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350
Am
J
C/inNuir
l992;55:350-5.PrintedinUSA.©1992AmericanSocietyforClinicalNutrition
Energyintakerequiredtomaintainbodyweightisnotaffectedbywidevariationindietcomposition13
RudolphLLeibel,JulesHirsch,BurtonEAppel,andGreggCChecani
ABSTRACTDietsrichinfatmaypromoteobesitybylead-
ingtoagreaterdepositionofadipose-tissuetriglyceridesthan
doisoenergeticdietswith
less
fat.Thispossibilitywasexaminedbyaretrospectiveanalysisoftheenergyneedsof16human
subjects(13adults,3children)fedliquiddietsofpreciselyknowncompositionwithwidelyvariedfatcontent,for15-56d(33±2
d,i±SE).Subjectslivedinametabolicwardandreceivedfluidformulaswithdifferentfatandcarbohydratecontent,physical
activitywaskeptconstant,andprecise
datawereavailableonenergyintakeanddaily
body
weight.Isoenergeticformulascon-
tamedvariouspercentagesofcarbohydrateascerelose
(low,15%;intermediate,40%or45%;high,75%,80%,or85%),aconstant
15%ofenergyasprotein(asmilkprotein),andthebalanceof
energyasfat(ascornoil).Evenwithextremechangesinthefat-
carbohydrateratio(fatenergyvaried
from0%to70%oftotal
intake),therewasnodetectableevidenceofsignitlcantvariationinenergyneedasa
functionofpercentagefatintake.
AmJCliiiNuir
l992;55:350-5.
KEYWORDSObesity,dietaryfat,dietarycarbohydrate,dietcomposition,energyrequirementsIntroductionSixty
years
ago,LHNewburghandhiscolleaguesexaminedthepossibilitythatso-calledendogenousobesitymightbethe
result
ofspecialmetabolicfactorsunrelatedtoenergyintakeor
physicalactivity(I).Theyfoundnoevidenceforsuchpurely
endogenousobesityandalsodemonstratedthatthelong-termeffectofanydieton
body
weightisrelatedonlytothetotalenergycontentofthediet.Otherfeaturesofthedietsuchas
carbohydrate
orfatcontentdidnot,inthelongrun,havecon-
sequentialeffectsonbody
weight.Inrecentyearstheadverseeffectsofhigh-fatdietsonhealthhave
been
emphasized,andthepossibilitythatahigh-fatintakemaybeaccompaniedbysomespecialinvivoeconomyof
energy
metabolismhasledtospeculationontheroleofdietcomposition
intheproductionofobesity.Variousinvestigators
have
reported
apositivecorrelationbetween
body
fatandthepercentageoffatinisoenergeticdietsfedtorodents
(2,
3)andhumans(4,5)andalackofeffectofdietaryfatonrespiratoryquotient(RQ)
inhumansubjectsstudiedfor9or24hafterthefeedingoffat
(6,7).Additionally,24-henergybalanceina
respiratory
chamber
isreportedtobeduealmostexclusivelytodifferencesinfatbalanceandunrelatedtocarbohydrateorproteinbalance(8).
Onegroupofinvestigatorsconcludedthat“fatintakemayplayaroleinobesitythatisindependentofenergyintake”(4).Theultimatetestofthevalidityofsuchapropositionisthelong-termeffectonmetabolicefficiencyofperturbationsofdietcomposition.Usingthetechniqueofcalorictitrimetry(9),in
whichaformuladietofspecifiedcompositionisfedoveraperiod
ofweeksundercircumstancesofcontrolledphysicalactivity,weexaminedtheeffectonmetabolicefficiency(asreflectedbychangesin
bodyweight)ofextremechangesinthecompositionofotherwise
isoenergeticdiets.Thistechniquewasmadepossiblebythecarefulcollectionofdataontheeffectsofformula
feeding,instudiesdoneovermanyyearsbyEHAhrensandhiscolleagues
attheHospitaloftheRockefellerUniversity
(
10,11).
