We study a dilute Bose gas of atoms whose scattering length a is large compared to the range of their interaction. We calculate the energy density E of a homogeneous Bose-Einstein condensate (BEC) to second order in the low-density expansion, expressing it in terms of a and a second parameter Lambda* that determines the low-energy observables in the three-body sector. The second-order correction to E has a small imaginary part that reflects the instability due to three-body recombination. In the case of a trapped BEC with large negative a, we calculate the coefficient of the three-body mean-field term in E in terms of a and Lambda*. It can be very large if there is an Efimov state near threshold.