The individual and combined effects of glycemic index and protein on glycemic response, hunger, and energy intake

Ultraprocessed Foods and Obesity Risk: A Critical Review of Reported Mechanisms

Epidemiologic evidence supports a positive association between ultraprocessed food (UPF) consumption and body mass index. This has led to recommendations to avoid UPFs despite very limited evidence establishing causality. Many mechanisms have been proposed, and this review critically aimed to evaluate selected possibilities for specificity, clarity, and consistency related to food choice (i.e., low cost, shelf-life, food packaging, hyperpalatability, and stimulation of hunger/suppression of fullness); food composition (i.e., macronutrients, food texture, added sugar, fat and salt, energy density, low-calorie sweeteners, and additives); and digestive processes (i.e., oral processing/eating rate, gastric emptying time, gastrointestinal transit time, and microbiome). For some purported mechanisms (e.g., fiber content, texture, gastric emptying, and intestinal transit time), data directly contrasting the effects of UPF and non-UPF intake on the indices of appetite, food intake, and adiposity are available and do not support a unique contribution of UPFs. In other instances, data are not available (e.g., microbiome and food additives) or are insufficient (e.g., packaging, food cost, shelf-life, macronutrient intake, and appetite stimulation) to judge the benefits versus the risks of UPF avoidance. There are yet other evoked mechanisms in which the preponderance of evidence indicates ingredients in UPFs actually moderate body weight (e.g., low-calorie sweetener use for weight management; beverage consumption as it dilutes energy density; and higher fat content because it reduces glycemic responses). Because avoidance of UPFs holds potential adverse effects (e.g., reduced diet quality, increased risk of food poisoning, and food wastage), it is imprudent to make recommendations regarding their role in diets before causality and plausible mechanisms have been verified.

The importance of glycemic index on post-prandial glycaemia in the context of mixed meals: A randomized controlled trial on pasta and rice

BACKGROUND AND AIMS

Post-prandial glycemic response (PPGR) depends on the intrinsic characteristic of the carbohydrate-rich foods as well as on the amount and type of other nutrients. This study aimed to explore whether the addition of condiments can affect the difference in PPGR between a low and a medium-high Glycemic Index (GI) food.

METHODS AND RESULTS

Spaghetti (S) and rice ® were consumed plain and after adding tomato sauce and extra virgin olive oil (TEVOO), or pesto sauce (P). The GI of R (63 ± 3) was statistically higher than that of S (44 ± 7) (p = 0.003). The Incremental Area Under the Curve (IAUC) for R was significantly greater than S (124.2 ± 12.1 and 82.1 ± 12.9 mmol∗min/L respectively) (p = 0.016) for blood glucose but not for insulin (1192.6 ± 183.6 and 905.2 ± 208.9 mU∗min/L, respectively) (p = 0.076). There were no significant differences after the addition of either TEVOO or P. The postprandial peaks of blood glucose and insulin for R (6.7 ± 0.3 mmol/L and 36.4 ± 4.9 mU/L, respectively) were significantly higher compared to S (6.0 ± 0.2 mmol/L and 26.7 ± 3.6 mU/L, respectively) (p = 0.033 and p = 0.025). The postprandial peak for insulin remained significantly higher with P (36.8 ± 3.7 and 28.6 ± 2.9 mU/L for R + P and S + P, p = 0.045) but not with EVOO (p = 0.963). Postprandial peaks for blood glucose were not significantly different with condiment.

CONCLUSIONS

The differences in PPGR were significant between spaghetti and rice consumed plain, they reduced or disappeared with fat adding, depending on the type of condiment used. REGISTRATION NUMBER: (www.clinicaltrial.gov):NCT03104712.

