Nutrition Society Medal Lecture. Appetite, feeding behaviour and energy balance in human subjects

Dietary Habits and Race Day Strategies among Flexitarian, Vegetarian, and Vegan Recreational Endurance Runners: A Cross-Sectional Investigation from The NURMI Study (Step 2)

Many of today's recreational runners have changed their diet from omnivorous to vegetarian or vegan for reasons like better sport performance, animal ethics, positive health, eco-aspects, or male infertility. Others have constructed the flexitarian diet due to current trends in sustainable eating. The aim of this investigation was to analyze the dietary habits and race day strategies of recreational endurance runners following current sustainable dietary trends. Recreational endurance runners (18+ years) were invited to complete the standardized online survey on socio-demography/anthropometry, motivations, running/racing history, food frequency, and race day dietary strategy. Chi-squared tests and Wilcoxon tests were used for the statistical analysis. In total, 289 participants submitted the survey; 146 subjects following flexitarian (n = 34), vegetarian (n = 50), or vegan (n = 62) diets were included in the final sample. Significant differences were found across the diet types: BMI (p = 0.018), fruit/vegetable consumption (p < 0.001), and the dietary motive of performance (p = 0.045). The findings suggest that the flexitarian diet may be appropriate for health- and environmentally conscious populations living in a meat-centered society and lacking social support to eat completely vegetarian/vegan. Following a plant-based diet is perceived as easy for health-conscious, athletic populations, and the vegan diet does not require a particularly effortful/complex race day strategy for endurance runners.

Diet composition and energy intake in humans

Absolute energy from fats and carbohydrates and the proportion of carbohydrates in the food supply have increased over 50 years. Dietary energy density (ED) is primarily decreased by the water and increased by the fat content of foods. Protein, carbohydrates and fat exert different effects on satiety or energy intake (EI) in the order protein > carbohydrates > fat. When the ED of different foods is equalized the differences between fat and carbohydrates are modest. Covertly increasing dietary ED with fat, carbohydrate or mixed macronutrients elevates EI, producing weight gain and vice versa. In more naturalistic situations where learning cues are intact, there appears to be greater compensation for the different ED of foods. There is considerable individual variability in response. Macronutrient-specific negative feedback models of EI regulation have limited capacity to explain how availability of cheap, highly palatable, readily assimilated, energy-dense foods lead to obesity in modern environments. Neuropsychological constructs including food reward (liking, wanting and learning), reactive and reflective decision making, in the context of asymmetric energy balance regulation, give more comprehensive explanations of how environmental superabundance of foods containing mixtures of readily assimilated fats and carbohydrates and caloric beverages elevate EI through combined hedonic, affective, cognitive and physiological mechanisms. This article is part of a discussion meeting issue 'Causes of obesity: theories, conjectures and evidence (Part II)'.

The energy balance model of obesity: beyond calories in, calories out

A recent Perspective article described the "carbohydrate-insulin model (CIM)" of obesity, asserting that it "better reflects knowledge on the biology of weight control" as compared with what was described as the "dominant energy balance model (EBM)," which fails to consider "biological mechanisms that promote weight gain." Unfortunately, the Perspective conflated and confused the principle of energy balance, a law of physics that is agnostic as to obesity mechanisms, with the EBM as a theoretical model of obesity that is firmly based on biology. In doing so, the authors presented a false choice between the CIM and a caricature of the EBM that does not reflect modern obesity science. Here, we present a more accurate description of the EBM where the brain is the primary organ responsible for body weight regulation operating mainly below our conscious awareness via complex endocrine, metabolic, and nervous system signals to control food intake in response to the body's dynamic energy needs as well as environmental influences. We also describe the recent history of the CIM and show how the latest "most comprehensive formulation" abandons a formerly central feature that required fat accumulation in adipose tissue to be the primary driver of positive energy balance. As such, the new CIM can be considered a special case of the more comprehensive EBM but with a narrower focus on diets high in glycemic load as the primary factor responsible for common obesity. We review data from a wide variety of studies that address the validity of each model and demonstrate that the EBM is a more robust theory of obesity than the CIM.

