The effects of high protein diets on thermogenesis, satiety and weight loss: a critical review

Dynamic Changes in Post-Ingestive Sensations after Consumption of a Breakfast Meal High in Protein or Carbohydrate

The obesity epidemic urges exploration of several parameters that play an important role in our eating behaviours. Post-ingestive sensations can provide a more comprehensive picture of the eating experience than mere satiety measurements. This study aimed to (1) quantify the dynamics of different post-ingestive sensations after food intake and (2) study the effect of protein and carbohydrate on hedonic and post-ingestive responses. Forty-eight participants (mean age 20.4) were served a breakfast meal high in protein (HighPRO) or high in carbohydrate (HighCHO) on two separate days using a randomised controlled crossover design. Post-ingestive sensations were measured every 30 min, for 3 h post intake using visual analogue scale (VAS). Results showed a significant main effect of time for all post-ingestive sensations. HighCHO induced higher hedonic responses compared to HighPRO, as well as higher ratings for post-ingestive sensations such as Satisfaction, Food joy, Overall wellbeing and Fullness. HighPRO, on the other hand, induced higher ratings for Sweet desire post intake. The development of sensations after a meal might be important for consumers’ following food choices and for extra calorie intake. More detailed knowledge in this area could elucidate aspects of overeating and obesity.

Is an Energy Surplus Required to Maximize Skeletal Muscle Hypertrophy Associated With Resistance Training

Resistance training is commonly prescribed to enhance strength/power qualities and is achieved via improved neuromuscular recruitment, fiber type transition, and/ or skeletal muscle hypertrophy. The rate and amount of muscle hypertrophy associated with resistance training is influenced by a wide array of variables including the training program, plus training experience, gender, genetic predisposition, and nutritional status of the individual. Various dietary interventions have been proposed to influence muscle hypertrophy, including manipulation of protein intake, specific supplement prescription, and creation of an energy surplus. While recent research has provided significant insight into optimization of dietary protein intake and application of evidence based supplements, the specific energy surplus required to facilitate muscle hypertrophy is unknown. However, there is clear evidence of an anabolic stimulus possible from an energy surplus, even independent of resistance training. Common textbook recommendations are often based solely on the assumed energy stored within the tissue being assimilated. Unfortunately, such guidance likely fails to account for other energetically expensive processes associated with muscle hypertrophy, the acute metabolic adjustments that occur in response to an energy surplus, or individual nuances like training experience and energy status of the individual. Given the ambiguous nature of these calculations, it is not surprising to see broad ranging guidance on energy needs. These estimates have never been validated in a resistance training population to confirm the "sweet spot" for an energy surplus that facilitates optimal rates of muscle gain relative to fat mass. This review not only addresses the influence of an energy surplus on resistance training outcomes, but also explores other pertinent issues, including "how much should energy intake be increased," "where should this extra energy come from," and "when should this extra energy be consumed." Several gaps in the literature are identified, with the hope this will stimulate further research interest in this area. Having a broader appreciation of these issues will assist practitioners in the establishment of dietary strategies that facilitate resistance training adaptations while also addressing other important nutrition related issues such as optimization of fuelling and recovery goals. Practical issues like the management of satiety when attempting to increase energy intake are also addressed.

Simple techniques to study multifaceted diabesity in the fly model

Diabetes and obesity are the two notorious metabolic disorders in today's world. Both diabetes and obesity are interlinked with each other and often referred to as 'Diabesity'. It is a complex and multi-organ failure disorder. Thus, many researches and tremendous efforts have been made toward prevention, treatment as well as early detection of diabesity. However, and still, there is a large gap in understanding the etiology as well as treatment of diabesity. Various animal models are also used to decipher the mechanism underlying diabesity. Among all the model organism, recently Drosophila melanogaster is gaining its importance to study diabetes, obesity, and other metabolic disorder. Various experimental methods like histological, biochemical, developmental, and behavioral assays are described in this study to detect diabetes as well as obesity in the fly model.

Comparison of the effects of a liquid breakfast meal with varying doses of plant-based soy protein on appetite profile, energy metabolism and intake

A dose dependent satiating and thermogenic effect of animal-based protein has been observed, however, less is known wherever plant-based protein elicits same response. The purpose of the study was to examine the effects of a breakfast meal containing varying doses of plant-based soy protein (SP) on appetite profile, hormone response, energy metabolism and energy intake.

METHODS

Seventeen participants (age: 27 ± 7 y, body fat: 21.5 ± 6.9%) in randomized order consumed one of three isoenergetic liquid breakfast meals (482 ± 5 kcals): high SP (HSP; 50 g), low SP (LSP; 25 g) and control (CON; 50 g carbohydrate) followed by an ad libitum lunch 3 h later. Appetite profile was measured before, immediately after and hourly during the 3 h postprandial period. Plasma concentrations of leptin and insulin were measured before, at 30 and 180 min.

RESULTS

Energy intake at lunch per kilogram of body weight was significantly higher after CON (11 ± 3.6 kcal/kg) compared to HSP (9.1 ± 3.0 kcal/kg) but not compared to LSP (10.2 ± 2.7 kcal/kg). Participants hunger was higher, whereas, satiety and fullness were lower after CON (p < 0.05). There were no significant differences (p > 0.05) observed in leptin or insulin responses between meals, however, a significant change over time was observed for insulin (p = 0.02) but not leptin (p > 0.05).

CONCLUSION

Liquid breakfast meals with higher dose of soy protein reduced energy intake when adjusted by body weight at lunch and was rated as more satiating compared to an isoenergetic CON meal.

Enzymatic Hydrolysis of a Collagen Hydrolysate Enhances Postprandial Absorption Rate-A Randomized Controlled Trial

Collagen is characterized by its high content of glycine, proline and hydroxyproline, and is found to exert beneficial effects on joint pain related to activity and osteoarthritis. However, to exert any beneficial effects it is essential that collagen is optimally absorbed. This study aimed to investigate the postprandial absorption of collagen and elucidate the impact of an exogenous enzymatic hydrolysis on absorption rate and bioavailability. A randomized, blinded, cross-over study was conducted where ten healthy male subjects received either 35 g enzymatically hydrolyzed collagen protein (EHC), 35 g non-enzymatically hydrolyzed collagen protein (NC) or placebo (250 mL water) on three nonconsecutive days. Blood samples were drawn before, and up to 240 min following, ingestion and the blood metabolome was characterized by nuclear magnetic resonance (NMR)-based metabolomics. A significant increase in the plasma concentration of nearly all amino acids (AAs) was observed over a 240 min period for both EHC and NC. In addition, the absorption rate and bioavailability of glycine, proline and hydroxyproline were significantly higher for EHC (p < 0.05). In conclusion, ingestion of collagen hydrolysates increases postprandial plasma concentrations of AAs over a period of 240 min, and an enzymatic hydrolysis increases the absorption rate and bioavailability of the collagen-rich AAs glycine, proline and hydroxyproline.