SubjectsandmethodsTherecordsofallsubjectsstudiedbytheLipidLaboratory
oftheRockefellerUniversityHospitalbetween1955and1965
whowerefedliquid-formuladietsofvariouscarbohydrate(CHO)andfatcompositionwerereviewed.Thesedietswereprepared
intheresearchkitchenoftheRockefellerUniversityHospital.Protein(20.9Id/g),whichrepresentedaconstant15%ofenergy,
wasderivedfrommilkprotein.Fat(37.7kJ/g)
wasfromcornoil.CHO(16.7kJ/g)wassuppliedascerelose,ahydratedform
ofglucose.Coefficientsofdigestibilitywereusedtodeterminethefinalavailableenergyvalueoftheconstituentsoftheformula
(12):protein,0.92;fat,0.95;andcarbohydrate,0.98.Datare-
gardingbombcalorimetryoftheseformulasarenotavailable.
Bombcalorimetry
performedoneightbatchesofsimilarformulapreparedintheresearchkitchenoftheRockefellerUniversityHospitalbetweenApril1988andJuly1990hadacoefficientof
variationforId/gof1.9%.Suchformulashowsa±0.2%cor-respondence
betweenbombcalorimetricandcalculatedenergycontent.Instudiesdesignedtoexaminetheeffectsofdietary
lipidtype
andquantityonlipoproteinmetabolism,theper-centageofCHOinthedietwassystematicallyalteredbyiso-
I
FromtheLaboratoryofHumanBehaviorandMetabolismandthe
PewCenterofNutritionalExcellence,RockefellerUniversity,NewYork.
2
Supportedinpartby
grants
DK
30583andRROO102fromtheNa-tionalInstitutesofHealth.
3
AddressreprintrequeststoRLLeibel,LaboratoryofHumanBe-haviorandMetabolism,RockefellerUniversity,1230YorkAvenue,New
York,NY10021.
ReceivedOctober25,1990.AcceptedforpublicationMarch6,1991.
DIETCOMPOSITIONANDENERGYREQUIREMENTS
351
TABLEIAnthropometryanddietcharacteristicsofadults
ID
SexAgeMeanweightWTINTSHeightBMItDaysondietDietPercentCHOPercentfatEnergyCORRECId
ykgkgcmd%%IdkJ1
M5676.01
76.10
75.59
76.19
165
-
27.9
-
24
32
45
75
40
10
10067
10067
9071
10242
2M43
75.28
75.42
75.41
75.68
167.5
-
26.8
-
43
28
45
85
40
0
9937
9991
10113
105193M5596.2195.9595.4696.21173.5
-
32.0
-
23181585700138621386212016146524M5359.4258.8159.0358.19157.5
-
24.0
-
39
44
15
75
70
10
9
100
9100
8690
82805M4162.2664.0262.3163.87164.5
-
23.0
-
153915457040103301033010330100966M5465.93
66.11
66.25
66.13
178
-
20.8
-
34384585400102011020110728102007M4963.8064.1363.9563.92164
-
23.7
-
2542458540094149414976591218M4170.7271.0470.8771.09170
-
24.5
-
22424585400105901059010590105909M5761.5861.5660.9861.79175
-
20.1
-
524745854001033092849657957710M6470.2470.5570.6870.78165
-
25.8
-
25
18
1585700849884989493920111F4945.70
46.95
45.42
46.92
163.5
-
17.1
-
28184585400745269296895692912F6452.6452.6852.8452.38156
-
21.6
-
56
34
15
75
70
10
7322
7322
7468
6824
13F5749.0748.5548.9848.57155.5
-
20.3
-
152815857007322770773227707
*
Timezerointerceptofregressionlineofweightvsdays.
t
Bodymassindex,inkg/rn’.
t
Idcorrectedforanyweightchangeduringtheperiodofformulafeeding.energeticreplacementwithfat.Theseformuladietsofvariedcompositionwerefedinrandomorder.Vitaminandmineral
supplementsweregivendailyinadditionto2gNaCI.Allsubjects
livedintheClinicalResearchCenter(RockefellerUniversity
Hospital);physicalactivitywasconstantatactivitiesofdaily
livingwithnoadditionalexercise.Theformulaswerealwaysfedinquantitiessufficienttomaintainaconstantbody
weightasnearlyaspossible.Interimadjustmentsinthequantityofformulaweremadetoachievethisgoal.Weights(tonearest0.1kg)were
obtainedeachmorningwiththesubjectclothedinunderwear.
