Abstract
OBJECTIVE: To examine the relationship between dietary energy density (DED) and risk of metabolic syndrome (MetS), its components and inflammatory markers. DESIGN: Cross-sectional study. Dietary intakes were assessed using a validated dish-based semi-quantitative FFQ. DED was calculated by dividing energy intake (kcal/d) by the total weight of foods only (g/d). MetS was defined based on the National Cholesterol Education Program Adult Treatment Panel III criteria. All associations were examined in the quartiles of DED, with higher quartiles indicating more energy-dense diets. SETTING: Isfahan, Iran. SUBJECTS: Female nurses (n 1036) aged >30 years. RESULTS: After controlling for potential confounders, individuals in the top quartile of DED had 78 % greater chance of MetS compared with those in the first (OR=1·78; 95 % CI 1·36, 2·98; P<0·001). Individuals in the highest quartile of DED were more likely to be abdominally obese (OR=1·51; 95 % CI 1·00, 2·63) and have hypertriacylglycerolaemia (OR=2·95; 95 % CI 1·58, 3·91) and low HDL cholesterol levels (OR=1·36; 95 % CI 1·17, 2·54) compared with those in the lowest quartile. Mean concentration of plasma high-sensitivity C-reactive protein (hs-CRP) across increasing quartiles of DED was 1·7, 1·7, 2·0, 2·4 mg/l (P for trend=0·04). Such increasing concentrations across increasing quartiles of DED were also seen for TNF-α (4·1, 4·5, 4·5, 4·8 ng/l; P for trend=0·03) and IL-6 (1·6, 1·6, 1·5, 2·5 ng/l; P for trend <0·01). CONCLUSIONS: Consumption of high-energy-dense foods was associated with increased chance of MetS, most of its features and inflammatory markers including hs-CRP, TNF-α and IL-6.