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PCCHA 2014 Reaching New Heights in College Health October 14, 2014 Colin K. Wills, B.Sc. Joannie Dobbs, PhD CND Human Nutrition, Food & Animal Sciences

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Increasing body weight of Americans (College Students) Increased weight during Freshman year in college 5 lbs. to 15 lbs. Health Conditions related to excess weight Gropper SS, et al. Journal of American College Health. 2009:58:3 Gropper SS, et al. Appl. Physiol. Nutr. Metab. 2012: 37: 11181123

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Nurse Nutritionist / Dietitian Health Educator Physical Trainer Psychology Medical Doctor Common Opponent Over-FAT Related Health Factor Hypertension Dyslipidemia Stroke Cardiovascular Disease Diabetes Metabolic Syndrome Some Cancers VS. http://www.cdc.gov/obesity/data/adult.html Flegal K, et al. JAMA. 2012;307(5):491-497. U.S. Department of Health and Human Services. Office of the Surgeon General, January 2010.

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1) Identify factors helpful in making healthful and appropriate weight loss recommendations BMI vs. Body Fat 2) Discuss research related to weight loss strategies most appropriate for long term weight / fat loss 3) Compare BMI and Body Composition as related to protein intake 4) Describe appropriate diet recommendations for weight loss

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1) Understanding the Role of Body Composition Health Weight loss 2) BMI not equal to Body Fat

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It is assumed that BMI reflects body fat Is that Correct?

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CDC - National Health and Nutrition Examination Survey (NHANES) 1999-2004 (Bio-electrical Impedance Analysis) Gender (n = 2286) Female (n) = 1059 Male (n) = 1227 College Aged ( 18-35 years) 24-hr Diet Recall JMP Pro 11; SAS http://www.cdc.gov/nchs/nhanes/search/nhanes.aspx

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BMI GroupsCategoryAssumptions < 18.5UnderweightUnder-FAT 18.5 - < 25NormalLEAN 25 - < 30OverweightOver-FAT 30 - < 35ObeseOver-FAT 35 - < 40Obese IOver-FAT > 40Morbid ObesityOver-FAT Institute of Medicine. DRI intakes for Energy, Carbohydrate, Fiber, Fat, Protein and Amino Acids. 2005.

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Body fat percentages for males and females and their classification FemalesMalesRating 8-15%5-10%Athletic 16-23%11-14%Good 24-30%15-20%Acceptable 31-36%21-24%Overweight >37> 24Obese Jeukendrup A, et al. Sport Nutrition, Second Edition. 2010

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http://www.cdc.gov/nchs/nhanes/search/nhanes.aspx BMI Groups FemaleMale Body Fat NMin %Max %NMin %Max % 405725.660.21922.651.5 (Acceptable < 30%)(Acceptable < 20%)

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BMI GroupsCategory Over-FAT vs. Normal / LEAN < 18.5UnderweightUnder-FAT Over-FAT* 18.5 - < 25NormalLEAN Over-FAT* 25 - < 30OverweightOver-FAT* LEAN > 30ObeseOver-FAT* LEAN *weight/fat modification would be beneficial

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Normal BMI but High %BF http://www.cdc.gov/nchs/nhanes/search/nhanes.aspx High BMI but Normal %BF High BMI & %BF Normal BMI & %BF

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Normal BMI but High %BF High BMI but Normal %BF High BMI & %BF Normal BMI & %BF http://www.cdc.gov/nchs/nhanes/search/nhanes.aspx

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Alcohol Protein FAT Carbohydrate Physical Activity Basal Energy Expenditure Thermic Effect of Food Energy Expenditure Energy Intake = =

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Alcohol Protein FAT Carbohydrate Physical Activity Basal Energy Expenditure Thermic Effect of Food Energy Expenditure Energy Intake > > Example 50 kcal extra a day ~5 lbs. in a year

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Alcohol Protein FAT Carbohydrate Physical Activity Basal Energy Expenditure Thermic Effect of Food Energy Expenditure Energy Intake <

Dietary Protein Consumed As Related To Percent Body Fat Above Or Below 30% Dietary Protein (gm) / Kg Bodyweight Female N < 30 % Body Fat > 30 % Body Fat 0.0 0.793268%92% 0.8 - < 1.253849%91% 1.25 - < 1.615925%75% 1.6 - < 210536%64% 2 - < 2.55928%72% 2.5 - < 31838%62% 3+860%40% http://www.cdc.gov/nchs/nhanes/search/nhanes.aspx

