Energy affected Rudolph
intake required to maintain body weight by wide variation in diet composition13 L Leibel,
ABSTRACT ing
to a greater
Jules
Hirsch,
Burton
E Appel,
Diets
rich in fat may promote
deposition
of adipose-tissue
obesity
(1 3 adults,
composition
with
3 children) widely
fed liquid
varied
diets
than
was examined of 16 human
ofprecisely
fat content,
for
Gregg
by lead-
triglycerides
do isoenergetic diets with less fat. This possibility by a retrospective analysis of the energy needs subjects
and
15-56
known d (33 ± 2
is not
C Checani One group of investigators concluded that “fat intake may play a role in obesity that is independent of energy intake” (4). The ultimate test of the validity of such a proposition is the long-term effect on metabolic efficiency of perturbations of diet composition. Using the technique of caloric titrimetry (9), in which
a formula
diet
ofspecified
composition
is fed over
a period
d, i ± SE). Subjects lived in a metabolic ward and received fluid formulas with different fat and carbohydrate content, physical activity was kept constant, and precise data were available on energy intake and daily body weight. Isoenergetic formulas contamed various percentages ofcarbohydrate as cerelose (low, 15%; intermediate, 40% or 45%; high, 75%, 80%, or 85%), a constant
ofweeks under circumstances ofcontrolled physical activity, we examined the effect on metabolic efficiency (as reflected by changes in body weight) ofextreme changes in the composition ofotherwise isoenergetic diets. This technique was made possible by the careful collection ofdata on the effects offormula feeding,
15%
at the Hospital
of the Rockefeller
Subjects
methods
of energy
energy
as protein
as fat (as corn
(as milk
oil). Even
protein),
with extreme varied from
carbohydrate ratio (fat energy intake), there was no detectable evidence in energy need as a function of percentage
Cliii Nuir
and
the
balance
of
changes in the fat0% to 70% of total
ofsignitlcant
fat intake.
fat, dietary
records
carbohydrate,
in the
research
Protein
(20.9
oil. CHO
Sixty years ago, LH Newburgh and his colleagues examined the possibility that so-called endogenous obesity might be the result of special metabolic factors unrelated to energy intake or (I).
They
found
no
evidence
for
such
purely
endogenous obesity and also demonstrated that the long-term effect of any diet on body weight is related only to the total energy content of the diet. Other features of the diet such as carbohydrate or fat content did not, in the long run, have consequential effects on body weight. In recent years the adverse effects of high-fat diets on health have been emphasized, and the possibility that a high-fat intake may be accompanied by some special in vivo economy of energy metabolism has led to speculation on the role ofdiet composition in the production of obesity. Various investigators have reported a positive correlation between body fat and the percentage of fat in isoenergetic diets fed to rodents (2, 3) and humans (4, 5) and a lack of effect of dietary fat on respiratory quotient (RQ) in human
subjects
(6, 7). Additionally,
studied
24-h energy
is reported to be due balance and unrelated 350
for 9 or 24 h after
balance
almost exclusively to carbohydrate
the
years
feeding
in a respiratory
of fat
by EH Ahrens
University
and
his colleagues
( 10,
1 1).
chamber
kitchen Id/g),
from (16.7
(12):
protein,
milk
by the Lipid
Hospital
between
diets ofvarious reviewed. These
of the
which
kJ/g)
0.92;
garding
bomb
Rockefeller
represented
protein.
was
and
1965
carbohydrate diets were
(CHO) prepared
University
Hospital.
a constant
Fat (37.7
supplied
Laboratory
1955
kJ/g)
as cerelose,
1 5% of energy, was from corn a hydrated
form
variation
for
fat,
0.95;
and
carbohydrate,
0.98.
Data
re-
calorimetry of these formulas are not available. Bomb calorimetry performed on eight batches ofsimilar formula prepared in the research kitchen of the Rockefeller University Hospital between April 1988 and July 1990 had a coefficient of Id/g
of
1 .9%.
Such
formula
shows
a ±0.2%
cor-
between bomb calorimetric and calculated energy content. In studies designed to examine the effects of dietary lipid type and quantity on lipoprotein metabolism, the percentage of CHO in the diet was systematically altered by isorespondence
I
From the Laboratory
Pew Center 2
of Human
Behavior
and Metabolism
and the
ofNutritional
Supported
Excellence, Rockefeller University, New York. in part by grants DK 30583 and RROO 102 from the Na-
tional
Institutes of Health. Address reprint requests to RL Leibel, Laboratory of Human havior and Metabolism, Rockefeller University, 1230 York Avenue, 3
BeNew
York, NY 10021.
l992;55:350-5.
Downloaded from https://academic.oup.com/ajcn/article-abstract/55/2/350/4715388 by Queen Mary University of London user on 22 March 2018
studied
University
of glucose. Coefficients of digestibility were used to determine the final available energy value ofthe constituents ofthe formula
to differences in fat or protein balance (8). Am J C/in Nuir
of all subjects
Rockefeller
was derived
activity
many
who were fed liquid-formula and fat composition were
Introduction
physical
over
and
The
Am J
ofthe
Obesity, dietary energy requirements
done
variation
l992;55:350-5.
KEY WORDS diet composition,
in studies
Received Accepted Printed
October 25, 1990. for publication March in USA.
6, 1991.
© 1992 American
Society
for Clinical
Nutrition
DIET TABLE I Anthropometry
and diet characteristics
COMPOSITION
AND
ENERGY
REQUIREMENTS
351
of adults Diet
ID
Sex
Age
Mean weight
y
kg
kg
76.01
75.59
76.10 75.42 96.21 95.95 59.42 58.81 62.26 64.02 65.93
76.19 75.41 75.68 95.46 96.21 59.03 58.19 62.31 63.87 66.25
66.11
66.13
63.80 64.13 70.72 71.04 61.58 61.56 70.24 70.55 45.70 46.95 52.64 52.68 49.07 48.55
63.95 63.92 70.87 71.09 60.98 61.79 70.68 70.78 45.42 46.92 52.84 52.38 48.98 48.57
M
1 2
56
M
43
75.28
3
M
55
4
M
53
5
M
41
6
M
54
7
M
49
8
M
41
9
M
57
10
M
64
11
F
49
12
F
64
13
F
57
*
Time
WT INTS
zero intercept
of regression
Height
Days on diet
BMIt
cm
165
27.9
-
-
167.5
26.8
-
-
173.5
32.0
-
-
157.5
24.0
-
-
164.5
23.0
-
-
178
20.8
-
-
164
23.7
-
-
170
24.5
-
-
175
20.1
-
-
165
25.8
-
17.1
-
21.6
-
-
155.5
20.3
-
line of weight
%
%
Id
24
45
40
10067
9071
32 43 28 23 18 39 44 15 39 34 38 25 42 22 42 52 47 25
75 45 85 15 85 15 75 15 45 45 85 45 85 45 85 45 85 15 85 45 85 15 75 15 85
10 40 0 70 0 70 10 70 40 40 0 40 0 40 0 40 0 70 0 40 0 70 10 70 0
10067 9937 9991 13862 13862 9 100 9100 10330 10330 10201 10201 9414 9414 10590 10590 10330 9284 8498 8498 7452 6929 7322 7322 7322 7707
10242 10113 10519 12016 14652 8690 8280 10330 10096 10728 10200 9765 9 121 10590 10590 9657 9577 9493 9201 6895 6929 7468 6824 7322 7707
28 18 56 34 15 28
-
156
-
CORREC Id
Energy
d
18
-
163.5
Percent fat
Percent CHO
kJ
vs days.
t Body mass index, t Id corrected
energetic
in kg/rn’. for any weight
replacement
composition
with
were
fed
change
fat.
during
These
in random
formula
order.
supplements
were given daily in addition
lived
Clinical
in the
Research
Hospital);
physical
activity
living
no additional
the period
of formula
diets
Vitamin (Rockefeller
was constant
of varied
and
to 2 g NaCI.
