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Developmental contributions to macronutrient selection: A randomized controlled trial in adult survivors of malnutrition

Developmental contributions to macronutrient selection: A randomized controlled trial in adult survivors of malnutrition
Developmental contributions to macronutrient selection: A randomized controlled trial in adult survivors of malnutrition
Background and objectives: Birthweight differences between kwashiorkor and marasmus suggest that intrauterine factors influence the development of these syndromes of malnutrition and may modulate risk of obesity through dietary intake. We tested the hypotheses that the target protein intake in adulthood is associated with birthweight, and that protein leveraging to maintain this target protein intake would influence energy intake (EI) and body weight in adult survivors of malnutrition.

Methodology: Sixty-three adult survivors of marasmus and kwashiorkor could freely compose a diet from foods containing 10, 15 and 25 percentage energy from protein (percentage of energy derived from protein (PEP); Phase 1) for 3 days. Participants were then randomized in Phase 2 (5 days) to diets with PEP fixed at 10%, 15% or 25%.

Results: Self-selected PEP was similar in both groups. In the groups combined, selected PEP was 14.7, which differed significantly (P < 0.0001) from the null expectation (16.7%) of no selection. Self-selected PEP was inversely related to birthweight, the effect disappearing after adjusting for sex and current body weight. In Phase 2, PEP correlated inversely with EI (P = 0.002) and weight change from Phase 1 to 2 (P = 0.002). Protein intake increased with increasing PEP, but to a lesser extent than energy increased with decreasing PEP.

Conclusions and implications: Macronutrient intakes were not independently related to birthweight or diagnosis. In a free-choice situation (Phase 1), subjects selected a dietary PEP significantly lower than random. Lower PEP diets induce increased energy and decreased protein intake, and are associated with weight gain.
2050-6201
158-169
Campbell, Claudia P.
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Raubenheimer, David
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Badaloo, Asha V.
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Gluckman, Peter D.
ef2e8b92-0b76-4a12-bd7c-01b0674f94d3
Martinez, Claudia
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Gosby, Alison
9cc50198-0cb2-4218-b6b0-194ec27868ba
Simpson, Stephen J.
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Osmond, Clive
2677bf85-494f-4a78-adf8-580e1b8acb81
Boyne, Michael S.
7d787822-30fc-42e4-b3d4-8d3df98dfabd
Forrester, Terrence E.
d5ed0294-0713-4521-baf9-923f1cae5e7f
Campbell, Claudia P.
ba9a9c27-1d60-4315-bcb2-a5f8dd3e28b2
Raubenheimer, David
5c2e1be5-1600-48eb-b1ed-d9a583b30d07
Badaloo, Asha V.
9e1971de-6be4-4916-a259-83e6e41be0d2
Gluckman, Peter D.
ef2e8b92-0b76-4a12-bd7c-01b0674f94d3
Martinez, Claudia
4aad6770-dad6-4239-93d0-4c03ba2d4da7
Gosby, Alison
9cc50198-0cb2-4218-b6b0-194ec27868ba
Simpson, Stephen J.
005999e3-5bbf-409b-96cc-ace084230444
Osmond, Clive
2677bf85-494f-4a78-adf8-580e1b8acb81
Boyne, Michael S.
7d787822-30fc-42e4-b3d4-8d3df98dfabd
Forrester, Terrence E.
d5ed0294-0713-4521-baf9-923f1cae5e7f

Campbell, Claudia P., Raubenheimer, David, Badaloo, Asha V., Gluckman, Peter D., Martinez, Claudia, Gosby, Alison, Simpson, Stephen J., Osmond, Clive, Boyne, Michael S. and Forrester, Terrence E. (2016) Developmental contributions to macronutrient selection: A randomized controlled trial in adult survivors of malnutrition. Evolution, Medicine, and Public Health, 2016 (1), 158-169. (doi:10.1093/emph/eov030). (PMID:26817484)

Record type: Article

Abstract

Background and objectives: Birthweight differences between kwashiorkor and marasmus suggest that intrauterine factors influence the development of these syndromes of malnutrition and may modulate risk of obesity through dietary intake. We tested the hypotheses that the target protein intake in adulthood is associated with birthweight, and that protein leveraging to maintain this target protein intake would influence energy intake (EI) and body weight in adult survivors of malnutrition.

Methodology: Sixty-three adult survivors of marasmus and kwashiorkor could freely compose a diet from foods containing 10, 15 and 25 percentage energy from protein (percentage of energy derived from protein (PEP); Phase 1) for 3 days. Participants were then randomized in Phase 2 (5 days) to diets with PEP fixed at 10%, 15% or 25%.

Results: Self-selected PEP was similar in both groups. In the groups combined, selected PEP was 14.7, which differed significantly (P < 0.0001) from the null expectation (16.7%) of no selection. Self-selected PEP was inversely related to birthweight, the effect disappearing after adjusting for sex and current body weight. In Phase 2, PEP correlated inversely with EI (P = 0.002) and weight change from Phase 1 to 2 (P = 0.002). Protein intake increased with increasing PEP, but to a lesser extent than energy increased with decreasing PEP.

Conclusions and implications: Macronutrient intakes were not independently related to birthweight or diagnosis. In a free-choice situation (Phase 1), subjects selected a dietary PEP significantly lower than random. Lower PEP diets induce increased energy and decreased protein intake, and are associated with weight gain.

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Accepted/In Press date: 14 October 2015
e-pub ahead of print date: 27 January 2016
Organisations: MRC Life-Course Epidemiology Unit

Identifiers

Local EPrints ID: 394678
URI: https://eprints.soton.ac.uk/id/eprint/394678
ISSN: 2050-6201
PURE UUID: 387d06d1-cb8d-479a-b89a-7eef4a31e405
ORCID for Clive Osmond: ORCID iD orcid.org/0000-0002-9054-4655

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Date deposited: 23 May 2016 10:57
Last modified: 11 Apr 2019 00:38

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Contributors

Author: Claudia P. Campbell
Author: David Raubenheimer
Author: Asha V. Badaloo
Author: Peter D. Gluckman
Author: Claudia Martinez
Author: Alison Gosby
Author: Stephen J. Simpson
Author: Clive Osmond ORCID iD
Author: Michael S. Boyne
Author: Terrence E. Forrester

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