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Honfo SH, Senior AM, Legault V, Presse N, Turcot V, Gaudreau P, Simpson SJ, Raubenheimer D, Cohen AA. Evidence for protein leverage on total energy intake, but not body mass index, in a large cohort of older adults. Int J Obes (Lond) 2024; 48:654-661. [PMID: 38145994 DOI: 10.1038/s41366-023-01455-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 12/11/2023] [Accepted: 12/15/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Protein leverage (PL) is the phenomenon of consuming food until absolute intake of protein approaches a 'target value', such that total energy intake (TEI) varies passively with the ratio of protein: non-protein energy (fat + carbohydrate) in the diet. The PL hypothesis (PLH) suggests that the dilution of protein in energy-dense foods, particularly those rich in carbohydrates and fats, combines with protein leverage to contribute to the global obesity epidemic. Evidence for PL has been reported in younger adults, children and adolescents. This study aimed to test for PL and the protein leverage hypothesis (PLH) in a cohort of older adults. METHODS We conducted a retrospective analysis of dietary intake in a cohort of 1699 community-dwelling older adults aged 67-84 years from the NuAge cohort. We computed TEI and the energy contribution (EC) from each macronutrient. The strength of leverage of macronutrients was assessed through power functions ( TEI = μ * EC L ). Body mass index (BMI) was calculated, and mixture models were fitted to predict TEI and BMI from macronutrients' ECs. RESULTS In this cohort of older adults, 53% of individuals had obesity and 1.5% had severe cases. The mean TEI was 7673 kJ and macronutrients' ECs were 50.4%, 33.2% and 16.4%, respectively for carbohydrates, fat, and protein. There was a strong negative association (L = -0.37; p < 0.001) between the protein EC and TEI. Each percent of energy intake from protein reduced TEI by 77 kJ on average, ceteris paribus. However, BMI was unassociated with TEI in this cohort. CONCLUSIONS Findings indicate clear evidence for PL on TEI, but not on BMI, likely because of aging, body composition, sarcopenia, or protein wasting.
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Affiliation(s)
- Sewanou H Honfo
- PRIMUS Research Group, Department of Family Medicine, Université de Sherbrooke, 3001 12e Ave N, Sherbrooke, QC, J1H 5N4, Canada
| | - Alistair M Senior
- University of Sydney, Charles Perkins Centre, Camperdown, NSW, 2006, Australia
- University of Sydney, School of Life and Environmental Science, Camperdown, NSW, 2006, Australia
- University of Sydney, Sydney Precision Data Science Centre, Camperdown, NSW, 2006, Australia
| | - Véronique Legault
- Research Center on Aging, CIUSSS-de-l'Estrie-CHUS, Sherbrooke, QC, Canada
| | - Nancy Presse
- Research Center on Aging, CIUSSS-de-l'Estrie-CHUS, Sherbrooke, QC, Canada
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Valérie Turcot
- Research Center on Aging, CIUSSS-de-l'Estrie-CHUS, Sherbrooke, QC, Canada
| | - Pierrette Gaudreau
- Department of Medicine, Université de Montréal, Montréal, QC, Canada
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Stephen J Simpson
- University of Sydney, Charles Perkins Centre, Camperdown, NSW, 2006, Australia
- University of Sydney, School of Life and Environmental Science, Camperdown, NSW, 2006, Australia
| | - David Raubenheimer
- University of Sydney, Charles Perkins Centre, Camperdown, NSW, 2006, Australia
- University of Sydney, School of Life and Environmental Science, Camperdown, NSW, 2006, Australia
| | - Alan A Cohen
- PRIMUS Research Group, Department of Family Medicine, Université de Sherbrooke, 3001 12e Ave N, Sherbrooke, QC, J1H 5N4, Canada.
- Research Center on Aging, CIUSSS-de-l'Estrie-CHUS, Sherbrooke, QC, Canada.
- Department of Environmental Health Sciences, Butler Columbia Aging Center, Mailman School of Public Health, Columbia University, New York, NY, USA.