Center
feeding.
mineral
All subjects University
at activities
The
daily
analysis in slope gesting
of daily
weights ofweight for these
that
acute
not
occurring
fed
likely
the
weight as nearly as possible. Interim adjustments in the quantity of formula were made to achieve this goal. Weights (to nearest 0. 1 kg) were
riods.
with
in quantities
obtained
sufficient
each
morning
exercise. to maintain
with
the
The
formulas
were
a constant
subject
always
body
clothed
in underwear.
Though stools were not collected from these subjects, similar subjects on similar diets did not show differences in the fraction of energy intake excreted in the stool (EH Ahrens, personal communication,
The
1991).
records
studied from 1955 to 1965 were in which patients were fed formula diets of differing CHO-to-fat ratios. For inclusion in this analysis, each period of formula feeding had to be 2 wk and the subject had to have remained weight stable (to within 1 kg) within that period. Reasons for rejection of records were lack searched
of feeding
of each
changes
with
result
subject
were
examined
by regression
vs time. We found no evidence functions as the 2-wk period in water
changes
of feeding
excretion
in diet exactly
ofearly changes proceeded, sugand
composition. 2 g NaCI/d
retention
This
were
is most
in all dietary
pe-
Therefore, all days on a given diet were included in these analyses. The slope of each weight-vs-time plot was examined for significant deviation from zero. If the P value of this relationship was < 0.05, the energy requirement for the individual was corrected for this intercurrent change in weight. In making this
correction
we assigned
the conservative
Id/g to the weight change. ment was calculated as:
The
corrected
(high)
daily
value
energy
of 29.3
require-
of all patients
for consecutive
of two
different
periods
formulas
or the
absence
of feeding
periods of 2 wk. A total of 47 patient records were reviewed to obtain 16 (13 adults and 3 children) fitting the above criteria.
Downloaded from https://academic.oup.com/ajcn/article-abstract/55/2/350/4715388 by Queen Mary University of London user on 22 March 2018
CORREC
KJ
=
Id formula
x
-
29.3
(regression
slope
in grams
per day).
The time zero intercepts (WT INT) of these plots are given in Table 1. The clinical characteristics and diet specifications for each adult subject are given in Table 1. Many ofthese subjects were fed a no-fat diet for several weeks at a time. At the time these studies were done, it was uncertain
352
LEIBEL
whether essential fatty acid (EFA) deficiency would occur in adult humans. Only one subject (subject 6, Table 1) developed symptoms possibly related to EFA deficiency (ie, mild eczema relieved by the addition of fat to the diet). This study was approved by the Institutional Review Board of the Rockefeller University. Energy requirements of each subject were expressed both absolutely
and
corrected
for significant
slope
ofthe
weight-vs-time
plots.
In addition each subject’s requirements were expressed per unit of body surface area (13) or per amount of body weight#{176}73.Both body surface area and weight#{176}”provide good indirect estimates of metabolic mass (14). Statistical analyses were performed on a VAX PDP 1 1/780 computer running UNIX BMDP (1 5) and UNIXSTA T (16) programs.
ET
AL
TABLE 2 Anthropornetry and energy requirements on various carbohydrate diets
Intermediate Low CHO (n=6)
Weight (kg)
65.0
require-
ments to maintain weight are shown in Table 2. This table provides summary data on the weight-maintenance energy requirements of the 13 adult subjects studied on two diets of differing percent carbohydrate. Regression plots of diet vs various body size indexes
for the three
diet
compositions
are shown
in Figure
figure examines the relationship of measured energy intake (Id) and corrected energy intake (CORREC Id) regressed on surface area (SA) and also on weight#{176}75(%,.J1’O.l5). Although energy requirements were highly significantly related to body size indexes, analysis of variance (ANOVA) of regression coef2.
This
ficients
over
groups
did
not
indicate
any
significant
between-
group
difference, regardless of the body size index used abscissa (Table 3). Five of the subjects who had received very-low-CHO
(1 5%)
and
very-high-CHO
(75-85%)
in the
diets
both were
Paired t tests of the energy requirements (CORREC Id) of these subjects on the two diets indicated no difference due to diet composition [difference of means (low high) = -334.7 Id; t = -0.558; P = 0.6 1]. Similarly, a comparison (paired t test) ofenergy requirements in the seven subjects who received both moderate-CHO (45%) and very-high-CHO separately
examined.
-
(75,
85%)
diets
indicated
no difference
due
to diet
composition
± 527
5611 ± 113
± 17
9485±607
48.7
±
2.3
53.5
33.4
±
3.8
32.4
± 3.1
22.9
± 0.9
23.0
±
427
5439
/07’
180
±
406 ± 13
5506
±
163
418
±
13
410
1.0
151 ± 8
5448 ± 180 410
±
8
* i ± SE. Thirteen subjects were studied on two diets, hence a total of 26 feeding periods. The characteristics of all subjects examined on each diet (low, intermediate, or high CHO) are given.
[difference =
of means
(low
-
high)
=
-51.5
Id; I
=
-0.2236;
P
0.8305).
the no-fat diet might have induced subclinical EFA a separate analysis was done ofthe nine subjects who received a 0-fat diet vs the 17 dietary periods of those on 1070% fat intake. Linear-regression analysis of energy and CORREC Id vs SA and O.7S was performed for these two groups, and ANOVA of regression coefficients over groups showed no significant differences between lines of regression for no-fat and fat-containing diets (Table 4). Thus, there was no aberration of energy requirement in those receiving a no-fat diet. Because
deficiency,
Children
Table
5 shows data for the three children studied. Although for weight maintenance was 30-40% higher (ku kg#{176}”) than that for adults, no significant effect of diet composition on energy requirements is seen in children, as is the case with adults. energy
need
Discussion The energy by measuring
content of foodstuffs is conventionally determined heat released by the complete combustion of the
70% FatS
FIG 1. A l3-wk study ofsubject 12, first on 10% (75% CHO) ofenergy intake as fat and then on 70% (15% CHO) ofenergy intake as fat. During both periods, 7322 U per day were fed. Actual Id combusted were corrected, as described in Subjects and Methods, to 7468 U and 6824 Id per day, respectively. It is notable that there was only 1 kg of weight variation during the entire study.