Effect of a plant-based, low-fat diet versus an animal-based, ketogenic diet on ad libitum energy intake

The carbohydrate-insulin model of obesity posits that high-carbohydrate diets lead to excess insulin secretion, thereby promoting fat accumulation and increasing energy intake. Thus, low-carbohydrate diets are predicted to reduce ad libitum energy intake as compared to low-fat, high-carbohydrate diets. To test this hypothesis, 20 adults aged 29.9 ± 1.4 (mean ± s.e.m.) years with body mass index of 27.8 ± 1.3 kg m^-2 were admitted as inpatients to the National Institutes of Health Clinical Center and randomized to consume ad libitum either a minimally processed, plant-based, low-fat diet (10.3% fat, 75.2% carbohydrate) with high glycemic load (85 g 1,000 kcal^-1) or a minimally processed, animal-based, ketogenic, low-carbohydrate diet (75.8% fat, 10.0% carbohydrate) with low glycemic load (6 g 1,000 kcal^-1) for 2 weeks followed immediately by the alternate diet for 2 weeks. One participant withdrew due to hypoglycemia during the low-carbohydrate diet. The primary outcomes compared mean daily ad libitum energy intake between each 2-week diet period as well as between the final week of each diet. We found that the low-fat diet led to 689 ± 73 kcal d^-1 less energy intake than the low-carbohydrate diet over 2 weeks (P < 0.0001) and 544 ± 68 kcal d^-1 less over the final week (P < 0.0001). Therefore, the predictions of the carbohydrate-insulin model were inconsistent with our observations. This study was registered on ClinicalTrials.gov as NCT03878108 .

Did the Food Environment Cause the Obesity Epidemic?

Several putative explanations of the obesity epidemic relate to the changing food environment. Individual dietary macronutrients have each been theorized to be the prime culprit for population obesity, but these explanations are unlikely. Rather, obesity probably resulted from changes in the caloric quantity and quality of the food supply in concert with an industrialized food system that produced and marketed convenient, highly processed foods from cheap agricultural inputs. Such foods often contain high amounts of salt, sugar, fat, and flavor additives and are engineered to have supernormal appetitive properties driving increased consumption. Ubiquitous access to convenient and inexpensive food also changed normative eating behavior, with more people snacking, eating in restaurants, and spending less time preparing meals at home. While such changes in the food environment provide a likely explanation of the obesity epidemic, definitive scientific demonstration is hindered by the difficulty in experimentally isolating and manipulating important variables at the population level.

Challenges in simulating the human gut for understanding the role of the microbiota in obesity

There is an elevated incidence of cases of obesity worldwide. Therefore, the development of strategies to tackle this condition is of vital importance. This review focuses on the necessity of optimising in vitro systems to model human colonic fermentation in obese subjects. This may allow to increase the resolution and the physiological relevance of the information obtained from this type of studies when evaluating the potential role that the human gut microbiota plays in obesity. In light of the parameters that are currently used for the in vitro simulation of the human gut (which are mostly based on information derived from healthy subjects) and the possible difference with an obese condition, we propose to revise and improve specific standard operating procedures.

The Effect of Breakfast Prior to Morning Exercise on Cognitive Performance, Mood and Appetite Later in the Day in Habitually Active Women

Pre-exercise nutritional practices for active females exercising for mood, cognitive and appetite benefits are not well established. Results from an initial field pilot study showed that higher energy intake at breakfast was associated with lower fatigue and higher overall mood and alertness post-exercise (all p < 0.05). In a follow-up, randomised, controlled trial, 24 active women completed three trials in a balanced, cross-over design. At 0815 h participants completed baseline cognitive tasks, mood and appetite visual analogue scales (VAS) and were administered a cereal breakfast (providing 118 or 236 kcal) or no breakfast. After 45 min, they completed a 30 min run at 65% heart rate reserve (HRR). Parameters were re-assessed immediately after exercise, then hourly until lunch (~1240 h), immediately post-lunch and at 1500 and 1900 h via a mobile phone. Breakfast enhanced feelings of relaxation before lunch (p < 0.05, d > 0.40), though breakfast was detrimental for working memory mid-afternoon (p = 0.019, d = 0.37) and mental fatigue and tension later in the day (all p < 0.05, d > 0.038). Breakfast was also beneficial for appetite control before lunch irrespective of size (all p < 0.05, d > 0.43). These data provide information on pre-exercise nutritional practices for active females and suggest that a small breakfast eaten prior to exercise can benefit post-exercise mood and subjective appetite ratings.

Altered feeding patterns in rats exposed to a palatable cafeteria diet: increased snacking and its implications for development of obesity

BACKGROUND

Rats prefer energy-rich foods over chow and eat them to excess. The pattern of eating elicited by this diet is unknown. We used the behavioral satiety sequence to classify an eating bout as a meal or snack and compared the eating patterns of rats fed an energy rich cafeteria diet or chow.

