Lunch energy density and the metabolic syndrome in patients with type 2 diabetes mellitus

The aim of the present study was to investigate the possible associations between dietary energy density (ED) and the metabolic syndrome (MetS) in patients with type 2 diabetes. In the present case-control study, the dietary ED of 125 patients with type 2 diabetes (seventy-eight with (cases) the MetS and forty-seven without (controls) the MetS; mean age 62.0 (SD 9.4) years, mean diabetes duration 12.5 (SD 8.4) years and mean glycated Hb 7.2 (SD 1.3) %) was assessed by weighed diet records. The MetS was defined according to the 2009 Joint Interim Statement and ED by the amount of energy (kJ) in a given weight of food. Data are expressed as means (standard deviations) or medians (interquartile ranges). Patients with the MetS reported lower intakes of total energy and fibre, and a higher total food amount than the controls; the total ED did not differ, but the cases had a higher ED at lunch (mean 6.3 (SD 1.3) v. 5.9 (SD 0.8) kJ/g; P=0.017). In this meal, patients with the MetS had lower intakes of beans (median 0.7 (interquartile range 0.4-1.1) v. 1.1 (interquartile range 0.6-1.6) g/kg; P=0.020), vegetables (median 1.2 (interquartile range 0.6-1.7) v. 1.4 (interquartile range 1.0-2.0) g/kg; P=0.046) and total meat (median 1.3 (interquartile range 1.0-1.6) v. 1.4 (interquartile range 1.2-1.8) g/kg; P=0.034) than patients without the MetS. The associations between lunch ED (kJ/g) and food groups (g/kg) were confirmed for vegetables (r 20.584; P<0.001), fruits (r 20.233; P=0.070), beans (r 20. 189; P=0.037) and oils (r 0.323; P<.0001). In a multivariate logistic regression model, a high lunch ED was associated with the MetS (OR 6.89, 95% CI 1.35, 35.15; P=0.020) after adjusting for confounders. In conclusion, a high ED at lunch increased the odds of the presence of the MetS in patients with type 2 diabetes. Beans and vegetables may be the major contributors to this association and their consumption might be considered to decrease ED.