The association between major dietary patterns at dinner and obesity in adults living in Tehran: A population-based study

Introduction: Findings of studies on the association between evening meal and obesity are inconclusive. Thus, we sought to investigate the association between major dietary patterns at evening meal and obesity among apparently healthy adults in Tehran. Methods: This cross-sectional research was conducted using 833 adult men and women who lived in Tehran (age range: 20-59 years). Their dietary intake was evaluated by three, 24-h dietary recalls(24hDRs), and major patterns were identified using exploratory factor analysis. The association between major dietary patterns at dinner with general and central obesity was assessed using logistic regression analysis. Results: We identified 3 major dietary patterns at dinner including "prudent", "potatoes and eggs" and"Western" patterns. There was no significant relationship between prudent and general obesity (OR:0.76, 95% CI = 0.21, 1.15, P value = 0.20), and, a significant association was not observed between potatoes and eggs and general obesity (OR: 0.89, 95% CI = 0.60, 1.32, P value = 0.57) also, there was no significant relationship between Western dietary pattern and general obesity in this study (OR: 0.95,95% CI = 0.63, 1.43, P value = 0.82). Further analyses showed that there was no significant relationship between central obesity with any of the dietary patterns. Conclusion: The results of this study do not support a possible relationship between major dietary patterns at dinner with general and central obesity. However, the presented findings should be confirmed in prospective studies.

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.

Relevance of the Glycemic Index and Glycemic Load for Body Weight, Diabetes, and Cardiovascular Disease

Despite initial enthusiasm, the relationship between glycemic index (GI) and glycemic response (GR) and disease prevention remains unclear. This review examines evidence from randomized, controlled trials and observational studies in humans for short-term (e.g., satiety) and long-term (e.g., weight, cardiovascular disease, and type 2 diabetes) health effects associated with different types of GI diets. A systematic PubMed search was conducted of studies published between 2006 and 2018 with key words glycemic index, glycemic load, diabetes, cardiovascular disease, body weight, satiety, and obesity. Criteria for inclusion for observational studies and randomized intervention studies were set. The search yielded 445 articles, of which 73 met inclusion criteria. Results suggest an equivocal relationship between GI/GR and disease outcome. The strongest intervention studies typically find little relationship among GI/GR and physiological measures of disease risk. Even for observational studies, the relationship between GI/GR and disease outcomes is limited. Thus, it is unlikely that the GI of a food or diet is linked to disease risk or health outcomes. Other measures of dietary quality, such as fiber or whole grains may be more likely to predict health outcomes. Interest in food patterns as predictors of health benefits may be more fruitful for research to inform dietary guidance.

Increased Protein Consumption during the Day from an Energy-Restricted Diet Augments Satiety but Does Not Reduce Daily Fat or Carbohydrate Intake on a Free-Living Test Day in Overweight Women

Background: Higher-protein (HP) energy-restriction diets improve weight management to a greater extent than normal-protein (NP) versions. Potential mechanisms of action with regard to assessment of eating behaviors across the day have not been widely examined during energy restriction.Objectives: The objectives of this study were to test whether the consumption of an HP energy-restriction diet reduces carbohydrate and fat intakes through improvements in daily appetite, satiety, and food cravings compared with NP versions and to test whether protein type within the NP diets alters protein-related satiety.Methods: Seventeen overweight women [mean ± SEM age: 36 ± 1 y; body mass index (kg/m2): 28.4 ± 0.1] completed a randomized, controlled-feeding crossover study. Participants were provided with the following ∼1250-kcal/d energy-restricted (-750-kcal/d deficit) diets, each for 6 d: HP [124 g protein/d; 60% from beef and 40% from plant sources (HP-BEEF)] or NP (48 g protein/d) that was protein-type matched (NP-BEEF) or unmatched [100% from plant-based sources (NP-PLANT)]. On day 6 of each diet period, participants completed a 12-h testing day containing repetitive appetite, satiety, and food-craving questionnaires. On day 7, the participants were asked to consume their protein requirement within each respective diet but were provided with a surplus of carbohydrate- and fat-rich foods to consume, ad libitum, at each eating occasion across the day. All outcomes reported were primary study outcomes.Results: The HP-BEEF diet reduced daily hunger by 16%, desire to eat by 15%, prospective food consumption by 14%, and fast-food cravings by 15% but increased daily fullness by 25% compared with the NP-BEEF and NP-PLANT diets (all P < 0.05). However, consuming more protein throughout the day did not reduce the energy consumed ad libitum from the fat- and carbohydrate-rich foods (HP-BEEF: 2000 ± 180 kcal/d; NP-BEEF: 2120 ± 190 kcal/d; NP-PLANT: 2070 ± 180 kcal/d). None of the outcomes differed between the NP-BEEF and NP-PLANT treatments.Conclusions: Although appetite control, satiety, and food cravings improved after an HP energy-restriction diet, increased protein consumption did not reduce carbohydrate and fat intakes throughout the free-living test day in overweight healthy women exposed to highly palatable foods. This trial was registered at clinicaltrials.gov as NCT02614729.

