Dietary energy density (DED) is receiving increased attention reflecting recent reports of inverse associations with health outcomes. Although high DED meals are reportedly associated with low diet quality in the general population, such evidence in patients with diabetes is sparse, which led us clarify this issue in Japanese patients with T2DM. Analyzed were 1,615 outpatients with T2DM (men 62.2%) who attended 24 clinics specializing in diabetes care nationwide. Dietary habits were obtained using a food frequency questionnaire (FFQg) based on 18 food groups. DED (kcal/g) was calculated by dividing EI (kcal) from foods (excluding beverages) by weights of these foods (g). Mean DED (±SD) was 1.53±0.23 (kcal/g). Typical dietary patterns comprised of some significant food groups were extracted by principal component analysis. Pearson's correlation analysis was used to evaluate the associations between identified food patterns and DED. We could extract and validate three dietary patterns, which we labeled as “Healthy,” “Western,” and “Animal foods and confectionery.” Two patterns were significantly correlated with DED (Healthy: r=-0.48, Animal foods and confectionery: r=-0.69). A multivariate linear regression model was used to determine food groups that were independently related to DED. DED was positively associated with confectioneries (standardized β=0.19, P<0.001), bread (0.10, P<0.001), and fat and oil (0.09, P<0.001). On the contrary, DED was negatively associated with brightly colored vegetables (-0.25, P<0.001), fruits (-0.31, P<0.001), and light-colored vegetables (-0.43, P<0.001).

In conclusion, lower DED, which is related to higher intakes of vegetables and fruits was associated with a healthy diet pattern in T2DM patients. DED is a useful indicator of diet quality and could be utilized in nutritional education for people with T2DM.

Disclosure

Y. Takeda: None. K. Fujihara: None. M. Hatta: None. S.Y. Morikawa: None. C. Horikawa: None. D. Ishii: None. R. Nedachi: None. H. Maegawa: Research Support; Self; Antares Pharma, Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceutical Company Limited. Speaker's Bureau; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceutical Company Limited. H. Sone: Research Support; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Kowa Pharmaceutical Europe Co. Ltd., Kyowa Hakko Kirin Co., Ltd., Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited.

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