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Tsuruta H, Sugahara S, Kume S. Nutrient quality in dietary therapy for diabetes and diabetic kidney disease. J Diabetes Investig 2024. [PMID: 38591876 DOI: 10.1111/jdi.14208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/17/2024] [Accepted: 03/21/2024] [Indexed: 04/10/2024] Open
Abstract
Dietary therapy is crucial for diabetes care with the aim of preventing the onset and progression of diabetes and its complications. The traditional approach to dietary therapy for diabetes has primarily focused on restricting the intake of the three major nutrients and rigorously controlling blood glucose levels. However, advancements in nutritional science have shown that within the three major nutrients - carbohydrates, proteins and lipids - there exist multiple types, each with distinct impacts on type 2 diabetes and its complications, sometimes even showing conflicting effects. In light of this, the present review shifts its focus from the quantity to the quality of the three major nutrients. It aims to provide an overview of how the differences in nutrient quality can influence onset and progression of type 2 diabetes and diabetic kidney disease, highlighting the diverse effects and, at times, contradictory impacts associated with each nutrient type.
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Affiliation(s)
- Hiroaki Tsuruta
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Sho Sugahara
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Shinji Kume
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
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Batsis JA, Batchek DJ, Petersen CL, Gross DC, Lynch DH, Spangler HB, Cook SB. Protein Supplementation May Dampen Positive Effects of Exercise on Glucose Homeostasis: A Pilot Weight Loss Intervention. Nutrients 2023; 15:4947. [PMID: 38068805 PMCID: PMC10707998 DOI: 10.3390/nu15234947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/23/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The role of protein in glucose homeostasis has demonstrated conflicting results. However, little research exists on its impact following weight loss. This study examined the impact of protein supplementation on glucose homeostasis in older adults >65 years with obesity seeking to lose weight. METHODS A 12-week, nonrandomized, parallel group intervention of protein (PG) and nonprotein (NPG) arms for 28 older rural adults (body mass index (BMI) ≥ 30 kg/m2) was conducted at a community aging center. Both groups received twice weekly physical therapist-led group strength training classes. The PG consumed a whey protein supplement three times per week, post-strength training. Primary outcomes included pre/post-fasting glucose, insulin, inflammatory markers, and homeostasis model assessment of insulin resistance (HOMA-IR). RESULTS Mean age and baseline BMI were 72.9 ± 4.4 years and 37.6 ± 6.9 kg/m2 in the PG and 73.0 ± 6.3 and 36.6 ± 5.5 kg/m2 in the NPG, respectively. Mean weight loss was -3.45 ± 2.86 kg in the PG and -5.79 ± 3.08 kg in the NPG (p < 0.001). There was a smaller decrease in pre- vs. post-fasting glucose levels (PG: -4 mg ± 13.9 vs. NPG: -12.2 ± 25.8 mg/dL; p = 0.10), insulin (-7.92 ± 28.08 vs. -46.7 ± 60.8 pmol/L; p = 0.01), and HOMA-IR (-0.18 ± 0.64 vs. -1.08 ± 1.50; p = 0.02) in the PG compared to the NPG. CONCLUSIONS Protein supplementation during weight loss demonstrated a smaller decrease in insulin resistance compared to the NPG, suggesting protein may potentially mitigate beneficial effects of exercise on glucose homeostasis.
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Affiliation(s)
- John A. Batsis
- Division of Geriatric Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599, USA; (D.H.L.); (H.B.S.)
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (D.J.B.); (D.C.G.)
- The Dartmouth Institute for Health Policy, Dartmouth College, Hanover, NH 03755, USA;
- Center for Aging and Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Dakota J. Batchek
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (D.J.B.); (D.C.G.)
| | - Curtis L. Petersen
- The Dartmouth Institute for Health Policy, Dartmouth College, Hanover, NH 03755, USA;
- Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH 03755, USA
| | - Danae C. Gross
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (D.J.B.); (D.C.G.)
- Center for Aging and Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - David H. Lynch
- Division of Geriatric Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599, USA; (D.H.L.); (H.B.S.)
- Center for Aging and Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Hillary B. Spangler
- Division of Geriatric Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599, USA; (D.H.L.); (H.B.S.)
- Center for Aging and Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Summer B. Cook
- Department of Kinesiology, University of New Hampshire, Durham, NH 03824, USA;
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