title: Macronutrient composition of the diet and prospective weight change in participants of the EPIC-PANACEA study.
abstract: BACKGROUND
  The effect of the macronutrient composition of the usual diet on long term weight maintenance remains controversial.
  
  
  METHODS
  373,803 subjects aged 25-70 years were recruited in 10 European countries (1992-2000) in the PANACEA project of the EPIC cohort. Diet was assessed at baseline using country-specific validated questionnaires and weight and height were measured at baseline and self-reported at follow-up in most centers. The association between weight change after 5 years of follow-up and the iso-energetic replacement of 5% of energy from one macronutrient by 5% of energy from another macronutrient was assessed using multivariate linear mixed-models. The risk of becoming overweight or obese after 5 years was investigated using multivariate Poisson regressions stratified according to initial Body Mass Index.
  
  
  RESULTS
  A higher proportion of energy from fat at the expense of carbohydrates was not significantly associated with weight change after 5 years. However, a higher proportion of energy from protein at the expense of fat was positively associated with weight gain. A higher proportion of energy from protein at the expense of carbohydrates was also positively associated with weight gain, especially when carbohydrates were rich in fibre. The association between percentage of energy from protein and weight change was slightly stronger in overweight participants, former smokers, participants ≥60 years old, participants underreporting their energy intake and participants with a prudent dietary pattern. Compared to diets with no more than 14% of energy from protein, diets with more than 22% of energy from protein were associated with a 23-24% higher risk of becoming overweight or obese in normal weight and overweight subjects at baseline.
  
  
  CONCLUSIONS
  Our results show that participants consuming an amount of protein above the protein intake recommended by the American Diabetes Association may experience a higher risk of becoming overweight or obese during adult life.
authors.affiliation: Department of Epidemiology & Public Health, Imperial College London, London, United Kingdom. a.vergnaud@imperial.ac.uk
authors.forename: Anne-Claire
authors.initials: AC
authors.lastname: Vergnaud
authors.forename: Teresa
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authors.lastname: Norat
authors.forename: Traci
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authors.lastname: Mouw
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authors.lastname: Bueno-de-Mesquita
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authors.forename: Kay-Tee
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authors.forename: Heinz
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authors.lastname: Slimani
authors.forename: Florence
authors.initials: F
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authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Boutron-Ruault
authors.forename: Françoise
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authors.lastname: Clavel-Chapelon
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authors.lastname: Berrino
authors.forename: Amalia
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authors.forename: Rosario
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authors.forename: Fulvio
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authors.lastname: Ricceri
authors.forename: Laudina
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authors.lastname: Rodríguez
authors.forename: Esther
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authors.lastname: Molina-Montes
authors.forename: Pilar
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authors.lastname: Amiano
authors.forename: Aurelio
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authors.lastname: Barricarte
authors.forename: Maria-Dolores
authors.initials: MD
authors.lastname: Chirlaque
authors.forename: Francesca L
authors.initials: FL
authors.lastname: Crowe
authors.forename: Philippos
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authors.lastname: Orfanos
authors.forename: Androniki
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authors.lastname: Naska
authors.forename: Antonia
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authors.lastname: Trichopoulou
authors.forename: Birgit
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authors.lastname: Teucher
authors.forename: Rudolf
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authors.lastname: Kaaks
authors.forename: Heiner
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authors.lastname: Boeing
authors.forename: Brian
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authors.lastname: Buijsse
authors.forename: Ingeged
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authors.lastname: Johansson
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authors.lastname: Hallmans
authors.forename: Isabel
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authors.lastname: Drake
authors.forename: Emily
authors.initials: E
authors.lastname: Sonestedt
authors.forename: Marianne Uhre
authors.initials: MU
authors.lastname: Jakobsen
authors.forename: Kim
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authors.lastname: Overvad
authors.forename: Anne
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authors.lastname: Tjønneland
authors.forename: Jytte
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authors.lastname: Halkjær
authors.forename: Guri
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authors.lastname: Skeie
authors.forename: Tonje
authors.initials: T
authors.lastname: Braaten
authors.forename: Eiliv
authors.initials: E
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authors.forename: Petra H M
authors.initials: PH
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mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D004032:Diet; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D004044:Dietary Proteins / Q000008:administration & dosage; D002149:Energy Intake; D005060:Europe; D006801:Humans; D016014:Linear Models; D008875:Middle Aged; D009765:Obesity; D050177:Overweight; D016012:Poisson Distribution; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D015430:Weight Gain
chemical_list: D004040:Dietary Carbohydrates; D004044:Dietary Proteins