Association of breakfast energy density with diet quality and body mass index in American adults: National Health and Nutrition Examination Surveys, 1999-2004

Background: Recent reports suggest that dietary energy density (ED) is associated with diet quality, energy intake, and body weight. Breakfast consumption was also associated with diet quality and body weight; however, little is known about the association of breakfast consumption with dietary ED. Objectives: We examined differences in the ED (in energy content/g of food) of diets between breakfast consumers and nonconsumers, and in breakfast reporters we examined the association of ED of breakfast foods with ED of nonbreakfast foods, diet quality, and body mass index (BMI; in kg/ m(2)). Design: We combined dietary data from the 3 continuous National Health and Nutrition Examination Surveys (1999-2004) to determine the ED (in kcal/g) of foods and nutritive beverages and the ED of foods only (n = 12 316; >= 20 y). Linear and logistic regression methods were used to examine the independent associations of breakfast reporting or breakfast ED with 24-h ED, nonbreakfast ED, diet quality, and BMI. Results: The ED of 24-h dietary intake was lower among breakfast reporters than among nonreporters. Women breakfast reporters (but not men) had lower BMI than did nonreporters (27.9 +/- 0.2 compared with 29.4 +/- 0.4; P = 0.001). With increasing breakfast ED, nonbreakfast ED and fat intake increased, but micronutrient intake and the likelihood of mention of all 5 food groups declined. BMI increased with increasing breakfast ED in men but with increasing nonbreakfast ED in women (P <= 0.001). Conclusions: Our results support recommendations to encourage breakfast consumption and suggest that the ED of breakfast was associated with diet quality, overall diet ED, and body weight. Am J Clin Nutr 2008; 88: 1396-404.