Ultra-processed foods, protein leverage and energy intake in the USA
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Objective: Experimental studies have shown that human macronutrient regulation minimizes variation in absolute protein intake and consequently energy intake varies passively with dietary protein density (‘protein leverage’). According to the ‘protein leverage hypothesis’ (PLH), protein leverage interacts with a reduction in dietary protein density to drive energy overconsumption and obesity. Worldwide increase in consumption of ultra-processed foods (UPF) has been hypothesized to be an important determinant of dietary protein dilution, and consequently an ecological driving force of energy overconsumption and the obesity pandemic. The present study examined the relationships between dietary contribution of UPF, dietary proportional protein content and the absolute intakes of protein and energy. Design: National representative cross-sectional study. Setting: National Health and Nutrition Examination Survey 2009–2010. Subjects: Participants ( n 9042) aged ≥2 years with at least one day of 24 h dietary recall data. Results: We found a strong inverse relationship between consumption of UPF and dietary protein density, with mean protein content dropping from 18·2 to 13·3 % between the lowest and highest quintiles of dietary contribution of UPF. Consistent with the PLH, increase in the dietary contribution of UPF (previously shown to be inversely associated with protein density) was also associated with a rise in total energy intake, while absolute protein intake remained relatively constant. Conclusions: The protein-diluting effect of UPF might be one mechanism accounting for their association with excess energy intake. Reducing UPF contribution in the US diet may be an effective way to increase its dietary protein concentration and prevent excessive energy intake.
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The protein leverage hypothesis could partially explain the higher energy intake observed with the ultra-processed diet.
“suggests that the protein leverage hypothesis could partially explain the increase in energy intake with the ultra-processed diet”
From Ultra-Processed Diets Cause Excess Calorie Intake and Weight Gain: An Inpatient Randomized Controlled Trial of Ad Libitum Food Intake (2019) · cites this paper as Martinez Steele et al., 2018
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Self-citationKoemel, N. A., Senior, A. M., Celermajer, D. S., Grech, A. L., Gill, T. P., Simpson, S. J., Raubenheimer, D., & Skilton, M. R. (2023) · Nutrients · doi:10.3390/nu15020345 · Cited by 22 · see citing works
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Insights and gaps on protein digestion
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Low-Carbohydrate Diets in Children and Adolescents With or at Risk for Diabetes
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Short-term effects of high-protein, lower-carbohydrate ultra-processed foods on human energy balance
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Transgenerational Obesity and Healthy Aging in Drosophila
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Ultra-Processed Food Intakes and Health Outcomes in Adults Older Than 60 Years: A Systematic Review
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Self-citationNeri, D. A., Steele, E. M., Rauber, F., Costa, C. D. S., Benício, M. H. D., & Levy, R. B. (2024) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2024.02.003 · Cited by 13 · see citing works
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Grech, A. L., Rangan, A., Allman-Farinelli, M. A., Simpson, S. J., Gill, T. P., & Raubenheimer, D. (2022) · Nutrients · doi:10.3390/nu14193942 · Cited by 13 · see citing works
Self-citationEvidence for the protein leverage hypothesis in preschool children prone to obesity
Zhang, H., Senior, A. M., Saner, C. C. S., Olsen, N. J., Larsen, S. C., Simpson, S. J., Raubenheimer, D., & Heitmann, B. L. (2023) · Clinical Nutrition · doi:10.1016/j.clnu.2023.09.025 · Cited by 11 · see citing works
Self-citationShared Concerns and Opportunity for Joint Action in Creating a Food Environment That Supports Health
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Industrialized foods in early infancy: a growing need of nutritional research
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Interactive influences of food, contexts and neurocognitive systems on addictive eating
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The roles of different macronutrients in regulation of appetite, energy intake and adiposity
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Association between ultra-processed food and snacking behavior in Brazil
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Ageing impairs protein leveraging in a sex-specific manner in Drosophila melanogaster
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The dramatic rise of ultra-processed foods
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Dietary macronutrient content and energy intake in the mouse: hedonic or homeostatic override?
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Self-citationProtein Decoys, Alcohol, and Energy Intake: Testing a Mechanistic‐Ecological Model
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Nutritional Ecology and Human Health
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Self-citationOruçoğlu, B., Durmuş, E., & Kemaloğlu, M. (2024) · Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi · doi:10.37989/gumussagbil.1271480 · Cited by 3 · see citing works
- Authors
- Martínez Steele, E., Raubenheimer, D., Simpson, S. J., Baraldi, L. G., & Monteiro, C. A.
- Affiliations
- The University of Sydney (AU)
- Universidade de São Paulo (BR)
- Corresponding author
- Monteiro, Carlos A
- Venue
- Public Health Nutrition
- Publisher
- Cambridge University Press (CUP)
- Published
- 2017-10-16
- Volume
- 21
- Issue
- 1
- Pages
- 114-124
- ISSN
- 1368-9800 (ISSN-L)
- 1475-2727
- PMC
- PMC10260799
- OpenAlex
- W2761938775
- Cited by
- 144
- References
- 55
- Citations by year
- 2026: 11 · 2025: 16 · 2024: 24 · 2023: 19 · 2022: 22 · 2021: 17 · 2020: 13 · 2019: 17 · 2018: 1 · 2017: 2 · 2016: 1 · 2014: 1
- FWCI
- 8.46
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Public Health Nutrition (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Fundação de Amparo à Pesquisa do Estado de São Paulo (2015/, 15/14900-9)
- Ministério da Ciência, Tecnologia e Inovação
- Conselho Nacional de Desenvolvimento Científico e Tecnológico (2014‐0, 443477/2014-0)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Consumer Attitudes and Food Labeling
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Keywords
- ultra-processed foods, protein density, energy intake, protein intake, obesity, energy overconsumption
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Cross-Sectional Studies, Diet, Dietary Proteins, Food Analysis, Food Handling, Humans, Middle Aged, Nutrition Surveys, Mental Recall, Socioeconomic Factors, United States, Exercise, Nutrition Assessment, Young Adult, Fast Foods
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