Maintenance of resting energy expenditure after weight loss in premenopausal women: potential benefits of a high-protein, reduced-calorie diet

High Compared with Moderate Protein Intake Reduces Adaptive Thermogenesis and Induces a Negative Energy Balance during Long-term Weight-Loss Maintenance in Participants with Prediabetes in the Postobese State: A PREVIEW Study

BACKGROUND

Weight loss has been associated with adaptations in energy expenditure. Identifying factors that counteract these adaptations are important for long-term weight loss and weight maintenance.

OBJECTIVE

The aim of this study was to investigate whether increased protein/carbohydrate ratio would reduce adaptive thermogenesis (AT) and the expected positive energy balance (EB) during weight maintenance after weight loss in participants with prediabetes in the postobese state.

METHODS

In 38 participants, the effects of 2 diets differing in protein/carbohydrate ratio on energy expenditure and respiratory quotient (RQ) were assessed during 48-h respiration chamber measurements ∼34 mo after weight loss. Participants consumed a high-protein (HP) diet (n = 20; 13 women/7 men; age: 64.0 ± 6.2 y; BMI: 28.9 ± 4.0 kg/m 2) with 25:45:30% or a moderate-protein (MP) diet (n = 18; 9 women/9 men; age: 65.1 ± 5.8 y; BMI: 29.0 ± 3.8 kg/m 2) with 15:55:30% of energy from protein:carbohydrate:fat. Predicted resting energy expenditure (REEp) was calculated based on fat-free mass and fat mass. AT was assessed by subtracting measured resting energy expenditure (REE) from REEp. The main outcomes included differences in components of energy expenditure, substrate oxidation, and AT between groups.

RESULTS

EB (MP = 0.2 ± 0.9 MJ/d; HP = -0.5 ± 0.9 MJ/d) and RQ (MP = 0.84 ± 0.02; HP = 0.82 ± 0.02) were reduced and REE (MP: 7.3 ± 0.2 MJ/d compared with HP: 7.8 ± 0.2 MJ/d) was increased in the HP group compared with the MP group (P < 0.05). REE was not different from REEp in the HP group, whereas REE was lower than REEp in the MP group (P < 0.05). Furthermore, EB was positively related to AT (rs = 0.74; P < 0.001) and RQ (rs = 0.47; P < 0.01) in the whole group of participants.

CONCLUSIONS

In conclusion, an HP diet compared with an MP diet led to a negative EB and counteracted AT ∼34 mo after weight loss, in participants with prediabetes in the postobese state. These results indicate the relevance of compliance to an increased protein/carbohydrate ratio for long-term weight maintenance after weight loss. The trial was registered at clinicaltrials.gov as NCT01777893.

Metabolic advantages of higher protein diets and benefits of dairy foods on weight management, glycemic regulation, and bone

The Inst. of Medicine and World Health Organization have determined that 0.8 to 0.83 g protein·kg(-1) ·d(-1) is the quantity of protein required to establish nitrogen balance in nearly all healthy individuals. However, consuming higher protein diets may be metabolically advantageous, particularly for overweight and obese adults attempting weight loss, and for physically active individuals such as athletes and military personnel. Studies have demonstrated that higher protein diets may spare lean body mass during weight loss, promote weight management, enhance glycemic regulation, and increase intestinal calcium absorption, which may result in long-term improvements in bone health. The extent to which higher protein diets are beneficial is largely attributed to the digestive and absorptive properties, and also to the essential amino acid (EAA) content of the protein. Proteins that are rapidly digested and absorbed likely contribute to the metabolic advantages conferred by consuming higher protein diets. The EAA profiles, as well as the digestive and absorptive properties of dairy proteins, such as whey protein and casein, are particularly advantageous because they facilitate a rapid, robust, and sustained delivery of EAAs to the periphery. This article reviews the scientific literature assessing metabolic advantages associated with higher protein diets on weight management, glycemic regulation, and bone, with emphasis given to studies evaluating the potential benefits associated with dairy.

Higher-protein diets are associated with higher HDL cholesterol and lower BMI and waist circumference in US adults

BACKGROUND

Protein intake above the RDA attenuates cardiometabolic risk in overweight and obese adults during weight loss. However, the cardiometabolic consequences of consuming higher-protein diets in free-living adults have not been determined.

OBJECTIVE

This study examined usual protein intake [g/kg body weight (BW)] patterns stratified by weight status and their associations with cardiometabolic risk using data from the NHANES, 2001-2010 (n = 23,876 adults ≥19 y of age).

