Effects of isoenergetic, low-fat diets on energy metabolism in lean and obese women

A Review of the Effect of Dietary Composition on Fasting Substrate Oxidation in Healthy and Overweight Subjects

AIM

The purpose of this review was to assess existing evidence on the effects of chronic dietary macronutrient composition on substrate oxidation during a fasted state in healthy and overweight subjects.

METHODS

A systematic review of studies was conducted across five databases. Studies were included if they were English language studies of human adults, ≥19 years, used indirect calorimetry (ventilated hood technique), specified dietary macronutrient composition, and measured substrate oxidation.

RESULTS

There was no evidence that variations of a typical, non-experimental diet influenced rate or ratio of substrate utilization, however there may be an upper and lower threshold for when macronutrient composition may directly alter preferences for fuel oxidation rates during a fasted state.

CONCLUSION

This review indicates that macronutrient composition of a wide range of typical, non-experimental dietary fat and carbohydrate intakes has no effect on fasting substrate oxidation. This suggests that strict control of dietary intake prior to fasting indirect calorimetry measurements may be an unnecessary burden for study participants. Further research into the effects of long-term changes in isocaloric macronutrient shift is required.

Fasting substrate oxidation at rest assessed by indirect calorimetry: is prior dietary macronutrient level and composition a confounder?

Indirect calorimetry, the measurement of O₂ consumption and CO₂ production, constitutes an invaluable tool as the most common method for analyzing whole-body energy expenditure, and also provides an index of the nature of macronutrient substrate oxidation--namely, carbohydrate (CHO) versus fat oxidation. The latter constitutes a key etiological factor in obesity as this condition can only develop when total fat oxidation is chronically lower than total exogenous fat intake. The standardization of indirect calorimetry measurements is essential for accurately tracking the relative proportion of energy expenditure derived from CHO and fat oxidation. Here we analyze literature data to show that the average fasting respiratory quotient typically shifts from approximately 0.80 to 0.90 (indicating a doubling of resting CHO oxidation) in response to a switch in dietary CHO intake (as % energy) from 30 to 60%. This underscores the importance of taking into account dietary macronutrient composition prior to indirect calorimetry studies in the interpretation of data on substrate utilization and oxidation.

Dietary intake of palmitate and oleate has broad impact on systemic and tissue lipid profiles in humans

BACKGROUND

Epidemiologic evidence has suggested that diets with a high ratio of palmitic acid (PA) to oleic acid (OA) increase risk of cardiovascular disease (CVD).

OBJECTIVE

To gain additional insights into the relative effect of dietary fatty acids and their metabolism on CVD risk, we sought to identify a metabolomic signature that tracks with diet-induced changes in blood lipid concentrations and whole-body fat oxidation.

DESIGN

We applied comprehensive metabolomic profiling tools to biological specimens collected from 18 healthy adults enrolled in a crossover trial that compared a 3-wk high-palmitic acid (HPA) with a low-palmitic acid and high-oleic acid (HOA) diet.

RESULTS

A principal components analysis of the data set including 329 variables measured in 15 subjects in the fasted state identified one factor, the principal components analysis factor in the fasted state (PCF1-Fasted), which was heavily weighted by the PA:OA ratio of serum and muscle lipids, that was affected by diet (P < 0.0001; HPA greater than HOA). One other factor, the additional principal components analysis factor in the fasted state (PCF2-Fasted), reflected a wide range of acylcarnitines and was affected by diet in women only (P = 0.0198; HPA greater than HOA). HOA lowered the ratio of serum low-density lipoprotein to high-density lipoprotein (LDL:HDL) in men and women, and adjustment for the PCF1-Fasted abolished the effect. In women only, adjustment for the PCF2-Fasted eliminated the HOA-diet effect on serum total- and LDL-cholesterol concentrations. The respiratory exchange ratio in the fasted state was lower with the HPA diet (P = 0.04), and the diet effect was eliminated after adjustment for the PCF1-Fasted. The messenger RNA expression of the cholesterol regulatory gene insulin-induced gene-1 was higher with the HOA diet (P = 0.008).

