Changing Paradigms on Weight Management and

Macronutrient Intake

Weight Management DPG BreakfastOctober 20, 2013

Tia Rains, PhD Senior Director of Nutrition Research and Communications

Egg Nutrition Center

Heather Leidy, PhD Assistant Professor Nutrition & Exercise Physiology

University of Missouri Columbia

Objectives

• Summarize the relationship between historical dietary recommendations, macronutrient intake and subsequent health outcomes

• Discuss the impact of the quality and timing of protein consumption on appetite control and satiety

• Identify signals surrounding physiological and reward-driven eating behavior

• Provide recommendations to help individuals build healthy meals reflective of new evidence on macronutrient distribution

50 Years of Fat Phobia

Dietary Goals of 1977

1960s 1970s 1990s-2000s

Unintended Consequences of Fat Phobia

Carb Craze

Changes in the US Diet (1970 -2000)

• Grains • Fruit juices• Sodas• Snack foods

• Red meat• Dairy• Eggs

Refined Carbohydrates:Leading Source of Calories for Americans

*Data represents intake for ages 2 and above

Obesity Rates Have Doubled Since 1970s

New Evidence Suggests an Alternative Dietary Pattern for

Better Health• High refined

carbohydrates stimulate insulin, which promotes inflammation, obesity and CVD• Replacing refined carbohydrates with protein promotes a more favorable metabolic response

Protein RecommendationsFrom Deficiency to Optimization

AMDRAverage daily dietary nutrient intake level sufficient to meet the nutrient requirement of nearly all healthy individuals in a particular life stage and gender group

0.8 g protein/kg/day

RDAAcceptable range of intake for protein associated with reduced risk of chronic disease while providing intakes of essential nutrients

10-35% of Energy IntakeBased on essential amino acids serving as building blocks for several structural and functional proteins

Based on complementing the AMDRs for fat and carbohydrate

Risk ofInadequacy

Risk of AdverseEffects

RDA

acceptableintake

Protein: 0.8 g/kg 2.5 g/kgAMDR:

10-35% intake

Protein Recommendations from Deficiency to Optimization

The Protein Myth

“Adults eat more protein than they need!”

“While protein is an important macronutrient in the diet, most Americans are already currently consuming enough and do not need to increase their intake. As such, protein consumption, while important for nutrient adequacy…”

Roles of Protein: Providing Amino Acids

• Building blocks for new proteins• Providing energy – limited (~15% of

daily kcal) – but specific – muscle, liver, brain

• Metabolic precursors/signals tryptophan → serotonin arginine → nitrous oxide leucine → mTOR → muscle protein

synthesis

Leucine Acts as a Metabolic Signal for Muscle Protein Synthesis

mTOR

LeucineInsulin

Protein SynthesismTOR = mammalian target of rapamycin

2.5-3.0 g/meal

25-30 g protein

Protein Intake is Skewed

Breakfast Lunch Pre-dinner Dinner0

5

10

15

20

25

30

35

40

45

50

MalesFemales

LSM

g/m

eal

~14%

~31%

~43%

~4%

% Protein/d

Maximum protein synthesis

Emerging Benefits of Increased Dietary Protein

• Improved lipid profile (triglycerides)• Blood glucose modulation• Improved retention of muscle (elderly)• Increased satiety• Improved body composition• Weight management

2010 Dietary Guidelines

• “A healthy eating pattern limits intake of sodium, solid fats, added sugars, and refined grains and emphasizes nutrient dense foods and beverages-vegetables, fruits, whole grains, fat-free or low-fat milk and milk products, seafood, lean meats and poultry, eggs, beans and peas, and nuts and seeds”

Relation Between Energy Density and the Naturally Nutrient Rich Score for Grains

Drewnowski A Am J Clin Nutr 2005;82:721-732

Relation Between Energy Density and the Naturally Nutrient Rich Score for Meat and Dairy Products

Drewnowski A Am J Clin Nutr 2005;82:721-732

Perception: ‘We Eat Enough Protein’

Modified from Fulgoni VL; 2008; AJCN; 87(supp): 1554S-78

LowerLimit

Usual Daily Intake(% Calories)

Optimal?