Downloaded from https://academic.oup.com/ajcn/article-abstract/55/2/350/4715388 by Queen Mary University of London user on 22 March 2018
5422±
± 8
Days
1O%Fat
± 2.1
ICJ/SA
(J/lgO.7S)
on energy
± 3.9
9401
5519±305
Adults
composition
65.7
± 356
Energy/SA (U/rn’) Energy/wt#{176}7’
(kY/rn’)
ofdiet
± 3.4
9611±431
CORREC
of effect
64.4 9791
9217±732 55.7 ± 3.5 28.8 ± 6.5 22.8 ± 1.8
410
± 1004
(n=12)
kJCORREC Age(y) Days on diet (d) Wt#{176}75 (kg)
Results
absence
± 6.9
High CHO
9406
(U/IgO.7i)
1. The
CHO (n=8)
Energy (Id)
CORREC
Six subjects had been maintained on low CHO formula, eight on intermediate CHO, and 12 on high CHO. The mean period on each diet was 32 ± 2 d (i ± SE). A plot of the daily weight is shown in a typical patient (subject 12) who received a 10%fat diet for 5 wk followed by a 70%-fat diet for 8 wk (Fig 1). The small corrections, calculated as described, are shown in Table
of 13 adult subjects
DIET
COMPOSITION
AND
14000
ENERGY
REQUIREMENTS
353
16000
0
0
14000
12000
-)
12000
-)
10000
c
10000
DO
0
0
U
8000
8000
6000
6000
1 .4
1 .6
1 .8
2.0
2.2
2.4
1 .4
1 .6
1
.8
2.0
SA
2.2
2.4
SA
14000
16000
0
0
14000
12000 ,
C
12000
C.)
w
10000
.
10000
0
U
8000
6000
6000 15
20
25
30
wr
35
FIG 2. Regression liquid-formula diets
analyses of 24-hr energy of different CHO content. CHO diets. All subjects are adults.
components
in foodstuffs combustion
of the
diet.
A recent
showed that conventional of 37.690-40.091 Id/g.
(corrected
for
urea)
food
I 7.43 1 to 2 1 . 1 50 Id/g. CHOs vary less: glucose, 1 5.560 Id/g; and sucrose, 16.481
TABLE
analysis
.
LOWCHO=15% INTERMEDIATE
0
HIGH
protein kJ/g
energy
a heat of energy
varies
starches,
from
17.48 1 Id/g;
(17).
An analysis
equations
(y
=
rnx
+
Plot
b) for the plots
in Figure
= 75%,
25
30
35
ofthe
2
area (SA) or body weight#{176}”(WT#{176}75) for for low-CHO, intermediate, and high-
energy
value
expenditure the
offoodstuffs
by indirect
true
value
even
1 8). There could in the metabolic to systemic
energy
release
under
fuel
the
glucose
to and
P(cx)
reduce
the
0.92 0.88 0.93
0.009 0.005 0.000
TABLE
4
0.94 0.83 0.96
0.004 0.0 16 0.000
2720 1477
0.92 0.79 0.92
0.010 0.020 0.000
590 1883 3343
0.93 0.72 0.95
0.008 0.050 0.000
to calculate
may most
be in error
careful
oxidation
is not
in vitro.
total
energy
by
5% of
circumstances
if, because foods, the
greater error of different
as measured
the
as used
calorimetry
be even handling
bution
r
Equation
20
CHO = 40% or 45% 80% or 85%
quired for incorporation
3
Regression
CHO
intakes vs either body surface n = 6, 8, and 12, respectively,
of the
food fats have The metabolizable
of conventional
15
0.75 &
specific
c0
8000
.00
directly
Specifically,
(17,
of differences actual
contri-
predicted
by
the
re-
ATP
activation of amino acids preparatory to their into proteins and the ready interconversion of from
actual
glycogen
energy
via energy-requiring
value
of these
steps
substrates
could
in terms
of
A Low CHO Intermediate HighCHO
CHO
Low CHO Intermediate High CHO
CHO
y = 9699x y = 699 1 x y=9025x-6146
-
6950 2393
B y y
=
y
=
=
7243x 7979x 9443x
-
2992 4297 8962
C LowCHO Intermediate High CHO
CHO
y=5l5x-2330 y 310x y = 473x
-
y
=
-
y y
=
-
D Low CHO Intermediate High CHO
CHO
=
38 1 x 339x 556x
-
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For each of the four plots, the separate three levels of CHO feeding examined coefficients by ANOVA* Plot
*
There
P (a)
ANOVA
U vs SA
F14,01 = 0.464 F14201 = 1 . 1 77 F14,,1 = 0.830
Id vs
F14201 =
A: Id vs SA
B: CORREC C: Id vs O.75 D: CORREC
regressions for each of the for differences in regression
O.73
was no significant
shifts in apparent (r = -0.027, P
=
correlation
energy stores 0.89) or O.75 (r
body
1.236
between
the occasional
0.761 0.351 0.522 0.328 small
(Id - CORREC U) and either SA = 0.15, P = 0.94).
354
LEIBEL
TABLE 5 Anthropometry
and diet characteristics
ET
AL
of children Diet
ID
Sex
Mean weight
Age
M
15
9
M
16
10
F
net energy the
8
provision
presumably
kg
cm
19.91 20.77 20.80 21.44 26.19 25.88
19.66 20.37 20.59 21.18 26.10 25.91
115
for in vivo lower
reesterification
rate
offree
chemical
and
fatty
acids
might
of feeding
when
CHOs
cause of foods
measures
of combustion.
of heat
Short-term stantial promote that
studies
this
8 wk)
adult humans. who emphasized
does
than
we used
h) in humans
wk). On average,
while
required
an average
ofbody weight.
fat) despite Differences
lower-fat
diet
expenditure,
ingesting
obese
individuals intake
on various
resting
subjects of the
The
lack
in rodents ously,
may
account
was
and
for some
children
in this
libitum
(permitting was
study
a larger
cost
subjects
lost 2.8%
(1 1.3%
observed
in which huthat although
proportion
ofweight
between
gain
of excess in either
lean
by the
com-
influenced
effect
our
data
rodents
and are
ofgrowth
those
growing
itselfon
Against this explanation is our effect on energy requirements (Table weight
differ-
fed.
be because
a possible
designed
Prewitt
need and body subjects (BMI fat diet (1 20
of the
significantly
energy
of agreement (2, 3) may
to diet composition. lack of diet-composition
intake
to deposit not
excess
introducing
rate)
hand,
efforts to feed sufficient calories to maintain in physical activity and noncompliance on
appear
position
aspects
fat diet, these
calories
phetime
metabolic
other
on energy female to a 21.4%
the lower
as fat, the energy
or obese
time fat in
by Schutz et al (7), weight equilibrium
On the
more
extended
ences. Forbes (25) recently reviewed a series of studies man subjects were overfed for 2- 1 2 wk and found energy
in
a sub-
of dietary
no effect
(19-23).
of 10.5%
that
of these short-term subjects over shorter
et al (24) recently compared the effects composition of switching 18 outpatient 18-44) from a 37% fat diet (1 4 wk)
the
suggest
storage
reported
diets
or fat
differences with laboratory
in a more
operation studying
(24-h
vs low-CHO
increase thermic
protein
each
5). These gain),
to maintain
whereas body
rodents our
were human
d
%
%
k.J
36 41 40 30 42 23
40 80 40 80 40 80
40 0 40 0 40 0
6146 6146 5623 5623 6590 6590
the number
individual
extended
period
design
of this
tions:
our
being
fed ad
weight.
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adds
ofa
value
was
relatively
periods
small,
of time
(15-
studies concluding diets of differing of 6 d ( 19-22).
considerable by the
of29.3
to any
the
to the calcula-
intercurrent
a more
by using
no CHO The
power following
kJ/g
conservative,
Nonetheless,
5766 5590 5330 5125 6590 6590
likely
figure
figure
of 29.3
Id!
g, the confidence vs days (±8.2
interval (level 0.95) around the slope of weight g/d) and the total energy ingested by each adult
subject
the 95%
minus
in energy
confidence
requirements Id/32
days
gested.