METHODS

Linear and decile trends for association of usual protein intake with cardiometabolic risk factors including blood pressure, glucose, insulin, cholesterol, and triglycerides were determined with use of models that controlled for age, sex, ethnicity, physical activity, poverty-income ratio, energy intake (kcal/d), carbohydrate (g/kg BW) and total fat (g/kg BW) intake, body mass index (BMI), and waist circumference.

RESULTS

Usual protein intake varied across deciles from 0.69 ± 0.004 to 1.51 ± 0.009 g/kg BW (means ± SEs). Usual protein intake was inversely associated with BMI (-0.47 kg/m(2) per decile and -4.54 kg/m(2) per g/kg BW) and waist circumference (-0.53 cm per decile and -2.45 cm per g/kg BW), whereas a positive association was observed between protein intake and HDL cholesterol (0.01 mmol/L per decile and 0.14 mmol/L per g/kg BW, P < 0.00125).

CONCLUSIONS

Americans of all body weights typically consume protein in excess of the RDA. Higher-protein diets are associated with lower BMI and waist circumference and higher HDL cholesterol compared to protein intakes at RDA levels. Our data suggest that Americans who consume dietary protein between 1.0 and 1.5 g/kg BW potentially have a lower risk of developing cardiometabolic disease.

Effects of short-term energy deficit on muscle protein breakdown and intramuscular proteolysis in normal-weight young adults

The effects of short-term energy deficit (ED) on direct measures of muscle proteolysis and the intracellular mechanisms by which muscle proteins are degraded at rest and following aerobic exercise are not well described. This study evaluated the effects of a short-term diet-induced ED, on muscle fractional breakdown rate (FBR), intramuscular 26S proteasome activity, caspase-3 activation, and PSMA2 and MAFbx expression at rest, in the postabsorptive state, and following a single bout of moderate aerobic exercise (45 min at 65% peak oxygen uptake). Six men and 4 women participated in two 10-day diet interventions: weight maintenance (WM) followed by ED (80% estimated energy requirements). Dietary protein (1.5 g·kg−1·day−1) intake was constant for WM and ED. Mixed muscle FBR, proteasome activity, and intracellular proteolytic factor expression were measured using stable isotope methodology, fluorescent enzyme activity assays, and Western blotting, respectively. Overall, FBR and caspase-3 activation increased 60% and 11%, respectively, in response to ED (P < 0.05), but were not influenced by exercise. During ED, 26S proteasome α-subunit PSMA2 expression was 25% higher (P < 0.05) after exercise compared with rest. Exercise did not influence PSMA2 expression during WM, and MAFbx expression and 26S proteasome activity were not affected by ED or exercise. These data illustrate the effects of short-term, moderate ED on muscle protein degradation. In the context of skeletal muscle integrity during weight loss interventions, this work demonstrates a need for further investigations aimed at mitigating muscle loss associated with energy deficit imposed for intentional reduction of total body weight.

Effects of high-protein diets on fat-free mass and muscle protein synthesis following weight loss: a randomized controlled trial

The purpose of this work was to determine the effects of varying levels of dietary protein on body composition and muscle protein synthesis during energy deficit (ED). A randomized controlled trial of 39 adults assigned the subjects diets providing protein at 0.8 (recommended dietary allowance; RDA), 1.6 (2×-RDA), and 2.4 (3×-RDA) g kg(-1) d(-1) for 31 d. A 10-d weight-maintenance (WM) period was followed by a 21 d, 40% ED. Body composition and postabsorptive and postprandial muscle protein synthesis were assessed during WM (d 9-10) and ED (d 30-31). Volunteers lost (P<0.05) 3.2 ± 0.2 kg body weight during ED regardless of dietary protein. The proportion of weight loss due to reductions in fat-free mass was lower (P<0.05) and the loss of fat mass was higher (P<0.05) in those receiving 2×-RDA and 3×-RDA compared to RDA. The anabolic muscle response to a protein-rich meal during ED was not different (P>0.05) from WM for 2×-RDA and 3×-RDA, but was lower during ED than WM for those consuming RDA levels of protein (energy × protein interaction, P<0.05). To assess muscle protein metabolic responses to varied protein intakes during ED, RDA served as the study control. In summary, we determined that consuming dietary protein at levels exceeding the RDA may protect fat-free mass during short-term weight loss.

Normal vs. high-protein weight loss diets in men: effects on body composition and indices of metabolic syndrome

OBJECTIVE

This study assessed the effectiveness of a prescribed weight-loss diet with 0.8 versus 1.4 g protein·kg(-1) day(-1) on changes in weight, body composition, indices of metabolic syndrome, and resting energy expenditure (REE) in overweight and obese men.