A bedtime milk snack does not impact RMR, substrate utilisation and appetite the following morning in mildly overweight males

Nighttime eating is often associated with a negative impact on weight management and cardiometabolic health. However, data from recent acute metabolic studies have implicated a benefit of ingesting a bedtime snack for weight management. The present study compared the impact of ingesting a milk snack containing either 10 (BS10) or 30 g (BS30) protein with a non-energetic placebo (BS0) 30 min before bedtime on next morning metabolism, appetite and energy intake in mildly overweight males (age: 24·3 (sem 0·8) years; BMI: 27·4 (sem 1·1) kg/m2). Next morning measurements of RMR, appetite and energy intake were measured using indirect calorimetry, visual analogue scales and an ad libitum breakfast, respectively. Bedtime milk ingestion did not alter next morning RMR (BS0: 7822 (sem 276) kJ/d, BS10: 7482 (sem 262) kJ/d, BS30: 7851 (sem 261) kJ/d, P=0·19) or substrate utilisation as measured by RER (P=0·64). Bedtime milk ingestion reduced hunger (P=0·01) and increased fullness (P=0·04) during the evening immediately after snack ingestion, but elicited no effect the next morning. Next morning breakfast (BS0: 2187 (sem 365) kJ, BS10: 2070 (sem 336) kJ, BS30: 2582 (sem 384) kJ, P=0·21) and 24 h post-trial (P=0·95) energy intake was similar between conditions. To conclude, in mildly overweight adults, compared with a non-energetic placebo, a bedtime milk snack containing 10 or 30 g of protein does not confer changes in next morning whole-body metabolism and appetite that may favour weight management.

A Randomized Controlled Pilot Study to Assess Effects of a Daily Pistachio (Pistacia Vera) Afternoon Snack on Next-Meal Energy Intake, Satiety, and Anthropometry in French Women

Including nuts in the diet improves appetite control and does not lead to weight gain. However, for pistachios, evidence from randomized intervention studies is limited and there are no data on the effect of pistachios on satiety. The objective of this study was to assess the effect of daily consumption of pistachios as an afternoon snack on satiety, self-reported energy, self-reported nutrient intake, body weight, and body composition. This randomized controlled pilot study included two parallel groups of 30 healthy French women, in a free-living setting. For four weeks, groups were instructed to consume either 56 g (1318 kJ) of pistachios or 56 g of isoenergetic/equiprotein savory biscuits as an afternoon snack. Evening energy intake, changes in anthropometric measures, and daily intake of energy and selected nutrients were assessed. Visual analogue scales (VAS) were used to rate hunger, fullness, desire to eat, and prospective consumption. Satiety effects were not different between groups, as assessed by evening energy intake or VAS scores. Consuming pistachios or biscuits had no impact on body weight. Thiamin, vitamin B6, copper, and potassium intakes were significantly higher in the pistachio group. Consuming pistachios or biscuits as an afternoon snack resulted in similar post-snack food intake and subjective feelings of satiety. A daily pistachio snack for a month did not affect body weight or composition but it did improve micronutrient intake.

Maximizing the intersection of human health and the health of the environment with regard to the amount and type of protein produced and consumed in the United States

This review utilizes current national dietary guidelines and published databases to evaluate the impacts of reasonable shifts in the amount and type of protein intake in the United States on the intersection of human and environmental health. The established scientific basis and recommendations for protein intake as described in the US Dietary Reference Intakes are reviewed. Data on food availability from both the US Department of Agriculture and the Food and Agriculture Organization of the United Nations and data on consumption from the National Health and Nutrition Examination Survey are used to examine estimates of current US protein consumption. Greenhouse gas (carbon dioxide equivalents, CO2eq) and blue and green water impacts of US protein consumption resulting from US agricultural practices were obtained from previously published meta-analyses. A 25% decrease in protein intake paired with a 25% shift from animal food to plant food protein intake-from an 85:15 ratio to a 60:40 ratio-would best align protein intake with national dietary recommendations while simultaneously resulting in 40% fewer CO2eq emissions and 10% less consumptive water use. The modeling of this strategy suggests a savings of 129 billion kilograms of CO2eq and 3.1 trillion gallons of water relative to current consumption.

High Protein Diet Induces Oxidative Stress in Rat Cerebral Cortex and Hypothalamus

This is the first study to analyze the impact of high protein diet (HPD) on antioxidant defense, redox status, as well as oxidative damage on both a local and systemic level. Male Wistar rats were divided into two equal groups (n = 9): HPD (44% protein) and standard diet (CON; 24.2% protein). After eight weeks, glutathione peroxidase (GPx), glutathione reductase (GR), catalase (CAT), superoxide dismutase-1 (SOD-1), reduced glutathione (GSH), uric acid (UA), total antioxidant (TAC)/oxidant status (TOS) as well as advanced glycation end products (AGE), 4-hydroxynonenal (4-HNE), and malondialdehyde (MDA) were analyzed in the serum/plasma, cerebral cortex, and hypothalamus of HPD and CON rats. HPD resulted in higher UA concentration and activity of GPx and CAT in the hypothalamus, whereas in the cerebral cortex these parameters remained unchanged. A significantly lower GSH content was demonstrated in the plasma and hypothalamus of HPD rats when compared to CON rats. Both brain structures expressed higher content of 4-HNE and MDA, whereas AGE was increased only in the hypothalamus of HPD animals. Despite the enhancement in antioxidant defense in the hypothalamus, this mechanism does not protect the hypothalamus from oxidative damage in rats. Hypothalamus is more susceptible to oxidative stress caused by HPD.

Influence of Weight Reduction and Enhanced Protein Intake on Biomarkers of Inflammation in Older Adults with Obesity

Both aging and obesity are associated with increased levels of pro-inflammatory metabolites, while weight reduction is associated with improvements in inflammatory status. However, few studies have explored the response of key inflammatory markers to the combined settings of weight reduction in an aging population. There are also few studies that have investigated the potential impact of diet composition on inflammatory marker responses. In the MEASUR-UP trial, we evaluated changes in baseline levels of inflammatory markers with post-study levels for a traditional weight loss control group versus a group with generous, balanced protein intake. In this 6-month randomized controlled trial (RCT), older (≥60 years) adults with obesity (BMI ≥30 kg/m²) and Short Physical Performance Battery (SPPB) score of 4-10 were randomly assigned to either a traditional weight loss regimen, (Control, n = 14) or one with higher protein intake (≥30 g) at each meal (Protein, n = 25). All participants were prescribed a hypo-caloric diet and attended weekly support and education groups and weigh-ins. Protein participants consumed ≥30 g of high-quality protein/meal, including lean and extra lean beef provided to them for two of the three meals per day. Protein intakes were 0.8 and 1.2 g/kg/day for Control and Protein, respectively. Adiponectin, leptin, C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), interleukin-1 (IL-1), IL-6, IL-8, serum amyloid A (SAA), vascular cell adhesion molecule-1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1), and glycated serum protein (GSP) levels were measured at 0 and 6-month time points. At the 6-month endpoint, there was significant weight loss and decrease in BMI in both the Control (-4.8 ± 8.2 kg; -2.3 ± 2.4 kg/m²; p = 0.05) and Protein (-8.7 ± 7.4 kg; -2.9 ± 2.3 kg/m²; p < 0.0001) groups. SPPB scores improved in both arms, with a superior functional response in Protein (p < 0.05). Body fat (%) at baseline was positively correlated with leptin, hs-CRP, VCAM-1, ICAM-1, and GSP. Several markers of inflammation responded to the Protein group: leptin (p < 0.001), hs-CRP (p < 0.01), and ICAM-1 (p < 0.01) were decreased and adiponectin increased (p < 0.01). There were no significant changes in any inflammatory markers in the Control arm. In the between group comparison, only adiponectin trended towards a group difference (more improvement in Protein; p < 0.07). Our findings in the MEASUR-UP trial show that a weight loss diet with enhanced protein intake is comparable to an adequate protein diet in terms of weight loss success and that it can lead to improvements in inflammatory status, specifically for adiponectin, leptin, hs-CRP, and ICAM-1. These findings are important given current recommendations for higher protein intakes in older adults and justify the additional study of the inflammatory impact of an enhanced protein diet. (ClinicalTrials.gov identifier: NCT01715753).