Thus,
despite
studied,
when
subject
during
which
the
limits
on diets
± 7853
large
each
equals
the
riods
oftime
in body ciency 10 460
can
(range)
ofdiffering
relatively
number
of total
are taken
differences
number kilojoules
into
lead
For
example,
analysis
in 1 y. analysis
is very
ofthese
sensitive
made to account number ofdays
fed to each
account,
to clinically
diet. With this caveat timated in two ways.
it is un-
significant
2% greater
size
power subject
and
shifts
metabolic
data can be made.
to sample
for the special for which each
in-
of subjects
of one isoenergetic diet vs another would Id/d intake and 29.3 Id/g weight gain) lead
weight gain A formal
equals
kilojoules
5% difference in energy effivery small differences in the integrated over prolonged pe-
theoretically
composition.
of total
small
diet period
ofthe
composition
± 2.7%
likely that we failed to detect a ciency between diets. However, efficiency of energy metabolism
effi-
(assuming to a 3.2 kg
However,
cannot
such
readily
be
of this study in the large was maintained on each
in mind, the /3 (type II) error can 1) The variance about the slope
be esof the
regression equation relating CORREC Id to surface area (plot B, Fig 2) may be used to estimate the likelihood of missing differences ofany desired magnitude between energy requirements on formulas of different composition. Assuming, for example, the
finding of in three
diets
is extremely
I 3- 1 7 Id/g.
a 10% decrease
subjects’
studied
for extended
as demonstrated
assignment
continuthe response
of our
study,
changes
obtained
also
ofsubjects
was studied
CORREC kJ
Energy
56 d, i 33 d) on two diets. Comparable difference in energy requirements on content were conducted for a maximum
does not immediately (7). Our results suggest
preferential
here,
efficiency
relative in the with
This point was in fact made that human subjects achieve
expenditure
of high-
in greater
and
Percent fat
Percent CHO
Although
Conversely,
weight
on high-fat diets despite the nomena. Other investigators, periods ofenergy
-
of hydrolysis
compared
not operate
to produce
-
20.0
-
for potential systematic in vivo as compared
(24-48
phenomenon
(
15.7
137
result
(4l00 Id) dietary fat supplement the use offat as a metabolic fuel
frame
-
-
an apparent Differences
are
is yet an additional the energy value
15.0
115.5
cost
Days on diet
BMI
-
respiration.
energy
ofhandling ofdietary fats and hence in net in vivo generation of ATP. effect
Height
kg
y 14
WT INT
in energy
high-CHO
variance probability
(75%
proportional ofa
efficiency
or 85%)
/3 error
(CORREC
formula
to that (acceptance
(n
for the
=
Id) conferred 12 adult
high-CHO
of a false
null
by
studies)
and
formula,
the
hypothesis)
is
P = 0.1 1 (26). 2) A direct comparison between the distributions ofCORREC Id for the seven adult subjects studied on both 45% (intermediate) and 75% or 85% (high) CHO gives paired =
-0.2236,
P(a)
= 0.8304,
and
SD ofdifferences
=
607
Id. For
DIET Pu.
as 9 12 kJ/d 9.5% above,
escaping
detection
of total energy such calculations
Similar
results
not
or lean
may be an interaction to obesity, with higher sion ofa more it is of interest
Table equal
or higher
possible
that
substrate
fat’s
the
diminished
There
may
physical
fat-foods
favor
obesity
noted (29).
intrinsically
0% to 70%
intake
produced
nods
total
more-efficient
from
of observation
oftotal
as a metabolic
some
fuel energy
no significant averaging
source. changes 33 d.
bal-
subjects
was
activity (28);
ward. and
diet
such
in-
have a preference
based
under
energy
of our
physical
caloric
It is also
to a metabolic
individuals
the caveats not provide
had
efficiency
to fat accumulation in this study.
preference,
subjects
ofpositive
between
by increasing
Id on the higheradult
diets.
restriction
that obese
with does
of
regard 1-3 in
higher-fat
enhanced
activity
This
here and probably
other
the
of
There
phenotype (27). In this three subjects (subjects
on
by their
in a group to obesity.
and predisposition facilitating the expres-
in circumstances
that predispose were not examined
It has been
obtained
of the
U
be interactions
high
our results preference
one
putative
somewhat
been
represents
reasons discussed error in this study.
had lower CORREC
but
mainly
ance. Finally,
composition teractions
BMIs all
difference
susceptible
metabolic that the
CORREC
is seen
have
of diet composition dietary fat content
highest
whereas
This
per day. For the probable
individuals
efficient to note
1) with
diets,
is 0.05.
intake overstate
might
individuals
fat
AND
0.05, the between-diet difference is 912 Id (one tail). That probability of a difference between the two diets as large
=
is, the
obese
COMPOSITION
for
on palatability, intake.
However,
mentioned above, obese individuals Variations conditions in body
may from such with
fat an
in fat intake ofequal
energy
weight
over pe0
These studies could not have been performed without the generous help and advice of Dr EH Ahrens. Two anonymous reviewers provided helpful comments.
References 1.
2.
3. 4. 5.
6.
7.
Newburgh LH, Johnston MW. Endogenous obesity-a misconception. JAMA 1930;3:8l5-25. Schemmel R, Mickelsen 0, Motavi K. Conversion of dietary to body energy in rats as affected by strain, sex and ration. J Nutr l972;l02:1 187-97. Salmon DMW, Flatt JP. Effect ofdietary fat content on the incidence ofobesity among ad libitum fed mice. Int J Obes l985;9:443-9. Romieu I, Willett W, Stampfer MJ, et al. Energy intakes and other determinants of relative weight. Am J Clin Nutr 1988;47:406-l 2. Dreon DM, Frey-Heywitt B, Ellsworth N, Williams PT, Terry RB, Woud PD. Dietary fat:carbohydrate ratio and obesity in middleaged women. Am J Clin Nutr 1988;47:995-l000. Flatt JP, Ravussin E, Acheson KL, Jequier E. Effects ofdietary fat on postprandial substrate oxidation and on carbohydrate and fat balances. J Clin Invest 1985:76:1019-24. Schutz Y, Flatt JP, Jequier E. Failure ofdietary fat intake to promote fat oxidation: a factor favoring the development of obesity. Am J Clin Nutr l989;50:307-l4.
