Changes in intake of protein foods, carbohydrate amount and quality, and long-term weight change: results from 3 prospective cohorts
Open accessAbstract
Background Dietary guidelines recommend interchanging protein foods (e.g., chicken for red meat), but they may be exchanged for carbohydrate-rich foods varying in quality [glycemic load (GL)]. Whether such exchanges occur and how they influence long-term weight gain are not established.Objective Our objective was to determine how changes in intake of protein foods, GL, and their interrelationship influence long-term weight gain.Design We investigated the association between 4-y changes in consumption of protein foods, GL, and their interaction with 4-y weight change over a 16- to 24-y follow-up, adjusted for other lifestyle changes (smoking, physical activity, television watching, sleep duration), body mass index, and all dietary factors simultaneously in 3 prospective US cohorts (Nurses' Health Study, Nurses' Health Study II, and Health Professionals Follow-Up Study) comprising 120,784 men and women free of chronic disease or obesity at baseline.Results Protein foods were not interchanged with each other (intercorrelations typically <|0.05|) but with carbohydrate (negative correlation as low as -0.39). Protein foods had different relations with long-term weight gain, with positive associations for meats, chicken with skin, and regular cheese (per increased serving/d, 0.13-1.17 kg; P = 0.02 to P < 0.001); no association for milk, legumes, peanuts, or eggs (P > 0.40 for each); and relative weight loss for yogurt, peanut butter, walnuts, other nuts, chicken without skin, low-fat cheese, and seafood (-0.14 to -0.71 kg; P = 0.01 to P < 0.001). Increases in GL were independently associated with a 0.42-kg greater weight gain per 50-unit increase (P < 0.001). Significant interactions (P-interaction < 0.05) between changes in protein foods and GL were identified; for example, increased cheese intake was associated with weight gain when GL increased, with weight stability when GL did not change, and with weight loss when exchanged for GL (i.e., decrease in GL).Conclusion Protein foods were commonly interchanged with carbohydrate, and changes in protein foods and GL interacted to influence long-term weight gain.
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Both Mediterranean and DASH diet patterns improve a range of risk factors, reduce long-term weight gain, and are consistently associated with lower risk of clinical events.
“Both Mediterranean and DASH diet patterns improve a range of risk factors, reduce long-term weight gain, and are consistently associated with lower risk of clinical events.19, 21, 27-29”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [29]
Longitudinal studies suggest no harms of whole-fat milk for obesity, diabetes, or cardiovascular disease in adults.
“Longitudinal studies suggest no harms of whole-fat milk for obesity, diabetes, or cardiovascular disease in adults;28, 29, 51, 57, 58”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [29]
Increased fruits, nonstarchy vegetables, nuts, yogurt, fish, and whole grains each appear to protect against chronic weight gain: the more these foods are consumed, the less the average weight gain.
“Conversely, increased fruits, nonstarchy vegetables, nuts, yogurt, fish, and whole grains each appear to protect against chronic weight gain: the more these foods are consumed, the less the average weight gain.28, 29, 51, 55”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [29]
Other conventional metrics such as total fat, energy density, and added sugar may not reliably identify how specific foods influence weight gain.
“Other conventional metrics – e.g., total fat, energy density, even added sugar– may also not reliably identify how specific foods influence weight gain.28, 29, 51”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [29]
Intakes of low-fat milk and whole-fat milk appear relatively neutral for long-term weight control, suggesting they do not perturb normal homeostatic mechanisms.
“In contrast, intakes of other foods, such as low-fat milk and whole-fat milk, appear relatively neutral, suggesting they do not perturb the normal homeostatic mechanisms for long-term weight control.29, 51”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [29]
People switching to low-fat dairy products compensate elsewhere in their diet by increasing consumption of carbohydrates.
“that people switching to low-fat dairy products compensate elsewhere in their diet by increasing consumption of carbohydrates;29”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [29]
For meats, cheese, and eggs, influences on long-term weight gain vary depending on whether they are consumed together with refined carbohydrates (more weight gain) or in place of refined carbohydrates (less weight gain or relative weight loss).
“For meats, cheese, and eggs, influences on long-term weight gain appear to vary depending on whether they are consumed together with refined carbohydrates (in which case more weight gain is evident) or in place of refined carbohydrates (in which less weight gain or even relative weight loss is seen).29”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [29]
For long-term weight gain, foods rich in refined grains, starches, and sugar appear to be primary culprits.