METHODS

Eight week old male Sprague Dawley rats were exposed to lab chow or an energy-rich cafeteria diet (plus chow) for 16 weeks. After 5, 10 and 15 weeks, home-cage overnight feeding behavior was recorded. Eating followed by grooming then resting or sleeping was classified as a meal; whereas eating not followed by the full sequence was classified as a snack. Numbers of meals and snacks, their duration, and waiting times between feeding bouts were compared between the two conditions.

RESULTS

Cafeteria-fed rats ate more protein, fat and carbohydrate, consistently ingesting double the energy of chow-fed rats, and were significantly heavier by week 4. Cafeteria-fed rats tended to take multiple snacks between meals and ate fewer meals than chow-fed rats. They also ate more snacks at 5 weeks, were less effective at compensating for snacking by reducing meals, and the number of snacks in the majority of the cafeteria-fed rats was positively related to terminal body weights.

CONCLUSIONS

Exposure to a palatable diet had long-term effects on feeding patterns. Rats became overweight because they initially ate more frequently and ultimately ate more of foods with higher energy density. The early increased snacking in young cafeteria-fed rats may represent the establishment of eating habits that promote weight gain.

Problems in identifying predictors and correlates of weight loss and maintenance: implications for weight control therapies based on behaviour change

Weight management is a dynamic process, with a pre-treatment phase, a treatment (including process) phase and post-treatment maintenance, and where relapse is possible during both the treatment and maintenance. Variability in the statistical power of the studies concerned, heterogeneity in the definitions, the complexity of obesity and treatment success, the constructs and measures used to predict weight loss and maintenance, and an appreciation of who and how many people achieve it, make prediction difficult. In models of weight loss or maintenance: (i) predictors explain up to 20-30% of the variance; (ii) many predictors are the sum of several small constituent variables, each accounting for a smaller proportion of the variance; (iii) correlational or predictive relationships differ across study populations; (iv) inter-individual variability in predictors and correlates of outcomes is high and (v) most of the variance remains unexplained. Greater standardization of predictive constructs and outcome measures, in more clearly defined study populations, tracked longitudinally, is needed to better predict who sustains weight loss. Treatments need to develop a more individualized approach that is sensitive to patients' needs and individual differences, which requires measuring and predicting patterns of intra-individual behaviour variations associated weight loss and its maintenance. This information will help people shape behaviour change solutions to their own lifestyle needs.

Food nanotechnology: water is the key to lowering the energy density of processed foods

It is crucial that emergent technologies create foods that help prevent the causal mechanisms of the diet induced disease epidemic. Food nanotechnology could create modem convenience foods that mimic and improve on the nutritional value of the most nutritious cooked wild foods for humans. Structuring a solid processed food similar to a celery stalk using self-assembled, water-filled, edible nanocells or nanotubes would substantially lower its energy density (<1.6 kcal g(-1)). Food technologists could harness the natural turgor force to produce a firm chocolate bar, biscuit or breakfast cereal with a good bite, without altering the appearance or taste of the product. Water carries flavour with few calories, and taste sensation per mouthful could be improved by processing food on the nanoscale to increase the surface area that is in contact with taste and smell receptors. The bioavailable nutrient content (including cofactors) of processed foods could be increased by existing bioactive nanoencapsulation. This would allow people to continue to consume modern convenience food on a mass scale, while simultaneously and significantly increasing nutrient intake and reducing energy intake per day. Thus, helping to reduce mental ill health, obesity and other postprandial insults.

The price of protein: combining evolutionary and economic analysis to understand excessive energy consumption

Excessive weight gain appears, thermodynamically at least, straightforward: growing energy intake and/or falling energy expenditure create an energetic surplus, resulting in fat accumulation. The situation is, however, far more complex, with genetic, physiological, social, psychological and economic factors all implicated. Thus the causes of excessive weight gain remain difficult to disentangle. We combine two recent developments from different areas of nutrition research: the study of food prices in relation to energy content and the hypothesis that an evolved propensity to regulate protein intake more strongly than non-protein calories exerts powerful leverage on overall energy intake. We partition the energy content of a range of common supermarket foods, and show that increasing overall energy content only modestly raises the cost of foods, largely as a result of macronutrients having very different costs. Higher food prices are associated with higher protein content and lower carbohydrate content, whereas fat content was not significantly associated with food price. We show that the differential costs of energy from protein and carbohydrates may bias consumers towards diets high in carbohydrate energy, leading them to consume excessive energy to meet their dietary protein needs. We review evidence from physiology, evolution and economics that support our suggestion.

