Dietary energy density and the metabolic syndrome among Iranian women

Background/Objectives: In a comparison of women worldwide, Iranian women were found to have the highest prevalence of the metabolic syndrome. Furthermore, specific characteristics of diet in Middle-Eastern countries might provide additional information on the diet-disease relations. This study was performed to assess the association between dietary energy density and prevalence of the metabolic syndrome among Iranian women. Subjects/Methods: Usual dietary intakes were assessed in a cross-sectional study of 486 Iranian adult women by the use of a food frequency questionnaire. Dietary energy density was calculated as each individual's reported daily energy intake (kcal/d) into total weight of foods (excluding beverages) consumed (g/d). Anthropometric measures, fasting plasma glucose, serum lipid profiles and blood pressure were evaluated. The metabolic syndrome was defined according to Adult Treatment Panel III guidelines. Results: Mean dietary energy density was 1.77 +/- 0.35 kcal/g. Individuals in the top tertile of dietary energy density had 80% (odds ratio: 1.80; 95% confidence interval: 1.17, 3.15) greater odds of having the metabolic syndrome. Even after further adjustment for body mass index, this association remained significant. Higher dietary energy density was also significantly associated with greater odds of having abdominal adiposity (4.23; 2.51, 7.18), high-serum triacylglycerol concentrations (3.55; 2.31, 5.93) and low-serum high-density lipoprotein cholesterol levels (1.80; 1.13, 2.84). No overall significant associations were found between higher dietary energy density and risk of having elevated blood pressure or abnormal glucose homeostasis. Conclusions: Higher dietary energy density was significantly associated with a greater risk of the metabolic syndrome and most of its components. Further studies are required to focus on lowering dietary energy density as a probable strategy for preventing metabolic syndrome. European Journal of Clinical Nutrition (2011) 65, 598-605; doi: 10.1038/ejcn.2010.284; published online 12 January 2011