CONCLUSIONS

These results suggest that replacing dietary PA with OA reduces the blood LDL concentration and whole-body fat oxidation by modifying the saturation index of circulating and tissue lipids. In women, these effects are also associated with a higher production and accumulation of acylcarnitines, possibly reflecting a shift in fat catabolism.

Gender alters the effects of palmitate and oleate on fat oxidation and energy expenditure

OBJECTIVE

Because estrogen and testosterone affect transcription factors regulating mitochondrial function, we assessed the effects of gender on the metabolic response to dietary palmitic acid (PA) vs. oleic acid (OA) in subjects participating in a previously described trial.

METHODS AND PROCEDURES

Adults (N = 43) were studied after following a baseline diet (PA = 8.4% kcal, OA = 13.1% kcal) and after undergoing one of two experimental diets: high PA (HI PA) (PA = 16.8%, OA = 16.4% kcal) (N = 21; 11 men) or high OA (HI OA) (PA = 1.7%, and OA = 31.4%) (N = 22; 11 men).

RESULTS

Relative to baseline, the rate of fatty acid (FA) oxidation (% resting energy expenditure(REE)) (mean +/- s.e.m.) increased in women on HI OA while decreasing on HI PA in the fed (+11.8 +/- 5.6% vs. -6.3 +/- 4.2%, P = 0.02) and fasting states (+13.4 +/- 4.2% vs. -12.7 +/- 6.9%, P = 0.047), but changes in men were not statistically significant. Daily energy expenditure changed only in men, increasing on HI OA and decreasing on HI PA (+66 +/- 61 kcal/day or 1.2 +/- 1.0 kcal/kg fat-free mass (FFM)/day vs. -266 +/- 78 kcal/day or -4.2 +/- 1.3 kcal/kg FFM/day, P = 0.004 and P = 0.007, respectively).

DISCUSSION

Increased dietary PA/OA caused decreased FA oxidation in women, in the fed and fasted states and decreased daily energy expenditure (DEE) in men.

Dietary fat and weight gain among women in the Nurses' Health Study

OBJECTIVE

To assess the association of dietary fat and weight gain among adult women and to investigate whether offspring of overweight parents have a greater predisposition to weight gain due to intake of dietary fat.

RESEARCH METHODS AND PROCEDURES

This was an 8-year follow-up of 41,518 women in the Nurses' Health Study (NHS), a population-based, prospective cohort. The women were 41 to 68 years of age, free of cardiovascular disease, cancer, and diabetes in 1986 when "baseline" weight and diet were assessed. Eight years later (1994), changes in weight and dietary intake were assessed. Linear regression models were used to relate change in weight to fat intake and change in fat intake, using the percentage of energy from carbohydrate as the comparison, adjusted for age, BMI in 1986, leisure time physical activity, time spent sitting, percent of calories from protein, and change in percentage of calories from protein.

RESULTS

Overall, there was a weak positive association between total fat intake (beta=0.11) and weight gain. Increases in monosaturated and polyunsaturated fat were not associated with weight gain, but increases in animal fat, saturated fat, and trans fat had a positive association with weight change. There was not strong evidence of effect modification by parental weight status (p=0.7 to 0.8 for percentage of calories from total fat, animal fat, and vegetable fat); however, the associations were stronger among the overweight compared with leaner women (p<0.05 for percentage of calories from each type of fat). Among overweight women, for every one percentage increase in percentage of calories from trans fat, women gained an additional 2.3 lb (95% confidence interval, 1.80 to 2.86).

CONCLUSION

Our results show that, overall, percent of calories from fat has only a weak positive association with weight gain; however, percentage of calories from animal, saturated, and trans fat has stronger associations. There was no clear evidence that the diet-weight gain association was stronger among offspring of overweight parents, but dietary fat was associated with greater weight gain among overweight women.