DESIGN AND METHODS

Men were randomized to groups that consumed diets containing 750 kcal day(-1) less than daily energy needs for weight maintenance with either normal protein (NP, n = 21) or higher protein (HP, n = 22) content for 12 weeks. The macronutrient distributions of the NP and HP diets were 25:60:15, and 25:50:25 percent energy from fat, carbohydrate, and protein, respectively. Assessments were made pre and post intervention. The subjects were retrospectively subgrouped into overweight and obese groups.

RESULTS AND CONCLUSION

Both diet groups lost comparable body weight and fat. The HP group lost less lean body mass than the NP group (-1.9 ± 0.3 vs. -3.0 ± 0.4 kg). The effects of protein and BMI status on lean body mass loss were additive. The reductions in total cholesterol, HDL-C, triacylglycerol, glucose, and insulin, along with LDL-C, total cholesterol-to-HDL-C ratio, and HOMA-IR, were not statistically different between NP and HP. Likewise, macronutrient distributions of the diet did not affect the reductions in REE, and blood pressure. In conclusion, energy restriction effectively improves multiple clinical indicators of cardiovascular health and glucose control, and consumption of a higher-protein diet and accomplishing weight loss when overweight versus obese help men preserve lean body mass over a short period of time.

Addressing weight loss recidivism: a clinical focus on metabolic rate and the psychological aspects of obesity

Obesity in the United States has reached epidemic proportions and has become an unprecedented public health burden. This paper returns to the evidence for metabolic rate set points and emphasizes the clinical importance of addressing changes in metabolic rate throughout the weight loss process. In addition to the importance of clinically attending to the modulation of metabolic rate, the psychological aspects of obesity are addressed as part of the need to holistically treat obesity.

Skeletal muscle responses to negative energy balance: effects of dietary protein

Sustained periods of negative energy balance decrease body mass due to losses of both fat and skeletal muscle mass. Decreases in skeletal muscle mass are associated with a myriad of negative consequences, including suppressed basal metabolic rate, decreased protein turnover, decreased physical performance, and increased risk of injury. Decreases in skeletal muscle mass in response to negative energy balance are due to imbalanced rates of muscle protein synthesis and degradation. However, the underlying physiological mechanisms contributing to the loss of skeletal muscle during energy deprivation are not well described. Recent studies have demonstrated that consuming dietary protein at levels above the current recommended dietary allowance (0.8 g · kg(-1) · d(-1)) may attenuate the loss of skeletal muscle mass by affecting the intracellular regulation of muscle anabolism and proteolysis. However, the specific mechanism by which increased dietary protein spares skeletal muscle through enhanced molecular control of muscle protein metabolism has not been elucidated. This article reviews the available literature related to the effects of negative energy balance on skeletal muscle mass, highlighting investigations that assessed the influence of varying levels of dietary protein on skeletal muscle protein metabolism. Further, the molecular mechanisms that may contribute to the regulation of skeletal muscle mass in response to negative energy balance and alterations in dietary protein level are described.

The problem of nitrogen disposal in the obese

Amino-N is preserved because of the scarcity and nutritional importance of protein. Excretion requires its conversion to ammonia, later incorporated into urea. Under conditions of excess dietary energy, the body cannot easily dispose of the excess amino-N against the evolutively adapted schemes that prevent its wastage; thus ammonia and glutamine formation (and urea excretion) are decreased. High lipid (and energy) availability limits the utilisation of glucose, and high glucose spares the production of ammonium from amino acids, limiting the synthesis of glutamine and its utilisation by the intestine and kidney. The amino acid composition of the diet affects the production of ammonium depending on its composition and the individual amino acid catabolic pathways. Surplus amino acids enhance protein synthesis and growth, and the synthesis of non-protein-N-containing compounds. But these outlets are not enough; consequently, less-conventional mechanisms are activated, such as increased synthesis of NO∙ followed by higher nitrite (and nitrate) excretion and changes in the microbiota. There is also a significant production of N(2) gas, through unknown mechanisms. Health consequences of amino-N surplus are difficult to fathom because of the sparse data available, but it can be speculated that the effects may be negative, largely because the fundamental N homeostasis is stretched out of normalcy, forcing the N removal through pathways unprepared for that task. The unreliable results of hyperproteic diets, and part of the dysregulation found in the metabolic syndrome may be an unwanted consequence of this N disposal conflict.