Downloaded from https://academic.oup.com/ajcn/article-abstract/55/2/350/4715388 by Queen Mary University of London user on 22 March 2018
ENERGY
REQUIREMENTS
355
8. Abbott WGH, Howard BV, Christin L, et al. Short-term energy balance: relationship with protein, carbohydrate, and fat balances. Am J Physiol l988;255:E332-7. 9. Leibel RL, Hirsch J. Reduced energy requirements in reduced-obese patients. Metabolism l984;33:164-70. 10. Ahrens EH, Insull W, Hirsch J, et al. The effect on human serumlipids of a dietary fat, highly saturated, but poor in essential fatty acids. Lancet l959;l:l15-9. 1 1. Ahrens EH. The use ofliquid formula diets in metabolic studies: 15 years’ experience. Adv Metab Disord l970;4:297-332. 12. Watt BK, Merrill AL. Composition of Foods: raw, processed, prepared. Agriculture handbook no. 8. Washington, DC: US Government Printing Office, 1963. 13. DuBois D, DuBois EF. A formula to estimate the approximate surface area ifheight and weight be known. Arch Intern Med l9l6;17:86371. 14. Kleiber M. The fire of life. An introduction to animal energetics. Malabar, FL: Robert E Krieger, 1975. 15. Dixon WJ, ed. BMDP statistical software manual. Berkeley, CA: University of California Press, 1988. 16. Perlrnan G. Unixstat. Data analysis programs for UNIX. Tyngsboro, MA: Wang Institute ofGraduate Studies, 1986. 17. Livesey G, Elia M. Estimation of energy expenditure, net carbohydrate utilization, and net fat oxidation and synthesis by indirect calorimetry: evaluation of errors with special reference to the detailed composition of fuels. Am J Clin Nutr l988;47:608-28. 18. Elia M, Livesey G. Theory and validity ofindirect calorimetry during net lipid synthesis. Am J Clin Nutr 1988;47:59 1-607. 19. Lean MEJ, James WPT. Metabolic effects of isoenergetic nutrient exchange over 24 hours in relation to obesity in women. Int J Obes l988;12: 15-27. 20. Hurni M, Burnand B, Pittet P, Jequier E. Metabolic effects of a mixed and a high-carbohydrate diet in man, measured over 24 hours in a respiration chamber. Br J Nutr 1982;47:33-43. 21. McNeill G, Bruce AC, Ralph A, James WPT. Inter-individual differences in fasting nutrient oxidation and the influence ofdiet cornposition. Int J Obes l988;12:455-63. 22. Abbott WGH, Howard BV, Ruotolo G, Ravussin E. Energy expenditure in humans: effects of dietary fat and carbohydrate. Am J Physiol 1990;258:E347-5 1. 23. Hill JO, Peters JC, Reed GW, Schlundt DG, Sharp T, Green HL. Nutrient balance in humans: effects ofdiet composition. Am J Clin Nutr l991;54:lO-7. 24. Prewitt TE, Schmeisser D, Bowen PE, et al. Changes in body weight, body composition, and energy intake in women fed high- and lowfat diets. Am J Clin Nutr 199 1;54:304-lO. 25. Forbes GB. Do obese individuals gain weight more easily than nonobese individuals. Am J Clin Nutr l990;52:224-7. 26. Sokal RR, Rohlf FJ. Introduction to biostatistics. San Francisco:
WH Freeman,
1973:116-27.
Sims EAH Jr. Expenditure and storage of energy in man. J Clin Invest l987;79: 10 19-25. 28. Segal KR, Pi-Sunyer FX. Exercise and obesity. Med Clin North Am 1989;73:2 17-36. 29. Drewnowski A, Brunzell JD, Sande K, Iverius PH. Sweet tooth reconsidered: taste responsiveness in human obesity. Physiol Behav l985;35:6 17-22. 27.
intake required to maintain body weight by wide variation in diet composition13 L Leibel,
ABSTRACT ing
to a greater
Jules
Hirsch,
Burton
E Appel,
Diets
rich in fat may promote
deposition
of adipose-tissue
obesity
(1 3 adults,
composition
with
3 children) widely
fed liquid
varied
diets
than
was examined of 16 human
ofprecisely
fat content,
for
Gregg
by lead-
triglycerides
do isoenergetic diets with less fat. This possibility by a retrospective analysis of the energy needs subjects
and
15-56
known d (33 ± 2
is not
C Checani One group of investigators concluded that “fat intake may play a role in obesity that is independent of energy intake” (4). The ultimate test of the validity of such a proposition is the long-term effect on metabolic efficiency of perturbations of diet composition. Using the technique of caloric titrimetry (9), in which
a formula
diet
ofspecified
composition
is fed over
a period
d, i ± SE). Subjects lived in a metabolic ward and received fluid formulas with different fat and carbohydrate content, physical activity was kept constant, and precise data were available on energy intake and daily body weight. Isoenergetic formulas contamed various percentages ofcarbohydrate as cerelose (low, 15%; intermediate, 40% or 45%; high, 75%, 80%, or 85%), a constant
ofweeks under circumstances ofcontrolled physical activity, we examined the effect on metabolic efficiency (as reflected by changes in body weight) ofextreme changes in the composition ofotherwise isoenergetic diets. This technique was made possible by the careful collection ofdata on the effects offormula feeding,
15%
at the Hospital
of the Rockefeller
Subjects
methods
of energy
energy
as protein
as fat (as corn
(as milk
oil). Even
protein),
with extreme varied from
carbohydrate ratio (fat energy intake), there was no detectable evidence in energy need as a function of percentage
Cliii Nuir
and
the
balance
of
changes in the fat0% to 70% of total
ofsignitlcant
fat intake.
fat, dietary
records
carbohydrate,
in the
research
Protein
(20.9
oil. CHO
Sixty years ago, LH Newburgh and his colleagues examined the possibility that so-called endogenous obesity might be the result of special metabolic factors unrelated to energy intake or (I).
They
found
no
evidence
for
such
purely
endogenous obesity and also demonstrated that the long-term effect of any diet on body weight is related only to the total energy content of the diet. Other features of the diet such as carbohydrate or fat content did not, in the long run, have consequential effects on body weight. In recent years the adverse effects of high-fat diets on health have been emphasized, and the possibility that a high-fat intake may be accompanied by some special in vivo economy of energy metabolism has led to speculation on the role ofdiet composition in the production of obesity. Various investigators have reported a positive correlation between body fat and the percentage of fat in isoenergetic diets fed to rodents (2, 3) and humans (4, 5) and a lack of effect of dietary fat on respiratory quotient (RQ) in human
subjects
(6, 7). Additionally,
studied
24-h energy
is reported to be due balance and unrelated 350
for 9 or 24 h after
balance
almost exclusively to carbohydrate
the
years
feeding
in a respiratory
of fat
by EH Ahrens
University
and
his colleagues
( 10,
1 1).
chamber
kitchen Id/g),
from (16.7
(12):
protein,
milk
by the Lipid
Hospital
between
diets ofvarious reviewed. These
of the
which
kJ/g)
0.92;
garding
bomb
Rockefeller
represented
protein.
was
and
1965
carbohydrate diets were
(CHO) prepared
University
Hospital.
a constant
Fat (37.7
supplied
Laboratory
1955
kJ/g)
as cerelose,
1 5% of energy, was from corn a hydrated
form
variation
for
fat,
0.95;
and
carbohydrate,
0.98.
Data
re-
calorimetry of these formulas are not available. Bomb calorimetry performed on eight batches ofsimilar formula prepared in the research kitchen of the Rockefeller University Hospital between April 1988 and July 1990 had a coefficient of Id/g
of
1 .9%.
Such
formula
shows
a ±0.2%
cor-
between bomb calorimetric and calculated energy content. In studies designed to examine the effects of dietary lipid type and quantity on lipoprotein metabolism, the percentage of CHO in the diet was systematically altered by isorespondence
I
From the Laboratory
Pew Center 2
of Human
Behavior
and Metabolism
and the
ofNutritional
Supported
Excellence, Rockefeller University, New York. in part by grants DK 30583 and RROO 102 from the Na-
tional
Institutes of Health. Address reprint requests to RL Leibel, Laboratory of Human havior and Metabolism, Rockefeller University, 1230 York Avenue, 3
BeNew
York, NY 10021.
l992;55:350-5.
Downloaded from https://academic.oup.com/ajcn/article-abstract/55/2/350/4715388 by Queen Mary University of London user on 22 March 2018
studied
University
of glucose. Coefficients of digestibility were used to determine the final available energy value ofthe constituents ofthe formula
to differences in fat or protein balance (8). Am J C/in Nuir
of all subjects
Rockefeller
was derived
activity
many
who were fed liquid-formula and fat composition were
Introduction
physical
over
and
The
Am J
ofthe
Obesity, dietary energy requirements
done
variation
l992;55:350-5.