The effect of carbohydrate and fat variation in euenergetic diets on postabsorptive free fatty acid release

Diet composition and energy content modulate free fatty acid (FFA) release. The aim of this study was to evaluate the dose–response effects of euenergetic variations in dietary carbohydrate and fat content on postabsorptive FFA release. The rate of appearance (Ra) of palmitate was measured by infusion of [2,2-2H2]palmitate after an overnight fast in six healthy men on three separate occasions, i.e. after 7 d on euenergetic control, high-carbohydrate and high-fat diets. The protein content and composition was identical for each diet. Postabsorptive plasma fatty acid concentrations were not different between the high-carbohydrate and control diets (0·36 (SE 0·07) V. 0·43 (se 0·04) mmol/l), but were increased after the high-fat diet (0·75 (se 0·09) mmol/l, (P<0·01 compared with the other diets). Ra palmitate was not different between the high-carbohydrate and control diets (1·36 (se 0·20) v. 1·47 (se 0·15) μmol/kg per min). However, Ra palmitate was increased to 2·36 (se 0·26) μmol/kg per min after the high-fat diet (P<0·01 compared with the other diets). The fatty acid flux and whole-body fat oxidation were not affected by the high-carbohydrate diet compared with the control diet, but were increased by 67 and 47 % respectively, on the high-fat diet (P<0·01 compared with the other diets). A euenergetic high-fat diet results in increased postabsorptive FFA release and fat oxidation, whereas a euenergetic high-carbohydrate diet does not affect these variables of fat metabolism.

Low- and high-carbohydrate diets: body composition differences in rats

OBJECTIVE

To determine differences in adipose tissue mass, cell size, and lipid metabolism transcripts and differences in composition of body weight loss and energy expenditure (EE) after isoenergetic, energy-restricted intake of low-carbohydrate/high-fat/high-protein (LC) and high-carbohydrate/low-fat/moderate-protein (HC) diets.

RESEARCH METHODS AND PROCEDURES

Ten-week old female Sprague-Dawley rats were fed a high-fat diet ad libitum for 8 weeks to induce weight gain and fat deposition. Weight-matched rats were then assigned to isoenergetic LC (Atkins) and HC (American Dietary Association Exchange) diets for 10 weeks at 65% of ad libitum energy intake.

RESULTS

There was no significant difference in the serum lipid profiles or amount of body weight lost between the HC and LC groups, whereas a higher insulin sensitivity index (p < 0.01) resulted from the HC compared with the LC diet. Compared with the post-restriction LC group, the HC group demonstrated (p < 0.05) higher EE during active hours, lower mRNA levels for the lipogenic genes peroxisome proliferator-activated receptor gamma2, lipoprotein lipase, and, adipocyte fatty acid binding protein, decreased adipocyte cell volume, and decreased fat mass.

DISCUSSION

Results indicated down-regulation of lipogenic genes, decreased fat mass, and, therefore, improved body composition in the post-restriction HC compared with the LC group. The small mean differences between the two diet groups (p = 0.11) in 24-hour EE over the 10 weeks of diet intervention would account for the majority of the lower mean body weights in the post-restriction HC group. These data suggest that macronutrient composition of the diet influences body composition and indicate a distinction between HC and LC diets.

Increasing dietary palmitic acid decreases fat oxidation and daily energy expenditure

BACKGROUND

Oleic acid (OA) is oxidized more rapidly than is palmitic acid (PA).

OBJECTIVE

We hypothesized that changing the dietary intakes of PA and OA would affect fatty acid oxidation and energy expenditure.

DESIGN

A double-masked trial was conducted in 43 healthy young adults, who, after a 28-d, baseline, solid-food diet (41% of energy as fat, 8.4% as PA, and 13.1% as OA), were randomly assigned to one of two 28-d formula diets: high PA (40% of energy as fat, 16.8% as PA, and 16.4% as OA; n = 21) or high OA (40% of energy as fat, 1.7% as PA, and 31.4% as OA; n = 22). Differences in the change from baseline were evaluated by analysis of covariance.