Preventing diet induced disease: bioavailable nutrient-rich, low-energy-dense diets

What the World needs is an integrated and sustainable food policy that makes the best and most appropriate use of the technologies at our disposal to promote health and help prevent disease. Diet induced diseases account for the largest burden of chronic illnesses and health problems Worldwide. Historically a lack of knowledge about human nutritional requirements (including for the brain) helped promote diet induced disease. The scientific knowledge currently exists to help prevent many of the current deficiencies and imbalances in human diet. Primary prevention of cardiovascular disease and mental ill health starts, crucially, with maternal nutrition before the inception of pregnancy and continues throughout life of the new born and includes consuming more DHA and EPA omega-3 fats (and their cofactors) and other bioavailable brain nutrients and less high-energy-dense (>2 kcal g(-1)) foods (e.g. land-based cereal, chocolate, alcohol and refined sugar, fat and oil), so tissues synthesize less inflammatory mediators and to lower transient short-lived meal-induced oxidative stress, inflammation, proliferation and impaired nitric oxide (e.g. approximately 0.35-3.5 g DHA/ EPA day(-1) dependant on energy intake and noting the importance of cofactors). Micro- and nanotechnologies are already engineering nano foods for human (and livestock) consumption that may eventually (without excessive consumption) prevent the current diet induced disease epidemic, especially in future generations, by preventing the causal mechanisms of disease. Greater knowledge about the causal mechanisms of disease awaits to be discovered, which could further enhance the human desire to increase longevity in optimum health (creating more problems and challenges for society).

Is there a role for monounsaturated fat in the dietary management of obesity?

Animal and human studies indicate that high saturated fat (SFA) diets can be obesogenic. Monounsaturated fat (MUFA) has acute (meal related) effects that influence energy metabolism. These include increased postprandial fat oxidation and greater diet induced thermogenesis, factors that attenuate weight gain. Chronic (diet related) studies for 12 weeks or more, demonstrate that people following high MUFA diets do not gain excessive weight even when eating ad libitum. In fact, we have observed greater body weight and fat loss in men following an ad libitum MUFA diet, when compared to a SFA diet. High MUFA diets designed for weight loss should also incorporate a high vegetable intake according to traditional Mediterranean patterns. Such diets will promote the utilisation of fat and also have a low energy density. In our experience these diets are well accepted, and offer the prospect of greater long-term adherence to dietary advice.

Protein-leverage in mice: the geometry of macronutrient balancing and consequences for fat deposition

OBJECTIVE

The Protein-Leverage Hypothesis proposes that humans regulate their intake of macronutrients and that protein intake is prioritized over fat and carbohydrate intake, causing excess energy ingestion when diets contain low %protein. Here we test in a model animal, the mouse: (i) the extent to which intakes of protein and carbohydrate are regulated; (ii) if protein intake has priority over carbohydrates so that unbalanced foods low in %protein leads to increased energy intake; and (iii) how such variations in energy intake are converted into growth and storage.

METHODS AND PROCEDURES

We fed mice one of five isocaloric foods having different protein to carbohydrate composition, or a combination of two of these foods (N = 15). Nutrient intake and corresponding growth in lean body mass and lipid mass were measured. Data were analyzed using a geometric approach for analyzing intake of multiple nutrients.

RESULTS

(i) Mice fed different combinations of complementary foods regulated their intake of protein and carbohydrate toward a relatively well-defined intake target. (ii) When mice were offered diets with fixed protein to carbohydrate ratio, they regulated the intake of protein more strongly than carbohydrate. This protein-leverage resulted in higher energy consumption when diets had lower %protein and led to increased lipid storage in mice fed the diet containing the lowest %protein.

DISCUSSION

Although the protein-leverage in mice was less than what has been proposed for humans, energy intakes were clearly higher on diets containing low %protein. This result indicates that tight protein regulation can be responsible for excess energy ingestion and higher fat deposition when the diet contains low %protein.