Effects of Caloric Restriction with Protein Supplementation on Plasma Protein Profiles in Middle-Aged Women with Metabolic Syndrome-A Preliminary Open Study

Background: Clinical studies have demonstrated that higher protein intake based on caloric restriction (CR) alleviates metabolic abnormalities. However, no study has examined the effects of plasma protein profiles on caloric restriction with protein supplementation (CRPS) in metabolic syndrome (MetS). Therefore, using a proteomic perspective, this pilot study investigated whether CRPS ameliorated metabolic abnormalities associated with MetS in middle-aged women. Methods: Plasma samples of middle-aged women with MetS in CR (n = 7) and CRPS (n = 6) groups for a 12-week intervention were obtained and their protein profiles were analysed. Briefly, blood samples from qualified participants were drawn before and after the dietary treatment. Anthropometric, clinical, and biochemical variables were measured and correlated with plasma proteomics. Results: In results, we found that body mass index, total body fat, and fasting blood glucose decreased significantly after the interventions but were not different between the CR and CRPS groups. After liquid chromatography–tandem mass spectrometry analysis, the relative plasma levels of alpha-2-macroglobulin (A2M), C4b-binding protein alpha chain (C4BPA), complement C1r subcomponent-like protein (C1RL), complement component C6 (C6), complement component C8 gamma chain (C8G), and vitamin K-dependent protein S (PROS) were significantly different between the CRPS and CR groups. These proteins are involved in inflammation, the immune system, and coagulation responses. Moreover, blood low-density lipoprotein cholesterol levels were significantly and positively correlated with C6 plasma levels in both groups. Conclusions: These findings suggest that CRPS improves inflammatory responses in middle-aged women with MetS. Specific plasma protein expression (i.e., A2M, C4BPA, C1RL, C6, C8G, and PROS) associated with the complement system was highly correlated with fasting blood glucose (FBG), blood lipids (BLs), and body fat.

Effect of Macronutrient Composition on Appetite Hormone Responses in Adolescents with Obesity

Gut appetite hormone responses may be influenced by meal macronutrients and obesity. The primary aim of this study was to examine in adolescents with obesity and of healthy weight the effect of a high-protein and a high-carbohydrate meal on postprandial gut appetite hormones. A postprandial cross-over study with adolescents 11–19 years old was undertaken. Participants consumed, in random order, a high 79% carbohydrate (HCHO) and a high 55% protein (HP) meal. Ghrelin, glucagon-like peptide 1 (GLP-1), peptide YY (PYY), and self-reported appetite were assessed for four hours postprandial. Total energy intake from an ad libitum lunch and remaining 24 h was assessed. Eight adolescents with obesity (OB) and 12 with healthy weight (HW) participated. Compared with HW, OB adolescents displayed a smaller ghrelin iAUC (−25,896.5 ± 7943 pg/mL/4 h vs. −60,863.5 ± 13104 pg/mL/4 h) (p = 0.008) with no effect of meal (p > 0.05). The suppression of ghrelin relative to baseline was similar between OB and HW. Ghrelin suppression was greater following the HP vs. HCHO meal (effect of meal, p = 0.018). Glucose and insulin response were greater following HCHO vs. HP, with responses more marked in OB (time × weight × meal interaction, p = 0.003 and p = 0.018, respectively). There were no effects of weight or macronutrient on GLP-1 or PYY, appetite or subsequent energy intake. The present study demonstrates that dietary protein can modulate postprandial ghrelin responses; however, this did not translate to subsequent changes in subjective appetite or energy intake.

PANCOSMA COMPARATIVE GUT PHYSIOLOGY SYMPOSIUM: ALL ABOUT APPETITE REGULATION: Effects of diet and gonadal steroids on appetite regulation and food intake of companion animals

The prominent incidence of overweight and obese pet animals not only results in higher morbidity and mortality, but also poses a threat for the quality of life, longevity, and well-being of dogs and cats. To date, strategies to prevent BW gain or to induce weight loss have had modest success in the pet population. In part, due to the complexity and the multifactorial nature of this disease, which involves pet-human interaction, environmental and dietary factors, and an intertwined metabolic process that still is not fully understood. As such, research methods to investigate the role of physiological hormones and dietary management on mechanisms related to the control of feelings of satiety and hunger in pet animals is warranted. Increasing interest exists in exploring gut chemosensing mechanisms, the crosstalk between metabolic-active tissues, and the interface between the gut microbiota and the nervous system (gut-brain axis). The noninvasive nature of research conducted in companion animals focuses on systemic approaches to develop environmental, nutritional, or therapeutic interventions that can be translated from research settings to pet-owned households. Because the majority of the pet population is spayed or neutered, it is important to determine the effect that sex hormones might have on appetite regulation and fasting metabolic rate of these animals. In general, studies have revealed that gonadectomy may establish a new "set point" characterized by increased food intake and BW, accompanied by physiological and behavioral changes. Some studies have also shown associations between gonadectomy and alterations in appetite-related hormones (e.g., ghrelin, leptin, adiponectin, glucagon-like peptide-1). Manipulation of macronutrients in diets of dogs and cats have also been investigated as a mean to improve satiety. Most of the research in this area has focused on high-protein diets, predominantly, for cats, and the use of dietary fiber sources of contrasting fermentability and viscosity profiles. Dietary fibers may affect the production of fermentative end products and gut microbiome, digestive and absorptive processes, appetite-related hormones, and promote "gut fill" and satiety. More recent studies have reported profound effects of dietary manipulation on the phylogeny and functional capacity of gut microbial communities of dogs and cats.

The effects of whey and soy liquid breakfast on appetite response, energy metabolism, and subsequent energy intake

OBJECTIVES

The aim of this study was to examine the effects of animal-based protein (whey; WP) compared with plant-based protein (soy; SP) and carbohydrate (CHO) liquid breakfast on appetite, energy metabolism, and subsequent energy intake.

METHODS

Seventeen healthy individuals consumed three isocaloric breakfast smoothies with whey, soy, or carbohydrate (no protein) in a double-blind, randomized crossover design. Participants completed an 11-point rating scale of appetite profile (before, 0, 60, 120, and 180 min). Indirect calorimetry was used to determine the thermic effect of a meal (TEM; at 45-60, 105-120, and 165-180 min). An ad libitum lunch was offered at 180 min after breakfast and energy intake was assessed.

