Consumption of energy-dense, nutrient-poor foods by adult Americans: nutritional and health implications. The third National Health and Nutrition Examination Survey, 1988-1994

Background: Current dietary guidance recommends limiting the intake of energy-dense, nutrient-poor (EDNP) foods, but little is known about recent consumption patterns of these foods. Objective: The contribution of EDNP foods to the American diet and the associated nutritional and health implications were examined. Design: Data from the third National Health and Nutrition Examination Survey (n = 15611; age greater than or equal to 20 y) were used. EDNP categories included visible fats, nutritive sweeteners and sweetened beverages, desserts, and snacks. The potential independent associations of EDNP food intake with intakes of energy, macronutrients, micronutrients, and serum vitamin, lipid, and carotenoid profiles were examined with linear and logistic regression procedures. Results: EDNP foods supplied approximate to 27% of energy intake; alcohol provided an additional 4%. The relative odds of consuming foods from all 5 food groups and of meeting the recommended dietary allowance or daily reference intake for protein and several micronutrients decreased with increasing EDNP food intake (P < 0.0001). Energy intake and percentage of energy from fat were positively related to EDNP intake. Serum concentrations of vitamins A E, C, and B-12; folate; several carotenoids; and HDL cholesterol were inversely related (P less than or equal to 0.0005) whereas serum homocysteine concentration was positively related (P = 0.02) to EDNP food intake. Conclusions: The results suggest that EDNP foods were consumed at the expense of nutrient-dense foods, resulting in 1) increased risk of high energy intake, 2) marginal micronutrient intake, 3) poor compliance with nutrient- and food group-related dietary guidance, and 4) low serum concentrations of vitamins and carotenoids.