Sep. 29, 2000 Energy-dense, nutrient-poor foods (EDNP's), which are generally rich in fats, oils and sugars, occupy the very small "tip" of the Food Pyramid used to illustrate America's recommended dietary guidelines. Recent research published in The American Journal of Clinical Nutrition demonstrates that Americans continue to consume the same high percentage of these foods that they were in the 1970's, in most cases about a third of their daily calories from EDNP's. Dr. Ashima K. Kant analyzed data from the third 1988-1994 National Health and Nutrition Examination Survey (NHANES III) which surveyed the dietary habits of 15,611 participants. Analysis of the participants' diets showed that EDNP foods supplied 27% of energy intake overall, and alcohol provided an additional 4%, results similar to data from the 1976-1980 NHANES II. Apparently neither public education efforts encouraging consumers to limit their intake of these foods, nor the recent availability of many varieties of fat- and sugar- modified products has affected Americans' penchant for EDNP's. Empty-calorie choices continue to crowd out consumption of more nutrient-rich foods which should be part of a healthful eating pattern.
The odds of meeting recommended nutrient standards or consuming foods from all 5 food groups decreased with increasing intake of EDNP foods. In participants who consumed the highest levels of EDNP's, more than 50% of carbohydrate intake and more than 45% of fat intake came from nutrient-poor foods. As the percentage of calories from EDNP foods went up, serum concentrations of vitamins and micronutrients in the participants went down in an inverse relation. Higher consumption of EDNP foods was associated with higher levels of homocysteine and lower levels of HDL, or "good" cholesterol. LDL cholesterol levels were not affected by EDNP consumption. As a group, women whose diet included many empty-calorie foods fared worse nutritionally than men with the same dietary pattern. For instance, among the heaviest consumers of EDNP's, calcium levels were 31% of those recommended for men but 13% for women; folate levels were 31% for men but 15% for women; and protein levels were 68% for men but 52% for women. The highest consumers of EDNP foods were more likely to be women, to be non-Hispanic whites rather than other ethnic groups, to be <65 years of age, to have 12 years of education, and to have higher income levels. However, indicators of overweight such as body mass index or waist circumference did not differ between heavier and lighter consumers of EDNP's.
Public health-related implications for this continuing high consumption of empty-calorie foods include the risk for marginal nutrient intakes for many Americans and the probability that EDNP foods, being highly palatable and aggressively advertised, are playing a role in the increasing adiposity of the American population. Risk reduction for disorders such as cancer, diabetes and cardiovascular disease is less likely when compliance with recommended dietary recommendations is low, as these results indicate. In particular, data from the study relating to increased serum homocysteine and decreased HDL-cholesterol concentrations point to an increase in coronary heart disease risk with increased EDNP food intake. The author asserts that the suggested "Food Pyramid" strategy by which consumers could make fat, carbohydrate and energy substitutions for EDNP foods in their diets may be far too complex for the average consumer to implement. He states, "New strategies are needed to educate consumers on how to moderate their intake of EDNP foods and how to include these foods in their diet sensibly."
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