RESULTS

In the fed state, the respiratory quotient was lower (P = 0.01) with the high OA (0.86 +/- 0.01) than with the high-PA (0.89 +/- 0.01) diet, and the rate of fat oxidation was higher (P = 0.03) with the high-OA (0.0008 +/- 0.0001) than with the high-PA (0.0005 +/- 0.0001 mg . kg fat-free mass(-1) . min(-1)) diet. Resting energy expenditure in the fed and fasting states was not significantly different between groups. Change in daily energy expenditure in the high-OA group (9 +/- 60 kcal/d) was significantly different from that in the high-PA group (-214 +/- 69 kcal/d; P = 0.02 or 0.04 when expressed per fat-free mass).

CONCLUSIONS

Increases in dietary PA decrease fat oxidation and daily energy expenditure, whereas decreases in PA and increases in OA had the opposite effect. Increases in dietary PA may increase the risk of obesity and insulin resistance.

acp Best Practice No 168. The investigation and management of obesity

Obesity is a chronic condition characterised by an excess of body fat. It is a complex disorder of appetite regulation and energy metabolism controlled by specific biological factors. In the past 10 years, great progress has been made in the scientific understanding of the pathophysiology of obesity and the interactions between genetic predisposition to weight gain and the environment. This article will review the current understanding of the pathophysiology and the approach to the investigation and management of obesity.

Low-fat diets are preferred

This short review summarizes 4 main reasons for which low-fat diets are preferred to limit excessive weight gain: (1) For metabolic reasons, fat intake does not measurably stimulate fat oxidation; dietary fat above energy requirements is stored in adipose tissue. (2) Diets that are high in fat or are energy dense have a weak satiating effect and promote a passive overconsumption of energy relative to need. (3) A recent meta-analysis on the effect on body weight loss of low-fat diets followed for >2 months showed a significant weight difference of 3.3 kg between the diet and the control groups. A low-fat diet may also be beneficial in helping maintain weight loss. (4) Low-fat diets are also advocated to lower the risk of coronary heart disease and certain forms of cancer. There is no evidence showing that the small physiologic reduction of plasma highdensity lipoprotein cholesterol levels with a low-fat diet is detrimental.

Metabolic responses to nocturnal eating in men are affected by sources of dietary energy

Because night work is becoming more prevalent, we studied whether feeding at different times of a 24-h period would elicit different metabolic responses and whether dietary macronutrient composition would affect these responses. Seven men (26-43 y, 19.9-26.6 kg/m(2)) consumed two isocaloric diets, in a crossover design. The diets were a high carbohydrate (HC) diet [65 energy % (E%) carbohydrates, 20E% fat] and a high fat (HF) diet (40E% carbohydrates, 45E% fat). After a 6-d diet-adjustment period, the men were kept awake for 24 h and the food (continuation of respective diet) was provided as six isocaloric meals (i.e., every 4 h). Energy and substrate turnover, heart rate, mean arterial pressure (MAP), blood glucose, triacylglycerol (TAG), nonesterified fatty acid (NEFA) and glycerol were measured throughout the 24-h period. Significantly higher energy expenditure and NEFA concentration, and lower blood glucose and TAG concentrations were observed when the men consumed the HF diet than when they consumed the HC diet. Significant circadian patterns were seen in body and skin temperature (nadir, 0400-0500 h). When the men consumed the HF diet, significant circadian patterns were seen in fat oxidation (nadir, 0800-1200 h; plateau, 1200-0800 h), heat release (nadir, 0800-1200 h; plateau, 1600-0800 h), heart rate (nadir, 0000 h), blood glucose (nadir, 0800-1200 h; peak, 0000-0400 h), NEFA (nadir, 0800-1200 h; peak, 1200-2000 h) and TAG (nadir, 0800-1200 h; peak, 0400-0800 h) concentrations. Energy expenditure, carbohydrate oxidation, MAP and glycerol concentration did not display circadian patterns. Unequal variances eradicated most circadian effects in the HC-diet data. The increased TAG concentration in response to feeding at 0400 h might be involved in the higher TAG concentrations seen in shift workers. Distinct macronutrient/circadian-dependent postprandial responses were seen in most studied variables.