RESULTS

There was a significant difference in hunger (P = 0.033), fullness (P = 0.002), satiety (P = 0.001), desire to eat (P = 0.024), and prospective food consumption (P = 0.021) between the three breakfast meals. Fullness and SP compared with CHO. A higher (P < 0.001) TEM and lower (P < 0.05) respiratory exchange ratio (RER) was observed after WP and SP compared with CHO. In addition, a higher (P = 0.022) energy intake at lunch was observed after CHO (769 ± 259 kcal) compared with WP (654 ± 252 kcal) and SP (664 ± 296 kcal), with no difference (P = 0.966) between WP and SP. Consuming SP at breakfast exerts comparable effects to WP on appetite profile, energy metabolism, and subsequent energy intake, suggesting that SP is a reasonable alternative to WP as a protein supplement source to aid in body weight control.

Effects of a low carbohydrate diet on energy expenditure during weight loss maintenance: randomized trial

OBJECTIVE

To determine the effects of diets varying in carbohydrate to fat ratio on total energy expenditure.

DESIGN

Randomized trial.

SETTING

Multicenter collaboration at US two sites, August 2014 to May 2017.

PARTICIPANTS

164 adults aged 18-65 years with a body mass index of 25 or more.

INTERVENTIONS

After 12% (within 2%) weight loss on a run-in diet, participants were randomly assigned to one of three test diets according to carbohydrate content (high, 60%, n=54; moderate, 40%, n=53; or low, 20%, n=57) for 20 weeks. Test diets were controlled for protein and were energy adjusted to maintain weight loss within 2 kg. To test for effect modification predicted by the carbohydrate-insulin model, the sample was divided into thirds of pre-weight loss insulin secretion (insulin concentration 30 minutes after oral glucose).

MAIN OUTCOME MEASURES

The primary outcome was total energy expenditure, measured with doubly labeled water, by intention-to-treat analysis. Per protocol analysis included participants who maintained target weight loss, potentially providing a more precise effect estimate. Secondary outcomes were resting energy expenditure, measures of physical activity, and levels of the metabolic hormones leptin and ghrelin.

RESULTS

Total energy expenditure differed by diet in the intention-to-treat analysis (n=162, P=0.002), with a linear trend of 52 kcal/d (95% confidence interval 23 to 82) for every 10% decrease in the contribution of carbohydrate to total energy intake (1 kcal=4.18 kJ=0.00418 MJ). Change in total energy expenditure was 91 kcal/d (95% confidence interval -29 to 210) greater in participants assigned to the moderate carbohydrate diet and 209 kcal/d (91 to 326) greater in those assigned to the low carbohydrate diet compared with the high carbohydrate diet. In the per protocol analysis (n=120, P<0.001), the respective differences were 131 kcal/d (-6 to 267) and 278 kcal/d (144 to 411). Among participants in the highest third of pre-weight loss insulin secretion, the difference between the low and high carbohydrate diet was 308 kcal/d in the intention-to-treat analysis and 478 kcal/d in the per protocol analysis (P<0.004). Ghrelin was significantly lower in participants assigned to the low carbohydrate diet compared with those assigned to the high carbohydrate diet (both analyses). Leptin was also significantly lower in participants assigned to the low carbohydrate diet (per protocol).

CONCLUSIONS

Consistent with the carbohydrate-insulin model, lowering dietary carbohydrate increased energy expenditure during weight loss maintenance. This metabolic effect may improve the success of obesity treatment, especially among those with high insulin secretion.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02068885.

Effects of High Versus Low Protein Intake on Body Composition and Maximal Strength in Aspiring Female Physique Athletes Engaging in an 8-Week Resistance Training Program

Aspiring female physique athletes are often encouraged to ingest relatively high levels of dietary protein in conjunction with their resistance training programs. However, there is little to no research investigating higher versus lower protein intakes in this population. This study examined the influence of a high versus low-protein diet in conjunction with an 8-week resistance training program in this population. A total of 17 females (21.2 ± 2.1 years; 165.1 ± 5.1 cm; 61 ± 6.1 kg) were randomly assigned to a high-protein diet (HP: 2.5 g·kg^-1·day^-1; n = 8) or a low-protein diet (LP: 0.9 g·kg^-1·day^-1, n = 9) and were assessed for body composition and maximal strength prior to and after the 8-week protein intake and exercise intervention. Fat-free mass increased significantly more in the HP group as compared with the LP group (p = .009), going from 47.1 ± 4.5 to 49.2 ± 5.4 kg (+2.1 kg) and from 48.1 ± 2.7 to 48.7 ± 2 kg (+0.6 kg) in the HP and LP groups, respectively. Fat mass significantly decreased over time in the HP group (14.1 ± 3.6 to 13.0 ± 3.3 kg; p < .01), but no change was observed in the LP group (13.2 ± 3.7 to 12.5 ± 3.0 kg). Although maximal strength significantly increased in both groups, there were no differences in strength improvements between the two groups. In aspiring female physique athletes, a higher protein diet is superior to a lower protein diet in terms of increasing fat-free mass in conjunction with a resistance training program.

Meals based on cod or veal in combination with high or low glycemic index carbohydrates did not affect diet-induced thermogenesis, appetite sensations, or subsequent energy intake differently

The objective of this study was to investigate the acute effects of meals containing protein from either cod or veal in combination with high or low glycemic index (GI) carbohydrates, on diet-induced thermogenesis (DIT) (primary endpoint), appetite, energy intake (EI), as well as postpranidal ghrelin, glucose, and insulin responses. Twenty-three overweight men and women (mean ± SD age: 30.0 ± 7.6 y, BMI: 27.2 ± 1.4 kg/m²) consumed 4 test meals: cod with mashed potatoes (high GI carbohydrate), cod with wholegrain pasta (low GI carbohydrate), veal with mashed potatoes, and veal with wholegrain pasta (∼2010 kJ, ∼25.5 E% protein, ∼41.0 E% carbohydrate, ∼33.5 E% fat). Energy expenditure was measured at baseline and six times postprandially, each lasting 25 min. Additionally, appetite sensations were measured every half hour. Arterialized venous blood samples were drawn every 20 min until an ad libitum buffet-style lunch was served 3.5 h later. DIT did not differ between test meals (P > 0.05), and there were no differences in appetite sensations or ad libitum EI (all, P > 0.05). Meal-time interactions were found for glucose and insulin (P = 0.04 and P < 0.001). Pairwise comparisons revealed that glucose and insulin peaks were higher after the meals with high GI carbohydrates. No differences were found between meals with cod or veal in combination with carbohydrates with low or high GI on DIT, appetite sensations, or EI in overweight men and women. However, as expected meals with high GI carbohydrates resulted in higher glucose and insulin responses compared to meals with low GI carbohydrates regardless of protein source.

L-Arginine Increases Postprandial Circulating GLP-1 and PYY Levels in Humans

OBJECTIVE

The satiating effect of protein compared with other nutrients has been well described and is thought to be mediated, in part, by gut hormone release. Previously, it has been shown that oral L-arginine acts as a GLP-1 secretagogue both in vitro and in vivo in rodents. Here, the effect of L-arginine on gut hormone release in humans was investigated.

METHODS

The hypothesis was tested in two separate studies. The first study assessed the tolerability of oral L-arginine in healthy human subjects. The second study assessed the effect of oral L-arginine on gut hormone release following an ad libitum meal. Subjects were given L-arginine, glycine (control amino acid), or vehicle control in a randomized double-blind fashion.

