Lean Mass Loss Is Associated with Low Protein Intake during Dietary-Induced Weight Loss in Postmenopausal Women


      The health and quality-of-life implications of overweight and obesity span all ages in the United States. We investigated the association between dietary protein intake and loss of lean mass during weight loss in postmenopausal women through a retrospective analysis of a 20-week randomized, controlled diet and exercise intervention in women aged 50 to 70 years. Weight loss was achieved by differing levels of caloric restriction and exercise. The diet-only group reduced caloric intake by 2,800 kcal/week, and the exercise groups reduced caloric intake by 2,400 kcal/week and expended ∼400 kcal/week through aerobic exercise. Total and appendicular lean mass was measured using dual energy x-ray absorptiometry. Linear regression analysis was used to examine the association between changes in lean mass and appendicular lean mass and dietary protein intake. Average weight loss was 10.8±4.0 kg, with an average of 32% of total weight lost as lean mass. Protein intake averaged 0.62 g/kg body weight/day (range=0.47 to 0.8 g/kg body weight/day). Participants who consumed higher amounts of dietary protein lost less lean mass and appendicular lean mass (r=0.3, P=0.01 and r=0.41, P<0.001, respectively). These associations remained significant after adjusting for intervention group and body size. Therefore, inadequate protein intake during caloric restriction may be associated with adverse body-composition changes in postmenopausal women.
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        • Ogden C.L.
        • Carroll M.D.
        • Curtin L.R.
        • McDowell M.A.
        • Tabak C.J.
        • Flegal K.M.
        Prevalence of overweight and obesity in the United States, 1999-2004.
        JAMA. 2006; 295: 1549-1555
        • Harris T.B.
        • Launer L.J.
        • Madans J.
        • Feldman J.J.
        Cohort study of effect of being overweight and change in weight on risk of coronary heart disease in old age.
        BMJ. 1997; 314: 1791-1794
        • Sahyoun N.R.
        • Hochberg M.C.
        • Helmick C.G.
        • Harris T.
        • Pamuk E.R.
        Body mass index, weight change, and incidence of self-reported physician-diagnosed arthritis among women.
        Am J Public Health. 1999; 89: 391-394
        • Gallagher S.
        Bariatrics: Considering Mobility, Patient Safety and Caregiver Injury.
        CRC Press, New York2004
        • Goya W.S.
        • Gerald S.A.
        • Whincup P.H.
        • Walker M.
        Overweight and obesity and the burden of disease and disability in elderly men.
        Int J Obes Relat Metab Disord. 2004; 28: 1374-1382
        • Livingston E.H.
        • Ko C.Y.
        Use of the health and activities limitation index as a measure of quality of life in obesity.
        Obes Res. 2002; 10: 824-832
        • Janssen I.
        • Ross R.
        Linking age-related changes in skeletal muscle mass and composition with metabolism and disease.
        J Nutr Health Aging. 2005; 9: 408-419
        • Baumgartner R.N.
        • Koehler K.M.
        • Gallagher D.
        • Romero L.
        • Heymsfield S.B.
        • Ross R.R.
        • Garry P.J.
        • Lindeman R.D.
        Epidemiology of sarcopenia among the elderly in New Mexico.
        Am J Epidemiol. 1998; 147: 755-763
        • Weiss E.P.
        • Racette S.B.
        • Villareal D.T.
        • Fontana L.
        • Steger-May K.
        • Schechtman K.B.
        • Klein S.
        • Ehsani A.A.
        • Holloszy J.O.
        • Washington University School of Medicine CALERIE Group
        Lower extremity muscle size and strength and aerobic capacity decrease with caloric restriction but not with exercise-induced weight loss.
        J Appl Physiol. 2007; 102: 634-640
        • Ross R.
        • Dagnone D.
        • Jones P.J.
        • Smith H.
        • Paddags A.
        • Hudson R.
        • Janssen I.
