A low-energy-dense dietary pattern: a narrative review

Dietary recommendations have promoted the consumption of a low-energy-dense dietary pattern; however, guidelines to implement this dietary pattern are lacking. The objectives of this narrative review are to discuss approaches used to implement a low-energy-dense dietary pattern within dietary interventions and to understand if these approaches achieve a lower energy-dense diet. Interventions that modified the diet for the purpose of altering energy density were referenced. Articles were chosen on the basis of the authors' knowledge of the energy density literature, reviewing relevant articles' reference lists, and discussion among coauthors. Eight articles were chosen for this review. Two approaches have been used to alter energy density: 1) modification to the consumption of dietary components that influence energy density (eg, reducing fat, increasing fruits and vegetables) or 2) use of an energy density classification method based on the numeric energy density value of foods. Although both approaches were used successfully to lower energy density, only the approach that used an energy density classification method allowed for the establishment of specific behavioral goals for participants to achieve regarding energy density. The use of an energy density classification method to develop specific intake goals may aid in the behavioral implementation of a low-energy-dense dietary pattern, but more high-quality studies are needed to draw stronger conclusions. Furthermore, barriers to consuming a low-energy-dense dietary pattern, such as dietary costs, need to be considered.