Upper Limit

Protective &/or Beneficial Effects Beyond the RDA

Protein Consumption in America

Assembling the Pieces

Increased Dietary Protein

WeightLoss

Fat Loss

Lean Mass

Retention

Reduced Intake

Healthy Living(Body Weight Management)

Body Weight ManagementIncreased Dietary Protein during Energy Restriction

Wycherley TP, et al., 2012; AJCN; 96: 1281-98

Meta-analysis

• 24 trials in 1063 adults

• Duration of energy restriction: 12 ± 9 wk

• Intake: 1550 ± 270 kcal

Standard Protein Diet: 0.72 g·kg-1·d-1 (18 ± 2%)

High Protein Diet: 1.25 g·kg-1·d-1 (30 ± 2%)

Pre/Post Change

*

*

*

Body Weight ManagementIncreased Dietary Protein in Free-living Environment

Skov et al. 1999 Int J Obesity; 5238-536

6 month fat-restricted diet in 65 adults

Normal Protein (NP): 12% Protein (76 g/d) High Protein (HP): 25% Protein (128 g/d)

*HP vs. NP & Control; p<0.05

Otherwise ad libitum

*

Change in Body Weight

*HP vs. NP & Control; p<0.05

NP

**

-550 kcal/d

-450 kcal/d

Mechanism of action?

Mechanisms of Action

Increased Dietary Protein

WeightLoss

Fat Loss

Lean Mass

Retention

ProteinSynthesis

Reduced Intake

*

Symons et al., 2007; AJCN 86: 451-456

Protein-rich (24 g) meal

Mechanisms of Action

Increased Dietary Protein

WeightLoss

Fat Loss

‘Metabolism’RMRTEF

Lean Mass

Retention

ProteinSynthesis

Reduced Intake

RMRMeta-analysis

HP vs. SP Diets

*

Wycherley TP, et al., 2012; AJCN; 96: 1281-98

Mechanisms of Action

Increased Dietary Protein

WeightLoss

Fat Loss

Lean Mass

Retention

ProteinSynthesis

Appetite Control/ Satiety

Reduced Intake

‘Metabolism’RMRTEF

Physiological Hunger

Physiological Satiety

Appetite Control & Satiety

Physiological Signals

Circulation

VagusNerve

Pancreas

Stomach

DuodenumIleum

Adipose

Hypothalamus

Brain Stem

LeptinGhrelin

Insulin

PYY GLP-1

CCK

Perceived Sensations:

Hunger

Satiety

* *

*NP vs. HP; p<0.01

Leidy et al. 2007 Obesity; 1215-1225; Leidy et al. 2010; Obesity; 18(9): 1725-1732

4-h Post-meal Responses

Acute studies in overweight & obese adults & young people providing meals asNormal Protein (NP): 13-20g Protein (10-15% intake)

High Protein (HP): 28-50g Protein (25-40% intake)

High Protein & Physiological Signals

*NP vs. HP; p<0.01

Leidy et al. 2007 Obesity; 1215-1225; Leidy et al. 2010; Obesity; 18(9): 1725-1732

Acute studies in overweight & obese adults & young people providing meals asNormal Protein (NP): 13-20g Protein (10-15% intake)

High Protein (HP): 28-50g Protein (25-40% intake)

High Protein & Physiological Signals

*

*

4-h Post-meal Responses

High Protein & Eating Initiation

Acute study in 15 adults; eating initiation following 160 kcal afternoon snacksLow Protein (LP): 5 g protein (Regular Yogurt)Moderate Protein (MP): 14 g protein (Protein Infused Yogurt)High Protein (HP): 24 g protein (Greek Yogurt)

Different letters denote sign P<0.05

Voluntary Eating Request

a

b bc

Douglas, Leidy et al. 2012; Appetite; 58(1): 117-122

Mechanisms of Action

Increased Dietary Protein

WeightLoss

Fat Loss

Lean Mass

Retention

ProteinSynthesis

FoodReward/ Cravings

Appetite Control/ Satiety

Reduced Intake

‘Metabolism’RMRTEF

Reward-driven‘Hunger’

Physiological Hunger

Reward-drivenSatisfaction

Physiological Satiety

Food Reward & Cravings

Food Reward & Cravings

Circulation

VagusNerve

Pancreas

Stomach

DuodenumIleum

Adipose

Hypothalamus

Brain Stem

LeptinGhrelin

Insulin

PYY GLP-1

CCK

HungerFullness

‘Drug-like’ properties

‘Cheap’ / free

Food-centric ads

Taste/flavor

Social eating

Portion size

High Protein & Food Reward/Cravings

Leidy, 2011 Obesity 19(10): 2019-2025;

Acute studies in overweight & obese teens providing meals asNormal Protein (NP): 13-18 g Protein (14-18% intake)

High Protein (HP): 35-50 g Protein (40% intake)

Pre-LunchFood Stimuli

Perception: ‘We Eat Enough Protein’