Effects of isoenergetic overfeeding of either carbohydrate or fat in young men

Ten pairs of normal men were overfed by 5 MJ/d for 21 d with either a carbohydrate-rich or a fat-rich diet (C- and F-group). The two subjects in each pair were requested to follow each other throughout the day to ensure similar physical activity and were otherwise allowed to maintain normal daily life. The increase in body weight, fat free mass and fat mass showed great variation, the mean increases being 1·5 kg, 0·6 kg and 0·9 kg respectively. No significant differences between the C- and F-group were observed. Heat production during sleep did not change during overfeeding. The RQ during sleep was 0·86 and 0·78 in the C- and F-group respectively. The accumulated faecal loss of energy, DM, carbohydrate and protein was significantly higher in the C- compared with the F-group (30, 44, 69 and 51 % higher respectively), whereas the fat loss was the same in the two groups. N balance was not different between the C- and F-group and was positive. Fractional contribution from hepatic de novo lipogenesis, as measured by mass isotopomer distribution analysis after administration of [1-13C]acetate, was 0·20 and 0·03 in the C-group and the F-group respectively. Absolute hepatic de novo lipogenesis in the C-group was on average 211 g per 21 d. Whole-body de novo lipogenesis, as obtained by the difference between fat mass increase and dietary fat available for storage, was positive in six of the ten subjects in the C-group (mean 332 (SEM 191) g per 21 d). The change in plasma leptin concentration was positively correlated with the change in fat mass. Thus, fat storage during overfeeding of isoenergetic amounts of diets rich in carbohydrate or in fat was not significantly different, and carbohydrates seemed to be converted to fat by both hepatic and extrahepatic lipogenesis.

Control of energy balance in relation to energy intake and energy expenditure in animals and man: an ecological perspective

In this paper, we consider the control of energy balance in animals and man. We argue that patterns of mammalian feeding have evolved to control energy balance in uncertain environments. It is, therefore, expected that, under sedentary conditions in which the diet is rich in nutrients and abundantly available, animals and man will overeat. This suggests that no physiological defects are needed to induce overweight and ultimately obesity in man. Several considerations arise from these observations. The time period over which energy balance is controlled is far longer than allowed by most experiments. Physiological models of energy balance control often treat excess energy intake as a defect of regulation; ecological models view the same behaviour as part of normal energy balance control in environments where resources are uncertain. We apply these considerations to common patterns of human and animal feeding. We believe that the ecological perspective gives a more accurate explanation for the functionality of excess fat and the need to defend nutrient balance and avoid gross imbalances, as well as explaining hyperphagia in the face of plenty. By emphasising the common features of energy balance control in different mammalian species, the importance of changes in behaviour to accommodate changes in the environment becomes apparent. This also opens up possibilities for the control of body weight and the treatment of obesity in man.

Variations in postprandial ghrelin status following ingestion of high-carbohydrate, high-fat, and high-protein meals in males

AIM

The purpose of this study was to investigate the response of postprandial acylated ghrelin to changes in macronutrient composition of meals in healthy adult males.

METHODS

A randomized crossover study was performed. Ten healthy adult males were recruited. All subjects received, on separate occasions, a high-carbohydrate (HC), a high-fat (HF), and a high-protein (HP) meal. Blood samples were collected before and 15, 30, 60, 120, and 180 min following the ingestion of each meal. Plasma acylated ghrelin as well as serum insulin, glucose, and triglycerides were measured.

RESULTS

The levels of acylated ghrelin fell significantly following the three meals. The HC meal induced the most significant decrease in postprandial ghrelin secretion (-15.5 +/- 2.53 pg/ml) as compared with HF (-8.4 +/- 2.17 pg/ml) and HP (-10.0 +/- 1.79 pg/ml) meals (p < 0.05). However, at 180 min, the HP meal maintained significantly lower mean ghrelin levels (29.7 +/- 3.56 pg/ml) than both HC (58.4 +/- 5.75 pg/ml) and HF (45.7 +/- 5.89 pg/ml) meals and lower levels than baseline (43.4 +/- 5.34 pg/ml) (p <0.01). The postprandial insulin levels increased to significantly higher levels following the HC meal (+80.6 +/- 11.14 microU/ml) than following both HF (37.3 +/- 4.82 microU/ml) and HP (51.4 +/- 6.00 microU/ml) meals (p < 0.001). However, at 180 min, the mean insulin levels were found to be significantly higher following the HP meal (56.4 +/- 10.80 microU/ml) as compared with both HC (30.9 +/- 4.31 microU/ml) and HF (33.7 +/- 4.42 microU/ml) meals (p < 0.05). Acylated ghrelin was also found to be negatively correlated with circulating insulin levels, across all meals.

CONCLUSIONS

These results indicate that the nutrient composition of meals affects the extent of suppression of postprandial ghrelin levels and that partial substitution of dietary protein for carbohydrate or fat may promote longer-term postprandial ghrelin suppression and satiety. Our results also support the possible role of insulin in meal-induced ghrelin suppression.

