***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The energy density ( ED ; kcal/g ) of an entrée influences  children  's energy intake ( EI ) , but the effect of simultaneously changing both ED and portion size of an entrée on preschool children 's EI is unknown . In this within-subject crossover study , 3- to 5-year-old children ( 30 boys , 31 girls ) in a daycare facility were served a test lunch once/week for 4 weeks . The amount and type of vegetables and cheeses incorporated into the sauce of a pasta entrée were manipulated to create two versions that varied in ED by 25 % ( 1.6 or 1.2 kcal/g ) . Across the weeks , each version of the entrée was served to the children in each of two portion sizes ( 400 or 300 g ) . Lunch , consumed ad libitum , also included carrots , applesauce , and milk . Decreasing ED of the entrée by 25 % significantly ( P<0.0001 ) reduced children 's EI of the entrée by 25 % ( 63.1+/-8.3 kcal ) and EI at lunch by 17 % ( 60.7+/-8.9 kcal ) . Increasing the proportion of vegetables in the pasta entrée increased children 's vegetable intake at lunch by half of a serving of vegetables ( P<0.01 ) . Decreasing portion size of the entrée by 25 % did not significantly affect children 's total food intake or EI at lunch . Therefore , reducing the ED of a lunch entrée result ed in a reduction in  children 's EI from the entrée and from the meal in both portion size conditions . Decreasing ED by incorporating more vegetables into recipes is an effective way of reducing children 's  EI while increasing their vegetable intake Background Dietary energy density ( DED ) does not have a simple linear relationship to fat mass in children , which suggests that some children are more susceptible than others to the effects of DED . Children with the FTO ( rs9939609 ) variant that increases the risk of obesity may have a higher susceptibility to the effects of DED because their internal appetite control system is compromised . We tested the relationship between DED and fat mass in early adolescence and its interaction with FTO variants . Methods and Findings We carried out a prospect i ve analysis on 2,275 children enrolled in the Avon Longitudinal Study of Parents and Children ( ALSPAC ) .  Diet was assessed at age 10 y using 3-day diet diaries .  DED ( kJ/g ) was calculated excluding drinks . Children were genotyped for the FTO ( rs9939609  ) variant . Fat mass was estimated at age 13 y using the Lunar Prodigy Dual-energy X-ray Absorptiometry scanner . There was no evidence of interaction between DED at age 10 y and the high risk A allele of the FTO gene in relation to fat mass at age 13 y ( β = 0.005 , p = 0.51 ) , suggesting that the FTO gene has no effect on the relation between DED at 10 y and fat mass at 13 y. When DED at 10 y and the A allele of FTO were in the same model they were independently related to fat mass at 13 y. Each A allele of FTO was associated with 0.35±0.13 kg more fat mass at 13 y and each 1 kJ/g DED at 10 y was associated with 0.16±0.06 kg more fat mass at age 13 y , after controlling for misreporting of energy intake , gender , puberty , overweight status at 10 y , maternal education , TV watching , and physical activity . Conclusions This study reveals the multi-factorial origin of obesity and indicates that although FTO may put some children at greater risk of obesity , encouraging a low dietary energy density may be an effective strategy to help all children avoid excessive fat gain Background Experimental studies show that a reduction in dietary energy density ( ED ) is associated with reduced energy intake and body weight . However , few observational studies have investigated the role of ED on long-term weight and waist circumference change . Methods and Principal Findings This population -based prospect i ve cohort study included 89,432 participants from five European countries with mean age 53 years ( range : 20–78 years ) at baseline and were followed for an average of 6.5 years ( range : 1.9–12.5 years ) . Participants were free of cancer , cardiovascular diseases and diabetes at baseline .  