Original ArticleSecular differences in the association between caloric intake, macronutrient intake, and physical activity with obesity
Introduction
During the past several decades the prevalence of obesity has dramatically increased in both developed and developing nations [1], including the United States where the prevalence has more than doubled between the 1970s and 2012 [2]. Obesity is primarily thought to occur as a result of energy imbalance, where energy intake exceeds energy expenditure over an extended period of time [3]. Both food energy supply and total energy intake have substantially increased in most Westernised countries [4], [5], with evidence that the increase in energy supply closely matches the increase in overweight and obesity prevalence [5]. However, the association between energy intake and body mass index (BMI) is not consistent between studies [6], [7], and recent evidence has challenged the notion that body weight is simply a function of “calories in” and “calories out” [8]. Furthermore, macronutrient composition may also be an important determinant of body weight independently of energy intake [9]. Epidemiological studies suggest that carbohydrate intake and protein intake are inversely associated with BMI, while fat intake is positively associated with BMI [9], [10], [11], [12]. However, studies examining trends in macronutrient intake over time have shown inconsistent results [7], [11], and it is not known if the association between macronutrient intake and BMI has been consistent over time.
Physical activity is commonly thought to be the other half of the energy balance equation. Although maintaining or increasing physical activity is associated with attenuated weight gain over time [13], recent reports suggest that self-reported leisure-time physical activity has significantly increased during the period when there have been dramatic increases in obesity [14], [15]. Using a simplistic energy balance equation view, this would imply that the increases in physical activity over time have been overshadowed by greater secular increases in dietary intake. Given the complex relationship between energy intake, physical activity, and BMI, the objectives of this study were to (1) examine the secular trends in BMI, caloric intake, macronutrient intake, and physical activity over time in the United States population, and (2) to determine if caloric intake, macronutrient intake, and physical activity are independently associated with BMI and whether this association has changed over time.
Section snippets
NHANES
The National Health and Nutrition Examination Survey is a series of nationally representative surveys of the United States non-institutionalised civilian population using a complex multi-stage probability sample design. A detailed explanation of the data collection methods for these surveys has been previously described elsewhere [16]. Data for this study was obtained from the NHANES I (1971–1975, n = 31,973), NHANES II (1976–1980, n = 25,286), NHANES III (1988–1994, n = 33,994), and NHANES
Trends in BMI, caloric intake, macronutrient intake, and physical activity across time
Between 1971 and 2008, BMI increased 10% in men (P < 0.001) and 11% in women (P < 0.001) (Table 1). BMI was also significantly higher between 1988 and 2008 for both males and females (P < 0.001). There was a 10% higher total caloric intake across time for males, and a 14% high total caloric intake for females (Table 1) (P < 0.001). Compared to 1988–1994, total caloric intake continued to increase in males, while it remained relatively consistent in females (Table 1). In both sexes, relative caloric
Discussion
Despite an overall increase in caloric intake in the United States over the past four decades when concurrent increases in obesity were observed, we were unable to demonstrate a direct relationship between caloric intake and increase in BMI over time. This is in line with recent suggestions that other factors beyond total caloric intake may be contributing to the epidemic rise in obesity.
When caloric intake was expressed as a function of body weight, there remained a clear inverse association
Competing interests
The authors declare that they have no competing interests.
Author's contributions
JLK designed the study, REB, PM and PM performed the statistical analyses, REB drafted the manuscript, AMS and CIA provided critical revisions to the writing of the manuscript and offered guidance for statistical analysis. All authors read and approved the final manuscript.
References (47)
- et al.
Trends in energy intake among adults in the United States: findings from NHANES
Am J Clin Nutr
(2013) - et al.
Diet composition, energy intake, and exercise in relation to body fat in men and women
Am J Clin Nutr
(1990) - et al.
Association of macronutrient intake patterns with being overweight in a population-based random sample of men in France
Diabetes Metab
(2009) - et al.
Trends in carbohydrate, fat, and protein intakes and association with energy intake in normal-weight, overweight, and obese individuals: 1971–2006
Am J Clin Nutr
(2011) - et al.
Energy from fat is associated with obesity in U.S. men: results from the Prostate Cancer Prevention Trial
Prev Med
(2002) - et al.
Trends in leisure-, transport-, and work-related physical activity in Canada 1994–2005
Prev Med
(2010) - et al.
The Harris Benedict energy requirements equation reevaluated: resting and the body cell mass
Am J Clin Nutr
(1984) - et al.
Weight-control practices among U.S. adults, 2001–2002
Am J Prev Med
(2006) - et al.
Anthropometric, metabolic, psychosocial, and dietary characteristics of overweight/obese postmenopausal women with a history of weight cycling: a MONET (Montreal Ottawa New Emerging Team) study
J Am Diet Assoc
(2009) - et al.
Circulating levels of persistent organic pollutants are related to retrospective assessment of life-time weight change
Chemosphere
(2013)
Self-report-based estimates of energy intake offer an inadequate basis for scientific conclusions
Am J Clin Nutr
Quantification of the effect of energy imbalance on bodyweight
Lancet
Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: A systematic analysis for the Global Burden of Disease Study 2013
Lancet
Prevalence of childhood and adult obesity in the United States, 2011-2012
JAMA
Obesity: preventing and managing the global epidemic: report of a WHO consultation
Trends in obesity and energy supply in the WHO MONICA Project
Int J Obes Relat Metab Disord
Increased energy intake entirely accounts for increase in body weight in women but not in men in the UK between 1986 and 2000
Br J Nutr
Trends in energy and macronutrient intakes by weight status over four decades
Public Heal Nutr
Ten putative contributors to the obesity epidemic
Crit Rev Food Sci Nutr
Estimated change in physical activity level (PAL) and prediction of 5-year weight change in men: the Aerobics Center Longitudinal Study
Int J Obes Rel Metab Disord
Population trends in leisure-time physical activity: Minnesota Heart Survey, 1980–2000
Med Sci Sports Exerc
Compendium of physical activities: an update of activity codes and MET intensities
Med Sci Sport Exerc
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