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Honfo SH, Senior AM, Legault V, Presse N, Turcot V, Gaudreau P, Simpson SJ, Raubenheimer D, Cohen AA. Evidence for protein leverage on total energy intake, but not body mass index, in a large cohort of older adults. Int J Obes (Lond) 2024; 48:654-661. [PMID: 38145994 DOI: 10.1038/s41366-023-01455-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 12/11/2023] [Accepted: 12/15/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Protein leverage (PL) is the phenomenon of consuming food until absolute intake of protein approaches a 'target value', such that total energy intake (TEI) varies passively with the ratio of protein: non-protein energy (fat + carbohydrate) in the diet. The PL hypothesis (PLH) suggests that the dilution of protein in energy-dense foods, particularly those rich in carbohydrates and fats, combines with protein leverage to contribute to the global obesity epidemic. Evidence for PL has been reported in younger adults, children and adolescents. This study aimed to test for PL and the protein leverage hypothesis (PLH) in a cohort of older adults. METHODS We conducted a retrospective analysis of dietary intake in a cohort of 1699 community-dwelling older adults aged 67-84 years from the NuAge cohort. We computed TEI and the energy contribution (EC) from each macronutrient. The strength of leverage of macronutrients was assessed through power functions ( TEI = μ * EC L ). Body mass index (BMI) was calculated, and mixture models were fitted to predict TEI and BMI from macronutrients' ECs. RESULTS In this cohort of older adults, 53% of individuals had obesity and 1.5% had severe cases. The mean TEI was 7673 kJ and macronutrients' ECs were 50.4%, 33.2% and 16.4%, respectively for carbohydrates, fat, and protein. There was a strong negative association (L = -0.37; p < 0.001) between the protein EC and TEI. Each percent of energy intake from protein reduced TEI by 77 kJ on average, ceteris paribus. However, BMI was unassociated with TEI in this cohort. CONCLUSIONS Findings indicate clear evidence for PL on TEI, but not on BMI, likely because of aging, body composition, sarcopenia, or protein wasting.
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Affiliation(s)
- Sewanou H Honfo
- PRIMUS Research Group, Department of Family Medicine, Université de Sherbrooke, 3001 12e Ave N, Sherbrooke, QC, J1H 5N4, Canada
| | - Alistair M Senior
- University of Sydney, Charles Perkins Centre, Camperdown, NSW, 2006, Australia
- University of Sydney, School of Life and Environmental Science, Camperdown, NSW, 2006, Australia
- University of Sydney, Sydney Precision Data Science Centre, Camperdown, NSW, 2006, Australia
| | - Véronique Legault
- Research Center on Aging, CIUSSS-de-l'Estrie-CHUS, Sherbrooke, QC, Canada
| | - Nancy Presse
- Research Center on Aging, CIUSSS-de-l'Estrie-CHUS, Sherbrooke, QC, Canada
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Valérie Turcot
- Research Center on Aging, CIUSSS-de-l'Estrie-CHUS, Sherbrooke, QC, Canada
| | - Pierrette Gaudreau
- Department of Medicine, Université de Montréal, Montréal, QC, Canada
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Stephen J Simpson
- University of Sydney, Charles Perkins Centre, Camperdown, NSW, 2006, Australia
- University of Sydney, School of Life and Environmental Science, Camperdown, NSW, 2006, Australia
| | - David Raubenheimer
- University of Sydney, Charles Perkins Centre, Camperdown, NSW, 2006, Australia
- University of Sydney, School of Life and Environmental Science, Camperdown, NSW, 2006, Australia
| | - Alan A Cohen
- PRIMUS Research Group, Department of Family Medicine, Université de Sherbrooke, 3001 12e Ave N, Sherbrooke, QC, J1H 5N4, Canada.
- Research Center on Aging, CIUSSS-de-l'Estrie-CHUS, Sherbrooke, QC, Canada.
- Department of Environmental Health Sciences, Butler Columbia Aging Center, Mailman School of Public Health, Columbia University, New York, NY, USA.