Association of Animal and Plant Proteins Intake with Hypertension in Iranian Adult Population: Isfahan Healthy Heart Program

Background:

There is evidence regarding the relationship between dietary proteins intake and blood pressure (BP), but they had inconsistent results. Therefore, this study was designed to assess the association between different kinds of protein intake (animal and plant protein) and BP.

Materials and Methods:

Data were collected from Isfahan Healthy Heart Program. We performed a cross-sectional study among 9660 randomly selected Iranian adults aged ≥19-year-old that they were selected from three large Iranian regions in 2007. A simplified validated 48-item-food frequency questionnaire was used to assess dietary intake including all kinds of protein. Systolic and diastolic BPs were measured in duplicate by trained personnel using a standard protocol. Multivariable regressions were applied to assess the relationship between protein intake and BP levels and the presence of hypertension (HTN).

Results:

More frequent consumption of animal, plant, and total protein intake were inversely associated with BP in a crude model (P < 0.001); however, after adjustment for potential confounders this relationship remained only for plant protein (P = 0.04). The risk of HTN occurrence decreased in the highest quintile of total and plant protein consumption by 19% (odds ratio [OR] = 0.81; confidence interval [CI]: [0.65–0.96]; P for trend = 0.004) and 18% (OR = 0.82; [CI: (0.67–0.94]; P for trend = 0.03), respectively.

Conclusions:

More frequent protein intake, especially plant protein consumption was inversely associated with BP and risk of HTN among Iranian adults.

Effects of Higher Dietary Protein and Fiber Intakes at Breakfast on Postprandial Glucose, Insulin, and 24-h Interstitial Glucose in Overweight Adults

Dietary protein and fiber independently influence insulin-mediated glucose control. However, potential additive effects are not well-known. Men and women (n = 20; age: 26 ± 5 years; body mass index: 26.1 ± 0.2 kg/m²; mean ± standard deviation) consumed normal protein and fiber (NPNF; NP = 12.5 g, NF = 2 g), normal protein and high fiber (NPHF; NP = 12.5 g, HF = 8 g), high protein and normal fiber (HPNF; HP = 25 g, NF = 2 g), or high protein and fiber (HPHF; HP = 25 g, HF = 8 g) breakfast treatments during four 2-week interventions in a randomized crossover fashion. On the last day of each intervention, meal tolerance tests were completed to assess postprandial (every 60 min for 240 min) serum glucose and insulin concentrations. Continuous glucose monitoring was used to measure 24-h interstitial glucose during five days of the second week of each intervention. Repeated-measures ANOVA was applied for data analyses. The HPHF treatment did not affect postprandial glucose and insulin responses or 24-h glucose total area under the curve (AUC). Higher fiber intake reduced 240-min insulin AUC. Doubling the amount of protein from 12.5 g to 25 g/meal and quadrupling fiber from 2 to 8 g/meal at breakfast was not an effective strategy for modulating insulin-mediated glucose responses in these young, overweight adults.