RESULTS

At a dose of 17.1 mmol, L-arginine was well tolerated and stimulated the release of plasma GLP-1 (P < 0.05) and PYY (P < 0.001) following an ad libitum meal. Food diaries showed a trend toward lower energy intake and particularly fat intake following L-arginine treatment.

CONCLUSIONS

L-arginine can significantly elevate GLP-1 and PYY in healthy human volunteers in combination with a meal. Further work is required to investigate whether L-arginine may have utility in the suppression of appetite and food intake.

Influence of protein source on characteristics and quality of gluten-free cookies

Proteins are essential nutrients in the diet, with the recommended amount of daily protein consumption varying for people with different health status and activity level. Cookies could be an adequate carrier of proteins because of their great acceptability. The aim of this study was to analyse the effect of flour substitution with different types of protein (pea, potato, egg white and whey) in gluten-free cookies. Hydration properties, dough rheology, cookie characteristics (protein content, dimensions, texture) and sensory acceptability were studied. The hydration properties of mixtures with protein were lower than the control, with the exception of pea protein. As for results from rheological analysis, G' and G″ values for pea and potato protein were similar to the control, while egg white and whey protein had lower values. Addition of egg white and whey protein respectively, produced harder and wider cookies. The addition of potato protein yielded cookies with darker edges, however, pea protein did not lead to any significant change in cookie parameters. Sensory evaluation showed that the addition of pea protein produced cookies with the same scores as the control sample, signifying that cookies with added pea protein had the best acceptability.

The role of calcium sensing receptors in GLP-1 and PYY secretion after acute intraduodenal administration of L-Tryptophan in rats

Objectives: The calcium-sensing receptor (CaSR), the major sensor of extracellular Ca²⁺, is expressed in various tissues, including the gastrointestinal tract. Although the essential ligand of CaSR is calcium, its activity can be regulated by aromatic L-amino acids. The expression of CaSR on enteroendocrine cells suggests that CaSR functions as a physiological amino acid sensor for gut hormone release. Here, we investigated the effects of L-tryptophan (L-Trp) on rat glucagon-like peptide-1 (GLP-1), peptide YY (PYY), and insulin secretion, and the role of CaSR in this mechanism in vivo.Methods: The effects of intraduodenal L-Trp on GLP-1, PYY, and insulin secretion were investigated. A CaSR antagonist, NPS 2143, was administered to determine whether CaSR plays a role in L-Trp-mediated gut hormone release. Male Wistar rats were divided into L-Trp, L-Trp+NPS 2143, and L-Trp+vehicle groups. Blood samples were collected, before and after the intraduodenal infusions, for determining plasma glucose, L-Trp, insulin, GLP-1, and PYY levels.Results: Our study showed a significant increase in plasma GLP-1 and insulin levels, but not plasma PYY and glucose levels, following the acute intraduodenal administration of L-Trp. We demonstrated that CaSR plays a role in L-Trp-mediated GLP-1 secretion due to attenuation of GLP-1 release with the CaSR antagonist NPS 2143.Discussion: We demonstrated that GLP-1, but not PYY, secretion following intraduodenal L-Trp administration was mediated through calcium-sensing receptors. This mechanism underlying protein sensing in the gastrointestinal system may be important for the development of new therapeutic strategies without side effects for obesity and diabetes.

Gastric Emptying and Dynamic In Vitro Digestion of Drinkable Yogurts: Effect of Viscosity and Composition

Gastric emptying of food is mainly driven by the caloric concentration, the rheological properties of the chyme, and the physical state (liquid/solid) of food once in the stomach. The present work investigated: (1) The effect of the composition and the viscosity of drinkable yogurts on gastric emptying in pigs, and (2) the behavior of yogurts during dynamic in vitro digestion. Three isocaloric liquid yogurts were manufactured: Two enriched in protein and fiber showing either a low (LV) or high (HV) viscosity, one control enriched in sugar and starch (CT). They were labelled with 99mTc-sulfur colloid and given to pigs (n = 11) to determine gastric emptying pattern by gamma scintigraphy. Then dynamic in vitro digestion of the yogurts was done using the parameters of gastric emptying determined in vivo. Gastric emptying half-times were significantly longer for LV than CT, whereas HV exhibited an intermediate behavior. In vitro gastric digestion showed a quick hydrolysis of caseins, whereas whey proteins were more resistant in the stomach particularly for LV and HV. During the intestinal phase, both whey proteins and caseins were almost fully hydrolyzed. Viscosity was shown to affect the behavior of yogurt in the small intestine.

Pathways and mechanisms linking dietary components to cardiometabolic disease: thinking beyond calories

Calories from any food have the potential to increase risk for obesity and cardiometabolic disease because all calories can directly contribute to positive energy balance and fat gain. However, various dietary components or patterns may promote obesity and cardiometabolic disease by additional mechanisms that are not mediated solely by caloric content. Researchers explored this topic at the 2017 CrossFit Foundation Academic Conference 'Diet and Cardiometabolic Health - Beyond Calories', and this paper summarizes the presentations and follow-up discussions. Regarding the health effects of dietary fat, sugar and non-nutritive sweeteners, it is concluded that food-specific saturated fatty acids and sugar-sweetened beverages promote cardiometabolic diseases by mechanisms that are additional to their contribution of calories to positive energy balance and that aspartame does not promote weight gain. The challenges involved in conducting and interpreting clinical nutritional research, which preclude more extensive conclusions, are detailed. Emerging research is presented exploring the possibility that responses to certain dietary components/patterns are influenced by the metabolic status, developmental period or genotype of the individual; by the responsiveness of brain regions associated with reward to food cues; or by the microbiome. More research regarding these potential 'beyond calories' mechanisms may lead to new strategies for attenuating the obesity crisis.

Phosphorus ingestion with a high-carbohydrate meal increased the postprandial energy expenditure of obese and lean individuals

OBJECTIVES

Phosphorus ingestion with glucose was reported to stimulate the postprandial peripheral uptake of both phosphorus and glucose, a process that favors energy production. The aim of this study was to determine whether phosphorus ingestion with a meal can affect energy metabolism.

METHODS

Overnight fasted men (eight lean and seven obese) consumed a high-carbohydrate meal (648 kcal) with either placebo or phosphorus (500 mg) tablets in a random order. Energy expenditure and substrate oxidation were monitored for 240 min using ventilated hood indirect calorimetry.

RESULTS

Phosphorus ingestion with a meal increased the postprandial energy expenditure of both lean and obese individuals (P < 0.001), although in different patterns. Alterations in postprandial substrate oxidation was highly noticeable from time 120 min onward, where phosphorus-treated lean participants exhibited a significant decrease in respiratory quotient.

CONCLUSION

Phosphorus ingestion with a high-carbohydrate meal alters postprandial energy metabolism mainly by enhancing postprandial energy expenditure that may ultimatly favor weight loss.

Effects of consuming a high-protein diet with or without soy protein during weight loss and maintenance: a non-inferiority, randomized clinical efficacy trial

OBJECTIVE

This 12-month randomized, non-inferiority clinical trial sought to determine the impact of consuming soy protein as part of an energy-restricted, high-protein diet on weight loss, body composition and cardiometabolic health.

METHODS

Seventy-one adults (58 female) with overweight or obesity (body mass index: 32.9 ± 3.6 kg m-2) were randomly assigned to consume three servings of soy (S) or non-soy (NS) protein foods per day for 12 months. All participants completed a group-based behavioural weight loss program lasting 4 months (M4), and follow-up assessments were completed at month 12 (M12).

