title: Changes in intake of protein foods, carbohydrate amount and quality, and long-term weight change: results from 3 prospective cohorts.
abstract: BACKGROUND
  Dietary guidelines recommend interchanging protein foods (e.g., chicken for red meat), but they may be exchanged for carbohydrate-rich foods varying in quality [glycemic load (GL)]. Whether such exchanges occur and how they influence long-term weight gain are not established.
  
  
  OBJECTIVE
  Our objective was to determine how changes in intake of protein foods, GL, and their interrelationship influence long-term weight gain.
  
  
  METHODS
  We investigated the association between 4-y changes in consumption of protein foods, GL, and their interaction with 4-y weight change over a 16- to 24-y follow-up, adjusted for other lifestyle changes (smoking, physical activity, television watching, sleep duration), body mass index, and all dietary factors simultaneously in 3 prospective US cohorts (Nurses' Health Study, Nurses' Health Study II, and Health Professionals Follow-Up Study) comprising 120,784 men and women free of chronic disease or obesity at baseline.
  
  
  RESULTS
  Protein foods were not interchanged with each other (intercorrelations typically <|0.05|) but with carbohydrate (negative correlation as low as -0.39). Protein foods had different relations with long-term weight gain, with positive associations for meats, chicken with skin, and regular cheese (per increased serving/d, 0.13-1.17 kg; P = 0.02 to P < 0.001); no association for milk, legumes, peanuts, or eggs (P > 0.40 for each); and relative weight loss for yogurt, peanut butter, walnuts, other nuts, chicken without skin, low-fat cheese, and seafood (-0.14 to -0.71 kg; P = 0.01 to P < 0.001). Increases in GL were independently associated with a 0.42-kg greater weight gain per 50-unit increase (P < 0.001). Significant interactions (P-interaction < 0.05) between changes in protein foods and GL were identified; for example, increased cheese intake was associated with weight gain when GL increased, with weight stability when GL did not change, and with weight loss when exchanged for GL (i.e., decrease in GL).
  
  
  CONCLUSIONS
  Protein foods were commonly interchanged with carbohydrate, and changes in protein foods and GL interacted to influence long-term weight gain.
authors: From Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA (JDS and DM); Department of Nutrition (JDS, DSL, EBR, WW, and FBH) and Department of Epidemiology (TH, EBR, WW, FBH, and DM), Harvard School of Public Health, Boston, MA; New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, Boston, MA (DSL); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (EBR, WW, and FBH). jess.smith@tufts.edu.
authors: Jessica D
authors: JD
authors: Smith
authors: From Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA (JDS and DM); Department of Nutrition (JDS, DSL, EBR, WW, and FBH) and Department of Epidemiology (TH, EBR, WW, FBH, and DM), Harvard School of Public Health, Boston, MA; New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, Boston, MA (DSL); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (EBR, WW, and FBH).
authors: Tao
authors: T
authors: Hou
authors: From Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA (JDS and DM); Department of Nutrition (JDS, DSL, EBR, WW, and FBH) and Department of Epidemiology (TH, EBR, WW, FBH, and DM), Harvard School of Public Health, Boston, MA; New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, Boston, MA (DSL); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (EBR, WW, and FBH).
authors: David S
authors: DS
authors: Ludwig
authors: From Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA (JDS and DM); Department of Nutrition (JDS, DSL, EBR, WW, and FBH) and Department of Epidemiology (TH, EBR, WW, FBH, and DM), Harvard School of Public Health, Boston, MA; New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, Boston, MA (DSL); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (EBR, WW, and FBH).
authors: Eric B
authors: EB
authors: Rimm
authors: From Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA (JDS and DM); Department of Nutrition (JDS, DSL, EBR, WW, and FBH) and Department of Epidemiology (TH, EBR, WW, FBH, and DM), Harvard School of Public Health, Boston, MA; New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, Boston, MA (DSL); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (EBR, WW, and FBH).
authors: Walter
authors: W
authors: Willett
authors: From Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA (JDS and DM); Department of Nutrition (JDS, DSL, EBR, WW, and FBH) and Department of Epidemiology (TH, EBR, WW, FBH, and DM), Harvard School of Public Health, Boston, MA; New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, Boston, MA (DSL); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (EBR, WW, and FBH).
authors: Frank B
authors: FB
authors: Hu
authors: From Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA (JDS and DM); Department of Nutrition (JDS, DSL, EBR, WW, and FBH) and Department of Epidemiology (TH, EBR, WW, FBH, and DM), Harvard School of Public Health, Boston, MA; New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, Boston, MA (DSL); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (EBR, WW, and FBH).
authors: Dariush
authors: D
authors: Mozaffarian
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D003611:Dairy Products; D004032:Diet; D004040:Dietary Carbohydrates / Q000008:administration & dosage*; D004044:Dietary Proteins / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D038321:Glycemic Index; D006801:Humans; D008019:Life Style; D008297:Male; D008460:Meat; D008875:Middle Aged; D011446:Prospective Studies; D015430:Weight Gain; D015431:Weight Loss
chemical_list: D001786:Blood Glucose; D004040:Dietary Carbohydrates; D004044:Dietary Proteins
keywords: dietary change; glycemic index; glycemic load; protein; weight change