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Lipid, protein and carbohydrate intake in relation to body mass index


Objective: To examine whether the same amount of energy intake has different consequences on body mass index (BMI), depending on the source of energy from specific macronutrients.

Design: Cross-sectional study, in the context of the European Prospective Investigation into Cancer and nutrition (EPIC).

Setting: Communities all over Greece.

Subjects: A total of 27 862 apparently healthy volunteers, men and women, ages 25–82 y.

Interventions: None.

Methods: Dietary information was collected through an interviewer-administered semi-quantitative food frequency questionnaire. In the context of a cross-sectional analysis, we calculated changes of BMI per increments of energy intake from protein, carbohydrates, saturated, polyunsaturated and monounsaturated lipids and ethanol, controlling for mutual confounding and other confounders, among all participants, and after exclusion of under-reporters and/or those on a diet.

Results: Protein intake was positively associated with BMI. The association was evident when nutrients were not mutually adjusted for and increased after mutual adjustment among nutrients (β=0.80 kg/m2 per 418.4 kJ or 100 kcal increment, 95% confidence interval 0.55–1.06 for men, and β=1.59, 95% CI 1.30–1.88 for women), as well as after exclusion of under-reporters and/or those on a diet. The effects of other macronutrients were less substantial or consistent.

Conclusions: There is evidence indicating that protein intake is conducive to obesity. Moreover, our data suggest that neither saturated or monounsaturated lipids nor carbohydrates are likely to play a major role in increasing BMI over and beyond that indicated by their energy content.

Sponsorship: EPIC-Greece is supported by the Europe Against Cancer Program of the European Commission and the Greek Ministry of Health.

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  • Ainsworth BE, Haskell WL, Leon AS . 1993 Compendium of physical activities: classification of energy costs of human physical activities Med. Sci. Sports Exerc. 25: 71–80

    CAS  Article  Google Scholar 

  • Astrup A, Toubro S, Raben A, Skov AR . 1997 The role of low-fat diets and fat substitutes in body weight management: what have we learned from clinical studies? J. Am. Dietet. Assoc. 97 Suppl 7: S82–S87

    CAS  Article  Google Scholar 

  • Bray GA . 1996 Obesity In Present Knowledge in Nutrition, ed. EE Ziegler & LJ Filer 19–32 ILSI Press: Washington, DC

    Google Scholar 

  • Bray GA, Popkin BM . 1998 Dietary fat intake does affect obesity! Am. J. Clin. Nutr. 68: 1157–1173

    CAS  Article  Google Scholar 

  • De Groot LC, van Staveren WA . 1995 Reduced physical activity and its association with obesity Nutr. Rev. 53: 11–13

    CAS  Article  Google Scholar 

  • Garrow JS . 1986 Obesity In Human Nutrition and Dietetics, ed. LSP Davidson, R Passmore & MA Eastwood 465–479 Churchill Livingstone: Edinburgh

    Google Scholar 

  • Gnardellis C, Trichopoulou A, Katsouyianni K, Polychronopoulos E, Rimm EB, Trichopoulos D . 1995 Reproducibility and validity of an extensive semi-quantitative Food Frequency Questionnaire among Greek school teachers Epidemiology 6: 74–77

    CAS  Article  Google Scholar 

  • Gnardellis C, Boulou C, Trichopoulou A . 1998 Magnitude determinants and impact of under-reporting of energy intake in a cohort study in Greece Public Hlth. Nutr. 1: 131–137

    CAS  Google Scholar 

  • Goldberg GR, Black AE, Jebb SA, Cole TJ, Murgatroyd PR, Coward WA, Prentice AM . 1991 Critical evaluation of energy intake data using fundamental principles of energy physiology: 1. Derivation of cut-off values to identify under-recording Eur. J Clin. Nutr. 45: 569–581

    CAS  PubMed  Google Scholar 

  • Hill JO, Melanson EL, Wyatt HT . 2000 Dietary fat intake and regulation of energy balance: implications for obesity J. Nutr. 130: Suppl 2S: 284S–288S

    CAS  Article  Google Scholar 

  • Katsouyianni K, Rimm EB, Gnardellis C, Trichopoulos D, Polychronopoulos E, Trichopoulou A . 1997 Reproducibility and relative validity of an extensive semi-quantitative Food Frequency Questionnaire using dietary records and chemical markers among Greek school teachers Int. J. Epidemiol. 26 Suppl 1: 118–127

    Article  Google Scholar 

  • Klesges RC, Klesges LM, Haddock CK, Eck LH . 1992 A longitudinal analysis of the impacts of dietary intake and physical activity on weight change in adults Am. J. Clin. Nutr. 55: 812–822

    Article  Google Scholar 

  • Martinez ME, Giovannucci E, Spiegelman D, Hunter DJ, Willett WC, Colditz GA . 1997 Leisure-time physical activity, body size, and colon cancer in women. Nurses' Health Study Research Group J. Natl. Cancer Inst. 89: 948–955

    CAS  Article  Google Scholar 

  • McCarty MF . 2000 The origins of Western obesity: a role for animal protein? Med. Hypoth. 54: 488–494

    CAS  Article  Google Scholar 

  • Nelson LH, Tucker LA . 1996 Diet composition related to body fat in a multivariate study of 203 men J. Am. Diet. Assoc. 96: 771–777

    CAS  Article  Google Scholar 

  • Parker DR, Gonzalez S, Derby CA . 1997 Dietary factors in relation to weight change among men and women from two southeastern New England communities Int. J. Obes. Relat. Metab. Disord. 21: 103–109