RESULTS

Body weight was reduced in both groups at M4 (S: -7.0% ± 5.2%, NS: -7.1% ± 5.7%) and M12 (S: 3.6% ± 5.1%, NS: -4.8% ± 7.3%). Body weight reductions (mean difference [90% confidence interval]) were not different between S and NS at either time point (M4: -0.16% [-1.4, 3.6], P = 0.90; M12: 1.1% [-1.4, 3.6], P = 0.44). Differences in body fat mass loss were not different between S and NS at M4 (0.29 ± 0.84 kg, P = 0.73) or M12 (0.78 ± 1.5 kg, P = 0.59). Weight loss-induced improvements in cholesterol, triglycerides and blood pressure did not differ between S and NS.

CONCLUSION

These results indicate that soy-based protein foods can be effectively incorporated into an energy-restricted, high-protein diet for improving body weight, body composition and cardiometabolic health.

Effect of macronutrient composition on meal-induced thermogenesis in adolescents with obesity

PURPOSE

Manipulation of meal macronutrient may be a useful way to modulate meal-induced thermogenesis (MIT) to induce increases in energy expenditure. The objective of this study was to examine in adolescents with obesity and of healthy weight and the effect of a high protein and high carbohydrate meal on MIT.

METHODS

An acute cross-over study with adolescents aged 11-19 years was undertaken. Participants consumed in random order, a high 79% carbohydrate (HCHO), and a high 55% protein (HP) meal (adjusted to 25% of energy requirements). MIT and subjective appetite were assessed for 4 h postprandial and an ad libitum lunch served. Data calculated as total AUC and expressed as mean ± SEM.

RESULTS

Thirteen adolescents with obesity (mean BMI z score 2.3 ± 0.1) and 13 healthy weight (BMI z score 0.0 ± 0.2) participated. Mean MIT (% of energy intake) was greater after the HP (8.19 ± 0.709%) compared with the HCHO meal (4.36 ± 0.480%) (p < 0.001). The HP compared with the HCHO meal promoted greater fullness (12,994 ± 1208 vs 11,186 ± 1220 mm/4 h) (p = 0.016) and decreased hunger (8868 ± 1315 vs 10984 mm ± 1438 mm/4 h) (p = 0.007). These effects observed were independent of body weight.

CONCLUSIONS

High protein meals can increase MIT and fullness and reduce hunger compared with high carbohydrate meals in adolescents with obesity. Future research is warranted to determine if MIT can be targeted through manipulation of dietary choices to support weight management strategies.

TRIAL REGISTRATION

This study is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR). Trial ID: ACTRN12612001066875.

Defining the Optimal Dietary Approach for Safe, Effective and Sustainable Weight Loss in Overweight and Obese Adults

Various dietary approaches with different caloric content and macronutrient composition have been recommended to treat obesity in adults. Although their safety and efficacy profile has been assessed in numerous randomized clinical trials, reviews and meta-analyses, the characteristics of the optimal dietary weight loss strategy remain controversial. This mini-review will provide general principles and practical recommendations for the dietary management of obesity and will further explore the components of the optimal dietary intervention. To this end, various dietary plans are critically discussed, including low-fat diets, low-carbohydrate diets, high-protein diets, very low-calorie diets with meal replacements, Mediterranean diet, and diets with intermittent energy restriction. As a general principle, the optimal diet to treat obesity should be safe, efficacious, healthy and nutritionally adequate, culturally acceptable and economically affordable, and should ensure long-term compliance and maintenance of weight loss. Setting realistic goals for weight loss and pursuing a balanced dietary plan tailored to individual needs, preferences, and medical conditions, are the key principles to facilitate weight loss in obese patients and most importantly reduce their overall cardiometabolic risk and other obesity-related comorbidities.

The Precompetition Macronutrient Intake of Elite Gaelic Football Players

Competition-related dietary intake has not yet been investigated in Gaelic football. The present study examined the precompetition macronutrient intake of elite male Gaelic football players. Forty players from two teams completed a food diary on the 2 days preceding competition (Day 1 and Day 2) and on the match day prior to the match (match day). Carbohydrate intake was significantly greater on Day 2 compared with Day 1, for both absolute (295 ± 98 vs. 318 ± 77 g; p = .048; -23.6 g, 95% confidence interval [-47.3, 0.2]; Cohen's d = 0.27) and relative intake (3.4 ± 1.1 vs. 3.7 ± 1.0 g/kg; p = .027; -0.3 g/kg, 95% confidence interval [-0.6, -0.03]; Cohen's d = 0.32). The number of players in accordance with and not in accordance with the guidelines for carbohydrate intake on Day 2 was significantly different to an expected frequency distribution, χ²(1) = 32.400; p ≤ .001; φ = 0.9, with a greater number of players not meeting the guidelines (observed N = 2 vs. 38). The number of players in accordance with and not in accordance with the recommendations for carbohydrate intake on match day was significantly different to an expected frequency distribution, χ²(1) = 8.100; p = .004; φ = 0.45, with a greater number of players meeting the guidelines (observed N = 29 vs. 11). The major finding from the current investigation was that a significantly greater number of players did not meet carbohydrate intake guidelines on the day before competition. Individualized nutritional interventions are required in order to modify the current prematch dietary intake.

Hunger, Food Cravings, and Diet Satisfaction are Related to Changes in Body Weight During a 6-Month Behavioral Weight Loss Intervention: The Beef WISE Study

Previously published findings from the Beef WISE Study (Beef's Role in Weight Improvement, Satisfaction, and Energy) indicated equivalent weight loss between two energy-restricted higher protein (HP) diets: A HP diet with ≥4 weekly servings of lean beef (B; n = 60) and a HP diet restricted in all red meats (NB; n = 60). Long-term adherence to dietary prescriptions is critical for weight management but may be adversely affected by changes in appetite, food cravings, and diet satisfaction that often accompany weight loss. A secondary a priori aim of the Beef WISE Study was to compare subjective ratings of appetite (hunger and fullness), food cravings, and diet satisfaction (compliance, satisfaction, and deprivation) between the diets and determine whether these factors influenced weight loss. Subjective appetite, food cravings, and diet satisfaction ratings were collected throughout the intervention, and body weight was measured at the baseline, after the weight loss intervention (week 16), and after an eight-week follow-up period (week 24). Hunger and cravings were reduced during weight loss compared to the baseline, while fullness was not different from the baseline. The reduction in cravings was greater for B vs. NB at week 16 only. Higher deprivation ratings during weight loss were reported in NB vs. B at weeks 16 and 24, but participants in both groups reported high levels of compliance and diet satisfaction with no difference between groups. Independent of group assignment, higher baseline hunger and cravings were associated with less weight loss, and greater diet compliance, diet satisfaction, and lower feelings of deprivation were associated with greater weight loss. Strategies to promote reduced feelings of hunger, cravings, and deprivation may increase adherence to dietary prescriptions and improve behavioral weight loss outcomes.