KEY WORDS diet composition,
in studies
Received Accepted Printed
October 25, 1990. for publication March in USA.
6, 1991.
© 1992 American
Society
for Clinical
Nutrition
DIET TABLE I Anthropometry
and diet characteristics
COMPOSITION
AND
ENERGY
REQUIREMENTS
351
of adults Diet
ID
Sex
Age
Mean weight
y
kg
kg
76.01
75.59
76.10 75.42 96.21 95.95 59.42 58.81 62.26 64.02 65.93
76.19 75.41 75.68 95.46 96.21 59.03 58.19 62.31 63.87 66.25
66.11
66.13
63.80 64.13 70.72 71.04 61.58 61.56 70.24 70.55 45.70 46.95 52.64 52.68 49.07 48.55
63.95 63.92 70.87 71.09 60.98 61.79 70.68 70.78 45.42 46.92 52.84 52.38 48.98 48.57
M
1 2
56
M
43
75.28
3
M
55
4
M
53
5
M
41
6
M
54
7
M
49
8
M
41
9
M
57
10
M
64
11
F
49
12
F
64
13
F
57
*
Time
WT INTS
zero intercept
of regression
Height
Days on diet
BMIt
cm
165
27.9
-
-
167.5
26.8
-
-
173.5
32.0
-
-
157.5
24.0
-
-
164.5
23.0
-
-
178
20.8
-
-
164
23.7
-
-
170
24.5
-
-
175
20.1
-
-
165
25.8
-
17.1
-
21.6
-
-
155.5
20.3
-
line of weight
%
%
Id
24
45
40
10067
9071
32 43 28 23 18 39 44 15 39 34 38 25 42 22 42 52 47 25
75 45 85 15 85 15 75 15 45 45 85 45 85 45 85 45 85 15 85 45 85 15 75 15 85
10 40 0 70 0 70 10 70 40 40 0 40 0 40 0 40 0 70 0 40 0 70 10 70 0
10067 9937 9991 13862 13862 9 100 9100 10330 10330 10201 10201 9414 9414 10590 10590 10330 9284 8498 8498 7452 6929 7322 7322 7322 7707
10242 10113 10519 12016 14652 8690 8280 10330 10096 10728 10200 9765 9 121 10590 10590 9657 9577 9493 9201 6895 6929 7468 6824 7322 7707
28 18 56 34 15 28
-
156
-
CORREC Id
Energy
d
18
-
163.5
Percent fat
Percent CHO
kJ
vs days.
t Body mass index, t Id corrected
energetic
in kg/rn’. for any weight
replacement
composition
with
were
fed
change
fat.
during
These
in random
formula
order.
supplements
were given daily in addition
lived
Clinical
in the
Research
Hospital);
physical
activity
living
no additional
the period
of formula
diets
Vitamin (Rockefeller
was constant
of varied
and
to 2 g NaCI.
Center
feeding.
mineral
All subjects University
at activities
The
daily
analysis in slope gesting
of daily
weights ofweight for these
that
acute
not
occurring
fed
likely
the
weight as nearly as possible. Interim adjustments in the quantity of formula were made to achieve this goal. Weights (to nearest 0. 1 kg) were
riods.
with
in quantities
obtained
sufficient
each
morning
exercise. to maintain
with
the
The
formulas
were
a constant
subject
always
body
clothed
in underwear.
Though stools were not collected from these subjects, similar subjects on similar diets did not show differences in the fraction of energy intake excreted in the stool (EH Ahrens, personal communication,
The
1991).
records
studied from 1955 to 1965 were in which patients were fed formula diets of differing CHO-to-fat ratios. For inclusion in this analysis, each period of formula feeding had to be 2 wk and the subject had to have remained weight stable (to within 1 kg) within that period. Reasons for rejection of records were lack searched
of feeding
of each
changes
with
result
subject
were
examined
by regression
vs time. We found no evidence functions as the 2-wk period in water
changes
of feeding
excretion
in diet exactly
ofearly changes proceeded, sugand
composition. 2 g NaCI/d
retention
This
were
is most
in all dietary
pe-
Therefore, all days on a given diet were included in these analyses. The slope of each weight-vs-time plot was examined for significant deviation from zero. If the P value of this relationship was < 0.05, the energy requirement for the individual was corrected for this intercurrent change in weight. In making this
correction
we assigned
the conservative
Id/g to the weight change. ment was calculated as:
The
corrected
(high)
daily
value
energy
of 29.3
require-
of all patients
for consecutive
of two
different
periods
formulas
or the
absence
of feeding
periods of 2 wk. A total of 47 patient records were reviewed to obtain 16 (13 adults and 3 children) fitting the above criteria.
Downloaded from https://academic.oup.com/ajcn/article-abstract/55/2/350/4715388 by Queen Mary University of London user on 22 March 2018
CORREC
KJ
=
Id formula
x
-
29.3
(regression
slope
in grams
per day).
The time zero intercepts (WT INT) of these plots are given in Table 1. The clinical characteristics and diet specifications for each adult subject are given in Table 1. Many ofthese subjects were fed a no-fat diet for several weeks at a time. At the time these studies were done, it was uncertain
352
LEIBEL
whether essential fatty acid (EFA) deficiency would occur in adult humans. Only one subject (subject 6, Table 1) developed symptoms possibly related to EFA deficiency (ie, mild eczema relieved by the addition of fat to the diet). This study was approved by the Institutional Review Board of the Rockefeller University. Energy requirements of each subject were expressed both absolutely
and
corrected
for significant
slope
ofthe
weight-vs-time
plots.
In addition each subject’s requirements were expressed per unit of body surface area (13) or per amount of body weight#{176}73.Both body surface area and weight#{176}”provide good indirect estimates of metabolic mass (14). Statistical analyses were performed on a VAX PDP 1 1/780 computer running UNIX BMDP (1 5) and UNIXSTA T (16) programs.
ET
AL
TABLE 2 Anthropornetry and energy requirements on various carbohydrate diets
Intermediate Low CHO (n=6)
Weight (kg)
65.0
require-
ments to maintain weight are shown in Table 2. This table provides summary data on the weight-maintenance energy requirements of the 13 adult subjects studied on two diets of differing percent carbohydrate. Regression plots of diet vs various body size indexes
for the three
diet
compositions
are shown
in Figure
figure examines the relationship of measured energy intake (Id) and corrected energy intake (CORREC Id) regressed on surface area (SA) and also on weight#{176}75(%,.J1’O.l5). Although energy requirements were highly significantly related to body size indexes, analysis of variance (ANOVA) of regression coef2.
This
ficients
over
groups
did
not
indicate
any
significant
between-
group
difference, regardless of the body size index used abscissa (Table 3). Five of the subjects who had received very-low-CHO
(1 5%)
and
very-high-CHO
(75-85%)
in the
diets
both were
Paired t tests of the energy requirements (CORREC Id) of these subjects on the two diets indicated no difference due to diet composition [difference of means (low high) = -334.7 Id; t = -0.558; P = 0.6 1]. Similarly, a comparison (paired t test) ofenergy requirements in the seven subjects who received both moderate-CHO (45%) and very-high-CHO separately
examined.
-
(75,
85%)
diets
indicated
no difference
due
to diet
composition
± 527
5611 ± 113
± 17
9485±607
48.7
±
2.3
53.5
33.4
±
3.8
32.4
± 3.1
22.9
± 0.9
23.0
±
427
5439
/07’
180
±
406 ± 13
5506
±
163
418
±
13
410
1.0
151 ± 8
5448 ± 180 410
±
8
* i ± SE. Thirteen subjects were studied on two diets, hence a total of 26 feeding periods. The characteristics of all subjects examined on each diet (low, intermediate, or high CHO) are given.
