The aim of the present study was to investigate the interaction between the angiotensin-converting enzyme 1 (
ACE) I/D polymorphism and energy and macronutrient intakes on adiposity-related phenotypes among toddlers and preschoolers. A representative sample of 2374 Greek children aged 1 to 5 years old was examined (Growth, Exercise and Nutrition Epidemiological Study in preSchoolers (GENESIS)). Dietary and anthropometric (i.e. BMI, waist circumference (WC)) assessments were carried out using standard procedures. DNA samples were obtained from 2102 children and were genotyped for the ACEI/D polymorphism. Among the entire population, 17 % were ‘at risk of overweight’ and a similar percentage were ‘overweight’. The frequencies of the II, ID and DD genotypes were 16, 46 and 38 %, respectively. Significant interactions were found between the ACEI/D polymorphism and total energy intake on WC ( P= 0·004 for interaction) and the ACEI/D polymorphism and protein intake on BMI and being overweight ( P< 0·05 for interaction). Furthermore, it was found that the ACEI/D polymorphism may modify the effect of fat intake on WC and BMI, but this interaction disappeared after adjustment for additional potential confounders. Stratified analyses revealed that total energy is correlated with WC and protein intake is associated with BMI and being overweight only among carriers of the D-allele (i.e. DD or ID genotypes). These results suggest that the ACEI/D polymorphism may act as a modifying factor in the response of adiposity-related phenotypes to diet.