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Ultra-processed foods, protein leverage and energy intake in the USA

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Martínez Steele, Euridice, Raubenheimer, David, Simpson, Stephen J, Baraldi, Larissa Galastri, Monteiro, Carlos A·2018·Public Health Nutrition

DOI 10.1017/s1368980017001574PMC PMC10260799

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Abstract

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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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
ORCID: Raubenheimer, David
Simpson, Stephen J
Baraldi, Larissa Galastri
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
DOI: 10.1017/s1368980017001574
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
FWCI: 8.46
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.cambridge.org/core/terms (unspecified)
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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Ultra-processed foods, protein leverage and energy intake in the USA

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