Original Article
Secular differences in the association between caloric intake, macronutrient intake, and physical activity with obesity

https://doi.org/10.1016/j.orcp.2015.08.007Get rights and content

Summary

Background

To determine whether the relationship between caloric intake, macronutrient intake, and physical activity with obesity has changed over time.

Methods

Dietary data from 36,377 U.S. adults from the National Health and Nutrition Survey (NHANES) between 1971 and 2008 was used. Physical activity frequency data was only available in 14,419 adults between 1988 and 2006. Generalised linear models were used to examine if the association between total caloric intake, percent dietary macronutrient intake and physical activity with body mass index (BMI) was different over time.

Results

Between 1971 and 2008, BMI, total caloric intake and carbohydrate intake increased 10–14%, and fat and protein intake decreased 5–9%. Between 1988 and 2006, frequency of leisure time physical activity increased 47–120%. However, for a given amount of caloric intake, macronutrient intake or leisure time physical activity, the predicted BMI was up to 2.3 kg/m2 higher in 2006 that in 1988 in the mutually adjusted model (P < 0.05).

Conclusions

Factors other than diet and physical activity may be contributing to the increase in BMI over time. Further research is necessary to identify these factors and to determine the mechanisms through which they affect body weight.

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.

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