The Effects of Breakfast Consumption and Composition on Metabolic Wellness with a Focus on Carbohydrate Metabolism

Findings from epidemiologic studies indicate that there are associations between breakfast consumption and a lower risk of type 2 diabetes mellitus (T2DM) and metabolic syndrome, prompting interest in the influence of breakfast on carbohydrate metabolism and indicators of T2DM risk. The objective of this review was to summarize the available evidence from randomized controlled trials assessing the impact of breakfast on variables related to carbohydrate metabolism and metabolic wellness. Consuming compared with skipping breakfast appeared to improve glucose and insulin responses throughout the day. Breakfast composition may also be important. Dietary patterns high in rapidly available carbohydrate were associated with elevated T2DM risk. Therefore, partial replacement of rapidly available carbohydrate with other dietary components, such as whole grains and cereal fibers, proteins, and unsaturated fatty acids (UFAs), at breakfast may be a useful strategy for producing favorable metabolic outcomes. Consumption of fermentable and viscous dietary fibers at breakfast lowers glycemia and insulinemia. Fermentable fibers likely act through enhancing insulin sensitivity later in the day, and viscous fibers have an acute effect to slow the rate of carbohydrate absorption. Partially substituting protein for rapidly available carbohydrate enhances satiety and diet-induced thermogenesis, and also favorably affects lipoprotein lipids and blood pressure. Partially substituting UFA for carbohydrate has been associated with improved insulin sensitivity, lipoprotein lipids, and blood pressure. Overall, the available evidence suggests that consuming breakfast foods high in whole grains and cereal fiber, while limiting rapidly available carbohydrate, is a promising strategy for metabolic health promotion.

Protein-Enriched Liquid Preloads Varying in Macronutrient Content Modulate Appetite and Appetite-Regulating Hormones in Healthy Adults

BACKGROUND

Dietary protein is considered the most satiating macronutrient, yet there is little evidence on whether the effects observed are attributable to the protein or to the concomitant manipulation of carbohydrates and fat.

OBJECTIVE

The aim was to examine the effect of consumption of preloads varying in macronutrient content on appetite, energy intake, and biomarkers of satiety.

METHODS

Using a randomized, within-subjects, 2-level factorial design, 36 adults [mean ± SD age: 27 ± 5 y; body mass index (in kg/m(2)): 24.3 ± 1.6) received a breakfast consisting of 1 of 7 isovolumetric (670 mL) and isoenergetic (2100 kJ) liquid preloads matched for energy density and sensory properties but with different macronutrient composition (levels: 9%, 24%, or 40% of energy from protein combined with a carbohydrate-to-fat ratio of 0.4, 2, or 3.6, respectively). Appetite ratings and blood samples were collected and assessed at baseline and every 30 and 60 min, respectively, until a lunch test meal, which participants consumed ad libitum, was served 3.5 h after breakfast.

RESULTS

Prospective consumption was 12% lower after intake of the high-protein (40%)/3.6 carbohydrate:fat preload than after intake of the low-protein (9%)/0.4 carbohydrate:fat preload (P = 0.02) solely because of the increased protein, irrespective of the manipulation of the other macronutrients. Most appetite ratings tended to be suppressed (13%) with increasing protein content of the preloads (P < 0.06). Carbohydrate elicited greater increases in fullness and postprandial responses of glucose and insulin than did protein and fat. The glucose concentration was suppressed and glucagon-like peptide 1 increased more after intake of the high-protein (40%)/0.4 carbohydrate:fat preload than after the other preloads (P < 0.001). No statistically significant differences in postprandial ghrelin release or ad libitum energy intake at lunch were found.

CONCLUSIONS

By varying all 3 macronutrients simultaneously and in a systematically balanced manner, we found that protein had a more pronounced effect on suppressing appetite than did carbohydrates and fat. Modulating the nutritional profile of a meal by replacing fat with protein can influence appetite in healthy adults. This trial was registered at www.clinicaltrials.gov as NCT01849302.