Animal and Plant Protein Intake and Body Mass Index and Waist Circumference in a Korean Elderly Population

Controversy exists on whether animal and plant proteins influence obesity differently. The purpose of this study was to evaluate the association between total, animal, and plant protein intake with the body mass index (BMI), waist circumference (WC), and renal function in the Korean elderly. Study participants included Korean adults aged 60 years or older from the Korean National Health and Nutrition Examination Survey in 2013–2014. Height, weight, and waist circumference were measured and the body mass index was calculated. One-day 24-hour recall data were used to estimate daily total, animal, and plant protein intake. Glomerular filtration rate (GFR) was calculated by using the Modification of Diet in Renal Disease (MDRD) equation. General linear modellings were used to assess the relationships between protein intake, BMI and WC. The mean age was 69.2 ± 0.2 years and 44.2% were male. The total daily protein intake was 1.1 ± 0.02 g/kg/day and 0.9 ± 0.02 g/kg/day for males and females, respectively. Only one third of protein intake was from animal sources. In males, BMI (regression coefficient (95% CI); −1.30 (−1.55, −1.06), p < 0.001; −0.29 (−0.52, −0.05), p = 0.016; −1.30 (−1.8, −1.02), p < 0.001, respectively) and WC (−3.87 (−4.58, −3.16), p < 0.001; −0.90 (−1.58, −0.22), p = 0.010; −3.88 (−4.68, −3.08), p < 0.001, respectively) decreased as daily intake of plant protein (g/kg/day), animal protein (g/kg/day) and total protein (g/kg/day) increased. Similar associations were shown in Korean females. GFR was not associated with protein intake regardless of protein source in both sexes. In Korean adults aged 60 years or older, the protein intake was associated with a favorable obesity index without decrease in renal function. The effect was similar in both males and females, with both animal and plant proteins.

Relationship of a Special Acidified Milk Protein Drink with Cognitive Performance: A Randomized, Double-Blind, Placebo-Controlled, Crossover Study in Healthy Young Adults

A previous in vivo study with rats suggested that a special milk protein drink manufactured using an acidification procedure to suppress the aggregation of milk proteins was absorbed quickly after feeding. We performed a randomized, double-blind, placebo-controlled, repeated-measure crossover study to investigate the short-term effects on cognitive performance in 29 healthy young adult men after they consumed this drink in the morning. After an overnight fast, subjects were tested for performance in the Uchida⁻Kraepelin serial arithmetic test and the Stroop test as well as for subjective feeling, body temperature, and heart rate variability before and after consumption of either the acidified milk protein drink or an isoenergetic placebo drink. Subjects showed a significant improvement in performance in the Uchida⁻Kraepelin test, the primary outcome measured, when they consumed the acidified milk protein drink compared with the placebo control condition. In addition, consumption of the acidified milk protein drink, compared with the placebo control, was associated with increases in vagally-mediated heart rate variability indices which, from recent theoretical perspectives, may reflect a higher ability to modulate cognitive and behavioral processes. There was no significant difference in subjective feelings and body temperature between the test drink conditions. These data suggest that consumption of the acidified milk protein drink may improve cognitive performance, with possible involvement of physiological systems that regulate cognition and behavior.

Time and age trends in morning and evening protein intakes of German children and adolescents

The present study describes time and age trends in morning and evening protein intakes and sources among German children and adolescents from 1985 to 2014. A total of 9757 three-day weighed dietary records of 1246 3- to 18-year-old participants of the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) study were analysed using polynomial mixed-effects regression models. Morning protein intake increased over the study period by approximately 1 % of morning energy intake (linear trend P < 0·0001), with the youngest and the oldest children having the highest protein intake (linear, quadratic trend P < 0·0001). Evening protein intake increased over time by approximately 2 % of evening energy intake in girls (linear trend P < 0·0001) and 1 % of evening energy intake in boys (quadratic trend P = 0·0313), with decreasing intake with age (girls: linear trend P < 0·0001; boys: linear trend P = 0·0963). Time trends were largely due to increases in protein from ‘starchy foods’. In conclusion, morning and evening protein intakes increased modestly between 1985 and 2014; these increases were, however, not accompanied by increases in traditional protein sources (i.e. meat or dairy products).

Effects of chocolate-based products intake on blood glucose, insulin and ghrelin levels and on satiety in young people: a cross-over experimental study

This cross-over experimental study aimed to examine the effects of filled chocolate consumption on blood glucose, insulin and ghrelin levels in 20 volunteers. After a one-week run-in period, study participants consumed two chocolate-based products, the tested biscuit or water for 21 days as a morning snack. After a two-week wash-out period, participants consumed another tested food for another 21 days. Each participant consumed all four test foods within an 18-week period. The participants' blood insulin increased slowly after two chocolate-based products intakes on the first day and satiety levels after eating chocolate-based products and the tested biscuit were the same. Chocolate consumption for three weeks had no adverse effects on blood glucose, insulin or ghrelin levels. In conclusion, compared to eating the tested biscuit, 21-day consumption of the tested chocolate-based products had no adverse effects on the blood glucose, insulin and ghrelin levels. This trial is registered with chictr.org.cn: ChiCTR-IOR-16009525.

Out-of-Home Food Consumers in Brazil: What do They Eat?

Considering the increased contribution of foods consumed outside home and their potential impact on diet, this study aims to identify eating out patterns and their association with nutritional dietary quality in Brazil. We used the Individual Food Intake Survey 2008–2009, conducted with 34,003 individuals aged 10 and up. We used factor analysis by principal component to identify out-of-home eating patterns and linear regression to explore the association between patterns scores and dietary quality. We identified three food patterns. The “Traditional meal” pattern carried more rice, beans, meat, roots and tubers, pasta, vegetables and eggs. The “typical Brazilian breakfast/tea” pattern carried more fresh bread, margarine, milk, cheese and butter. The “Ultra-processed food” pattern carried more ready-to-eat meals and soft drinks. The “traditional meal” pattern was positively associated with calories from proteins, fiber, iron, potassium and sodium densities, whereas “typical Brazilian breakfast/tea” and “ultra-processed food” patterns were positively associated with energy density, the percentage of calories from lipids or carbohydrates, trans fat and free sugar. Out-of-home eating may have a negative impact on nutritional dietary quality when based on ultra-processed food. However, it is possible to maintain a healthy out-of-home diet with adherence to traditional Brazilian cuisine.

Does high-carbohydrate intake lead to increased risk of obesity? A systematic review and meta-analysis

OBJECTIVES

The present study aimed to test the association between high and low carbohydrate diets and obesity, and second, to test the link between total carbohydrate intake (as a percentage of total energy intake) and obesity.

SETTING, PARTICIPANTS AND OUTCOME MEASURES

We sought MEDLINE, PubMed and Google Scholar for observation studies published between January 1990 and December 2016 assessing an association between obesity and high-carbohydrate intake. Two independent reviewers selected candidate studies, extracted data and assessed study quality.

RESULTS

The study identified 22 articles that fulfilled the inclusion and exclusion criteria and quantified an association between carbohydrate intake and obesity. The first pooled strata (high-carbohydrate versus low-carbohydrate intake) suggested a weak increased risk of obesity. The second pooled strata (increasing percentage of total carbohydrate intake in daily diet) showed a weak decreased risk of obesity. Both these pooled strata estimates were, however, not statistically significant.