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Dietary Protein Consumed As Related To Percent Body Fat Above Or Below 20% (gm) Protein / Kg Bodyweight Male N < 20 % Body Fat > 20 % Body Fat 0.0 0.7924948%52% 0.8 - < 1.2537556%44% 1.25 - < 1.625876%24% 1.6 - < 216680%20% 2 - < 2.510578%22% 2.5 - < 35170%30% 3+2364%36% http://www.cdc.gov/nchs/nhanes/search/nhanes.aspx

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Types of Diets PRO Protein at 1.6 g/kg bodyweight CHO Protein at 0.8 g/kg bodyweight Individuals who completed the 12 mo. PRO (n = 41) and CHO (n = 30) treatments regardless of compliance. Individuals who successfully maintained a 10% weight loss at 12 mo. (PRO, n = 20; CHO, n = 14) o Baseline - o 12 mo. - Adapted from Layman DK, Evans E, et al. J Nutr. 2009:139;514-521 Evans E, et al. Nutrition & Metabolism. 2012:9;55. Layman D, Evans E, et al. J Nutr.2005:135;1903-1910.

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During the meals vs. Unequal Protein distribution More likely to provide a greater 24 hour protein anabolic response Adapted from Layman D. Nutrition & Metabolism. 2009;6-12. Adapted from Paddon-Jones, Rassmussen, et al. Curr Opin Clin Nutr Metab Care 2009, 12: 8690. Ingestion of 90 grams of protein, distributed evenly at 3 meals Ingestion of 90 grams of proteins unevenly distributed throughout the day

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Diet Types by Categories BalancedLiquid AbsFlat BellyMacrobioticTraditional AsianMartha's Vineyard Acid AlkalineFlexitarianMayo ClinicVeganLemonade Anti-InflammatoryGluten-FreeMediterraneanVegetarianPurium Biggest LoserGlycemic-IndexNutri-systemVolumetrics DASHJenny CraigSlim-FastZone Engine 2Low FODMAPSpark Solution Low-CalorieLow-Fat Low Carbohydrate High ProteinMiscellaneous CookieMacrobioticAtkins Grapefruit MedifastOrnishEco-AtkinsDukanMark Bittman's VB6 NutrisystemTLCDukanLEARNPower Protein Raw FoodVegetarianMedifast Blood Type Slim-FastVeganPaleo Skinny Bitch The FastSouth Beach Johnston BC, et al. JAMA. 2014;312(9):923-933. http://health.usnews.com/best-diet http://www.webmd.com/diet

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A large scientific panel of scientists 2-year review 16,000 studies on diet and obesity. Using Dietary Recommendations to MAINTAIN a healthy weight should NOT be used to get obese people to a healthy weight.

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http://www.fda.gov/iceci/inspections/inspectionguides/ucm074948.htm Average Protein per Typical Food Serving Food Sources NLEA Serving Size (g) NLEA Volume per Serving Energy (kcal) Protein (g) Kcal/ g protein Fish / Chicken / Beef 85~ 3 oz. ckd1708 2% Cottage Cheese 110~ 0.5 oz. cup1008 Cheese301 thin slice11016 Legumes / Beans 90 ~ 0.5 oz. cup 12016 Beans - Processed 130~ 0.5 oz. cup15020 Grains1400.6 -1 cup16032 Nuts30~ 3.5 Tbsp.19036

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1.Know Their Body Fat 2.Their Weight Goal 3.Eating Style (? Dietary Sources: Iron, Zinc, Protein) 4.Their Daily Calories (Goal or Actual) Do they use an App 5.Supplement Use (Protein/Multi/Other) 6.Dieting Frequency & Largest Weight Loss 7.# Hours Exercise and Sleep per 24 hours

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This book is translated into as many languages as the Bible Promotes Blood Donations to Lose Weight and Other Unhealthy Weight Loss Practices

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1) Overall Health of Individual a)Fat Loss not Weight Loss b)Build Lean Muscle Tissue as Improving Immune function (1.6 gm protein / kg B.wt) c)Weight Resistance Exercise d)Total Energy Deficit: No more than 500 kcal per day (Dietary and/or Physical Activity) e)Ensuring all Essential Nutrients

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This work is supported in part by USDA Smith Lever Funding for Project 289H.

