Changing Paradigms on Weight Management and Macronutrient Intake Weight Management DPG Breakfast

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

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 RecommendationsFrom 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. Protein: 0.8 g/kg 2.5 g/kg Protein Recommendations from Deficiency to Optimization RDA Risk of Inadequacy Risk of Adverse Effects acceptable intake AMDR: 10-35% intake

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 2.5-3.0 g/meal 25-30 g protein Leucine Insulin mTOR Protein Synthesis mTOR = mammalian target of rapamycin

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

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 ClinNutr 2005;82:721-732

19. Relation Between Energy Density and the Naturally Nutrient Rich Score for Meat and Dairy Products Drewnowski A Am J ClinNutr 2005;82:721-732

20. Protein Consumption in America Perception: ‘We Eat Enough Protein’ Usual Daily Intake (% Calories) Upper Limit Optimal? Lower Limit Protective &/or Beneficial Effects Beyond the RDA Modified from Fulgoni VL; 2008; AJCN; 87(supp): 1554S-78

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

22. Body Weight Management Increased Dietary Protein during Energy Restriction Pre/Post Change • 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%) * * * Wycherley TP, et al., 2012; AJCN; 96: 1281-98

23. Body Weight Management Increased Dietary Protein in Free-living Environment 6 month fat-restricted diet in 65 adults Normal Protein (NP): 12% Protein (76 g/d) High Protein (HP): 25% Protein (128 g/d) Otherwise ad libitum Change in Body Weight -450 kcal/d -550 kcal/d * * Mechanism of action? * NP *HP vs. NP & Control; p<0.05 *HP vs. NP & Control; p<0.05 Skovet al. 1999 Int J Obesity; 5238-536

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

25. Mechanisms of Action RMR Meta-analysis HP vs. SP Diets Reduced Intake Increased Dietary Protein Weight Loss Fat Loss * ‘Metabolism’ RMR TEF Lean Mass Retention Protein Synthesis Wycherley TP, et al., 2012; AJCN; 96: 1281-98

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

27. Appetite Control & Satiety Physiological Hunger Physiological Satiety

28. Physiological Signals Perceived Sensations: Hunger Satiety

29. High Protein & Physiological Signals 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 * * *NP vs. HP; p<0.01 Leidy et al. 2007 Obesity; 1215-1225; Leidy et al. 2010; Obesity; 18(9): 1725-1732

30. High Protein & Physiological Signals 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 * * *NP vs. HP; p<0.01 Leidy et al. 2007 Obesity; 1215-1225; Leidy et al. 2010; Obesity; 18(9): 1725-1732

31. High Protein & Eating Initiation 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) Voluntary Eating Request c b b Different letters denote sign P<0.05 a Douglas, Leidy et al. 2012; Appetite; 58(1): 117-122

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

33. Food Reward & Cravings Reward-driven ‘Hunger’ Physiological Hunger Reward-driven Satisfaction Physiological Satiety

34. Food Reward & Cravings Hunger Fullness ‘Drug-like’ properties Taste/flavor Social eating ‘Cheap’ / free Food-centric ads Portion size

35. High Protein & Food Reward/Cravings 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 Leidy, 2011 Obesity 19(10): 2019-2025;

36. Protein Consumption in America Perception: ‘We Eat Enough Protein’ Usual Daily Intake (% Calories) Upper Limit 25-30% of daily intake Lower Limit *24-30 g protein/eating occasion Modified from Fulgoni VL; 2008; AJCN; 87(supp): 1554S-78

37. Protein Intake is Skewed ~43% ~31% % Protein/d ~14% ~4%

38. Protein-Rich Breakfast 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 Breakfast Skipping Normal Protein High Protein Leidy, HJ, 2013; American J Clinical Nutrition 97(4): 677-688

39. Protein-Rich Breakfast 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 Breakfast Skipping Normal Protein High Protein Leidy, HJ, 2013; American J Clinical Nutrition 97(4): 677-688

40. Protein-Rich Breakfast 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 Leidy, HJ, 2013; American J Clinical Nutrition 97(4): 677-688

41. Summary • 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

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

46. Cottage Cheese and Fruit

47. Lox and Bagel

48. Yogurt Parfait

49. Toast and Peanut Butter

50. Scrambled Eggs with Cheese