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Moore H, Siroux J, Pereira B, Miguet M, Fillon A, Dionnet C, Julian V, Duclos M, Boirie Y, Finlayson G, Isacco L, Thivel D. The energy content of meals with a similar macronutrient distribution may have a greater impact on appetite sensations than food preferences in adolescents with obesity: A secondary analysis. Appetite 2023; 191:107063. [PMID: 37774844 DOI: 10.1016/j.appet.2023.107063] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/19/2023] [Accepted: 09/26/2023] [Indexed: 10/01/2023]
Abstract
PURPOSE The energy and macronutrient composition of a meal has been shown to influence postprandial appetitive responses, but it is not clear how energy content independent of macronutrient distribution affects postprandial appetite in adolescents with obesity. Extracting data from a primary study testing the effect of energy turnover on appetite, this secondary analysis assessed how fixed meals varying in energy content with similar macronutrient distributions influences postprandial appetite sensations and food reward. METHODS Using a randomised, counterbalanced crossover design, N = 14 adolescents with obesity (Mage = 12.71, SDage = 0.99; 10 female) consumed fixed lunch meals with similar macronutrient content starting at 750 kcal in energy and progressively increasing by 250 kcal on three different test days. Liking and wanting for food images varying in fat and taste were assessed at baseline and immediately after meal consumption. Appetite sensations were assessed in half-hour intervals from baseline to 1-h post-meal. RESULTS The area under the curve for subjective hunger (p < .001, ω = 0.36), desire to eat (p < .001, ω = 0.54), and prospective food consumption (p = .004, ω = 0.32) were significantly lower after consumption of the higher calorie meals relative to the lowest. Explicit wanting for sweet foods increased after intake of the intermediate calorie meal yet decreased after the highest calorie meal (p = .014, ω = 0.09). Conversely, implicit wanting sweet bias increased after consumption of the test meal independent of energy content (p < .001, ω = 0.15). CONCLUSION The consumption of additional calories without a meaningful change in macronutrient distribution may affect appetite sensations more reliably than hedonic responses to energy-dense foods in adolescents with obesity.
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Affiliation(s)
- Halim Moore
- Clermont Auvergne University, EA 3533, Laboratory of the Metabolic Adaptations to Exercise Under Physiological and Pathological Conditions (AME2P), CRNH Auvergne, Clermont-Ferrand, France.
| | - Julie Siroux
- Clermont Auvergne University, EA 3533, Laboratory of the Metabolic Adaptations to Exercise Under Physiological and Pathological Conditions (AME2P), CRNH Auvergne, Clermont-Ferrand, France
| | - Bruno Pereira
- Unit of Biostatistics (DRCI), Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Maud Miguet
- Clermont Auvergne University, EA 3533, Laboratory of the Metabolic Adaptations to Exercise Under Physiological and Pathological Conditions (AME2P), CRNH Auvergne, Clermont-Ferrand, France; Department of Surgical Sciences, Functional Pharmacology and Neuroscience, Uppsala University, Uppsala, Sweden
| | - Alicia Fillon
- Clermont Auvergne University, EA 3533, Laboratory of the Metabolic Adaptations to Exercise Under Physiological and Pathological Conditions (AME2P), CRNH Auvergne, Clermont-Ferrand, France; Observatoire National de l'Activité Physique et de la Sédentarité (ONAPS), Faculty of Medicine, Clermont Auvergne University, Clermont-Ferrand, France
| | - Celine Dionnet
- Clermont Auvergne University, EA 3533, Laboratory of the Metabolic Adaptations to Exercise Under Physiological and Pathological Conditions (AME2P), CRNH Auvergne, Clermont-Ferrand, France
| | - Valérie Julian
- Department of Sport Medicine and Functional Explorations, University Teaching Hospital of Clermont-Ferrand, Diet and Musculoskeletal Health Team, CRNH, INRA, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Martine Duclos
- Department of Sport Medicine and Functional Explorations, University Teaching Hospital of Clermont-Ferrand, Diet and Musculoskeletal Health Team, CRNH, INRA, University of Clermont Auvergne, Clermont-Ferrand, France; International Research Chair Health in Motion, Clermont Auvergne University Foundation, Clermont-Ferrand, France
| | - Yves Boirie
- Department of Human Nutrition, Clermont-Ferrand University Hospital, G. Montpied Hospital, Diet and Musculoskeletal Health Team, CRNH, INRA, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Graham Finlayson
- Appetite Control & Energy Balance Research Group, School of Psychology, Faculty of Medicine & Health, University of Leeds, Leeds, West Yorkshire, UK
| | - Laurie Isacco