Thoughstoolswerenotcollectedfromthesesubjects,similarsubjectsonsimilardietsdidnotshowdifferencesinthefractionofenergyintakeexcretedinthestool(EHAhrens,personal
communication,1991).
Therecordsofallpatientsstudiedfrom1955to1965were
searchedforconsecutiveperiods
inwhichpatientswerefedfor-muladietsofdifferingCHO-to-fatratios.Forinclusioninthis
analysis,eachperiodofformulafeedinghadtobe
2
wkandthesubjecthadtohaveremainedweightstable(towithin1kg)withinthatperiod.Reasonsforrejectionofrecordswerelack
offeedingoftwodifferentformulasortheabsenceoffeeding
periodsof
2
wk.Atotalof47patientrecordswerereviewedtoobtain16(13adultsand3children)fittingtheabovecriteria.Thedailyweightsofeachsubjectwereexaminedbyregression
analysisofweightvstime.Wefoundnoevidenceofearlychangesinslopeforthesefunctionsasthe2-wkperiodproceeded,sug-gestingthatacutechangesinwaterexcretionandretentionwere
notoccurringwithchangesindietcomposition.Thisismost
likelytheresultoffeedingexactly2gNaCI/dinalldietarype-
riods.Therefore,alldaysonagivendietwereincludedinthese
analyses.
Theslopeofeachweight-vs-timeplot
was
examinedforsignificantdeviationfromzero.Ifthe
P
valueofthisrela-
tionshipwas
<
0.05,theenergyrequirementfortheindividualwascorrectedforthisintercurrentchangeinweight.Inmaking
thiscorrectionweassignedtheconservative(high)valueof29.3
Id/gtotheweightchange.Thecorrecteddailyenergyrequire-mentwascalculatedas:CORRECKJ
=
Id
formula
-
29.3
x
(regressionslopeingramsperday).Thetimezerointercepts(WTINT)oftheseplotsaregiveninTable1.TheclinicalcharacteristicsanddietspecificationsforeachadultsubjectaregiveninTable1.Manyofthesesubjectswerefedano-fatdietforseveralweeksatatime.Atthetimethesestudiesweredone,itwasuncertain
352LEIBELETALwhetheressentialfattyacid(EFA)deficiencywouldoccurinadulthumans.Onlyonesubject(subject6,Table1)developedsymptomspossiblyrelatedtoEFAdeficiency(ie,mildeczemarelievedbytheadditionoffattothediet).ThisstudywasapprovedbytheInstitutionalReviewBoardoftheRockefellerUniversity.
Energyrequirements
ofeachsubjectwereexpressed
bothab-solutelyandcorrectedforsignificantslopeoftheweight-vs-time
plots.Inadditioneachsubject’srequirementswereexpressed
per
unitof
bodysurfacearea(13)or
peramountof
body
weight#{176}73.oth
body
surfaceareaandweight#{176}”provide
good
indirectestimatesofmetabolic
mass
(14).Statisticalanalyseswere
performed
onaVAXPDP11/780computerrunning
UNIXBMDP
(15)and
UNIXSTAT
(16)programs.Results
Adults
SixsubjectshadbeenmaintainedonlowCHOformula,eightonintermediateCHO,and12onhighCHO.Themeanperiodoneachdietwas32±2d(i±SE).Aplotofthedailyweight
isshowninatypical
patient(subject12)who
receiveda10%-
fatdietfor5wkfollowedbya70%-fatdietfor8wk(Fig1).Thesmallcorrections,calculatedasdescribed,areshowninTable
1.Theabsenceofeffectofdietcompositiononenergyrequire-
mentstomaintainweightareshowninTable2.Thistablepro-videssummarydataontheweight-maintenanceenergyrequire-mentsofthe13adultsubjectsstudiedontwodietsofdiffering
percentcarbohydrate.Regression
plotsofdietvsvarious
bodysizeindexesforthethreedietcompositionsareshowninFigure
2.
