Zhang, Hanyue; Senior, Alistair M; Saner, Christoph; Olsen, Nanna J; Larsen, Sofus C; Simpson, Stephen J; Raubenheimer, David; Heitmann, Berit L (2023). Evidence for the protein leverage hypothesis in preschool children prone to obesity. Clinical nutrition, 42(11), pp. 2249-2257. Elsevier 10.1016/j.clnu.2023.09.025
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BACKGROUND & AIMS
The protein leverage hypothesis (PLH) proposed that strict regulation of protein intake drives energy overconsumption and obesity when diets are diluted by fat and/or carbohydrates. Evidence about the PLH has been found in adults, while studies in children are limited. Thus, we aimed to test the PLH by assessing the role of dietary protein on macronutrients, energy intake, and obesity risk using data from preschool children followed for 1.3 years.
METHODS
553 preschool children aged 2-6 years from the 'Healthy Start' project were included.
EXPOSURES
The proportion of energy intake from protein, fat, and carbohydrates collected from a 4-day dietary record.
OUTCOMES
Energy intake, BMI z-score, fat mass (FM) %, waist- (WHtR) and hip-height ratio (HHtR). Power function analysis was used to test the leverage of protein on energy intake. Mixture models were used to explore interactive associations of macronutrient composition on all these outcomes, with results visualized as response surfaces on the nutritional geometry.
RESULTS
Evidence for the PLH was confirmed in preschool children. The distribution of protein intake (% of MJ, IQR: 3.2) varied substantially less than for carbohydrate (IQR: 5.7) or fat (IQR: 6.3) intakes, suggesting protein intake is most tightly regulated. Absolute energy intake varied inversely with dietary percentage energy from protein (L = -0.14, 95% CI: -0.25, -0.04). Compared to children with high fat or carbohydrate intakes, children with high dietary protein intake (>20% of MJ) had a greater decrease in WHtR and HHtR over the 1.3-year follow-up, offering evidence for the PLH in prospective analysis. But no association was observed between macronutrient distribution and changes in BMI z-score or FM%.
CONCLUSIONS
In this study in preschool children, protein intake was the most tightly regulated macronutrient, and energy intake was an inverse function of dietary protein concentration, indicating the evidence for protein leverage. Increases in WHtR and HHtR were principally associated with the dietary protein dilution, supporting the PLH. These findings highlight the importance of protein in children's diets, which seems to have significant implications for childhood obesity risk and overall health.
Item Type: |
Journal Article (Original Article) |
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Division/Institute: |
04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Paediatric Medicine 04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Paediatric Medicine > Endocrinology/Metabolic Disorders 04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > Unit Childrens Hospital > Forschungsgruppe Endokrinologie / Diabetologie / Metabolik (Pädiatrie) |
UniBE Contributor: |
Saner, Christoph |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
0261-5614 |
Publisher: |
Elsevier |
Language: |
English |
Submitter: |
Pubmed Import |
Date Deposited: |
13 Oct 2023 14:05 |
Last Modified: |
11 Jan 2024 14:40 |
Publisher DOI: |
10.1016/j.clnu.2023.09.025 |
PubMed ID: |
37820518 |
Uncontrolled Keywords: |
Children Energy intake Nutritional geometry Obesity Protein leverage hypothesis |
BORIS DOI: |
10.48350/187127 |
URI: |
https://boris.unibe.ch/id/eprint/187127 |
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