        Reduction in obesity and related comorbid conditions after diet-induced weight loss or exercise-induced weight loss in men.
        Ann Intern Med. 2000; 133: 92-103
        • Janssen I.
        • Fortier A.
        • Hudson R.
        • Ross R.
        Effects of an energy-restrictive diet with or without exercise on abdominal fat, intermuscular fat, and metabolic risk factors in obese women.
        Diabetes Care. 2002; 25: 431-438
        • Krieger J.W.
        • Sitren H.S.
        • Daniels M.J.
        • Langkamp-Henken B.
        Effects of variation in protein and carbohydrate intake on body mass and composition during energy restriction: A meta-regression 1.
        Am J Clin Nutr. 2006; 83: 260-274
        • Institute of Medicine
        Protein and Amino Acids.
        in: National Academies Press, Washington, DC2002: 465-608
        • Campbell W.W.
        • Trappe T.A.
        • Wolfe R.R.
        • Evans W.J.
        The recommended dietary allowance for protein may not be adequate for older people to maintain skeletal muscle.
        J Gerontol A Biol Sci Med Sci. 2001; 56: M373-M380
        • Pellet P.L.
        • Young V.R.
        The effects of different levels of energy intake on protein metabolism and of different levels of protein intake on energy metabolism: A statistical evaluation from the published literature.
        in: Scrimshaw N.S. Schurch B. Protein-Energy Interactions. International Dietary Energy Consultative Group, Lausanne, Switzerland1992: 81-121
        • Layman D.K.
        • Boileau R.A.
        • Erickson D.J.
        • Painter J.E.
        • Shiue H.
        • Sather C.
        • Christou D.D.
        A reduced ratio of dietary carbohydrate to protein improves body composition and blood lipid profiles during weight loss in adult women.
        J Nutr. 2003; 133: 411-417
        • Layman D.K.
        • Evans E.
        • Baum J.I.
        • Seyler J.
        • Erickson D.J.
        • Boileau R.A.
        Dietary protein and exercise have additive effects on body composition during weight loss in adult women.
        J Nutr. 2005; 135: 1903-1910
        • Leidy H.J.
        • Carnell N.S.
        • Mattes R.D.
        • Campbell W.W.
        Higher protein intake preserves lean mass and satiety with weight loss in pre-obese and obese women.
        Obesity (Silver Spring). 2007; 15: 421-429
        • You T.
        • Murphy K.M.
        • Lyles M.F.
        • Demons J.L.
        • Lenchik L.
        • Nicklas B.J.
        Addition of aerobic exercise to dietary weight loss preferentially reduces abdominal adipocyte size.
        Int J Obes (Lond). 2006; 30: 1211-1216
        • National Institutes of Health
        Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: The evidence report.
        Obesity Res. 1998; 6: 51S-209S
        • Castaneda C.
        • Charnley J.M.
        • Evans W.J.
        • Crim M.C.
        Elderly women accommodate to a low-protein diet with losses of body cell mass, muscle function, and immune response.
        Am J Clin Nutr. 1995; 62: 30-39
      1. Gordon MM, Bopp M, Easter L, Miller GD, Lyles MF, Houston DK, Nicklas BJ, Kritchevsky SB. Effects of dietary protein on the composition of weight loss in post-menopausal women. J Nutr Health Aging. In press.

        • Pierson Jr, R.N.
        • Lin D.H.
        • Phillips R.A.
        Total-body potassium in health: Effects of age, sex, height, and fat.
        Am J Physiol. 1974; 226: 206-212


      M. J. Bopp is a clinical research dietitian and D. K. Houston is an assistant professor, Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, L. Lenchik is an associate professor, Department of Radiology, L. Easter is a nutrition coordinator at the General Clinical Research Center, S. B. Kritchevsky is director of the J. Paul Sticht Center on Aging and professor, Department of Internal Medicine, and B. J. Nicklas is professor, Department of Internal Medicine, all at the Wake Forest University School of Medicine, Winston-Salem, NC.