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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
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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
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50 Years of Fat Phobia
Dietary Goals of 1977
1960s 1970s 1990s-2000s
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Unintended Consequences of Fat Phobia
Carb Craze
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Changes in the US Diet (1970 -2000)
• Grains • Fruit juices• Sodas• Snack foods
• Red meat• Dairy• Eggs
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Refined Carbohydrates:Leading Source of Calories for Americans
*Data represents intake for ages 2 and above
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Obesity Rates Have Doubled Since 1970s
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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
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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
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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
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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…”
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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
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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
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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
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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
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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”
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Relation Between Energy Density and the Naturally Nutrient Rich Score for Grains
Drewnowski A Am J Clin Nutr 2005;82:721-732
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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
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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
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Assembling the Pieces
Increased Dietary Protein
WeightLoss
Fat Loss
Lean Mass
Retention
Reduced Intake
Healthy Living(Body Weight Management)
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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
*
*
*
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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?
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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
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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
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Mechanisms of Action
Increased Dietary Protein
WeightLoss
Fat Loss
Lean Mass
Retention
ProteinSynthesis
Appetite Control/ Satiety
Reduced Intake
‘Metabolism’RMRTEF
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Physiological Hunger
Physiological Satiety
Appetite Control & Satiety
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Physiological Signals
Circulation
VagusNerve
Pancreas
Stomach
DuodenumIleum
Adipose
Hypothalamus
Brain Stem
LeptinGhrelin
Insulin
PYY GLP-1
CCK
Perceived Sensations:
Hunger
Satiety
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* *
*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
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*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
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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
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Mechanisms of Action
Increased Dietary Protein
WeightLoss
Fat Loss
Lean Mass
Retention
ProteinSynthesis
FoodReward/ Cravings
Appetite Control/ Satiety
Reduced Intake
‘Metabolism’RMRTEF
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Reward-driven‘Hunger’
Physiological Hunger
Reward-drivenSatisfaction
Physiological Satiety
Food Reward & Cravings
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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
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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
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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
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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
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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
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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
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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
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• 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
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Putting Protein
Into Practic
e
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Tips for Meal Planning
• 25-30 grams high-quality protein
• Opt for whole grains• Include vegetables, fruit
or both– Use MyPlate as a guide
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High-Quality Protein Breakfast
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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
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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
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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
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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
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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
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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
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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
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Questions
52
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