Postprandial acylated ghrelin status following fat and protein manipulation of meals in healthy young women

The aim of the present study was to investigate the postprandial effect of diet composition on circulating acylated ghrelin levels in healthy women. A randomized cross-over study of three experimental treatments was performed. A total of 11 healthy young women of normal body weight completed the study. All 11 subjects consumed three iso-energetic meals of different macronutrient composition, a balanced meal (50% carbohydrates, 30% fat and 20% protein), a high-fat meal (45% carbohydrates, 45% fat and 10% protein) and a high-protein meal (45% carbohydrates, 20% fat and 35% protein), for breakfast on separate days. The test meals were administered 1 month apart. Blood samples were withdrawn immediately before and at 15, 30, 60, 120 and 180 min after the test meal for measurement of plasma acylated ghrelin, as well as serum glucose, insulin and triacylglycerol (triglyceride) levels. Acylated ghrelin fell significantly after ingestion of both the balanced and high-protein meals. Ghrelin persisted at significantly lower levels than baseline for a longer duration following the high-protein meal (P<0.05 at 15, 30, 60 and 120 min) compared with the balanced meal (P<0.05 at 30 and 60 min). Moreover, acylated ghrelin levels correlated negatively with the postprandial insulin levels. In conclusion, postprandial changes in acylated plasma ghrelin depend on the macronutrient composition of the meal and are possibly influenced by insulin.

Origins and evolution of the Western diet: health implications for the 21st century

There is growing awareness that the profound changes in the environment (eg, in diet and other lifestyle conditions) that began with the introduction of agriculture and animal husbandry approximately 10000 y ago occurred too recently on an evolutionary time scale for the human genome to adjust. In conjunction with this discordance between our ancient, genetically determined biology and the nutritional, cultural, and activity patterns of contemporary Western populations, many of the so-called diseases of civilization have emerged. In particular, food staples and food-processing procedures introduced during the Neolithic and Industrial Periods have fundamentally altered 7 crucial nutritional characteristics of ancestral hominin diets: 1) glycemic load, 2) fatty acid composition, 3) macronutrient composition, 4) micronutrient density, 5) acid-base balance, 6) sodium-potassium ratio, and 7) fiber content. The evolutionary collision of our ancient genome with the nutritional qualities of recently introduced foods may underlie many of the chronic diseases of Western civilization.

Inhibition of glucose oxidation by alpha-cyano-4-hydroxycinnamic acid stimulates feeding in rats

Alpha-cyano-4-hydroxycinnamic acid (4-CIN, 100-200 mg/kg b.wt.), which impairs glucose oxidation by inhibiting pyruvate transport across the mitochondrial membrane, stimulated feeding in rats following intraperitoneal injection without affecting blood glucose level. Like 2-deoxy-D-glucose (2-DG), an inhibitor of glycolysis, 4-CIN probably acts mainly on the CNS through activation of alpha(2)-adrenergic receptors, because the feeding response to 4-CIN was eliminated by phentolamine or yohimbine. Unlike feeding elicited by 2-DG, 4-CIN-induced feeding was eliminated by total abdominal (but not hepatic branch) vagotomy. Since peripheral atropinization also blocked 4-CIN-induced feeding, activation of central parasympathetic neurons seems to be involved in 4-CIN-induced feeding. The feeding response to 4-CIN was diminished in rats fed a high-fat diet, probably because metabolic sensors sensing fatty acid oxidation counteract the feeding response to 4-CIN. The results suggest that inhibition of glucose oxidation by blocking pyruvate entry into mitochondria stimulates feeding in rats in particular when fed a high-carbohydrate diet.

Geometric analysis of macronutrient intake in humans: the power of protein?

We introduce a state-space, geometrical approach that has previously been derived and tested using non-human animals and aim to demonstrate that it has the potential to generate testable hypotheses and provide novel insights into human nutrition and diet selection. This 'Geometric Framework' is unusual in that it focuses on the interactions between dietary constituents, and thus emphasizes the manner in which organisms regulate the balance of nutrients ingested. We report results from a pilot study, which indicate that protein ingestion is more strongly regulated than carbohydrate+fat. On the basis of these results and a brief survey of other experimental and population-level data, we hypothesize that regulation of protein intake may explain more of the modern human nutritional condition than has previously been appreciated.

A decrease in physical activity affects appetite, energy, and nutrient balance in lean men feeding ad libitum

BACKGROUND

It is not clear how decreased activity quantitatively affects energy balance (EB) in subjects feeding ad libitum.

