title: Protein leverage affects energy intake of high-protein diets in humans.
abstract: BACKGROUND
  The protein leverage hypothesis requires specific evidence that protein intake is regulated more strongly than energy intake.
  
  
  OBJECTIVE
  The objective was to determine ad libitum energy intake, body weight changes, and appetite profile in response to protein-to-carbohydrate + fat ratio over 12 consecutive days and in relation to age, sex, BMI, and type of protein.
  
  
  METHODS
  A 12-d randomized crossover study was performed in 40 men and 39 women [mean ± SD age: 34.0 ± 17.6 y; BMI (in kg/m(2)): 23.7 ± 3.4] with the use of diets containing 5%, 15%, and 30% of energy from protein from a milk or plant source.
  
  
  RESULTS
  Protein-content effects did not differ by age, sex, BMI, or type of protein. Total energy intake was significantly lower in the high-protein (7.21 ± 3.08 MJ/d) condition than in the low-protein (9.33 ± 3.52 MJ/d) and normal-protein (9.62 ± 3.51 MJ/d) conditions (P = 0.001), which was predominantly the result of a lower energy intake from meals (P = 0.001). Protein intake varied directly according to the amount of protein in the diet (P = 0.001). The AUC of visual analog scale appetite ratings did not differ significantly, yet fluctuations in hunger (P = 0.019) and desire to eat (P = 0.026) over the day were attenuated in the high-protein condition compared with the normal-protein condition.
  
  
  CONCLUSIONS
  We found evidence to support the protein leverage hypothesis in that individuals underate relative to energy balance from diets containing a higher protein-to-carbohydrate + fat ratio. No evidence for protein leverage effects from diets containing a lower ratio of protein to carbohydrate + fat was obtained. It remains to be shown whether a relatively low protein intake would cause overeating or would be the effect of overeating of carbohydrate and fat. The study was registered at clinicaltrials.gov as NCT01320189.
authors.affiliation: Department of Human Biology, Maastricht University, Maastricht, The Netherlands. eap.martens@maastrichtuniversity.nl
authors.forename: Eveline A
authors.initials: EA
authors.lastname: Martens
authors.forename: Sofie G
authors.initials: SG
authors.lastname: Lemmens
authors.forename: Margriet S
authors.initials: MS
authors.lastname: Westerterp-Plantenga
mesh_terms: D000293:Adolescent; D000328:Adult; D001066:Appetite / Q000187:drug effects; D015415:Biomarkers / Q000652:urine; D001835:Body Weight; D018592:Cross-Over Studies; D004032:Diet; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D004041:Dietary Fats / Q000008:administration & dosage; D004044:Dietary Proteins / Q000008:administration & dosage*; D002149:Energy Intake / Q000502:physiology*; D004734:Energy Metabolism; D005260:Female; D006801:Humans; D006815:Hunger / Q000502:physiology; D016014:Linear Models; D008297:Male; D062407:Meals; D008875:Middle Aged; D016037:Single-Blind Method; D055815:Young Adult
chemical_list: D015415:Biomarkers; D004040:Dietary Carbohydrates; D004041:Dietary Fats; D004044:Dietary Proteins