CONCLUSIONS

On the basis of the current study, it cannot be concluded that a high-carbohydrate diet or increased percentage of total energy intake in the form of carbohydrates increases the odds of obesity. A central limitation of the study was the non-standard classification of dietary intake across the studies, as well as confounders like total energy intake, activity levels, age and gender. Further studies are needed that specifically classify refined versus unrefined carbohydrate intake, as well as studies that investigate the relationship between high fat, high unrefined carbohydrate-sugar diets.

PROSPERO REGISTRATION NUMBER

CRD42015023257.

A randomized study of dietary composition during weight-loss maintenance: Rationale, study design, intervention, and assessment

BACKGROUND

While many people with overweight or obesity can lose weight temporarily, most have difficulty maintaining weight loss over the long term. Studies of dietary composition typically focus on weight loss, rather than weight-loss maintenance, and rely on nutrition education and dietary counseling, rather than controlled feeding protocols. Variation in initial weight loss and insufficient differentiation among treatments confound interpretation of results and compromise conclusions regarding the weight-independent effects of dietary composition. The aim of the present study was to evaluate three test diets differing in carbohydrate-to-fat ratio during weight-loss maintenance.

DESIGN AND DIETARY INTERVENTIONS

Following weight loss corresponding to 12±2% of baseline body weight on a standard run-in diet, 164 participants aged 18 to 65years were randomly assigned to one of three test diets for weight-loss maintenance through 20weeks (test phase). We fed them high-carbohydrate (60% of energy from carbohydrate, 20% fat), moderate-carbohydrate (40% carbohydrate, 40% fat), and low-carbohydrate (20% carbohydrate, 60% fat) diets, controlled for protein content (20% of energy). During a 2-week ad libitum feeding phase following the test phase, we assessed the effect of the test diets on body weight.

OUTCOMES

The primary outcome was total energy expenditure, assessed by doubly-labeled water methodology. Secondary outcomes included resting energy expenditure and physical activity, chronic disease risk factors, and variables to inform an understanding of physiological mechanisms by which dietary carbohydrate-to-fat ratio might influence metabolism. Weight change during the ad libitum feeding phase was conceptualized as a proxy measure of hunger.

Effects of high-impact exercise on the physical properties of bones of ovariectomized rats fed to a high-protein diet

The aim of this study was to evaluate the effects of high-impact physical exercise as a prophylactic and therapeutic means in osteopenic bones of rats submitted to ovariectomy and protein diet intake. A total of 64 Wistar rats were divided into eight groups (n = 8 each), being: OVX, ovx, standard diet and sedentary; OVXE, ovx, standard diet and jump; OVXP, ovx, high-protein diet and sedentary; and OVXEP, ovx, high-protein diet and jump; SH, sham, standard diet and sedentary; SHE, sham, standard diet and jump; SHP, sham, high-protein diet and sedentary; and SHEP, sham, high-protein diet and jump. OVX surgery consists of ovariectomy, and sham was the control surgery. The jumping protocol consisted of 20 jumps/day, 5 days/week. The bone structure was evaluated by densitometry, mechanical tests, histomorphometric, and immunohistochemical analyses. A high-protein diet resulted in increased bone mineral density (P = .049), but decreased maximal load (P = .026) and bone volume fraction (P = .023). The benefits of physical exercise were demonstrated by higher values of the maximal load in the trained groups compared to the sedentary groups (P < .001). The sham groups had decreased immunostaining of osteocalcin (P = .004) and osteopontin (P = .010) compared to ovx groups. However, the high-protein diet (P = .005) and jump exercise (P = .017) resulted in lower immunostaining of osteopontin compared to the standard diet and sedentary groups, respectively. In this experimental model, it was concluded that ovariectomy and a high-fat diet can negatively affect bone tissue and the high-impact exercise was not enough to suppress the deleterious effects caused by the protein diet and ovariectomy.

A randomized controlled trial to evaluate the effects of high Protein Complete (lActo) VEgetaRian (PACER) diet in non-diabetic obese Asian Indians in North India

In view of the increasing prevalence of obesity in largely vegetarian Asian Indians, it is important to research a high protein, low carbohydrate vegetarian diet. The present study was designed to evaluate the effects of a “High Protein Complete (lacto) VEgetaRian Diet (Acronym; ‘PACER diet’), on weight, body composition and metabolic profiles in non-diabetic obese Asian Indians living in north India.

In this 8-week randomized control trial, 102 vegetarian subjects with body mass index (BMI) >25 kg/m² were randomized to either a test diet (PACER diet; high protein, high fat and moderately low carbohydrate, lacto-vegetarian diet) or control diet (standard vegetarian diet formulated as the dietary guidelines for Asian Indians) after 4 weeks of diet and exercise run-in period. A standard exercise protocol was followed for both groups. Body weight, BMI, waist circumference (WC), blood pressure, fasting plasma glucose (FPG), fasting serum insulin and lipid profile were assessed before and after the intervention.

There was significant weight loss along with improvements in cardio-metabolic risk factors among both the groups post intervention. Percent reductions in the intervention group for weight (6.1± 2.9; p < 0.001), WC (3.9 ± 1.7; p < 0.001), FPG (5.9 ± 3.2; p < 0.001), total cholesterol (10.2 ± 6.3: p < 0.001), serum triacylglycerol (13.6 ± 10.6; p < 0.001) and low-density lipoprotein cholesterol (11.9 ± 7.1; p < 0.001]) were significantly greater than the control diet group. In summary, intervention with a PACER diet (high protein, high fat and moderately low carbohydrate, lacto-vegetarian diet) showed significant improvement in weight loss, body composition and cardio-metabolic profile as compared to a standard vegetarian diet among obese Asian Indians in north India.

Dietary Protein and Energy Balance in Relation to Obesity and Co-morbidities

Dietary protein is effective for body-weight management, in that it promotes satiety, energy expenditure, and changes body-composition in favor of fat-free body mass. With respect to body-weight management, the effects of diets varying in protein differ according to energy balance. During energy restriction, sustaining protein intake at the level of requirement appears to be sufficient to aid body weight loss and fat loss. An additional increase of protein intake does not induce a larger loss of body weight, but can be effective to maintain a larger amount of fat-free mass. Protein induced satiety is likely a combined expression with direct and indirect effects of elevated plasma amino acid and anorexigenic hormone concentrations, increased diet-induced thermogenesis, and ketogenic state, all feed-back on the central nervous system. The decline in energy expenditure and sleeping metabolic rate as a result of body weight loss is less on a high-protein than on a medium-protein diet. In addition, higher rates of energy expenditure have been observed as acute responses to energy-balanced high-protein diets. In energy balance, high protein diets may be beneficial to prevent the development of a positive energy balance, whereas low-protein diets may facilitate this. High protein-low carbohydrate diets may be favorable for the control of intrahepatic triglyceride IHTG in healthy humans, likely as a result of combined effects involving changes in protein and carbohydrate intake. Body weight loss and subsequent weight maintenance usually shows favorable effects in relation to insulin sensitivity, although some risks may be present. Promotion of insulin sensitivity beyond its effect on body-weight loss and subsequent body-weight maintenance seems unlikely. In conclusion, higher-protein diets may reduce overweight and obesity, yet whether high-protein diets, beyond their effect on body-weight management, contribute to prevention of increases in non-alcoholic fatty liver disease NAFLD, type 2 diabetes and cardiovascular diseases is inconclusive.