“For long-term weight gain, food rich in refined grains, starches, and sugar appear to be primary culprits.28, 29”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [29]
The gut microbiome appears increasingly important; probiotics in yogurt appear to interact with microbiota to reduce weight gain.
“The gut microbiome also appears increasingly important; e.g., probiotics in yogurt appear to interact with microbiota to reduce weight gain.28, 29, 51-54”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [29]
Poor quality carbohydrates are associated with long-term weight gain, diabetes, and CVD.
“Consistent with this constellation of adverse effects, poor quality carbohydrates are associated with long-term weight gain, diabetes, and CVD.29, 89, 158, 167”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [29]
In longitudinal studies among adults, neither low-fat nor whole-fat milk are appreciably related to chronic weight gain.
“In longitudinal studies among adults, neither low-fat nor whole-fat milk are appreciably related to chronic weight gain.28, 29, 51”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [29]
Increases in butter consumption are associated with modestly greater long-term weight gain.
“Increases in butter consumption are associated with modestly greater long-term weight gain.29”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [29]
The impact of cheese consumption on long-term weight may vary depending on how it is consumed: more weight gain is seen when cheese is accompanied by refined carbohydrates, and less weight gain or even relative weight loss when cheese replaces refined carbohydrates.
“The impact of cheese consumption on long-term weight may vary depending on how it is consumed: more weight gain is seen when cheese is accompanied by refined carbohydrates, and less weight gain or even relative weight loss when cheese replaces refined carbohydrates.29”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [29]
Yogurt appears protective against long-term weight gain, although when sugar-sweetened, approximately half the benefit appears lost.
“Yogurt appears protective against long-term weight gain,28, 29, 51 although when sugar-sweetened, approximately half the benefit appears lost.29”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [29]
For long-term weight maintenance, the fat content of foods is a poor metric for differentiating protective vs. harmful effects.
“For long-term weight maintenance, the fat content of foods is a poor metric for differentiating protective vs. harmful effects.28, 29, 51”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [29]
While unprocessed red meats and butter may be relatively neutral for CHD, no studies demonstrate appreciable benefits, all meats appear to increase diabetes, and processed meats are strongly linked to CHD.
“While unprocessed red meats and butter may be relatively neutral for CHD, no studies demonstrate appreciable benefits, all meats appear to increase diabetes, and processed meats are strongly linked to CHD (see Meats, above).20, 29, 173, 178”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [29]
Despite high energy density, nuts do not contribute to weight gain, changes in waist circumference, or obesity.
“Despite their high energy density, nuts do not contribute to weight gain, changes in waist circumference, or obesity perhaps owing to their satiating effects and increased fecal energy losses. (215,216).”
From Food Consumption and its Impact on Cardiovascular Disease: Importance of Solutions Focused on the Globalized Food System (2015) · cites this paper as [216]
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- Authors
- Smith, J. D., Hou, T., Ludwig, D. S., Rimm, E. B., Willett, W., Hu, F. B., & Mozaffarian, D.
- Affiliations
- Tufts University (US)
- Corresponding author
- Smith, Jessica D
- ORCID
- Venue
- The American Journal of Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2015-06
- Volume
- 101
- Issue
- 6
- Pages
- 1216-1224
- ISSN
- 0002-9165 (ISSN-L)
- PMC
- PMC4441808
- OpenAlex
- W2109060632
- Cited by
- 129
- References
- 36
- Citations by year
- 2026: 2 · 2025: 9 · 2024: 14 · 2023: 9 · 2022: 11 · 2021: 8 · 2020: 8 · 2019: 18 · 2018: 17 · 2017: 13 · 2016: 13 · 2015: 7
- FWCI
- 17.83
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- American Journal of Clinical Nutrition (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- Funders
- Canadian Institutes of Health Research
- National Heart, Lung and Blood Institute (R01 HL115189, DM)
- NIH (P01 CA87969)
- Nurses’ Health Study (UM1 CA176726)
- Nurses’ Health Study II (UM1 CA167552)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diet, Metabolism, and Disease
- Health Sciences › Medicine › Physiology › Diet and metabolism studies
- Keywords
- protein-rich foods, glycemic load, carbohydrate intake, long-term weight change, weight gain, cheese intake, meat consumption, Fabaceae, nuts, dairy products, dietary habits, weight stability
- MeSH terms
- Adult, Blood Glucose, Dairy Products, Diet, Dietary Carbohydrates, Dietary Proteins, Female, Follow-Up Studies, Humans, Life Style, Male, Meat, Middle Aged, Prospective Studies, Weight Gain, Weight Loss, Body Mass Index, Glycemic Index
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