    CAS  Article  Google Scholar 

  • Pols MA, Peeters PHM, Cocke M, Slimani N, Bueno-de-Mesquita HB, Collette HJA . 1997 Estimation of reproducibility and relative validity of questions included in the EPIC physical activity questionnaire Int. J. Epidemiol. 26: Sl8l–Sl89

    Article  Google Scholar 

  • Riboli F . 1992 Nutrition and Cancer: Background and rationale of the European Prospective Investigation into Cancer and Nutrition (EPIC) Ann. Oncol. 3: 783–791

    CAS  Article  Google Scholar 

  • Rising R, Harper IT, Fontvielle AM, Ferraro RT, Spraul M, Ravussin F . 1994 Determinants of total daily energy expenditure: variability in physical activity Am. J. Clin. Nutr. 59: 800–804

    CAS  Article  Google Scholar 

  • Rolland-Cachera MF, Deheeger M, Akrout M, Bellisle F . 1995 Influence of macronutrients on adiposity development: a follow up study of nutrition and growth from 10 months to 8 y of age Int. J. Obes. Relat. Metab. Disord. 19: 573–578

    CAS  PubMed  Google Scholar 

  • Schofield WN . 1985 Predicting basal metabolic rate, new standards and review of previous work Hum. Nutr. Clin. Nutr. 39C Suppl 1: 5–41

    Google Scholar 

  • Schulz LO, Schoeller DA . 1994 A compilation of total daily energy expenditure and body weights in healthy adults Am. J. Clin. Nutr. 60: 676–681

    CAS  Article  Google Scholar 

  • Seidell JC . 1998a Dietary fat and obesity: an epidemiologic perspective Am. J. Clin. Nutr. 67 Suppl 3: 546S–550S

    CAS  Article  Google Scholar 

  • Seidell JC . 1998b Societal and personal costs of obesity Exp. Clin. Endocrinol. Diabetes 106 Suppl 2: 7–9

    CAS  PubMed  Google Scholar 

  • Shetty PS. Henry CJK, Black AE, Prentice AM . 1996 Energy requirements of adults: an update on basal metabolic rates (BMRs) and physical activity levels (PALs) Eur. J. Clin. Nutr. 50 Suppl 1: S11–S23

    PubMed  Google Scholar 

  • Slattery ML, McDonald A, Bild DE, Caan BJ, Hilner JE, Jacobs DR Jr, Liu K . 1992 Associations of body fat and its distribution with dietary intake, physical activity, ethanol, and smoking in blacks and whites Am. J. Clin. Nutr. 55: 943–949

    CAS  Article  Google Scholar 

  • Stata Corporation . l999 Intercooled Stata 6.0 for Windows 98/95/NT. Stata Corporation: College Station, TX

    Google Scholar 

  • Stubbs RJ, Prentice AM, James WP . 1997 Carbohydrates and energy balance Ann. N.Y. Acad. Sci. 819: 44–69

    CAS  Article  Google Scholar 

  • Trichopoulou A . 1992 Composition of Greek Foods and Dishes (in Greek and English). Athens School of Public Health: Athens

    Google Scholar 

  • Trichopoulou A, Toupadaki N, Tzonou A, Katsouyanni K, Manousos O, Kada E, Trichopoulos D . 1993 The macronutrient composition of the Greek diet: estimates derived from six case-control studies Eur. J. Clin. Nutr. 47: 549–558

    CAS  PubMed  Google Scholar 

  • Trichopoulou A, Gnardellis CH, Lagiou A, Benetou V, Trichopoulos D . 2000 Body mass idex in relation to energy intake and expenditure among adults in Greece Epidemiology 11: 333–336

    CAS  Article  Google Scholar 

  • Wacholder S, Schatzkin A, Freedman LS, Kipnis V, Hartman A, Brown CC . 1994 Can energy adjustment separate the effects of energy from those of specific macronutrients? Am. J. Epidemiol. 140: 848–855

    CAS  Article  Google Scholar 

  • West DB, York B . 1998 Dietary fat, genetic predisposition, and obesity: lessons from animal models Am. J. Clin. Nutr. 67: 505S–512S

    CAS  Article  Google Scholar 

  • Willett W, Stampfer MJ . 1986 Total energy intake: implications for epidemiologic analyses Am. J. Epidemiol. 124: 17–27

    CAS  Article  Google Scholar 

  • Willett WC . 1998a Is dietary fat a major determinant of body fat? Am. J. Clin. Nutr. 67 Suppl 3: 556S–562S

    CAS  Article  Google Scholar 

  • Willett WC . 1998b Nutritional Epidemiology. Oxford University Press: New York

    Book  Google Scholar 

  • World Cancer Research Fund, American Institute for Cancer Research . 1997 Energy and related factors In Food Nutrition and the Prevention of Cancer: a Global Perspective 366–375 World Cancer Research Fund and American Institute for Cancer Research: Washington DC

    Google Scholar 

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The European Prospective Investigation into Cancer and nutrition (EPIC) is co-ordinated by the International Agency for Research on Cancer (IARC) and supported by the Europe Against Cancer Program of the European Commission. The Greek segment of the EPIC study is also supported by the Greek Ministry of Health.

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Correspondence to A Trichopoulou.

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Trichopoulou, A., Gnardellis, C., Benetou, V. et al. Lipid, protein and carbohydrate intake in relation to body mass index. Eur J Clin Nutr 56, 37–43 (2002).

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  • protein
  • lipids
  • carbohydrates
  • body mass index
  • obesity

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