OBJECTIVE

We assessed the effect of an imposed sedentary routine on appetite, energy intake (EI), EB, and nutrient balance in lean men for 7 d.

DESIGN

Six men with a mean (+/-SD) age of 23.0 +/- 2.3 y, weight of 69.2 +/- 11.4 kg, and height of 1.76 +/- 0.07 m were each studied twice during a sedentary [1.4 x resting metabolic rate (RMR)] and a moderately active (1.8 x RMR) regimen. During each treatment, they resided in the whole-body indirect calorimeter for the 7 d and had ad libitum access to a medium-fat diet of constant, measurable composition. Meal size, frequency, and composition were continually monitored. Motivation to eat was recorded during waking hours. Subjects were weighed in light clothing each morning, and their weight was corrected to nude.

RESULTS

Energy expenditure was 9.7 and 12.8 MJ/d [P < 0.01; SE of the difference between means (SED) = 0.41] during the sedentary and active regimens, respectively. EI was 13.5 and 14.4 MJ/d (P = 0.463, SED = 1.06), respectively. There was no regimen effect on hunger, appetite, or body weight. By day 7, cumulative EB was 26.3 and 11.1 MJ, respectively.

CONCLUSIONS

Reducing a level of physical activity from 1.8 to 1.4 x RMR can markedly affect EB. A sedentary routine does not induce a compensatory reduction of EI and leads to a significantly positive EB, most of which is stored as fat.

Substitution of saturated with monounsaturated fat in a 4-week diet affects body weight and composition of overweight and obese men

A randomised crossover study of eight overweight or obese men (aged 24-49 years, BMI 25.5-31.3 kg/m(2)), who followed two diets for 4 weeks each, was performed to determine whether substitution of saturated fat with monounsaturated fat affects body weight and composition. Subjects were provided with all food and beverages as modules (selected ad libitum) of constant macronutrient composition, but differing energy content. The % total energy from saturated fat, monounsaturated fat and polyunsaturated fat was 24, 13 and 3 % respectively on the saturated fatty acid (SFA)-rich diet and 11, 22 and 7 % respectively on the monounsaturated fatty acid (MUFA)-rich diet. MUFA accounted for about 80 % of the unsaturated fats consumed on both diets. Body composition, blood pressure, energy expenditure (resting and postprandial metabolic rates, substrate oxidation rate, physical activity), serum lipids, the fatty acid profile of serum cholesteryl esters and plasma glucose and insulin concentrations were measured before and after each diet period. Significant (P< or =0.05) differences in total cholesterol and the fatty acid composition of serum cholesteryl esters provided evidence of dietary adherence. The men had a lower weight (-2.1 (SE 0.4) kg, P=0.0015) and fat mass (-2.6 (SE 0.6) kg, P=0.0034) at the end of the MUFA-rich diet as compared with values at the end of the SFA-rich diet. No significant differences were detected in energy or fat intake, energy expenditure, substrate oxidation rates or self-reported physical activity. Substituting dietary saturated with unsaturated fat, predominantly MUFA, can induce a small but significant loss of body weight and fat mass without a significant change in total energy or fat intake.

The evolution of the control of food intake

The ultimate goal of an organism is to maximise its inclusive fitness, and an important sub-goal must be the optimisation of the lifetime pattern of food intake, in order to meet the nutrient demands of survival, growth and reproduction. The conventional assumption that fitness is maximised by maximising daily food intake, subject to physical and physiological constraints, has been challenged recently. Instead, it can be argued that fitness is maximised by balancing benefits and costs over the organism's lifetime. The fitness benefits of food intake are a function of its contribution to survival, growth (including necessary body reserves) and reproduction. Against these benefits must be set costs. These costs include not only extrinsic foraging costs and risks, such as those due to predation, but also intrinsic costs associated with food intake, such as obesity and oxidative metabolism that may reduce vitality and lifespan. We argue that the aggregate of benefits and costs form the fitness function of food intake and present examples of such an approach to predicting optimal food intake.