[difference =
of means
(low
-
high)
=
-51.5
Id; I
=
-0.2236;
P
0.8305).
the no-fat diet might have induced subclinical EFA a separate analysis was done ofthe nine subjects who received a 0-fat diet vs the 17 dietary periods of those on 1070% fat intake. Linear-regression analysis of energy and CORREC Id vs SA and O.7S was performed for these two groups, and ANOVA of regression coefficients over groups showed no significant differences between lines of regression for no-fat and fat-containing diets (Table 4). Thus, there was no aberration of energy requirement in those receiving a no-fat diet. Because
deficiency,
Children
Table
5 shows data for the three children studied. Although for weight maintenance was 30-40% higher (ku kg#{176}”) than that for adults, no significant effect of diet composition on energy requirements is seen in children, as is the case with adults. energy
need
Discussion The energy by measuring
content of foodstuffs is conventionally determined heat released by the complete combustion of the
70% FatS
FIG 1. A l3-wk study ofsubject 12, first on 10% (75% CHO) ofenergy intake as fat and then on 70% (15% CHO) ofenergy intake as fat. During both periods, 7322 U per day were fed. Actual Id combusted were corrected, as described in Subjects and Methods, to 7468 U and 6824 Id per day, respectively. It is notable that there was only 1 kg of weight variation during the entire study.
Downloaded from https://academic.oup.com/ajcn/article-abstract/55/2/350/4715388 by Queen Mary University of London user on 22 March 2018
5422±
± 8
Days
1O%Fat
± 2.1
ICJ/SA
(J/lgO.7S)
on energy
± 3.9
9401
5519±305
Adults
composition
65.7
± 356
Energy/SA (U/rn’) Energy/wt#{176}7’
(kY/rn’)
ofdiet
± 3.4
9611±431
CORREC
of effect
64.4 9791
9217±732 55.7 ± 3.5 28.8 ± 6.5 22.8 ± 1.8
410
± 1004
(n=12)
kJCORREC Age(y) Days on diet (d) Wt#{176}75 (kg)
Results
absence
± 6.9
High CHO
9406
(U/IgO.7i)
1. The
CHO (n=8)
Energy (Id)
CORREC
Six subjects had been maintained on low CHO formula, eight on intermediate CHO, and 12 on high CHO. The mean period on each diet was 32 ± 2 d (i ± SE). A plot of the daily weight is shown in a typical patient (subject 12) who received a 10%fat diet for 5 wk followed by a 70%-fat diet for 8 wk (Fig 1). The small corrections, calculated as described, are shown in Table
of 13 adult subjects
DIET
COMPOSITION
AND
14000
ENERGY
REQUIREMENTS
353
16000
0
0
14000
12000
-)
12000
-)
10000
c
10000
DO
0
0
U
8000
8000
6000
6000
1 .4
1 .6
1 .8
2.0
2.2
2.4
1 .4
1 .6
1
.8
2.0
SA
2.2
2.4
SA
14000
16000
0
0
14000
12000 ,
C
12000
C.)
w
10000
.
10000
0
U
8000
6000
6000 15
20
25
30
wr
35
FIG 2. Regression liquid-formula diets
analyses of 24-hr energy of different CHO content. CHO diets. All subjects are adults.
components
in foodstuffs combustion
of the
diet.
A recent
showed that conventional of 37.690-40.091 Id/g.
(corrected
for
urea)
food
I 7.43 1 to 2 1 . 1 50 Id/g. CHOs vary less: glucose, 1 5.560 Id/g; and sucrose, 16.481
TABLE
analysis
.
LOWCHO=15% INTERMEDIATE
0
HIGH
protein kJ/g
energy
a heat of energy
varies
starches,
from
17.48 1 Id/g;
(17).
An analysis
equations
(y
=
rnx
+
Plot
b) for the plots
in Figure
= 75%,
25
30
35
ofthe
2
area (SA) or body weight#{176}”(WT#{176}75) for for low-CHO, intermediate, and high-
energy
value
expenditure the
offoodstuffs
by indirect
true
value
even
1 8). There could in the metabolic to systemic
energy
release
under
fuel
the
glucose
to and
P(cx)
reduce
the
0.92 0.88 0.93
0.009 0.005 0.000
TABLE
4
0.94 0.83 0.96
0.004 0.0 16 0.000
2720 1477
0.92 0.79 0.92
0.010 0.020 0.000
590 1883 3343
0.93 0.72 0.95
0.008 0.050 0.000
to calculate
may most
be in error
careful
oxidation
is not
in vitro.
total
energy
by
5% of
circumstances
if, because foods, the
greater error of different
as measured
the
as used
calorimetry
be even handling
bution
r
Equation
20
CHO = 40% or 45% 80% or 85%
quired for incorporation
3
Regression
CHO
intakes vs either body surface n = 6, 8, and 12, respectively,
of the
food fats have The metabolizable
of conventional
15
0.75 &
specific
c0
8000
.00
directly
Specifically,
(17,
of differences actual
contri-
predicted
by
the
re-
ATP
activation of amino acids preparatory to their into proteins and the ready interconversion of from
actual
glycogen
energy
via energy-requiring
value
of these
steps
substrates
could
in terms
of
A Low CHO Intermediate HighCHO
CHO
Low CHO Intermediate High CHO
CHO
y = 9699x y = 699 1 x y=9025x-6146
-
6950 2393
B y y
=
y
=
=
7243x 7979x 9443x
-
2992 4297 8962
C LowCHO Intermediate High CHO
CHO
y=5l5x-2330 y 310x y = 473x
-
y
=
-
y y
=
-
D Low CHO Intermediate High CHO
CHO
=
38 1 x 339x 556x
-
Downloaded from https://academic.oup.com/ajcn/article-abstract/55/2/350/4715388 by Queen Mary University of London user on 22 March 2018
For each of the four plots, the separate three levels of CHO feeding examined coefficients by ANOVA* Plot
*
There
P (a)
ANOVA
U vs SA
F14,01 = 0.464 F14201 = 1 . 1 77 F14,,1 = 0.830
Id vs
F14201 =
A: Id vs SA
B: CORREC C: Id vs O.75 D: CORREC
regressions for each of the for differences in regression
O.73
was no significant
shifts in apparent (r = -0.027, P
=
correlation
energy stores 0.89) or O.75 (r
body
1.236
between
the occasional
0.761 0.351 0.522 0.328 small
(Id - CORREC U) and either SA = 0.15, P = 0.94).