Relative changes in resting energy expenditure during weight loss: a systematic review

A more comprehensive understanding of the effects of weight loss on the changes in resting energy expenditure (EE) is relevant. A MEDLINE search was performed to identify studies with information relevant to this systematic review. From this search, the mean rate of resting EE decrease relative to weight loss was calculated from 90 available publications. A decrease of resting EE relative to weight loss of -15.4 +/- 8.7 kcal kg(-1) was observed from 2977 [corrected] subjects. No sex differences were noted in the overall resting EE decrease relative to weight loss. However, a significant sex differences was seen with pharmacological interventions, which seemed to depress the resting EE relative to weight loss to a greater extent in men than in women (P < 0.05). A greater drop in resting EE relative to weight loss was observed for short interventions (more than 2 but less than 6 weeks) when compared with long interventions (<6 weeks) (-27.7 +/- 6.7 vs. -12.8 +/- 7.1 kcal kg(-1)) (P < 0.001). Men and women have a similar decrease in resting EE relative to weight loss except in the case of pharmacological interventions. Short interventions also produced greater resting EE losses relative to weight loss.

Acute energy deprivation affects skeletal muscle protein synthesis and associated intracellular signaling proteins in physically active adults

To date, few studies have characterized the influence of energy deprivation on direct measures of skeletal muscle protein turnover. In this investigation, we characterized the effect of an acute, moderate energy deficit (10 d) on mixed muscle fractional synthetic rate (FSR) and associated intracellular signaling proteins in physically active adults. Eight men and 4 women participated in a 20-d, 2-phase diet intervention study: weight maintenance (WM) and energy deficient (ED; approximately 80% of estimated energy requirements). Dietary protein (1.5 g x kg(-1) x d(-1)) and fat (approximately 30% of total energy) were constant for WM and ED. FSR and intracellular signaling proteins were measured on d 10 of both interventions using a primed, constant infusion of [(2)H(5)]-phenylalanine and Western blotting techniques, respectively. Participants lost approximately 1 kg body weight during ED (P < 0.0001). FSR was reduced approximately 19% (P < 0.05) for ED (0.06 +/- 0.01%/h) compared with WM (0.074 +/- 0.01%/h). Protein kinase B and eukaryotic initiation factor 4E binding protein 1 phosphorylation were lower (P < 0.05) during ED compared with WM. AMP activated protein kinase phosphorylation decreased (P < 0.05) over time regardless of energy status. These findings show that FSR and associated synthetic intracellular signaling proteins are downregulated in response to an acute, moderate energy deficit in physically active adults and provide a basis for future studies assessing the impact of prolonged, and perhaps more severe, energy restriction on skeletal muscle protein turnover.

Hair protein and amino acid 13C and 15N abundances take more than 4 weeks to clearly prove influences of animal protein intake in young women with a habitual daily protein consumption of more than 1 g per kg body weight

A high protein or meat intake might be a risk factor for metabolic disorders. Stable isotopic abundances (SIA) of hair can be used as biomarkers for animal protein intake due to characteristic isotopic patterns of food proteins. We investigated if an additional meat intake (M, 200 g pork fillet/day) or an omission of meat and meat products (NOM) can influence the natural (15)N and (13)C SIA within 4 weeks in hair and plasma of young women. The daily protein intake (means +/- SD) was 1.40 +/- 0.29, 2.25 +/- 0.35, and 1.15 +/- 0.26 g/kg at baseline, during M, and during NOM, respectively. At baseline the animal protein intake correlated with bulk SIA of hair ((15)N: R(2) = 0.416; (13)C: R(2) = 0.664; n = 14). However, isotope ratio mass spectrometry (IRMS) analyses have not shown that hair and plasma SIA were changed significantly after M or NOM. Possible reasons were discussed. Urinary SIA were significantly lower after M than after NOM ((15)N: p = 0.039; (13)C: p = 0.006) and close to those of pork fillet. Characteristic patterns of SIA were measured in individual amino acids (AA) by gas chromatography/combustion isotope ratio mass spectrometry (GC/C/IRMS). The results confirmed considerable differences in SIA between AA (delta(15)N, up to 22 per thousand; delta(13)C, up to 31 per thousand). Plots of (15)N versus (13)C abundances in hair revealed characteristic differences between indispensable and dispensable AA. The intervention-dependent changes of AA-specific SIA were not as clear as expected. Although the AA-specific SIA may reveal more detailed characteristics of physiological conditions, further methodological research is required. We suggest that the SIA of leucine can be potential markers of protein intake. The reliability of SIA as biomarkers of protein intake still have to be tested in longer lasting intervention studies in humans. The results may have implications in the assessment for possible benefits and risks of protein consumption.