Changing Paradigms on Weight Management and Macronutrient Intake Weight Management DPG Breakfast October 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 s 1970s1990s-2000s

Unintended Consequences of Fat Phobia Carb Craze

Changes in the US Diet ( ) 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 Recommendations From Deficiency to Optimization AMDR Average 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 RDA Acceptable range of intake for protein associated with reduced risk of chronic disease while providing intakes of essential nutrients 10-35% of Energy Intake Based on essential amino acids serving as building blocks for several structural and functional proteins Based on complementing the AMDRs for fat and carbohydrate

Risk of Inadequacy Risk of Adverse Effects RDA acceptable intake Protein: 0.8 g/kg 2.5 g/kg AMDR: 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 Leucine Insulin Protein Synthesis mTOR = mammalian target of rapamycin g/meal g protein

Protein Intake is Skewed ~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:

Relation Between Energy Density and the Naturally Nutrient Rich Score for Meat and Dairy Products Drewnowski A Am J Clin Nutr 2005;82:

Perception: ‘We Eat Enough Protein’ Modified from Fulgoni VL; 2008; AJCN; 87(supp): 1554S-78 Lower Limit Upper Limit Protective &/or Beneficial Effects Beyond the RDA

Increased Dietary Protein Weight Loss Fat Loss Lean Mass Retention Reduced Intake Healthy Living (Body Weight Management)

Increased Dietary Protein during Energy Restriction Wycherley TP, et al., 2012; AJCN; 96: 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 * * *

Increased Dietary Protein in Free-living Environment Skov et al Int J Obesity; 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?

Increased Dietary Protein Weight Loss Fat Loss Lean Mass Retention Protein Synthesis Reduced Intake * Symons et al., 2007; AJCN 86: Protein-rich (24 g) meal

Increased Dietary Protein Weight Loss Fat Loss ‘Metabolism’ RMR TEF Lean Mass Retention Protein Synthesis Reduced Intake * Wycherley TP, et al., 2012; AJCN; 96:

Increased Dietary Protein Weight Loss Fat Loss Lean Mass Retention Protein Synthesis Appetite Control/ Satiety Reduced Intake ‘Metabolism’ RMR TEF

Physiological Hunger Physiological Satiety

Perceived Sensations: Hunger Satiety

* * * NP vs. HP; p<0.01 Leidy et al Obesity; ; Leidy et al. 2010; Obesity; 18(9): h Post-meal Responses Acute studies in overweight & obese adults & young people providing meals as Normal Protein (NP): 13-20g Protein (10-15% intake) High Protein (HP): 28-50g Protein (25-40% intake)

* NP vs. HP; p<0.01 Leidy et al Obesity; ; Leidy et al. 2010; Obesity; 18(9): Acute studies in overweight & obese adults & young people providing meals as Normal Protein (NP): 13-20g Protein (10-15% intake) High Protein (HP): 28-50g Protein (25-40% intake) * * 4-h Post-meal Responses

Acute study in 15 adults; eating initiation following 160 kcal afternoon snacks Low 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 b c Douglas, Leidy et al. 2012; Appetite; 58(1):

Increased Dietary Protein Weight Loss Fat Loss Lean Mass Retention Protein Synthesis Food Reward/ Cravings Appetite Control/ Satiety Reduced Intake ‘Metabolism’ RMR TEF

Reward-driven ‘Hunger’ Physiological Hunger Reward-driven Satisfaction Physiological Satiety

HungerFullness ‘Drug-like’ properties ‘Cheap’ / free Food-centric ads Taste/flavor Social eating Portion size

Leidy, 2011 Obesity 19(10): ; Acute studies in overweight & obese teens providing meals as Normal Protein (NP): g Protein (14-18% intake) High Protein (HP): g Protein (40% intake) Pre-Lunch Food Stimuli

Perception: ‘We Eat Enough Protein’ Modified from Fulgoni VL; 2008; AJCN; 87(supp): 1554S-78 Lower Limit Upper Limit *24-30 g protein/eating occasion

~14% ~31% ~43% ~4% % Protein/d

Leidy, HJ, 2013; American J Clinical Nutrition 97(4): Breakfast Skipping Normal Protein High 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

Leidy, HJ, 2013; American J Clinical Nutrition 97(4): Breakfast Skipping Normal Protein High 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

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

Putting Protein Into Practice

Tips for Meal Planning grams high-quality protein Opt for whole grains Include vegetables, fruit or both –Use MyPlate as a guide

High-Quality Protein Breakfast

Homemade Breakfast Sandwich FoodProtein (g)CarbFatCalories 1 Egg Canadian Bacon 2 slices Cheese calorie Bread Round Total

Cottage Cheese and Fruit FoodProtein (g)CarbFatCalories Low Fat Cottage Cheese, 1 Cup Fruit, 1 Cup Wheat Germ, 1 Tbsp Total

Lox and Bagel FoodProtein (g)CarbFatCalories Thomas Bagel Thin Smoked Salmon, 4 oz Cottage Cheese, 2 Tbsp Total

Yogurt Parfait FoodProtein (g)CarbFatCalories 1 Cup Plain Greek Yogurt Tbsp. Special K Protein Plus Cereal Tbsp. Wheat Germ Cup Berries Total

Toast and Peanut Butter FoodProtein (g)CarbFatCalories 100 Calorie Bread Round Tbsp. Peanut Butter oz. Milk Total

Scrambled Eggs with Cheese FoodProtein (g)CarbFatCalories 3 Eggs oz. Low Fat Cheese Total

Egg White Omelet with Canadian Bacon FoodProtein (g)CarbFatCalories ¾ Cup Egg White Omelet Canadian Bacon, 2 Slices Total

Questions 52

Thank You WM DPG!