- Clermont Auvergne University, EA 3533, Laboratory of the Metabolic Adaptations to Exercise Under Physiological and Pathological Conditions (AME2P), CRNH Auvergne, Clermont-Ferrand, France
| | - David Thivel
- Clermont Auvergne University, EA 3533, Laboratory of the Metabolic Adaptations to Exercise Under Physiological and Pathological Conditions (AME2P), CRNH Auvergne, Clermont-Ferrand, France; International Research Chair Health in Motion, Clermont Auvergne University Foundation, Clermont-Ferrand, France
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Zhang H, Senior AM, Saner C, Olsen NJ, Larsen SC, Simpson SJ, Raubenheimer D, Heitmann BL. Evidence for the protein leverage hypothesis in preschool children prone to obesity. Clin Nutr 2023; 42:2249-2257. [PMID: 37820518 DOI: 10.1016/j.clnu.2023.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 08/10/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND & AIMS The protein leverage hypothesis (PLH) proposed that strict regulation of protein intake drives energy overconsumption and obesity when diets are diluted by fat and/or carbohydrates. Evidence about the PLH has been found in adults, while studies in children are limited. Thus, we aimed to test the PLH by assessing the role of dietary protein on macronutrients, energy intake, and obesity risk using data from preschool children followed for 1.3 years. METHODS 553 preschool children aged 2-6 years from the 'Healthy Start' project were included. EXPOSURES The proportion of energy intake from protein, fat, and carbohydrates collected from a 4-day dietary record. OUTCOMES Energy intake, BMI z-score, fat mass (FM) %, waist- (WHtR) and hip-height ratio (HHtR). Power function analysis was used to test the leverage of protein on energy intake. Mixture models were used to explore interactive associations of macronutrient composition on all these outcomes, with results visualized as response surfaces on the nutritional geometry. RESULTS Evidence for the PLH was confirmed in preschool children. The distribution of protein intake (% of MJ, IQR: 3.2) varied substantially less than for carbohydrate (IQR: 5.7) or fat (IQR: 6.3) intakes, suggesting protein intake is most tightly regulated. Absolute energy intake varied inversely with dietary percentage energy from protein (L = -0.14, 95% CI: -0.25, -0.04). Compared to children with high fat or carbohydrate intakes, children with high dietary protein intake (>20% of MJ) had a greater decrease in WHtR and HHtR over the 1.3-year follow-up, offering evidence for the PLH in prospective analysis. But no association was observed between macronutrient distribution and changes in BMI z-score or FM%. CONCLUSIONS In this study in preschool children, protein intake was the most tightly regulated macronutrient, and energy intake was an inverse function of dietary protein concentration, indicating the evidence for protein leverage. Increases in WHtR and HHtR were principally associated with the dietary protein dilution, supporting the PLH. These findings highlight the importance of protein in children's diets, which seems to have significant implications for childhood obesity risk and overall health.
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Affiliation(s)
- Hanyue Zhang
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, DK 2000 Frederiksberg, Denmark; Section for General Practice, Department of Public Health, University of Copenhagen, 1014 Copenhagen K, Denmark
| | - Alistair M Senior
- Charles Perkins Centre, University of Sydney, Sydney, 2006 New South Wales, Australia; School of Life and Environmental Sciences, University of Sydney, Sydney, 2006 New South Wales, Australia
| | - Christoph Saner
- Division of Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Department of Biomedical Research, University of Bern, 3010 Bern, Switzerland; Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, VIC, 3052 Australia
| | - Nanna J Olsen
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, DK 2000 Frederiksberg, Denmark
| | - Sofus C Larsen
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, DK 2000 Frederiksberg, Denmark
| | - Stephen J Simpson
- Charles Perkins Centre, University of Sydney, Sydney, 2006 New South Wales, Australia; School of Life and Environmental Sciences, University of Sydney, Sydney, 2006 New South Wales, Australia
| | - David Raubenheimer
- Charles Perkins Centre, University of Sydney, Sydney, 2006 New South Wales, Australia; School of Life and Environmental Sciences, University of Sydney, Sydney, 2006 New South Wales, Australia
| | - Berit L Heitmann
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, DK 2000 Frederiksberg, Denmark; Charles Perkins Centre, University of Sydney, Sydney, 2006 New South Wales, Australia; Section for General Practice, Department of Public Health, University of Copenhagen, 1014 Copenhagen K, Denmark.