Meal fatty acid uptake in adipose tissue: gender effects in nonobese humans

We tested for gender differences in dietary fatty acid metabolism in 12 nonobese men and 12 nonobese women using the meal fatty acid tracer/adipose tissue biopsy study design. In addition to determining body composition, measurements of regional adipose tissue lipoprotein lipase activity, blood flow, and fat cell size were performed to place the meal fatty acid kinetic studies in perspective. Twenty-four hours after ingesting the test meal, the concentration of meal fatty acids was greater (P < 0.05) in abdominal subcutaneous than in thigh adipose tissue in both men (0. 61 +/- 0.12 vs. 0.45 +/- 0.09 mg/g) and women (0.59 +/- 0.10 vs. 0. 43 +/- 0.05) but was not different between men and women. A greater percentage of dietary fat was stored in subcutaneous adipose tissue in women than in men (38 +/- 3 vs. 24 +/- 3%, respectively, P < 0. 05), and a greater portion of meal fatty acid disposal was unaccounted for in men. Significant gender differences in regional adipose tissue blood flow after meal ingestion were noted; the differences were in the direction that could support greater nutrient storage in lower body fat in women.

Meal fatty acid uptake in human adipose tissue: technical and experimental design issues

The adipose tissue uptake of dietary fat has been studied using fatty acid radiotracers incorporated into a meal, followed by adipose tissue biopsies. A number of experimental design issues, including the use of isotopic tracers to measure meal fatty acid oxidation and plasma appearance of tracer, as well as the heterogeneity of adipose tissue fatty acid uptake, have been addressed. We examined these questions in a study of 24 volunteers (12 men and 12 women) who consumed a meal containing [(3)H]triolein and [(14)C]triolein. Slight differences in the purity of [(3)H]triolein vs. [(14)C]triolein were found, which could affect the apparent adipose tissue uptake of meal fatty acids. The adipose tissue triglyceride specific activity from bilateral biopsy sites agreed well, implying that a unilateral biopsy is satisfactory for measuring tracer uptake. Meal fatty acid oxidation measured using [(3)H]triolein and [(14)C]triolein was well correlated (r = 0.79, P < 0.0001). The peak tracer appearance in plasma chylomicrons occurred 1 h after the ingestion of a second, unlabeled meal. Our findings have implications for the experimental design of future meal fatty acid tracer/adipose tissue biopsy studies.

Dietary approaches to the treatment of obesity

According to the National Institute of Health guidelines for the treatment of overweight and obesity, the most important element in a weight loss program is the reduction in energy intake. Reducing the fat content of the diet and increasing physical activity without restricting energy intake are relatively inefficient methods of weight loss. Because individuals tend to consume a constant weight of food, the decrease in energy intake on a reduced-fat diet is likely related to the lower energy density of the diet. Diets of low energy density, which are typically low in fat and rich in complex carbohydrates, allow individuals to consume satisfying portions of food while reducing their energy intake. Because a wide variety of foods can be included in a diet that is low in energy density, this type of diet encourages the adoption of life-long eating habits that are integral to the maintenance of weight loss and the prevention of weight gain.

Dietary fat patterns in urban African American women

The purpose of this study was to describe the scope of fatty food preferences of urban African American women and to examine factors associated with the selection of high fat foods. A volunteer sample of urban African American women church-goers were invited for dietary and risk factor screening at health fairs held following Sunday services. A standardized instrument, the Fat Intake Scale (FIS), was administered primarily by dietitians to estimate dietary fat intake and usual food choices. A sum score of 25 or more is thought to be associated with higher fat and cholesterol intake. As a validation of the FIS, a 24-hour recall was administered to a subsample. Sociodemographics, smoking status and comorbidity were assessed by self-report. Body weight, height, and total blood serum cholesterol were assessed using standardized measurement techniques. In the 521 participating women, 61% were classified as obese based on national reference norms for body mass index (BMI). More than 81% had an FIS of 25 or greater. On multiple logistic regression analysis, significant predictors of a higher fat diet (FIS > or = 25) included age greater than 45 years, obesity, and the absence of comorbidity. These findings suggest that there are independent predictors of selection of a diet high in fat. This has implications for planning and targeting community-based nutrition interventions for African American women who exhibit among the highest rates of obesity in the U.S. and who suffer an excess burden of obesity-related diseases.