Modified from Fulgoni VL; 2008; AJCN; 87(supp): 1554S-78

LowerLimit

Usual Daily Intake(% Calories)

25-30% of daily intake

Upper Limit

*24-30 g protein/eating occasion

Protein Consumption in America

Breakfast Lunch Pre-dinner Dinner0

5

10

15

20

25

30

35

40

45

50

MalesFemales

LSM

g/m

eal

~14%

~31%

~43%

~4%

% Protein/d

Protein Intake is Skewed

Protein-Rich Breakfast

Leidy, HJ, 2013; American J Clinical Nutrition 97(4): 677-688

Breakfast SkippingNormal ProteinHigh Protein

Acute study in 20 overweight/obese ‘breakfast skipping’ young women; 350 kcal breakfast Skipped Breakfast (BS): -------------

Normal Protein (NP): 15% (13g) Protein; 65% CHO; 20% Fat High Protein (HP): 40% (35g) Protein 40% CHO; 20% Fat

Protein-Rich Breakfast

Leidy, HJ, 2013; American J Clinical Nutrition 97(4): 677-688

Breakfast SkippingNormal ProteinHigh Protein

Acute study in 20 overweight/obese ‘breakfast skipping’ young women; 350 kcal breakfast Skipped Breakfast (BS): -------------

Normal Protein (NP): 15% (13g) Protein; 65% CHO; 20% Fat High Protein (HP): 40% (35g) Protein 40% CHO; 20% Fat

Protein-Rich Breakfast

Leidy, HJ, 2013; American J Clinical Nutrition 97(4): 677-688

Acute study in 20 overweight/obese ‘breakfast skipping’ young women; 350 kcal breakfast Skipped Breakfast (BS): -------------

Normal Protein (NP): 15% (13g) Protein; 65% CHO; 20% Fat High Protein (HP): 40% (35g) Protein 40% CHO; 20% Fat

• Both meals reduced brain activation in regions controlling food motivation & reward; however, the high protein meal led to greater reductions

• A diet rich in protein appears to be an optimal strategy to prevent and/or treat obesity through improvements in body weight management and energy intake regulation

• Mechanism of action: increased appetite control & satiety reduced reward-driven eating behavior

• Quantities that elicit these responses:• 25-30% daily intake (24-30 g/eating occasion) as

high quality protein

• Unique benefits re: the consumption of a protein-rich breakfast

Summary

Putting Protein

Into Practic

e

Tips for Meal Planning

• 25-30 grams high-quality protein

• Opt for whole grains• Include vegetables, fruit

or both– Use MyPlate as a guide

High-Quality Protein Breakfast

Homemade Breakfast SandwichFood Protein (g) Carb Fat Calories

1 Egg 6 0.4 4.8 72

Canadian Bacon 2 slices

11 0.6 3.9 86

Cheese 7 0.5 2.0 50

100 calorie Bread Round

5 21 1 100

Total 29 22.5 11.7 308

Cottage Cheese and Fruit

Food Protein (g) Carb Fat CaloriesLow Fat Cottage Cheese, 1 Cup

28 10 0 160

Fruit, 1 Cup 1 15 0 60

Wheat Germ, 1 Tbsp.

2 3 1 25

Total 31 28 1 245

Lox and Bagel

Food Protein (g) Carb Fat Calories

Thomas Bagel Thin

5 24 1 110

Smoked Salmon, 4 oz.

20.6 0 5 132

Cottage Cheese, 2 Tbsp.

3.5 1 6 21

Total 29.1 25 12 263

Yogurt Parfait

Food Protein (g) Carb Fat Calories1 Cup Plain Greek Yogurt

18 7 0 100

6 Tbsp. Special K Protein Plus Cereal

5 7 1.5 50

2 Tbsp. Wheat Germ

4 6 2 50

1 Cup Berries 1 12 0 62

Total 28 32 3.5 262

Toast and Peanut Butter

Food Protein (g) Carb Fat Calories100 Calorie Bread Round

6 22 1 100

3 Tbsp. Peanut Butter

12 9 24 250

8 oz. Milk 9 12 0 90

Total 27 37 25 440

Scrambled Eggs with Cheese

Food Protein (g) Carb Fat Calories3 Eggs 18 1.2 14.4 216

2 oz. Low Fat Cheese

14 1.0 4.0 100

Total 32 2.2 18.4 316

Egg White Omelet with Canadian BaconFood Protein (g) Carb Fat Calories

¾ Cup Egg White Omelet

18 1 0 90

Canadian Bacon, 2 Slices

11 0.6 3.9 80

Total 29 1.6 3.9 170

Questions

52

Thank YouWM DPG!