. Y. Yachi: None. H. Sone: Research Support; Self; Novo Nordisk Inc., Eli Lilly and Company, MSD K.K., Chugai Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Development Center Asia, Pte. Ltd., Daiichi Sankyo Company, Limited, Ono Pharmaceutical Co., Ltd., Kyowa Hakko Kirin Co., Ltd., Sanofi, Kowa Pharmaceuticals America, Inc., Eisai Inc..

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