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Thank you for your time and attention.

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Authors, V. (2005). Dietary Reference Intakes for Energy, Carbohydrates, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Brown, L. D. (2014). "Endocrine regulation of fetal skeletal muscle growth: impact on future metabolic health." Journal of Endocrinology 221(2): R13- R29. Devkota, S. and D. K. Layman (2010). "Protein metabolic roles in treatment of obesity." Current Opinion in Clinical Nutrition and Metabolic Care 13(4): 403-407. Elwyn, D. H. (1980). "NUTRITIONAL-REQUIREMENTS OF ADULT SURGICAL PATIENTS." Critical Care Medicine 8(1): 9-20. Evans, E. M., et al. (2012). "Effects of protein intake and gender on body composition changes: a randomized clinical weight loss trial." Nutrition & Metabolism 9. Flegal, K. M., et al. (2012). "Prevalence of Obesity and Trends in the Distribution of Body Mass Index Among US Adults, 1999-2010." Jama-Journal of the American Medical Association 307(5): 491-497. Gropper, S. S., et al. (2012). "Weight and Body Composition Changes during the First Three Years of College." Journal of obesity 2012: 634048-634048. Gropper, S. S., et al. (2009). "The Freshman 15-A Closer Look." Journal of American College Health 58(3): 223-231. Helen A Guthrie, M. F. P. (1995). Human Nutrition. Mosby-Year Book, Inc., James M. Smith. Jensen, M. D., et al. (2014). "2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society." Journal of the American College of Cardiology 63(25): 2985-3025. Jeukendrup A, G. M. (2010). Sports Nutrition, Second Edition. Human Kinetics, Inc. Johnston, B. C., et al. (2014). "Comparison of weight loss among named diet programs in overweight and obese adults: a meta-analysis." Jama 312(9): 923-933. Kushner, R. F. (2003). Roadmaps for Clinical Practice: Case Studies in Disease Prevention and Health Promotion -Assessment and Management of Adult Obesity: A Primer for Physicians. Dietary Management. American Medical Association, American Medical Association. Layman, D. K. (2005). "Human Nutrition and Metabolism Dietary Protein and Exercise Have Additive Effects on Body Composition during Weight Loss in Adult Women." The Journal of Nutrition: 1903-1910.

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Layman, D. K. (2009). "Dietary Guidelines should reflect new understandings about adult protein needs." Nutrition & Metabolism 6. Layman, D. K. (2009). "A Moderate-Protein Diet Produces Sustatined Weight Loss and Long-Term Changes in Body Composition and Blood Lipids in Obese Adults." The Journal of Nutrition 6: 514-521. Layman, D. K. (2014). "Eating patterns, diet quality and energy balance, A perspective and future directions for the food industry." Physiology & Behavior 134: Mamerow, M. M., et al. (2014). "Dietary Protein Distribution Positively Influences 24-h Muscle Protein Synthesis in Healthy Adults." Journal of Nutrition 144(6): 8 Munro, H. (1964). General aspects of the regulation of protein metabolism by diet and by hormones. Mammalian protein metabolism. J. A. HN Munro. New York: Academic Press. Paddon-Jones, D. and B. B. Rasmussen (2009). "Dietary protein recommendations and the prevention of sarcopenia." Current Opinion in Clinical Nutrition and Metabolic Care 12(1): 86-90. Services, US Dept Health Human. (2010). The Surgeon General's Vision for a Health and Fit Nation. Rocville, MD, Department of Health and Human Services, Office of Surgeon General. Vernon R. Young, Y.-M. Y., Naomi K. Fukagawa (1992). Whole Body Energy and Nitrogen (Protein) Relationships. Energy Metabolism: Tissue Determinants and Cellular Corollaries. H. N. T. John M. Kinney. New York, Raven Press: 139-161. http://www.cdc.gov/obesity/data/adult.html http://www.cdc.gov/nchs/nhanes/search/nhanes.aspx http://health.usnews.com/best-diet http://www.webmd.com/diet http://www.fda.gov/iceci/inspections/inspectionguides/ucm074948.htm