1 University of North Carolina - Chapel Hill, United States.
Dietary energy density (DED) in low and middle income countries (LMICs) is rising with economic development and increased availability of fats and refined sugars. Understanding food consumption patterns contributing to DED may offer insights for obesity prevention and weight loss recommendations in LMIC. This study aimed to identify and describe the food groups that contribute Dietary Energy Density (DED) from solid foods, and estimate the association of DED to changes in waist circumference (WC) from 1994-2012 in 2,180 adult, non-pregnant Filipino women, aged 25-76y in the Cebu Longitudinal Health and Nutrition Survey (CLHNS). We calculated % contribution by food group to DED per survey year. We used longitudinal random effects models to estimate the association of DED to WC, adjusting for energy intake (EI), age, survey year, education level, urbanicity, log household income, and EI-DED and age-DED interactions. Finally, we predicted changes in WC across ages and EI. Cereals & cereal products; fish, meat & poultry, and sugars and syrups provided a mean of at least 66, 17, and 1.5% of DED between 1994 and 2012, respectively. The association of DED with WC varies across levels of age and EI. After adjustment for relevant covariates, we observe a predicted positive association of DED with WC across ages with greater increases in ages >45y. While there is a statistically significant interaction between DED and EI (p<0.001, a=0.05), differences in WC do not seem clinically significant across EI levels at the same DED. Our data suggests that DED is associated with adverse implications in WC among middle-aged and older Filipino women. Furthermore, the generalizability of these findings can be applied to other LMIC populations undergoing through similar stages of the Nutrition Transition, specifically Latin American populations given similar food cultures influenced by previous colonial history.