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Epidemiology and Population Health

Evidence for protein leverage on total energy intake, but not body mass index, in a large cohort of older adults

International Journal of Obesity volume 48, pages 654–661 (2024)Cite this article

Subjects

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 (\({TEI}=\mu * {{EC}}^{L}\)). 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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Fig. 1: Overview of total energy intake association with macronutrient intakes.
Fig. 2: Nonlinear power regression estimates of macronutrients strength of leverage regarding unadjusted total energy intake (TEI), weight-height-adjusted TEI and body mass index.
Fig. 3: Right-angle mixture triangles.

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Data availability

All data supporting the conclusions of these analyses are presented in the manuscript or the supplementary material. Details of additional data can be obtained from the study authors upon reasonable request.

Code availability

The developed R project, containing all computer codes used for generating and analyzing the results presented in this article, is available upon request to ensure transparency and reproducibility. Interested parties may contact the corresponding author to obtain access to the codes. We are committed to facilitating open and collaborative research practices and will provide the codes promptly, along with any necessary documentation and version details.

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Funding

Funding

The NuAge Study was supported by a research grant from the Canadian Institutes of Health Research (CIHR; MOP-62842). The NuAge Database and Biobank are supported by the Fonds de recherche du Québec (FRQ; 2020-VICO-279753), the Quebec Network for Research on Aging, a thematic network funded by the Fonds de Recherche du Québec - Santé (FRQS) and by the Merck-Frosst Chair funded by La Fondation de l’Université de Sherbrooke. NP is a Junior 1 Research Scholar of the FRQS. AAC is a Senior Research Scholar of the FRQS. PG is a fellow of the Canadian Academy of Health Sciences.

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Authors and Affiliations

  1. PRIMUS Research Group, Department of Family Medicine, Université de Sherbrooke, 3001 12e Ave N, Sherbrooke, QC, J1H 5N4, Canada

    Sewanou H. Honfo & Alan A. Cohen

  2. University of Sydney, Charles Perkins Centre, Camperdown, NSW, 2006, Australia

    Alistair M. Senior, Stephen J. Simpson & David Raubenheimer

  3. University of Sydney, School of Life and Environmental Science, Camperdown, NSW, 2006, Australia

    Alistair M. Senior, Stephen J. Simpson & David Raubenheimer

  4. University of Sydney, Sydney Precision Data Science Centre, Camperdown, NSW, 2006, Australia

    Alistair M. Senior

  5. Research Center on Aging, CIUSSS-de-l’Estrie-CHUS, Sherbrooke, QC, Canada

    Véronique Legault, Nancy Presse, Valérie Turcot & Alan A. Cohen

  6. Centre de Recherche de l’Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada

    Nancy Presse

  7. Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada

    Nancy Presse

  8. Department of Medicine, Université de Montréal, Montréal, QC, Canada

    Pierrette Gaudreau

  9. Centre de recherche du Centre hospitalier de l’Université de Montréal, Montréal, QC, Canada

    Pierrette Gaudreau

  10. Department of Environmental Health Sciences, Butler Columbia Aging Center, Mailman School of Public Health, Columbia University, New York, NY, USA

    Alan A. Cohen

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  1. Sewanou H. Honfo
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Contributions

SHH conducted data analysis data and wrote the manuscript. AAC designed the study and reviewed the manuscript. NP, VT gave access to NuAge data and reviewed the manuscript. VL, PG, SJS and DR reviewed the manuscript.

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Correspondence to Alan A. Cohen.

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Honfo, S.H., Senior, A.M., Legault, V. et al. Evidence for protein leverage on total energy intake, but not body mass index, in a large cohort of older adults. Int J Obes 48, 654–661 (2024). https://doi.org/10.1038/s41366-023-01455-6

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