ArticleEvolution, medicine, and public health2016
Developmental contributions to macronutrient selection: a randomized controlled trial in adult survivors of malnutrition.
Article in Evolution, medicine, and public health, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
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Who cites it
16 citing papers in PubMed, 34 citations in OpenAlex.
- Trial
- Macronutrient mixtures and interactions in health and disease.Nature reviews. Endocrinology · 2026Review
- Protein Decoys, Alcohol, and Energy Intake: Testing a Mechanistic-Ecological Model.Obesity reviews : an official journal of the International Association for the Study of Obesity · 2026Review
- Food Macronutrient Composition Influences Attentional Bias Toward Food Cues.Annals of the New York Academy of Sciences · 2026Article
- Integrated behavioral and metabolically flexible responses of wild orangutans to ecologically driven dietary variation.Science advances · 2025Article
- Protein appetite as an integrator in the obesity system: the protein leverage hypothesis.Philosophical transactions of the Royal Society of London. Series B, Biological sciences · 2023Review
- Testing for Protein Leverage in Patients with Gastric Bypass: A Pilot Study.Annals of nutrition & metabolism · 2023Article
- Faster rehabilitation weight gain during childhood is associated with risk of non-communicable disease in adult survivors of severe acute malnutrition.PLOS global public health · 2023Article
- Macronutrient (im)balance drives energy intake in an obesogenic food environment: An ecological analysis.Obesity (Silver Spring, Md.) · 2022Article
- Article
- Testing the protein-leverage hypothesis using population surveillance data.Royal Society open science · 2022Article
- Review
- The Potential Role of Protein Leverage in the US Obesity Epidemic.Obesity (Silver Spring, Md.) · 2019Article
- Ultra-processed foods, protein leverage and energy intake in the USA.Public health nutrition · 2018Article
- Neonatal Nutrition Predicts Energy Balance in Young Adults Born Preterm at Very Low Birth Weight.Nutrients · 2017Article
- Meta-analysis of variance: an illustration comparing the effects of two dietary interventions on variability in weight.Evolution, medicine, and public health · 2016Article
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Authors and funding
10 authors at 5 institutions in 4 countries.
Funding
Abstract
BACKGROUND AND
objectivesBirthweight 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%.
resultsSelf-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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