Diet-induced thermogenesis and satiety in humans after full-fat and reduced-fat meals

Diet-induced thermogenesis was measured during and after a full-fat lunch, an identical but reduced-fat, reduced-energy lunch, and an iso-energetic reduced-fat lunch in 32 normal-weight men and women, age 35-55. Hunger and satiety were scored during and after the lunches, and their relationship to diet-induced thermogenesis was assessed. Diet-induced thermogenesis was relatively higher after the reduced-fat, reduced-energy lunch compared to the full-fat lunch (6.7% vs. 5.2%; p < 0.05). The respiratory quotients were significantly lower after the full-fat lunch than after the 2 reduced-fat lunches (p < 0.05). After the iso-energetic reduced-fat lunch, hunger scores were significantly reduced and satiety scores significantly increased (p < 0.05) until 1800 h. compared to the other 2 lunches. Satiety scores were positively related to the magnitude of diet-induced thermogenesis expressed as an absolute increase in metabolic rate during and after the meal. We conclude that hunger and satiety scores, substrate utilization, and diet-induced thermogenesis showed clear and different short-term responses to diets that differed with respect to the percentage energy from fat and/or the energy content of the meal.

Energy expenditure and physical activity in subjects consuming full-or reduced-fat products as part of their normal diet

It has been suggested that energy expenditure is higher in subjects consuming reduced-fat, high-carbohydrate diets than in subjects consuming full-fat, low-carbohydrate diets. In a 6-month randomized, controlled trial, seventeen women and twenty men (age 20-35 years; BMI 22-28 kg/m2) had free access either to a range of about forty-five reduced-fat products or the full-fat equivalents. At the end of the 6 months, energy intake, sleeping metabolic rate (SMR), average daily metabolic rate (ADMR), and physical activity (AO) were measured. The intervention resulted in a mean difference of the change of the fat content of the diet of 6% of energy (P < 0.01) between the two groups. SMR. ADMR and AO were virtually the same in both groups. The results suggest that the change in fat content of the diet has no effect on physical activity and energy expenditure. However, subjects with a higher activity level consumed more carbohydrate (ADMR/SMR: r = 0.49, P < 0.01: AO: r = 0.57, P < 0.001).

Diet composition related to body fat in a multivariate study of 203 men

OBJECTIVE

To assess whether usual diet (especially intake of dietary fat, carbohydrate, and fiber) was related to body fat percentage in healthy men.

DESIGN

A written questionnaire provided data on demographic and lifestyle characteristics. Dietary fat, carbohydrate, protein, and fiber intakes were analyzed using the National Cancer Institute food frequency questionnaire. Percentage of body fat was determined using three-site skinfold measurements, and a submaximal treadmill test was used to estimate aerobic fitness.

SUBJECTS

Subjects were 203 healthy men (14.0 +/- 5.3% mean body fat) aged 21 to 71 years. The subjects were chosen from randomly selected districts within Utah County and volunteered for free diet and fitness evaluations.

STATISTICAL ANALYSIS

Multiple regression analysis determined the extent to which the individual diet components predicted body composition before and after controlling for energy intake, fitness level, body weight, and age. Multivariate analysis of variance was used to compare relative body fat groups in regard to dietary variables.

RESULTS

Reported intakes of carbohydrate (P = .0085, R2 = .022), complex carbohydrate (P = .0127, R2 = .024), and fiber (P = .002, R2 = .03) were inversely associated with body fat after controlling for age, energy intake, and fitness level. Energy intake was positively related to body fat after controlling for age, fitness level, and body weight. When subjects were separated into low-, moderate-, and high-body-fat groups, the fattest subjects reported eating significantly more dietary fat (P = .05) and less carbohydrate (P = .01), complex carbohydrate (P = .01), and fiber (P = .005) than the leanest subjects. No significant difference in reported energy intake was noted across body fat groups.

APPLICATIONS

Composition of the diet may play a role in obesity beyond energy intake in men over the long-term. Lifestyle changes for men should probably include modifications in diet composition, especially increased consumption of foods high in complex carbohydrate and fiber.