Thisfigureexaminestherelationshipof
measuredenergyin-take(Id)
andcorrectedenergyintake(CORRECId)
regressed
onsurfacearea(SA)andalsoonweight#{176}75
%,J1O.l5).
Althoughenergy
requirementswerehighlysignificantlyrelatedto
body
sizeindexes,analysisofvariance(ANOVA)ofregressioncoef-
ficientsovergroupsdidnotindicateanysignificantbetween-
groupdifference,regardlessofthe
bodysize
index
usedintheabscissa
(Table3).Fiveofthesubjectswhohadreceivedboth
very-low-CHO(15%)andvery-high-CHO(75-85%)dietswereseparatelyexamined.
Paired
t
tests
oftheenergyrequirements(CORRECId)ofthesesubjectsonthetwodietsindicatednodifferenceduetodietcomposition[differenceofmeans(low
-
high)
=
-334.7Id;
t
=
-0.558;
P
=
0.61].Similarly,acom-
parison(pairedttest)ofenergyrequirements
inthesevensubjectswhoreceivedbothmoderate-CHO
(45%)
andvery-high-CHO(75,85%)dietsindicatednodifferenceduetodietcomposition
TABLE
2
Anthropornetryandenergyrequirementsof13adultsubjectsonvariouscarbohydrate
diets
Intermediate
Low
CHO
(n=6)
CHO
(n=8)
High
CHO
(n=12)
Weight(kg)65.0
±6.964.4±3.465.7±3.9
Energy(Id)
9406
±
1004
9791±3569401±527
kJCORREC9217±732
9611±4319485±607
Age(y)
55.7
±
3.548.7
±
2.353.5±2.1
Days
ondiet(d)28.8
±6.533.4
±
3.832.4
±3.1
Wt#{176}75kg)22.8
±1.822.9±0.923.0±1.0
Energy/SA(U/rn’)5519±3055611±1135422±151Energy/wt#{176}7’
(U/IO.7i)
410
±17427±8410±8
CORREC
ICJ/SA
(kY/rn’)
5439
±
180
5506
±
1635448
±180
CORREC
07’
(/lO.7S)
406
±13418
±
13410
±
8
*
i
±
SE.Thirteensubjectswerestudiedon
twodiets,henceatotal
of26feedingperiods.Thecharacteristicsofallsubjectsexaminedon
eachdiet
(low,intermediate,orhighCHO)aregiven.[differenceofmeans(low
-
high)
=
-51.5Id;I
=
-0.2236;
P
=
0.8305).
Because
theno-fatdietmighthaveinducedsubclinicalEFAdeficiency,aseparateanalysiswasdoneoftheninesubjectswho
receiveda
0-fatdietvsthe17dietary
periods
ofthoseon10-
70%
fatintake.Linear-regressionanalysisofenergyandCOR-RECIdvsSAand
.7S
was
performedforthesetwogroups,andANOVAofregressioncoefficientsovergroupsshowedno
significantdifferencesbetween
linesofregressionforno-fatand
fat-containingdiets
(Table4).Thus,therewasnoaberrationof
energy
requirementinthosereceivingano-fatdiet.
Children
Table
5
showsdataforthethreechildrenstudied.Although
energyneed
forweightmaintenancewas30-40%higher(kukg#{176}”)hanthatforadults,nosignificanteffectofdiet
compo-
sitiononenergyrequirementsis
seen
inchildren,asisthecasewithadults.DiscussionTheenergycontentof
foodstuffsisconventionallydetermined
bymeasuringheatreleasedbythecompletecombustionofthe
Days
1O%Fat
70%
FatS
FIG1.Al3-wkstudyofsubject12,first
on
10%
(75%CHO)
ofenergyintakeasfatandthenon70%(15%CHO)ofenergyintakeasfat.Duringbothperiods,7322Uperdaywere
fed.ActualIdcombustedwerecorrected,as
describedinSubjectsandMethods,to7468Uand
6824Id
perday,respectively.
Itisnotablethatthere
was
only
1kgofweightvariationduringtheentirestudy.
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