Human eating behaviour in an evolutionary ecological context

Present-day human eating behaviour in industrialised society is characterised by the consumption of high-energy-density diets and often unstructured feeding patterns, largely uncoupled from seasonal cycles of food availability. Broadly similar patterns of feeding are found among advantaged groups in economically-emerging and developing nations. Such patterns of feeding are consistent with the evolutionary ecological understanding of feeding behaviour of hominids ancestral to humans, in that human feeding adaptations are likely to have arisen in the context of resource seasonality in which diet choice for energy-dense and palatable foods would have been selected by way of foraging strategies for the maximisation of energy intake. One hallmark trait of human feeding behaviour, complex control of food availability, emerged with Homo erectus (1.9 x 10(6)-200000 years ago), who carried out this process by either increased meat eating or by cooking, or both. Another key trait of human eating behaviour is the symbolic use of food, which emerged with modern Homo sapiens (100000 years ago to the present) between 25000 and 12000 years ago. From this and subsequent social and economic transformations, including the origins of agriculture, humans have come to use food in increasingly elaborate symbolic ways, such that human eating has become increasingly structured socially and culturally in many different ways.

Carbohydrates, appetite and feeding behavior in humans

The view of carbohydrates in relation to obesity has changed over the past few decades from being conducive to overconsumption and weight gain to being protective. This article reviews the mechanisms by which carbohydrate is purported to protect against weight gain. Although carbohydrate is metabolized and stored in the body less efficiently than fat, when de novo lipogenesis is invoked on very high carbohydrate diets, the beneficial effect on energy balance is likely to be minimal when typical high fat Western diets are consumed. However, it has been suggested that high carbohydrate foods may influence energy balance by reducing food intake through greater satiety effects, reducing energy density and displacing fat from the diet-the fat-sugar seesaw effect. To date, there seem to be few differences between sugars and starches on satiety and energy intake, but few studies have examined this. Some reduced-fat, and, therefore, higher carbohydrate, foods are highly energy dense. High carbohydrate foods do not necessarily have a low energy density. Evidence from recent studies suggests that adding carbohydrate, and especially sugar, to the diet neither displaces fat from the diet nor protects against elevated energy intake. Although it is easier to overeat on high fat than low fat foods, simply replacing fat with carbohydrate in the diet may not be as protective against overconsumption as the energy density or fat-sugar seesaw arguments suggest.

Associations between energy density and macronutrient composition in the diets of pre-school children: sugars vs. starch

OBJECTIVE

To investigate the associations between energy density (ED) and macronutrient composition in the National Diet and Nutrition Survey of Children aged 1(1/2)-4(1/2) y, hypothesizing that high-ED diets tend to be high in sugars as well as fat.

DESIGN

Further analysis of data from a cross-sectional dietary survey of 1675 children with complete 4-day weighed dietary records. Differences in diet composition and food choice between children with diets of high, medium and low ED (defined as kJ/g of all food and drink) were identified. The possibility of confounding by water, or by soft drinks, was also explored in age-adjusted correlations.

RESULTS

High-ED diets (>3.7 kJ/g of total diet) were proportionately richer in fat and lower in carbohydrate, compared with diets of low ED (<2.9 kJ/g). In contrast to the hypothesis, high-ED diets were found to be proportionately lower in sugars, and higher in starch. Children with high-ED diets consumed more of a whole range of foods: meat, eggs, potatoes, cereal products, confectionery, sugar/preserves and savoury snacks, but consumed less soft drinks, water and fruit.

CONCLUSION

The inverse relationship observed between sugars and energy density may be partly attributable to the reciprocal relationship between sugars and fat, expressed as a proportion of energy. It may also reflect developing preferences in young childhood for a more adult-type, energy-dense, diet. Further work is required to verify ED/macronutrient relationships in other age groups, as the results have potential implications for obesity prevention and for food product development.

New understanding in obesity research

A public-health approach considers the relevance of nutritional research in the prevention and management of obesity. Well-defined and internationally-agreed definitions based on BMI allow an assessment of the worldwide prevalence of overweight and obesity. There are about 250 million obese adults in the world, and many more overweight. Obesity is emerging in the Third World, first in urban middle-aged women. With economic developments, obesity then occurs in men and younger women. In the West childhood obesity is rapidly emerging, with concern that early-onset obesity is especially hazardous. In Asians the risks of excess visceral fat occur at lower body weights than in Caucasians. The propensity to visceral obesity in Asians may relate to malnourished mothers and low birth weight. The International Obesity Task Force is considering many issues, including the health economics of obesity. It has developed a strategy to define childhood obesity, which in children over 6 years is likely to predict long-term weight and health problems. While the search for genetic markers of obesity continues, with particular interest in the leptin gene, it is clear that societal change, with the decline in physical activity and the passive overconsumption of high-fat diets are major contributors to the global increase in obesity. The public-health aspects of obesity research are therefore challenging.