Macronutrient (im)balance drives energy intake in an obesogenic food environment: An ecological analysis.

Abstract

The protein leverage hypothesis (PLH) postulates that strong regulation of protein intake drives energy overconsumption and obesity when human diets are diluted by fat and carbohydrates. The two predictions of the PLH are that humans (i) regulate intake to maintain protein within a narrow range and that (ii) energy intake is an inverse function of percentage energy from protein because absolute protein intake is maintained within narrow limits. Multidimensional nutritional geometry was used to test the predictions of the PLH using dietary data from the Australian National Nutrition and Physical Activity Survey. Both predictions of the PLH were confirmed in a population setting: the mean protein intake was 18.4%, and energy intake decreased with increasing energy from protein (L=-0.18, p < 0.0001). It was demonstrated that highly processed discretionary foods are a significant diluent of protein and associated with increased energy but not increased protein intake. These results support an integrated ecological and mechanistic explanation for obesity, in which low-protein highly processed foods lead to higher energy intake because of the biological response to macronutrient imbalance driven by a dominant appetite for protein. This study supports a central role for protein in the obesity epidemic, with significant implications for global health.