1. 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

2. 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

3. 50 Years of Fat Phobia Dietary Goals of 1977 1960s 1970s1990s-2000s

4. Unintended Consequences of Fat Phobia Carb Craze

5. Changes in the US Diet (1970 -2000) Grains Fruit juices Sodas Snack foods Red meat Dairy Eggs

6. Refined Carbohydrates: Leading Source of Calories for Americans *Data represents intake for ages 2 and above

8. Obesity Rates Have Doubled Since 1970s

9. 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

10. 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

11. 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

12. 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…”

13. 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

14. Leucine Acts as a Metabolic Signal for Muscle Protein Synthesis mTOR Leucine Insulin Protein Synthesis mTOR = mammalian target of rapamycin 2.5-3.0 g/meal 25-30 g protein

15. Protein Intake is Skewed ~14% ~31% ~43% ~4% % Protein/d Maximum protein synthesis

16. 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

17. 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”

18. Relation Between Energy Density and the Naturally Nutrient Rich Score for Grains Drewnowski A Am J Clin Nutr 2005;82:721-732

19. 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

20. 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

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

22. Increased 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 * * *

23. Increased 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?

24. Increased Dietary Protein Weight Loss Fat Loss Lean Mass Retention Protein Synthesis Reduced Intake * Symons et al., 2007; AJCN 86: 451-456 Protein-rich (24 g) meal

25. Increased Dietary Protein Weight Loss Fat Loss ‘Metabolism’ RMR TEF Lean Mass Retention Protein Synthesis Reduced Intake * Wycherley TP, et al., 2012; AJCN; 96: 1281-98

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

27. Physiological Hunger Physiological Satiety

28. Perceived Sensations: Hunger Satiety

29. * * * 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 as Normal Protein (NP): 13-20g Protein (10-15% intake) High Protein (HP): 28-50g Protein (25-40% intake)

30. * 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 as Normal Protein (NP): 13-20g Protein (10-15% intake) High Protein (HP): 28-50g Protein (25-40% intake) * * 4-h Post-meal Responses

31. 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): 117-122

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

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

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

35. Leidy, 2011 Obesity 19(10): 2019-2025; Acute studies in overweight & obese teens providing meals as Normal Protein (NP): 13-18 g Protein (14-18% intake) High Protein (HP): 35-50 g Protein (40% intake) Pre-Lunch Food Stimuli

36. 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

37. ~14% ~31% ~43% ~4% % Protein/d

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

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

40. 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

42. Putting Protein Into Practice

43. Tips for Meal Planning 25-30 grams high-quality protein Opt for whole grains Include vegetables, fruit or both –Use MyPlate as a guide

44. High-Quality Protein Breakfast

45. Homemade Breakfast Sandwich FoodProtein (g)CarbFatCalories 1 Egg 60.44.872 Canadian Bacon 2 slices 110.63.986 Cheese 70.52.050 100 calorie Bread Round 5211100 Total 2922.511.7308

46. Cottage Cheese and Fruit FoodProtein (g)CarbFatCalories Low Fat Cottage Cheese, 1 Cup 28100160 Fruit, 1 Cup 115060 Wheat Germ, 1 Tbsp. 23125 Total 31281245

47. Lox and Bagel FoodProtein (g)CarbFatCalories Thomas Bagel Thin 5241110 Smoked Salmon, 4 oz. 20.605132 Cottage Cheese, 2 Tbsp. 3.51621 Total 29.12512263

48. Yogurt Parfait FoodProtein (g)CarbFatCalories 1 Cup Plain Greek Yogurt 1870100 6 Tbsp. Special K Protein Plus Cereal 571.550 2 Tbsp. Wheat Germ 46250 1 Cup Berries 112062 Total 28323.5262

49. Toast and Peanut Butter FoodProtein (g)CarbFatCalories 100 Calorie Bread Round 6221100 3 Tbsp. Peanut Butter 12924250 8 oz. Milk 912090 Total 273725440

50. Scrambled Eggs with Cheese FoodProtein (g)CarbFatCalories 3 Eggs 181.214.4216 2 oz. Low Fat Cheese 141.04.0100 Total 322.218.4316

51. Egg White Omelet with Canadian Bacon FoodProtein (g)CarbFatCalories ¾ Cup Egg White Omelet 181090 Canadian Bacon, 2 Slices 110.63.980 Total 291.63.9170

52. Questions 52

53. Thank You WM DPG!