The role of protein in weight loss and maintenance

Over the past 20 y, higher-protein diets have been touted as a successful strategy to prevent or treat obesity through improvements in body weight management. These improvements are thought to be due, in part, to modulations in energy metabolism, appetite, and energy intake. Recent evidence also supports higher-protein diets for improvements in cardiometabolic risk factors. This article provides an overview of the literature that explores the mechanisms of action after acute protein consumption and the clinical health outcomes after consumption of long-term, higher-protein diets. Several meta-analyses of shorter-term, tightly controlled feeding studies showed greater weight loss, fat mass loss, and preservation of lean mass after higher-protein energy-restriction diets than after lower-protein energy-restriction diets. Reductions in triglycerides, blood pressure, and waist circumference were also reported. In addition, a review of the acute feeding trials confirms a modest satiety effect, including greater perceived fullness and elevated satiety hormones after higher-protein meals but does not support an effect on energy intake at the next eating occasion. Although shorter-term, tightly controlled feeding studies consistently identified benefits with increased protein consumption, longer-term studies produced limited and conflicting findings; nevertheless, a recent meta-analysis showed persistent benefits of a higher-protein weight-loss diet on body weight and fat mass. Dietary compliance appears to be the primary contributor to the discrepant findings because improvements in weight management were detected in those who adhered to the prescribed higher-protein regimen, whereas those who did not adhere to the diet had no marked improvements. Collectively, these data suggest that higher-protein diets that contain between 1.2 and 1.6 g protein · kg^-1 · d^-1 and potentially include meal-specific protein quantities of at least ∼25-30 g protein/meal provide improvements in appetite, body weight management, cardiometabolic risk factors, or all of these health outcomes; however, further strategies to increase dietary compliance with long-term dietary interventions are warranted.

Association between Macronutrients Intake, Visceral Obesity and Blood Pressure in a Sample of Obese Egyptian Women

AIM

Study the association between the total caloric intake, protein, lipid, and some classes of fatty acids of the diet, and their effects on blood pressure in a sample of Egyptian obese women with and without visceral obesity.

METHODS

Five hundred forty-nine obese women were included in the study with mean age of 38.1 ± 11.56 years and mean Body mass index [BMI] of 36.17 ± 7.23. They enrolled in a program for losing weight. Visceral fat was determined using ultrasound. Blood pressure was measured 3 times and the mean was recorded. Twenty four hours dietary recall was reported.

RESULTS

Thirty point four percentages of samples has visceral obesity ≥ 7cm; they were the older, showed higher values of BMI, visceral obesity and blood pressure. Significant difference was found between groups regarding mean value of BMI, visceral obesity, both systolic blood pressure SBP and diastolic blood pressure DBP and most of the daily macronutrients intake. In groups (2&3) positive significant correlation was recorded between (SBP) & (DBP) and total daily intake of total calories, carbohydrate, total fat, saturated fatty acids and cholesterol, and negative significant correlation with total daily intake of total protein, animal and vegetable protein, linolenic and linoleic fatty acids, while oleic fatty acid showed negative correlation with SBP&DBP in all groups.

CONCLUSION

This study emphasizes the hypothesis that the macronutrients composition of diet influences blood pressure in different ways, in obese patients with visceral obesity.

A randomized trial to manipulate the quality instead of quantity of dietary proteins to influence the markers of satiety

AIMS

To test whether a breakfast including eggs (EB) containing high-quality protein decreases subsequent food intake and increases satiety-related hormones in overweight or obese adults more than a breakfast including cereal (CB) of lower protein quality, but matched for energy density and macronutrient composition.

METHODS

Twenty healthy overweight or obese subjects were randomized to eat an EB or a CB daily under supervision for one week, followed by a crossover to the opposite breakfast week after a two-week washout period. On days 1 and 7 of each test week, a structured lunch was provided ad libitum. Food intake, hunger and satiety scores, and blood parameters were measured before and after breakfast. Outcomes were analyzed using mixed effects statistical models for repeated measures analysis of variance.

