Dietary Energy Intake Is Associated With Type 2 Diabetes Risk Markers in Children OBJECTIVE Energy intake, energy density, and nutrient intakes are implicated in type 2 di- abetes risk in adults, but little is known about their influence on emerging type 2 diabetes risk in childhood. We examined these associations in a multiethnic population of children. RESEARCH DESIGN AND METHODS This was a cross-sectional study of 2,017 children predominantly of white European, South Asian, and black African-Caribbean origin aged 9–10 years who had a detailed 24-h dietary recall and measurements of body composition and provided a fasting blood sample for measurements of plasma glucose, HbA 1c , and serum insulin; homeostasis model assessment of insulin resistance was also derived. RESULTS Energy intake was positively associated with insulin resistance. After the removal of 176 participants with implausible energy intakes (unlikely to be representative of habitual intake), energy intake was more strongly associated with insulin re- sistance and was also associated with glucose and fat mass index. Energy density was also positively associated with insulin resistance and fat mass index. How- ever, in mutually adjusted analyses, the associations for energy intake remained while those for energy density became nonsignificant. Individual nutrient intakes showed no associations with type 2 diabetes risk markers. CONCLUSIONS Higher total energy intake was strongly associated with high levels of insulin re- sistance and may help to explain emerging type 2 diabetes risk in childhood. Studies are needed to establish whether reducing energy intake produces sus- tained favorable changes in insulin resistance and circulating glucose levels. Diabetes Care 2014;37:116–123 | DOI: 10.2337/dc13-1263 Type 2 diabetes is a major global public health problem, requiring concerted preventive efforts (1). Diet appears to play an important role in the etiology of type 2 diabetes, although the importance of specific dietary components has not been completely resolved (2). In adults, diets with a high energy intake (3,4) and a high energy density (5) have been implicated in type 2 diabetes risk. Specific aspects of 1 Division of Population Health Sciences and Education, St George’s, University of London, London, U.K. 2 Human Nutrition Research, Medical Research Council, Cambridge, U.K. Corresponding author: Angela S. Donin, adonin@sgul.ac.uk. Received 29 May 2013 and accepted 3 August 2013. This article contains Supplementary Data online at http://care.diabetesjournals.org/lookup/ suppl/doi:10.2337/dc13-1263/-/DC1. © 2014 by the American Diabetes Association. See http://creativecommons.org/licenses/by- nc-nd/3.0/ for details. Angela S. Donin, 1 Claire M. Nightingale, 1 Christopher G. Owen, 1 Alicja R. Rudnicka, 1 Susan A. Jebb, 2 Gina L. Ambrosini, 2 Alison M. Stephen, 2 Derek G. Cook, 1 and Peter H. Whincup 1 116 Diabetes Care Volume 37, January 2014 EPIDEMIOLOGY/HEALTH SERVICES RESEARCH