354
LEIBEL
TABLE 5 Anthropometry
and diet characteristics
ET
AL
of children Diet
ID
Sex
Mean weight
Age
M
15
9
M
16
10
F
net energy the
8
provision
presumably
kg
cm
19.91 20.77 20.80 21.44 26.19 25.88
19.66 20.37 20.59 21.18 26.10 25.91
115
for in vivo lower
reesterification
rate
offree
chemical
and
fatty
acids
might
of feeding
when
CHOs
cause of foods
measures
of combustion.
of heat
Short-term stantial promote that
studies
this
8 wk)
adult humans. who emphasized
does
than
we used
h) in humans
wk). On average,
while
required
an average
ofbody weight.
fat) despite Differences
lower-fat
diet
expenditure,
ingesting
obese
individuals intake
on various
resting
subjects of the
The
lack
in rodents ously,
may
account
was
and
for some
children
in this
libitum
(permitting was
study
a larger
cost
subjects
lost 2.8%
(1 1.3%
observed
in which huthat although
proportion
ofweight
between
gain
of excess in either
lean
by the
com-
influenced
effect
our
data
rodents
and are
ofgrowth
those
growing
itselfon
Against this explanation is our effect on energy requirements (Table weight
differ-
fed.
be because
a possible
designed
Prewitt
need and body subjects (BMI fat diet (1 20
of the
significantly
energy
of agreement (2, 3) may
to diet composition. lack of diet-composition
intake
to deposit not
excess
introducing
rate)
hand,
efforts to feed sufficient calories to maintain in physical activity and noncompliance on
appear
position
aspects
fat diet, these
calories
phetime
metabolic
other
on energy female to a 21.4%
the lower
as fat, the energy
or obese
time fat in
by Schutz et al (7), weight equilibrium
On the
more
extended
ences. Forbes (25) recently reviewed a series of studies man subjects were overfed for 2- 1 2 wk and found energy
in
a sub-
of dietary
no effect
(19-23).
of 10.5%
that
of these short-term subjects over shorter
et al (24) recently compared the effects composition of switching 18 outpatient 18-44) from a 37% fat diet (1 4 wk)
the
suggest
storage
reported
diets
or fat
differences with laboratory
in a more
operation studying
(24-h
vs low-CHO
increase thermic
protein
each
5). These gain),
to maintain
whereas body
rodents our
were human
d
%
%
k.J
36 41 40 30 42 23
40 80 40 80 40 80
40 0 40 0 40 0
6146 6146 5623 5623 6590 6590
the number
individual
extended
period
design
of this
tions:
our
being
fed ad
weight.
Downloaded from https://academic.oup.com/ajcn/article-abstract/55/2/350/4715388 by Queen Mary University of London user on 22 March 2018
adds
ofa
value
was
relatively
periods
small,
of time
(15-
studies concluding diets of differing of 6 d ( 19-22).
considerable by the
of29.3
to any
the
to the calcula-
intercurrent
a more
by using
no CHO The
power following
kJ/g
conservative,
Nonetheless,
5766 5590 5330 5125 6590 6590
likely
figure
figure
of 29.3
Id!
g, the confidence vs days (±8.2
interval (level 0.95) around the slope of weight g/d) and the total energy ingested by each adult
subject
the 95%
minus
in energy
confidence
requirements Id/32
days
gested.
Thus,
despite
studied,
when
subject
during
which
the
limits
on diets
± 7853
large
each
equals
the
riods
oftime
in body ciency 10 460
can
(range)
ofdiffering
relatively
number
of total
are taken
differences
number kilojoules
into
lead
For
example,
analysis
in 1 y. analysis
is very
ofthese
sensitive
made to account number ofdays
fed to each
account,
to clinically
diet. With this caveat timated in two ways.
it is un-
significant
2% greater
size
power subject
and
shifts
metabolic
data can be made.
to sample
for the special for which each
in-
of subjects
of one isoenergetic diet vs another would Id/d intake and 29.3 Id/g weight gain) lead
weight gain A formal
equals
kilojoules
5% difference in energy effivery small differences in the integrated over prolonged pe-
theoretically
composition.
of total
small
diet period
ofthe
composition
± 2.7%
likely that we failed to detect a ciency between diets. However, efficiency of energy metabolism
effi-
(assuming to a 3.2 kg
However,
cannot
such
readily
be
of this study in the large was maintained on each
in mind, the /3 (type II) error can 1) The variance about the slope
be esof the
regression equation relating CORREC Id to surface area (plot B, Fig 2) may be used to estimate the likelihood of missing differences ofany desired magnitude between energy requirements on formulas of different composition. Assuming, for example, the
finding of in three
diets
is extremely
I 3- 1 7 Id/g.
a 10% decrease
subjects’
studied
for extended
as demonstrated
assignment
continuthe response
of our
study,
changes
obtained
also
ofsubjects
was studied
CORREC kJ
Energy
56 d, i 33 d) on two diets. Comparable difference in energy requirements on content were conducted for a maximum
does not immediately (7). Our results suggest
preferential
here,
efficiency
relative in the with
This point was in fact made that human subjects achieve
expenditure
of high-
in greater
and
Percent fat
Percent CHO
Although
Conversely,
weight
on high-fat diets despite the nomena. Other investigators, periods ofenergy
-
of hydrolysis
compared
not operate
to produce
-
20.0
-
for potential systematic in vivo as compared
(24-48
phenomenon
(
15.7
137
result
(4l00 Id) dietary fat supplement the use offat as a metabolic fuel
frame
-
-
an apparent Differences
are
is yet an additional the energy value
15.0
115.5
cost
Days on diet
BMI
-
respiration.
energy
ofhandling ofdietary fats and hence in net in vivo generation of ATP. effect
Height
kg
y 14
WT INT
in energy
high-CHO
variance probability
(75%
proportional ofa
efficiency
or 85%)
/3 error
(CORREC
formula
to that (acceptance
(n
for the
=
Id) conferred 12 adult
high-CHO
of a false
null
by
studies)
and
formula,
the
hypothesis)
is
P = 0.1 1 (26). 2) A direct comparison between the distributions ofCORREC Id for the seven adult subjects studied on both 45% (intermediate) and 75% or 85% (high) CHO gives paired =
-0.2236,
P(a)
= 0.8304,
and
SD ofdifferences
=
607
Id. For
DIET Pu.
as 9 12 kJ/d 9.5% above,
escaping
detection
of total energy such calculations
Similar
results
not
or lean
may be an interaction to obesity, with higher sion ofa more it is of interest
Table equal
or higher
possible
that
substrate
fat’s
the
diminished
There
may
physical
fat-foods
favor
obesity
noted (29).
intrinsically
0% to 70%
intake
produced
nods
total
more-efficient
from
of observation
oftotal
as a metabolic
some
fuel energy
no significant averaging
source. changes 33 d.
bal-
subjects
was
activity (28);
ward. and
diet
such
in-
have a preference
based
under
energy
of our
physical
caloric
It is also
to a metabolic
individuals
the caveats not provide
had
efficiency
to fat accumulation in this study.
preference,
subjects
ofpositive
between
by increasing
Id on the higheradult
diets.
restriction
that obese
with does
of
regard 1-3 in
higher-fat
enhanced
activity
This
here and probably
other
the
of
There
phenotype (27). In this three subjects (subjects
on
by their
in a group to obesity.
and predisposition facilitating the expres-
in circumstances
that predispose were not examined
It has been
obtained
of the
U
be interactions
high
our results preference
one
putative
somewhat
been
represents
reasons discussed error in this study.
had lower CORREC
but
mainly
ance. Finally,
composition teractions
BMIs all
difference
susceptible
metabolic that the
CORREC
is seen
have
of diet composition dietary fat content
highest
whereas
This
per day. For the probable
individuals
efficient to note
1) with
diets,
is 0.05.
intake overstate
might
individuals
fat
AND
0.05, the between-diet difference is 912 Id (one tail). That probability of a difference between the two diets as large
=
is, the
obese
COMPOSITION
for
on palatability, intake.
However,
mentioned above, obese individuals Variations conditions in body
may from such with
fat an
in fat intake ofequal
energy
weight
over pe0
These studies could not have been performed without the generous help and advice of Dr EH Ahrens. Two anonymous reviewers provided helpful comments.
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2.
3. 4. 5.
6.
7.
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