ED  was calculated as the energy intake ( kcal ) from foods divided by the weight ( g ) of foods . Multiple linear regression analyses were performed to investigate the associations of ED with annual weight and waist circumference change . Mean ED was 1.7 kcal/g and differed across study centers . After adjusting for baseline anthropometrics , demographic and lifestyle factors , follow-up duration and energy from beverages , ED was not associated with weight change , but significantly associated with waist circumference change overall . For 1 kcal/g ED , the annual weight change was −42 g/year [ 95 % confidence interval ( CI ) : −112 , 28 ] and annual waist circumference change was 0.09 cm/year [ 95 % CI : 0.01 , 0.18 ] . In participants with baseline BMI < 25 kg/m2 , 1 kcal/g ED was associated with a waist circumference change of 0.17 cm/year [ 95 % CI : 0.09 , 0.25 ] . Conclusion Our results suggest that lower ED diets do not prevent weight gain but have a weak yet potentially beneficial effect on the prevention of abdominal obesity as measured by waist circumference This study examined the effect of energy density , independent of fat content and palatability , on food and energy intakes . With use of a within-subjects design , normal-weight women ( n = 18 ) were provided with meals for 2 d during each of three test sessions . During lunch , dinner , and an evening snack , subjects were given free access to a main entree varying in energy density ( low , medium , or high ) . The manipulated main entrees were similar in palatability to their counterparts across conditions . Low-energy compulsory ( consumption required ) side dishes accompanied each meal . Subjects also consumed a st and ard , compulsory breakfast . Results showed that subjects consumed a similar amount of food ( by weight ) across the three conditions of energy density . Thus , significantly more energy was consumed in the condition of high energy density ( 7532 + /- 363 kJ , or 1800 + /- 86 kcal ) than in the medium- ( 6356 + /- 281 kJ , or 1519 + /- 67 kcal ) and low- ( 5756 + /- 178 kJ , or 1376 + /- 43 kcal ) energy-density conditions ( P < 0.0001 ) . There were no differences in hunger or fullness before meals , after meals , or over the 2 d across conditions . The results from this study indicate that energy density affects energy intake independent of macronutrient content or palatability , suggesting that the overconsumption of high-fat foods may be due to their high energy density rather than to their fat content BACKGROUND The contribution of energy density ( ED ) of the total diet to increased risk of obesity  from childhood into adolescence is unclear . OBJECTIVE We assessed the relation between the ED of the diet in childhood , calculated in a number of ways , and change in adiposity from childhood to adolescence . DESIGN In a prospect i ve study , 48 children ( 30 boys , 18 girls ) were initially studied at age 6 - 8 y ( baseline ) and followed up at age 13 - 17 y.  Daily ED , energy intake , and food intake were assessed at baseline by 7-d weighed food records concurrent with estimates of total energy expenditure ( TEE ) by doubly labeled water .  ED was calculated with the use of 5 published methods . Obesity risk was defined with the use of body fat from total body water by isotope dilution . Body fat was normalized for height and expressed as fat mass index ( FMI ) . Change in adiposity was calculated as follow-up FMI minus baseline FMI . RESULTS Misreporting of energy intake at the group level at baseline was low relative to the TEE . ED of the total diet  at baseline by the 3 methods for calculating ED that excluded all or most beverages was prospect ively associated with change in FMI . However , ED of the total diet  by any of the methods was not associated with change in the percentage body fat , body mass index , or waist circumference z scores . CONCLUSION The methods used to calculate ED and to assess obesity risk lead to different conclusions about the relation between the ED of the diet in childhood and gain in fat into adolescence BACKGROUND Consuming foods low in energy density ( kcal/g ) decreases energy intake over several days , but the effectiveness of this strategy for weight loss has not been tested . OBJECTIVE The effects on weight loss of 2 strategies for reducing the energy density of the diet were compared over 1 y. DESIGN Obese women ( n = 97 ) were r and omly assigned to groups counseled either to reduce their fat intake ( RF group ) or to reduce their fat intake and increase their intake of water-rich foods , particularly fruit and vegetables ( RF+FV group ) . No goals for energy or fat intake were assigned ; the subjects were instructed to eat ad libitum amounts of food while following the principles of their diet . RESULTS After 1 y , study completers ( n = 71 ) in both groups had significant decreases in body weight ( P < 0.0001 ) . Subjects in the RF+FV group , however , had a significantly different pattern of weight loss ( P = 0.002 ) than did subjects in the RF group . After 1 y , the RF+FV group lost 7.9 + /- 0.9 kg and the RF group lost 6.4 + /- 0.9 kg . Analysis of all r and omly assigned subjects also showed a different pattern of weight loss between groups ( P = 0.021 ) . Diet records indicated that both groups had similar reductions in fat intake . The RF+FV group , however , had a lower dietary energy density than did the RF group ( P = 0.019 ) as the result of consuming a greater weight of food ( P = 0.025 ) , especially fruit and vegetables ( P = 0.037 ) . The RF+FV group also reported less hunger ( P = 0.003 ) . CONCLUSION Reducing dietary energy density , particularly by combining increased fruit and vegetable intakes with decreased fat intake , is an effective strategy for managing body weight while controlling hunger BACKGROUND Dietary energy density ( ED ) reductions are associated with energy intake ( EI ) reductions . Little is known about influences on body weight ( BW ) . OBJECTIVES We examined the effects of behavioral interventions on ED values and explored how 6-mo ED changes relate to BW . DESIGN Prehypertensive and hypertensive persons were r and omly assigned to 1 of 3 groups : the established group received an 18-session intervention implementing well-established hypertension recommendations ( eg , weight loss , sodium reduction , and physical activity ) , the established+Dietary Approaches to Stop Hypertension ( DASH ) group received an 18-session intervention also implementing the DASH diet , and the advice group received 1 session on these topics . Two 24-h dietary recalls were collected ( n=658 ) . RESULTS Each group had significant declines in EI , ED , and BW . The established and established+DASH groups had the greatest EI and BW reductions . The established+DASH group had the greatest ED reduction and the greatest increase in the weight of food consumed . When groups were combined and analyzed by ED change tertiles , participants in the highest tertile ( ie , largest ED reduction ) lost more weight ( 5.9 kg ) than did those in the middle ( 4.0 kg ) or lowest ( 2.4 kg ) tertile . Participants in the highest and middle tertiles increased the weight of food they consumed ( 300 and 80 g/d , respectively ) but decreased their EI ( 500 and 250 kcal/d ) . Conversely , those in the lowest tertile decreased the weight of food consumed ( 100 g/d ) , with little change in EI . The highest and middle tertiles had favorable changes in fruit , vegetable , vitamin , and mineral intakes . CONCLUSION Both large and modest ED reductions were associated with weight loss and improved diet quality BACKGROUND Studies have shown that energy intake increases when both the fat content and energy density of the entire diet increases . When the fat content and energy density vary independently of one another , however , energy density , but not fat content , influences intake . OBJECTIVE The present study examined whether energy intake in lean and obese women is affected when either the energy density or the fat content of a portion of the diet is manipulated and palatability is held constant . DESIGN In a within-subjects design , 17 lean and 17 obese women consumed meals in the laboratory for four , 4-d test periods . In 3 of these test periods the energy density ( 4.4 and 6.7 kJ/g ) or the fat content ( 16 % and 36 % of energy ) of compulsory entrees representing 50 % of each subject 's usual energy intake was manipulated . Additional self-selected foods were consumed ad libitum at meals and as snacks . RESULTS There were no systematic differences in palatability of the manipulated foods across conditions . Obese and lean participants responded similarly to the dietary manipulations . Intake of self-selected foods at meals was reduced significantly by 16 % for both lean and obese subjects in the low- compared with the high-energy-density condition . The fat content of the compulsory foods 
    Output:
    
Based on this evidence , the 2010 Dietary Guidelines Advisory Committee concluded that strong and consistent evidence in adults indicates that dietary patterns relatively low in energy density improve weight loss and weight maintenance .
In addition , the committee concluded that there was moderately strong evidence from method ologically rigorous longitudinal cohort studies in children and adolescents to suggest that there is a positive association between dietary energy density and increased adiposity .
This review supports a relationship between energy density and body weight in adults and in children and adolescents such that consuming diets lower in energy density may be an effective strategy for managing body weight