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Boirie Y, Pinel A, Guillet C. Protein and amino acids in obesity: friends or foes? Curr Opin Clin Nutr Metab Care 2023; 26:508-513. [PMID: 37807957 DOI: 10.1097/mco.0000000000000978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
PURPOSE OF REVIEW Nutritional interventions using protein and amino acids in obesity are popular therapeutical strategies to limit obesity development. However, the effects of dietary protein intake and amino acid metabolic alterations involved in obesity pathophysiology have not been completely unravelled. Significant recent studies have brought to light new findings in these areas, which are the primary focus of this review. RECENT FINDINGS We describe the effects of protein intake on weight regain prevention, the influence on gut microbiota, the response to low-protein highly processed foods, and the contrasting impacts of a high-protein diet on adults and children. We also explore newly discovered correlations between amino acids, liver fat accumulation, and the dysregulation of the liver-pancreas axis due to alterations in amino acid levels in the context of obesity. Lastly, we consider branched-chain amino acids, along with glycine and tryptophan, as significant biomarkers during periods of positive or negative energy balance. SUMMARY Interventions using dietary protein in obesity may be useful, especially during energy restriction but also in sarcopenic obesity. Furthermore, metabolic profiles that encompass alterations in certain amino acids can provide valuable insights into the metabolic condition of patients with obesity, particularly in relation to insulin resistance and the risk of developing type 2 diabetes.
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Affiliation(s)
- Yves Boirie
- Human Nutrition Unit, University of Clermont Auvergne, INRAE, CRNH Auvergne
- Clinical Nutrition Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Alexandre Pinel
- Human Nutrition Unit, University of Clermont Auvergne, INRAE, CRNH Auvergne
| | - Christelle Guillet
- Human Nutrition Unit, University of Clermont Auvergne, INRAE, CRNH Auvergne
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Raubenheimer D, Simpson SJ. Protein appetite as an integrator in the obesity system: the protein leverage hypothesis. Philos Trans R Soc Lond B Biol Sci 2023; 378:20220212. [PMID: 37661737 PMCID: PMC10475875 DOI: 10.1098/rstb.2022.0212] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/21/2023] [Indexed: 09/05/2023] Open
Abstract
Despite the large volume and extensive range of obesity research, there is substantial disagreement on the causes and effective preventative strategies. We suggest the field will benefit from greater emphasis on integrative approaches that examine how various potential contributors interact, rather than regarding them as competing explanations. We demonstrate the application of nutritional geometry, a multi-nutrient integrative framework developed in the ecological sciences, to obesity research. Such studies have shown that humans, like many other species, regulate protein intake more strongly than other dietary components, and consequently if dietary protein is diluted there is a compensatory increase in food intake-a process called protein leverage. The protein leverage hypothesis (PLH) proposes that the dilution of protein in modern food supplies by fat and carbohydrate-rich highly processed foods has resulted in increased energy intake through protein leverage. We present evidence for the PLH from a variety of sources (mechanistic, experimental and observational), and show that this mechanism is compatible with many other findings and theories in obesity research. This article is part of a discussion meeting issue 'Causes of obesity: theories, conjectures and evidence (Part II)'.
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Affiliation(s)
- David Raubenheimer
- Charles Perkins Centre and School of Life and Environmental Sciences, The University of Sydney, Sydney, New South Wales 2006, Australia
| | - Stephen J. Simpson
- Charles Perkins Centre and School of Life and Environmental Sciences, The University of Sydney, Sydney, New South Wales 2006, Australia
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Tatar M. Stalking the link between reproduction and aging: After decades of research, it still remains a mystery whether and how reproduction drives the process of aging: After decades of research, it still remains a mystery whether and how reproduction drives the process of aging. EMBO Rep 2023; 24:e57374. [PMID: 37144246 PMCID: PMC10240196 DOI: 10.15252/embr.202357374] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 04/25/2023] [Indexed: 05/06/2023] Open
Abstract
The hypothesis that aging and number of offspring are linked with each other has attracted much attention and research, but evidence for it remains elusive.
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Affiliation(s)
- Marc Tatar
- Department of Ecology, Evolution and Organismal BiologyBrown UniversityProvidenceRIUSA
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