RESULTS

Compared to the CB week, during the EB week, a) feeling of fullness was greater (P<0.05) on day 1 but not on day 7; b) energy intake was not significantly lower on either day; c) right before lunch, acylated ghrelin was lower and PYY3-36 was higher on day 1 (P<0.01 and <0.002, respectively) but not on day 7; d) PYY3-36, but not ghrelin, showed greater rise between breakfast and lunch on days 1(P<0.001) and 7(P<0.01).

CONCLUSION

Despite a highly similar energy density and macronutrient composition, the higher protein quality breakfast significantly influenced fullness, ghrelin and PYY3-36. Only the effect on PYY3-36 lasted throughout the week. A next step would be to test if the benefits are pronounced and lasting, if protein quality of all meals is increased.

Dietary protein intake and blood pressure: a meta-analysis of randomized controlled trials

The authors conducted a meta-analysis of randomized controlled trials to evaluate the association of dietary protein intake with blood pressure. To identify articles published before April 2011, the authors searched electronic databases, conducted a manual bibliography review, and consulted experts in the field. Forty trials (including 3,277 participants in total) met the eligibility criteria and were included. Using a standardized form, 2 investigators independently abstracted data on study design, participant characteristics, and treatment outcomes. Net change estimates were pooled across trials using random-effects models. Compared with carbohydrate, dietary protein intake was associated with significant changes in mean systolic and diastolic blood pressure of -1.76 mm Hg (95% confidence interval (CI): -2.33, -1.20) and -1.15 mm Hg (95% CI: -1.59, -0.71), respectively (both P 's < 0.001). Both vegetable protein and animal protein were associated with significant blood pressure changes of -2.27 mm Hg (95% CI: -3.36, -1.18) and -2.54 mm Hg (95% CI: -3.55, -1.53), respectively, for systolic blood pressure (both P 's < 0.001) and -1.26 mm Hg (95% CI: -2.26, -0.26) and -0.95 mm Hg (95% CI: -1.72, -0.19), respectively, for diastolic blood pressure (both P 's = 0.014). Blood pressure reduction was not significantly different when vegetable protein was compared directly with animal protein. These findings indicate that partially replacing dietary carbohydrate with protein may be important for the prevention and treatment of hypertension.

Reducing the glycemic index or carbohydrate content of mixed meals reduces postprandial glycemia and insulinemia over the entire day but does not affect satiety

OBJECTIVE

We evaluated the effects of mixed meals differing in glycemic index (GI) and carbohydrate content on postprandial serum glucose and insulin response, hunger, and satiety over the course of a 12-h day.

RESEARCH DESIGN AND METHODS

In this randomized crossover trial, 26 overweight or obese adults received four diets in random order (high GI, high carbohydrate [HGI-HC]; high GI, low carbohydrate [HGI-LC]; low GI, high carbohydrate [LGI-HC]; and low GI, low carbohydrate [LGI-LC]). All meals were prepared by a metabolic kitchen. Participants received breakfast, lunch, and dinner over the course of a 12-h day. Primary outcomes were postprandial serum glucose and insulin quantified as area under the curve. Hunger, fullness, and satiety were assessed by visual analog scale.

RESULTS

The HGI-LC, LGI-HC, and LGI-LC diets significantly reduced glucose and insulin area under the curve compared with the HGI-HC diet (P < 0.001 for all comparisons). There were no significant differences in ratings of hunger, fullness, or satiety between the different dietary treatments.

CONCLUSIONS

Reducing the GI or carbohydrate content of mixed meals reduces postprandial glycemia and insulinemia, and these changes can be sustained over the course of an entire day. However, there were no differences in subjective hunger and satiety ratings between the diets. These results demonstrate that maintaining a low GI or glycemic load diet is an effective method of controlling serum glucose and insulin levels.